Variations of high frequency parameter of heart rate variability following osteopathic manipulative treatment in healthy subjects compared to control group and sham therapy: randomized controlled trial

Abstract

Context: Heart Rate Variability (HRV) indicates how heart rate changes in response to inner and external stimuli. HRV is linked to health status and it is an indirect marker of the autonomic nervous system (ANS) function.Objective: To investigate the influence of osteopathic manipulative treatment (OMT) on cardiac autonomic modulation in healthy subjects, compared with sham therapy and control group.Methods: Sixty-six healthy subjects, both male and female, were included in the present 3-armed randomized placebo controlled within subject cross-over single blinded study. Participants were asymptomatic adults (26.7 ± 8.4 y, 51% male, BMI 18.5 ± 4.8), both smokers and non-smokers and not on medications. At enrollment subjects were randomized in three groups: A, B, C. Standardized structural evaluation followed by a patient need-based osteopathic treatment was performed in the first session of group A and in the second session of group B. Standardized evaluation followed by a protocoled sham treatment was provided in the second session of group A and in the first session of group B. No intervention was performed in the two sessions of group C, acting as a time-control. The trial was registered on clinicaltrials.gov identifier: NCT01908920.Main Outcomes Measures: HRV was calculated from electrocardiography before, during and after the intervention, for a total amount time of 25 min and considering frequency domain as well as linear and non-linear methods as outcome measures.Results: OMT engendered a statistically significant increase of parasympathetic activity, as shown by High Frequency power (p < 0.001), expressed in normalized and absolute unit, and possibly decrease of sympathetic activity, as revealed by Low Frequency power (p < 0.01); results also showed a reduction of Low Frequency/High Frequency ratio (p < 0.001) and Detrended fluctuation scaling exponent (p < 0.05).Conclusions: Findings suggested that OMT can influence ANS activity increasing parasympathetic function and decreasing sympathetic activity, compared to sham therapy and control group.

Osteopathic manipulative treatment showed reduction of length of stay and costs in preterm infants

“…[39] Therefore, OMT could reduce the release of cytokines and the sympathetic activity creating a cascade of biological and neurological events able to modulate both inflammatory and ANS mechanisms. [40,41] …”

Nociception, pain, neuroplasticity and the practice of Osteopathic Manipulative Medicine

“…(7) Utilize OMT that decrease sympathoexcitation and promote increase parasympathetic activity. Studies of soft tissue techniques, balanced ligamentous tension, balanced membranous tension, and cranial sacral techniques have been associated with changes in parameters associated with increased parasympathetic activity and increased vagal control of heart rate [197,198]. In contrast, subjects receiving SMT techniques demonstrate changes (heart rate variability measures, skin conductance, increased heart rate and blood pressure) associated with decreased parasympathetic and increased sympathetic nervous system function [187,199e205].…”

Single Osteopathic Manipulative Therapy Session Dampens Acute Autonomic and Neuroendocrine Responses to Mental Stress in Healthy Male Participants

“…11 The cervical myofascial release technique dampened tilt-induced sympathetic prevalence significantly, as shown by a lower LF:HF ratio compared with that found after sham manipulation. 7 In a 2015 study, Ruffini et al 10 reported a significant increase in HF power as well as a reduction in LF:HF ratio in resting participants undergoing OMT, thus supporting the view that OMT influences autonomic neural modulation of HR by increasing parasympathetic activity and shifting sympathovagal balance toward vagal prevalence. 10 This experimental evidence suggests that OMT is a potentially powerful approach to enhance the parasympathetic input to the heart and hence prevent exaggerated stress-induced sympathetically driven cardiac activations.…”

“…[4][5][6] In more recent years, by means of HRV measurement techniques, the impact of OMT (osteopathic manipulative treatment) on cardiac sympathovagal balance has been assessed. [7][8][9][10] For example, a single cervical OMT protocol (upper cervical spine manipulation) was applied to healthy normotensive participants under resting conditions, and its effects were compared with sham therapy ( placement of fingers with no pressure exerted). 9 The treatment resulted in an increase in the spectral power in the high-frequency (HF) band, indicative of parasympathetic modulation of heart rate (HR) and a decrease in the ratio of low-frequency (LF) to HF power (LF:HF), indicating sympathovagal balance, compared with the sham treatment.…”