title: Complementary medicine for the management of chronic stress: superiority of active versus passive techniques.
abstract: BACKGROUND
  Recent epidemiological data indicate that chronic stress is an important component of cardiovascular risk, implicitly suggesting that stress management might offer a useful complement to orthodox medical treatment and prevention of hypertension. In this context, information on mechanisms, such as subclinical increases in arterial pressure and sympathetic drive, is well documented. Conversely, evidence on methodologies and comparative efficacy needs to be improved. Accordingly, this study was planned to test the autonomic and subjective effects of two popular modalities of stress management.
  
  
  METHODS
  We studied 70 patients complaining of stress-related symptoms, avoiding any potential autonomic confounder, such as established hypertension or drug treatment. Patients were divided in three groups: group I (n = 30) followed a breathing-guided relaxation training (active); group II (n = 15) an oriental massage, shiatsu (passive); and group III (n = 25) followed a sham intervention. Subjective effects of stress were assessed by validated questionnaires and autonomic nervous system regulation by spectral analysis of RR interval variability. Factor analysis was used to extract information simultaneously embedded in subjective and functional data.
  
  
  RESULTS
  Although the problem of a greater quantity of treatment procedure in the active group than in the passive group existed, results showed that active relaxation, further to slightly reducing arterial pressure, might be more effective in relieving symptoms of stress and inducing an improved profile of autonomic cardiovascular regulation, as compared with passive massage or sham intervention.
  
  
  CONCLUSIONS
  This active technique seems capable of beneficially addressing simultaneously the individual psychological and physiopathological dimensions of stress in clinical settings, with potentially beneficial effects on cardiovascular risk profile.
authors.affiliation: Department of Clinical Sciences L. Sacco, University of Milano, Italy. daniela.lucini@ctnv.unimi.it
authors.forename: Daniela
authors.initials: D
authors.lastname: Lucini
authors.forename: Mara
authors.initials: M
authors.lastname: Malacarne
authors.forename: Nadia
authors.initials: N
authors.lastname: Solaro
authors.forename: Silvano
authors.initials: S
authors.lastname: Busin
authors.forename: Massimo
authors.initials: M
authors.lastname: Pagani
mesh_terms: D019050:Acupressure; D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D012064:Relaxation Therapy / Q000379:methods*; D012119:Respiration; D013312:Stress, Physiological / Q000502:physiology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome