Foot Soaking Therapy with Warm Water Decrease Blood Pressure

of Patients with Hypertension

Wantiyah Wantiyah, Bagus Arditya Husada and Latifa Aini Susumaningrum

Faculty of Nursing, University of Jember, East Java, Indonesia

Keywords: Foot Soaking Therapy, Hypertension in Elderly, Blood Pressure.

Abstract: The goal in caring patients with hypertension is to maintain normal blood pressure. Foot soaking therapy is a

relaxation technique that could be used to manage blood pressure. This study analyzed the effect of foot

soaking therapy with warm water on blood pressure in elderly. This research used quasy experimental with

control group pretest-posttest design. The sampling technique was purposive sampling involving 30

respondents divided into 15 respondents as experimental group and 15 respondents as control group. Foot

soaking therapy was done in 5 days within 15 minutes for each session. Data were analyzed by using

dependent and independent t test with confidence interval of 95% (α = 0.05). There was significant difference

of blood pressure after therapy (p sistolic = 0.001; p diastolic = 0.001). Meanwhile, there was no significant

difference of blood pressure in control group (p sistolic = 0.682; p diastolic = 0.185). In both groups, the blood

pressure of elderly with hypertension declined but higher in the intervention group than in the control

group. There was a significant difference of blood pressure between two groups (p sistolik = 0.001 and p

diastolic = 0.001). The relaxation effect of foot soaking therapy stimulates the pituitary gland to release

endorphine hormone, causing systemic vasodilation. Therefore, foot soaking therapy using warm

water affects the blood pressure on elderly with hypertension.

1 BACKGROUND

Elderly characterized by decreased of ability to

improve or maintain its normal function due to

degenerative health problems such as hypertension

(Nugroho, 2000). Hypertension is an asymptomatic

disorder accompanied by elevated systolic and

diastolic blood pressure and is often referred to as "the

silent killer" (Potter & Perry, 2005) (G, B, & Izzo,

2003). Raised blood pressure is the biggest single

contributor to the global burden of disease and to

global mortality. (Poulter, Prabhakaran, & Caulfield,

2015). Hypertension occurring in the elderly is due to

changes in the structure and function of the blood

vessels (Setyaningsih et al., 2014). Based on data

from World Health Organization (WHO), in 2013 the

number of uncontrolled hypertension clients

increased from 600 million in 1980 to 1 billion in

2008 (World Health Organization, 2013).

Data based on Basic Health Research in Indonesia

held in 2013 revealed that the prevalence of

hypertension was the highest prevalence of

degenerative diseases in elderly (based on

measurement result at age ≥18 years). East Java is one

province with hypertension prevalence is high

enough 26.2% (Badan Penelitian dan Pengembangan

Kesehatan, 2013). Based on data from the health

clinic at a social service in Jember as one district at

East Java, Indonesia, the number of elderly who

experienced hypertension in July to September 2017

as many as 53 people.

Management of hypertension aims to maintain

blood pressure in the normal range and improve the

health status and quality of life of the elderly.

Generally, the management of hypertension is

divided into pharmacological and

nonpharmacological therapy. However,

pharmacological therapy for the elderly has various

problems such as dependency effects, elderly

disobedience in taking antihypertensive drugs, and

side effects that may arise due to drug administration

(Aronow & Banach, 2012). Therefore, non

pharmacological treatment can be done to support

pharmacological treatment (Muttaqin, 2009). Non-

pharmacological management such as foot soak

therapy is a therapy with warm water to dilate muscle

tissue of the blood vessels to make blood circulation

smoothly (Solechah, Masi, & Rottie, 2016). Thus,

Wantiyah, ., Husada, B. and Susumaningrum, L.

Foot Soaking Therapy with Warm Water Decrease Blood Pressure of Patients with Hypertension.

DOI: 10.5220/0008321000890093

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 89-93

ISBN: 978-989-758-336-0

researchers want to analyze effect of foot soak

therapy using warm water against blood pressure

elderly in a Social Service at Jember Indonesia.

2 METHODS

This research was a quasy-experimental design used

pretest-postest design with control group. The

sampling technique used purposive sampling

involving 30 respondents divided into two groups, 15

respondents as treatment group and 15 respondents as

control group. Elderly can be included at this research

when they met the criterias such as: elderly with

hypertension grade I with independent care, and agree

to receive the therapy. While the exclusion criteras

were: elderly with complicated hypentension,

diabetes mellitus, and drop out. This research was

conducted in a social service at Jember, Indonesia.

The study was conducted in March 2017 until

December 2017. Elderly in intervention group got

foot soak therapy that was given 1x daily (once a day)

for five days with a duration of 15 minutes per

session. While elderly at control group they did not

got intervention or foot soak therapy so they did

regular activities as usual. They got therapy as in

intervention group after the research finished or in

other word after the measurement at post test. Data

collection techniques used mercury

sphygmomanometer and stethoscope. Data analysis

using descriptive and inferential analysist that is

dependent t-test and independent t-test with 95%

confidence interval (α = 0.05). This research applied

ethics principals such as anonimity, confidentiality,

justice, and beneficiency.

3 RESULTS

3.1 Characteristics of Respondents

Table 1 below described characteristics of

respondents determined by age, gender and history of

smooking. It can be concluded that in both group,

intervention and control group, the mean of age

almost same, more than 70 years old. For gender, in

both groups dominated by male, and most of

respondents did not have history of smooking (66,7

% in intervention group, and 73,3 % elderly did not

smooking in control group).

Table 1: Characteristic of respondents.

Characteristics

Intervention

Control

Age

Mean ±SD (year)

73.73

(8.77)

72.73

(7.95)

95%CI

68.88-78.59

68.33-77.14

Gender

Male

8 (53.3%)

10 (66.7%)

Female

7 (46.7%)

15 (33.3%)

History of smoking

Yes

5 (33.3%)

4 (26.7%)

10 (66.7%)

11 (73.3%)

3.2 Blood Pressure Measurements

Blood pressure in two groups were measured twice,

firstly for pre test and second for post test for both

systolic (SBP) and diastolic blood pressure (DBP)

without any intervention in between pre test and post

test. While in intervention group, pre test score was

measured before elderly got foot soak therapy and

post test was done after the therapy finished.

Measurement results can be seen in Table 2.

Table 2: Blood Pressure in intervention and control group.

Variable

Mean (mmHg) (± SD)

Mean (Δ)

95% CI

Pre

Post

Pre

Post

Control Group

BPS*

150.7±8.5

149.8±8.9

-0.8

146.5-154.9

145.5-154.1

0.68

DBP*

87.1±10.0

91.7±8.7

4.67

82-92.13

87.4-95.6

0.18

Intervention Group

SBP*

161.3±13.4

134.5±9.8

-26.8

154.5-168.1

130-139.6

0.001**

DBP*

87.1±9.0

77.5±6.6

-9.6

82.7-91.9

74.5-80.7

0.001**

*SBP: systolic Blood Pressure

DBP: diastolic blood presssure

**: significance at α = 0,05

Table 2 showed the differences of blood

pressure for both SBP and DBP in pre test and

post test. There was a silence decreased for

SBP from 150.7 (±8.5) in pre test became 149.8

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

(±8.9) in pos test. Meanwhile, the DBP increased

from 87.1 (±10.0) to 91.7 (±8.7) at post test. But,

based on statistically analyses used dependent t-test

there were no differences of blood pressure between

pre test post test in control group because the p value

got 0.68 for SBP and 0.18 for BPP, that is mean>α (α

= 0.05).

In intervention group, the blood pressure dereased

significanly in both SBP and DBP, that there were

decreased as 26.8 point for SBP and 9.6 point for

DBP. Therefore, there were differences of blood

pressure (SBP and DBP) after the elder people got

foot soak therapy (p = 0.001).

3.3 Effect of Foot Soak Therapy

Table 3 figured the result of independent t-test that

suggest the diferences of blood pressure in two group

after foot soak therapy. The results showed that there

was a significance difference of blood presssure mean

(SBP and DBP) in between intervention and control

group (p = 0.001). Hence, foot soak therapy can

decrease the blood pressure in elderly with

hypertension at a social service in Jember.

Table 3: The difference of blood pressure between

intervention and control group.

Variable

Mean(mmHg)

(± SD)

SBP*

Intervention

-26.8(±8.2)

0,001**

Control

-0.8 (±7.3)

DBP*

Intervention

-9.6 (±5.5)

0.001**

Control

4.67 (±12.9)

4 DISCUSSION

The average age of respondents in the treatment of

foot soak treatment group was 73.73 years and the

mean age in the control group was 72.73 years. Age

is one of hypertension risk factors. The higher the age,

the increase of the prevalence of hypertension

(Davey, 2006). This is due to changes in the structure

and function of blood vessels that occur in the elderly

due to aging, where the blood vessels lose their

elasticity thereby decreasing the blood vessel strain

(Smeltzer and Bare, 2001) (Black & Hawks, 2014).

Decreased stretching of the arteries and aorta causes

a decrease in the ability to accommodate the volume

of blood pumped by the heart. Thus, resulting in

cardiac output decreased and peripheral resistance

increased (Stanley and Beare, 2006).

The results of this study also found that most of

the respondents were dominated by male in each

group, that is as many as 18 people (60%). Gender,

as we know also one of hypertension risk factors. It is

because male tend to be exposed to risky behaviors

such as smoking (Howteerakul, Suwannapong,

Sittilerd, & Rawdaree, 2006). Most of the

respondents in this study did not have a smoking

history of 21 (70%). Smoking can increase the risk of

hypertension in the elderly (Aronow, 2011). The

nicotine content in cigarettes can stimulate the

adrenal expulsion so that the heart beats faster and

increases the risk of thrombosis (ASH, 2013).

Based on the result, posttest mean of systolic and

diastolic blood pressure in treatment group of foot

soak therapy decreased equal to 26.8 mmHg and 9.6

mmHg. The changes in systolic and diastolic blood

pressure can occur related to the relaxation response

felt by the respondents after the intervention of foot

soak given for five consecutive days and within the

same time frame.

Warm foot water soak therapy is an intervention

by utilizing the application of heat to the body to

increase the blood circulation, refresh the body and

provide an effect of increased relaxation (Handoyo,

2014; Permadi, 2015). The relaxation effect of foot

soak therapy is the effect of hot water that stimulates

the baroreceptor nerves thereby driving the impuls to

the vasomotor center and resulting in vasodilation of

the veins and arterioles. Vasodilation occurring in the

arterioles causes peripheral resistance to decrease,

thereby reducing venous return, and causing a

decrease in cardiac output (Khotimah, 2012;

Damayanti et al., 2014).

Foot soak therapy also stimulates the pituitary

gland to release endorphin hormones that activate the

parasympathetic nervous system and inhibit work

rather than the sympathetic nerves. This results in

systemic vasodilation resulting in decreased

peripheral resistance and decreased blood pressure. In

addition, the impuls received by the parasympathetic

nerves will be sent to the SA node through the Vagus

nerve. This encourages the release of acetylcholine

stimulated decrease in heart rate. Stimulus that occurs

in the parasympathetic nervous system also causes

decreased contractility, stroke volume, and cardiac

output as inotropic negative impact. This resulted in

decreased stroke volume and cardiac output resulting

a decrease in blood pressure (Muttaqin, 2009;

George, 2007).

The result of statistical test showed that p = 0.001

which means that there was a significant difference

Foot Soaking Therapy with Warm Water Decrease Blood Pressure of Patients with Hypertension

between pretest and posttest blood pressure value in

elderly with hypertension after foot soak therapy. The

results of this study are consistent with previous

studies that found that a 3-day foot bath treatment

with a duration of 30 minutes showed a significant

decrease in blood pressure with mean systolic blood

pressure drop -3.994 mmHg and diastolic -2.722

mmHg (Zahrah Z., 2016 ).

The difference results occured in control group.

Based on the results, it was obtained the average

value of systolic blood pressure or diastolic pretest

and posttest 150.67/87.07 mmHg and 149.87/91.73

mmHg. The results of pretest and posttest mean

differences in systolic and elderly blood pressure with

hypertension in the control group were -0.8 mmHg

and 4.667 mmHg.

Based on the results of the study it was found that

seven elderly respondents in the control group did not

experience a decrease in blood pressure but increased

blood pressure after 5 days observation on blood

pressure. Researchers argue that this, influenced by

excessive weight of the elderly. Obesity and aging

process that occurs in the elderly can affect the

structure of the heart, kidneys, and blood vessels so

that the risk of incidence of cardiovascular disease

increases (Aronow et al., 2011).

The results also showed six elderly people had

decreased blood pressure after 5 days of observation.

Researchers argue that this was influenced by

physical activity carried out by the elderly. Increased

physical activity is done to increase blood flow to the

heart and improve arterial function (Kowalski, 2010).

This is supported by the results of research that by

doing regular physical activity for 30-45 minutes a

day is effective in reducing the relative risk of

hypertension to 30 % (Kemenkes.RI, 2014).

Table 3 showed the results of independent t-test of

systolic and elderly diastolic blood pressure with

hypertension in the treatment and control group, ie p

value of Systolic = 0.001 and p value of diastolic

which means p <α (α = 0,05) a significant difference

in systolic and diastolic blood pressure between the

treatment group and the control group. Foot soak

therapy with warm is an intervention by utilizing the

application of heat to the body to smooth the blood

circulation, refresh the body and provide an effect of

increased relaxation (Handoyo K., 2014; Permadi,

2015).

Relaxation technique is a type of non-

pharmacological management that can be given to the

elderly and has been proven to lower blood pressure

(Muttaqin, 2009). This study provides foot soak

therapy for five days with a duration of 15 minutes in

each session. Relaxation responses felt by the elderly

can affect the physiological body. The effects of foot

soak therapy can stimulate the pituitary gland to

release endorphin hormone. This will activate the

parasympathetic nervous system and inhibit the

sympathetic nervous system so that it can cause a

drop in blood pressure (Muttaqin, 2009; George,

2007). The stimulus of foot soak therapy can also

stimulate baroreceptor nerves to push the implus into

the vasomotor center and lead to vasodilation of the

veins and arterioles resulting in a decrease in blood

pressure (Damayanti et al., 2014).

This study showed the differences of blood

pressure between the two groups, so it can be

concluded that foot soak therapy can lower blood

pressure through stimulus in the pituitary gland to

release endorphin hormones that cause stress on the

sympathetic nervous system and improve the

parasympathetic nervous system, increased activity

of the parasympathetic nervous system that causes

peripheral resistance decreased. The final result is

blood pressure also can decrease.

5 CONCLUSIONS

Based on the result of research and discussion it can

be conclude that there is significant influence of foot

doak therapy with warm water against blood pressure

elderly with hypertension. It is expected that warm

food bath soak therapy can be applied by nurses as a

nonpharmacological treatment to maintain blood

pressure in hypertension on elderly.

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Foot Soaking Therapy with Warm Water Decrease Blood Pressure of Patients with Hypertension