Open Access Research article

Short- and long-term effects of tactile massage on salivary cortisol concentrations in Parkinson’s disease: a randomised controlled pilot study

Carl-Johan Törnhage1*, Örjan Skogar23, Astrid Borg4, Birgitta Larsson5, Laila Robertsson2, Lena Andersson2, Lena Andersson5, Paulina Backström2, Per-Arne Fall6, Gunnar Hallgren5, Birgitta Bringer6, Miriam Carlsson2, Ulla Birgitta Lennartsson5, Håkan Sandbjörk5 and Johan Lökk3

Author Affiliations

1 Department of Pediatrics, Skaraborg Hospital, SE-541 85 Skovde, Sweden

2 Department of Geriatrics, Ryhov Hospital, Jönkoping, Sweden

3 Institution of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden

4 Swedish Parkinson Foundation, Stockholm, Sweden

5 Department of Neurology, Skaraborg Hospital, Skovde, Sweden

6 Department of Geriatrics, University Hospital, Linkoping, Sweden

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BMC Complementary and Alternative Medicine 2013, 13:357  doi:10.1186/1472-6882-13-357

Published: 13 December 2013



Parkinson’s disease (PD) is a chronic neurodegenerative disorder with limited knowledge about the normal function and effects of non-pharmacological therapies on the hypothalamic-pituitary-adrenal (HPA) axis. The aim of the study was to analyse the basal diurnal and total secretion of salivary cortisol in short- and long-term aspects of tactile massage (TM).


Design: Prospective, Controlled and Randomised Multicentre Trial.

Setting and interventions: Forty-five women and men, aged 50–79 years, were recruited. Twenty-nine of them were blindly randomised to tactile massage (TM) and 16 of them to the control group, rest to music (RTM). Ten interventions were given during 8 weeks followed by a 26 weeks of follow up. Salivary cortisol was collected at 8 am, 1 pm, 8 pm, and 8 am the next day, on five occasions. With the first and eighth interventions, it was collected immediately before and after intervention.

Main outcome measures: The primary aim was to assess and compare cortisol concentrations before and immediately after intervention and also during the follow-up period. The secondary aim was to assess the impact of age, gender, body mass index (BMI), duration and severity of PD, effects of interventional time-point of the day, and levodopa doses on cortisol concentration.


The median cortisol concentrations for all participants were 16.0, 5.8, 2.8, and 14.0 nmol/L at baseline, later reproduced four times without significant differences. Cortisol concentrations decreased significantly after TM intervention but no change in diurnal salivary cortisol pattern was found. The findings of reduced salivary cortisol concentrations immediately after the interventions are in agreement with previous studies. However, there was no significant difference between the TM and control groups. There were no significant correlations between cortisol concentrations and age, gender, BMI, time-point for intervention, time interval between anti-parkinson pharmacy intake and sampling, levodopa doses, duration, or severity of PD.


Diurnal salivary cortisol rhythm was normal. Salivary cortisol concentrations were significantly reduced after the TM intervention and after RTM, but there were no significant differences between the groups and no sustained long-term effect. No associations were seen between salivary cortisol concentration and clinical and/or pharmacological characteristics.

Trial registration, NCT01734876 and FoU Sweden 108881.

Circadian rhythm; Complementary therapies; Cortisol; Massage; Parkinson disease; Stress