THE EFFECTS OF CONTRAST BATH ON CIRCULATION: A

SYSTEMATIC REVIEW

Pratiwi Simarmata1, Dewi Elizadiani Suza2 and Rosina Tarigan2

1
Master Student Faculty of Nursing, Universitas Sumatera Utara, Prof. Maas Street No. 3 Kampus USU, Medan, Indonesia
2
Faculty of Nursing, Universitas Sumatera Utara, Prof. Maas Street No. 3 Kampus USU, Medan, Indonesia
email: pratiwisimarmata92@gmail.com

Keywords: Contrast bath and circulation.

Abstract: Contrast bath is the therapy of hot and cold water. Hot water causes relaxation in the subcutaneous and
intramuscular tissues. Cold water causes tissue contraction, thus creating pumping and increasing vascular
rotation in the tissues. The purpose of this systematic review is to analyse research evidence as a basis for
new research on the benefits of contrast bath on circulation. This systematic review uses article search
through CINAHL, Proquest, Pubmed, MEDLINE, and Science Direct uses the keyword contrast bath and
circulation starting from 2009 to 2017 obtained 8 quantitative journals. The results of this review discuss
physiological changes the treatment hot and cold water in the bloodstream, intramuscular temperature,
subcutaneous temperature. There are differences in protocol, the conditions of the research subject and the
results obtained limited the ability to draw benefits from contrast bath. Study participants were conduct in
adults. Two of the eight studies used healthy participants, while other studies were limit to participants with
diabetes and problems in the feet / hands. Conclusion: Contrast bath can increase superficial blood flow and
skin temperature, although these results cannot be performed in conditions of edema.
1 INTRODUCTION
Contrast bath is a hot and cold water therapy
technique. Physiologically contrast bath
associated with pumping made with hot and cold
water alternately. Hot water causes relaxation in the
subcutaneous and intramuscular tissues. Immersion
in hot water can improve skin circulation and lead
to vasodilation in soaking hot water [1,2]. Cold
water causes tissue contraction, thus creating action
of pumping and increasing vascular circulation in
the tissues. Contrast bath leads to increased blood
flow and pumping of blood vessels. Reduction of
pain, stiffness, edema and increased mobility are the
effects of contrast bath [3,4].
The contrast effect of bath on increasing
circulation is more effective than soaking in warm
water. [1,2]. Contrast bath can increase superficial
blood flow, but the effect on the intramuscular level
is unclear [1,5]. Thus contrast bath has a good
impact on patients with circulatory deficiencies.
The purpose of this systematic review is to
look for evidence-based research on the
effectiveness of contrast bath as a modality for
circulation
2 METHODS
Literature review is done by selecting the
appropriate articles published between 2009 and
2017. The search strategy includes the use of
electronic databases such as CINAHL, Proquest,
Pubmed, MEDLINE, and Science Direct.
The key words used are contrast bath, and
circulation. Inclusive criteria are articles that publish
original data. Unpublished articles, abstracts,
dissertations, theses, and books are excluded from
this review.
. temperature on intramuscular tissue, however, does
3 RESULTS
Of the total 28 articles related to contrast bath and
circulation, 8 related to the inclusion criteria. The
article taken as the last step. The articles consist of
quantitative research
28 articles have
identified using electronic
databases such
as CINAHL, Proquest, Pubmed 
MEDLINE, and Science
Direct.
n = 14 excluded:
- only abstract
-
14 related article
n = 6 excluded:
- No english
8 related articles and full
text included with contrast
bath and circulation reviews
Figure 1. Flow of the article selection process
Contrast bath is alternating using cold water hot
water alternately. The results of previous studies
found variations in the duration of water temperature
from contrast bath treatments. The duration of time
obtained ranged from 11 to 31 minutes, although the
average time spent was 20 minutes. Temperature
range of cold water used from 55.4°F (13°C) to 70°F
(21°C), while the temperature range of hot water is
100°F (37.7°C) to 106°F (41°C ) Where from the
results of previous studies stated the benefits of
warm water immersion, namely, increased shallow
blood flow and skin temperature occur [1,7].
Intramuscular tissue temperature, however, does not
rise. [8] Previous studies have suggested the benefits
of warm water immersion, increased shallow blood
flow and skin temperature occur [1,7]. But the
not rise. [8] Previous research intervened on the
subject. By placing it in a warm room before the
procedure. And the results obtained that placing
patients in warm rooms are more effective than
soaking warm water by themselves to increase
superficial blood flow. [8,9] Petroskfy et al. [9]
found that contrast bath is more effective in
increasing blood flow. However, there are other
studies that suggest otherwise that soaking warm
water can affect blood flow. although the findings
mention significant blood flow fluctuations. But
there is no significant physiological effect at
intramuscular temperature. [8] The physiological
effects of contrast bath can potentially only increase
blood flow at the subcutaneous level. The findings
of this systematic review do not support the use of
contrast bath to increase blood flow to deeper
tissues, skin temperature, intramuscular temperature,
and in one case, swelling. On the other hand, more
recent studies [1,9] support the use of contrasts to
increase superficial blood flow, especially when the
subject is exposed to a warm room before the
procedure.
4 DISCUSSION
Systematic review shows small number of research
results from the contrast bath benefits. The results
support an increase in superficial blood flow after
contrast bath use, but do not support its in increasing
blood flow the intramuscular level. Increased blood
flow in contrast bath is still unclear whether the
shallow blood flow changes more in warm water or
after using warm water. But there are studies that
support/reject the use of contrast baths for pain relief
and volume fluid management.
There are two different parts of this study. First,
researchers examined physiological changes after
contrast bath application and studied the effects on
pumping peripheral blood vessels and blood flow.
[1, 10] Second, research investigates the use of
contrast baths to increase temperature at the
intramuscular level. [8]. All show an increase in
shallow tissue temperature in the bloodstream by
soaking hot water compared to cold.
The study examined did not include discussion
or description of the instrument calibration used, as
well as limited subject diagnostic conditions.
Related to diabetes, problems with the hands or feet,
or normal, healthy participants, and may not reflect
patients who currently receive contrast bath as
treatment.
5 CONCLUSION
This systematic review provides guidance from
available evidence of the contrast bath effect on
circulation. Where the results of the study provide
unfavorable results in influencing shallow blood
flow and skin temperature. As well as the
differences in protocols used in research will also
produce different results.
Tabel 1: Summary of A Systematic Review

Reference Objective Study Design Populations

Instrument Results Country
Effects of contrast Test difference in Quasi 28 partisipan Blood flow The control group, with 3 minutes of hot USA
baths on skin blood skin blood flow in experimen (Laser immersion: 1 minute cold made the blood flow
flow on the dorsal and the feet in soaking Doppler) greater (p <0.01) and DM patients there was no
plantar foot in people warm and cold significant difference in blood flow between hot
with type 2 diabetes water and cold soaking (p> 0.05)
and age matched
controls
Knowing decreased Quasi 28 partisipan Blood flow Elderly patients, with the first hot water immersion USA
The effects of aging on
ability to cool experimen (Laser there was an increase in dorsal blood flow which
the skin blood
sensation in Doppler) was an initial flow of 22 ± 7 fluxes and a final
response to warm,
increasing flow of 42 ± 8 flux (p = 0.006), whereas in cold
cold, and contrast
circulation in the water immersion dorsal blood flow decreased
warm and cold baths
skin significantly to 13 ± 3 flux (p = 0.0003).
A Randomized To find contrast Quasi 114 partisipan Flow meter There is a difference in hand volume before USA
Controlled Study of bath effect on hand eksperimen Laser Doppler surgery p = 0.857 and after surgery with contras
Contrast Baths on volume bath treatment p = 0.584
Patients with Carpal
Tunnel Syndrome
Variation of skin To find variation Quasi 20 partisipan Humidity There were significant differences at 3 minutes (p Brazil
temperature during and skin temperature eksperimen thermometer = 0,000), 6 minutes (p = 0,010) and 9 minutes (p =
after contrast bath before and after (Minipa 0,019) for protocol A, but not at 12 minutes (p =
therapy contrast bath MT24) and 0,053). For protocol B, no significant differences
Thermometer were found
Effect of Time Ratio To determine Quasi 34 partisipan Doppler The first trial, compared to the first heating phase, Taiwan
of Heat to Cold on effect the time ratio eksperimen ultrasound averaged aMBV% significantly lower by 57% and
Brachial Artery Blood the brachial artery scanner 46% in the second and third heating phases.
Velocity During artery the mean
Contrast Baths blood velocity
(aMBV)
The Comparison of the To find out the Quasi 80 partisipan Digital The dorsalis pedis pulse is sig higher than 10 Iran
Effects of Contrast effect contrast bath eksperimen termometer minutes after applying it in the diabetes group (P =
Bath on Circulation of on circulation (Beurer Fieber 0.58). The results of measurements of skin
Contralateral Lower contralateral thermometer) temperature showed changes in healthy groups and
Limb in Type 2 extremity diabetes. Oral temperature did not differ
Diabetic and Healthy significantly in the normal and diabetic groups (P>
0.5).

Effectiveness of platar To know Quasi 30 partisipan Ultra Sound Average post-test scores for groups A (5.0) and B India
fascia stretching Vs effectiveness of eksperimen (USG) (3.53).
Contrast Bath ultrasound with
Combined with plantar fascia
ultrasound in platar stretching and
fasciitis contrast bath
technique
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