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Programmed manual reflexology therapy improves sleep quality, insomnia, and fatigue in adults with poor sleep quality via enhanced parasympathetic activity.

In a randomized crossover trial, 32 adults with poor sleep quality received 6 weeks of manual reflexology treatment (MRT) or foot massage equipment (FEM). MRT led to significantly greater reductions in PSQI global scores and all components, larger improvements in insomnia severity and both mental and physical fatigue, and immediate and sustained increases in HRV time-domain indices (SDNN, RMSSD, pNN50) with reduced LF/HF ratio, indicating enhanced parasympathetic modulation.

Last updated: Aug 5, 2026•1 RCTs•📖 Read as article →

Evidence Score

Evidence Score44/100
Human RCT★★☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Effects of a programmed reflexology therapy on sleep quality, insomnia, and fatigue among individuals with poor sleep quality: evidence for autonomic nervous system modulation.

observational

Chen SP, Gao MH, Huang CC, Huang WC · Complementary therapies in medicine (2026)

Participants: N/A
Duration: 6 weeks per intervention (crossover)
Intervention: Manual reflexology treatment (MRT) delivered once weekly for 30-40 minutes per session over 6 weeks, compared to foot massage equipment (FEM).
Outcome: Sleep quality (PSQI), insomnia severity (ISI), fatigue (FAS), heart rate, blood pressure, heart rate variability (HRV) time- and frequency-domain indices.
Effect Size: Not reported
Population: Adults with poor sleep quality (N=32).

Result:

PubMed: 42537947DOI: 10.1016/j.ctim.2026.103409

Mechanism Graph

Manual reflexology stimulates specific foot zones
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Triggers autonomic nervous system modulation
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Immediate decrease in heart rate and increase in HRV time-domain indices (SDNN, RMSSD, pNN50)
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Reduced LF, increased HF, lower LF/HF ratio indicating enhanced parasympathetic activity
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Cumulative autonomic modulation over 6 weeks leading to improved sleep, reduced insomnia and fatigue

Limitations

  • ⚠Small sample size (N=32) may limit generalizability
  • ⚠Crossover design may have carryover effects despite washout not specified
  • ⚠Single-blind or lack of blinding not mentioned, potential performance bias
  • ⚠Short-term follow-up (6 weeks) does not assess long-term sustainability

Frequently Asked Questions

What is manual reflexology treatment (MRT)?▼

MRT is a programmed foot reflexology therapy delivered by a therapist, following the TIDieR framework, involving manual pressure on specific foot zones to modulate autonomic nervous system activity.

How does MRT compare to foot massage equipment (FEM) for sleep?▼

MRT was significantly more effective than FEM in improving global PSQI scores, all PSQI components, insomnia severity, and both mental and physical fatigue. FEM only improved physical fatigue.

What physiological changes occur after MRT?▼

MRT induced an immediate decrease in heart rate and significant increases in HRV time-domain indices (SDNN, RMSSD, pNN50), along with reduced LF, increased HF, and lower LF/HF ratio, indicating enhanced parasympathetic activity.

Is MRT a recommended non-pharmacological intervention for poor sleep?▼

Yes, the study supports MRT as a feasible and evidence-based complementary intervention for sleep health promotion in individuals with poor sleep quality.

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References

  1. 1.Chen SP, Gao MH, Huang CC, Huang WC. "Effects of a programmed reflexology therapy on sleep quality, insomnia, and fatigue among individuals with poor sleep quality: evidence for autonomic nervous system modulation.." Complementary therapies in medicine, 2026. PMID: 42537947 DOI: 10.1016/j.ctim.2026.103409
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.