Mind-Body Medicine Research Update
Tai chi and postural stability in patients with Parkinson's disease.
The New England Journal of Medicine. 2012 Feb 9;366(6):511-9. by Li F, Harmer P, Fitzgerald K, Eckstrom E, Stock R, Galver J, Maddalozzo G, Batya SS. from Oregon Research Institute, Eugene, OR 97403, firstname.lastname@example.org
BACKGROUND: Patients with Parkinson's disease have substantially impaired balance, leading to diminished functional ability and an increased risk of falling. Although exercise is routinely encouraged by health care providers, few programs have been proven effective. METHODS: We conducted a randomized, controlled trial to determine whether a tailored tai chi program could improve postural control in patients with idiopathic Parkinson's disease. We randomly assigned 195 patients with stage 1 to 4 disease on the Hoehn and Yahr staging scale (which ranges from 1 to 5, with higher stages indicating more severe disease) to one of three groups: tai chi, resistance training, or stretching. The patients participated in 60-minute exercise sessions twice weekly for 24 weeks. The primary outcomes were changes from baseline in the limits-of-stability test (maximum excursion and directional control; range, 0 to 100%). Secondary outcomes included measures of gait and strength, scores on functional-reach and timed up-and-go tests, motor scores on the Unified Parkinson's Disease Rating Scale, and number of falls. RESULTS: The tai chi group performed consistently better than the resistance-training and stretching groups in maximum excursion (between-group difference in the change from baseline, 5.55 percentage points; 95% confidence interval [CI], 1.12 to 9.97; and 11.98 percentage points; 95% CI, 7.21 to 16.74, respectively) and in directional control (10.45 percentage points; 95% CI, 3.89 to 17.00; and 11.38 percentage points; 95% CI, 5.50 to 17.27, respectively). The tai chi group also performed better than the stretching group in all secondary outcomes and outperformed the resistance-training group in stride length and functional reach. Tai chi lowered the incidence of falls as compared with stretching but not as compared with resistance training. The effects of tai chi training were maintained at 3 months after the intervention. No serious adverse events were observed. CONCLUSIONS: Tai chi training appears to reduce balance impairments in patients with mild-to-moderate Parkinson's disease, with additional benefits of improved functional capacity and reduced falls. (Funded by the National Institute of Neurological Disorders and Stroke; ClinicalTrials.gov <http://ClinicalTrials.gov> number, NCT00611481.).
Impact of Tai Chi exercise on multiple fracture-related risk factors in post-menopausal osteopenic women: a pilot pragmatic, randomized trial. BMC Complement Altern Med. 2012 Jan 30;12(1):7. By Wayne PM, Kiel DP, Buring JE, Connors EM, Bonato P, Yeh GY, Cohen CJ, Mancinelli C, Davis RB.
BACKGROUND: Tai Chi (TC) is a mind-body exercise that shows potential as an effective and safe intervention for preventing fall-related fractures in the elderly. Few randomized trials have simultaneously evaluated TC's potential to reduce bone loss and improve fall-predictive balance parameters in osteopenic women. METHODS: In a pragmatic randomized trial, 86 post-menopausal osteopenic women, aged 45-70, were recruited from community clinics. Women were assigned to either nine months of TC training plus usual care (UC) vs. UC alone. Primary outcomes were changes between baseline and nine months of bone mineral density (BMD) of the proximal femur and lumbar spine (dual-energy X-ray absorptiometry) and serum markers of bone resorption and formation. Secondary outcomes included quality of life. In a subsample (n=16), quiet standing fall-predictive sway parameters and clinical balance tests was also assessed. Both intent-to-treat and per-protocol analyses employed. RESULTS: For BMD, no intent-to-treat analyses were statistically significant; however, per protocol analyses (i.e., only including TC participants who completed [greater than or equal to] 75% training requirements) of femoral neck BMD changes were significantly different between TC and UC (+0.04 vs. -0.98%; P=0.05). Changes in bone formation markers and physical domains of quality of life were also more favorable in per protocol TC vs. UC (P=0.05). Changes in sway parameters were significantly improved by TC vs. UC (average sway velocity, P=0.027; anterior-posterior sway range, P=0.014). Clinical measures of balance and function showed statistically non-significant trends in favor of TC. CONCLUSIONS:
TC training offered through existing community-based programs is a safe, feasible, and promising intervention for reducing multiple fracture risks. Our results affirm the value of a more definitive, longer-term trial of TC for osteopenic women, adequately powered to detect clinically relevant effects of TC on attenuation of BMD loss and reduction of fall risk in this population. Trail registration: clinicaltrials.govNCT01039012.
Mindfulness meditation counteracts self-control depletion. Conscious Cogn. 2012 Feb 4. [Epub ahead of print] by Friese M, Messner C, Schaffner Y. from Department of Psychology, University of Basel, Missionsstr. 60/62, 4055 Basel, Switzerland.
Abstract: Mindfulness meditation describes a set of different mental techniques to train attention and awareness. Trait mindfulness and extended mindfulness interventions can benefit self-control. The present study investigated the short-term consequences of mindfulness meditation under conditions of limited self-control resources. Specifically, we hypothesized that a brief period of mindfulness meditation would counteract the deleterious effect that the exertion of self-control has on subsequent self-control performance. Participants who had been depleted of self-control resources by an emotion suppression task showed decrements in self-control performance as compared to participants who had not suppressed emotions. However, participants who had meditated after emotion suppression performed equally well on the subsequent self-control task as participants who had not exerted self-control previously. This finding suggests that a brief period of mindfulness meditation may serve as a quick and efficient strategy to foster self-control under conditions of low resources.
Fifteen minutes of chair-based yoga postures or guided meditation performed in the office can elicit a relaxation response. Evid Based Complement Alternat Med. 2012;2012:501986. by Melville GW, Chang D, Colagiuri B, Marshall PW, Cheema BS. From School of Biomedical and Health Sciences, University of Western Sydney, Locked Bag 1797, Penrith, NSW 1797, Australia.
This study compared acute (15 min) yoga posture and guided meditation practice, performed seated in a typical office workspace, on physiological and psychological markers of stress. Twenty participants (39.6 ± 9.5 yr) completed three conditions: yoga, meditation, and control (i.e., usual work) separated by ≥24 hrs. Yoga and meditation significantly reduced perceived stress versus control, and this effect was maintained postintervention. Yoga increased heart rate while meditation reduced heart rate versus control (P < 0.05). Respiration rate was reduced during yoga and meditation versus control (P < 0.05). Domains of heart rate variability (e.g., SDNN and Total Power) were significantly reduced during control versus yoga and meditation. Systolic and diastolic blood pressure were reduced secondary to meditation versus control only (P < 0.05). Physiological adaptations generally regressed toward baseline post intervention. In conclusion, yoga postures or meditation performed in the office can acutely improve several physiological and psychological markers of stress. These effects may be at least partially mediated by reduced respiration rate. www.ncbi.nlm.nih.gov/pmc/articles/PMC3265094
A systematic review of the effectiveness of qigong exercise in supportive cancer care. Support Care Cancer. 2012 Jan 19. [Epub ahead of print] by Chan CL, Wang CW, Ho RT, Ng SM, Chan JS, Ziea ET, Wong VC. From Centre on Behavioral Health, The University of Hong Kong, 5 Sassoon Road, Pokfulam, Hong Kong, China.
PURPOSE: Qigong as a complementary and alternative modality of traditional Chinese medicine is often used by cancer patients to manage their symptoms. The aim of this systematic review is to critically evaluate the effectiveness of qigong exercise in cancer care. METHODS: Thirteen databases were searched from their inceptions through November 2010. All controlled clinical trials of qigong exercise among cancer patients were included. The strength of the evidence was evaluated for all included studies using the Oxford Centre for Evidence-based Medicine Levels of Evidence. The validity of randomized controlled trials (RCTs) was also evaluated using the Jadad Scale. RESULTS: Twenty-three studies including eight RCTs and fifteen non-randomized controlled clinical trials (CCTs) were identified. The effects of qigong on physical and psychosocial outcomes were examined in 14 studies and the effects on biomedical outcomes were examined in 15 studies. For physical and psychosocial outcomes, it is difficult to draw a conclusion due to heterogeneity of outcome measures and variability of the results in the included studies. Among reviewed studies on biomedical outcomes, a consistent tendency appears to emerge which suggests that the patients treated with qigong exercise in combination with conventional methods had significant improvement in immune function than the patients treated with conventional methods alone. CONCLUSIONS: Due to high risk of bias and methodological problems in the majority of included studies, it is still too early to draw conclusive statements. Further vigorously designed large-scale RCTs with validated outcome measures are needed.
Taiji practice attenuates psychobiological stress reactivity – A randomized controlled trial in healthy subjects. Psychoneuroendocrinology. 2012 Jan 3. [Epub ahead of print] by Nedeljkovic M, Ausfeld-Hafter B, Streitberger K, Seiler R, Wirtz PH. From University of Bern, Institute of Complementary Medicine KIKOM, Imhoof-Pavillon, Inselspital, CH-3010 Bern, Switzerland.
BACKGROUND: Stress reducing effects of Taiji, a mindful and gentle form of body movement, have been reported in previous studies, but standardized and controlled experimental studies are scarce. The present study investigates the effect of regular Taiji practice on psychobiological stress response in healthy men and women. METHODS: 70 participants were randomly assigned to either Taiji classes or a waiting list. After 3months, 26 (8 men, 18 women) persons in the Taiji group and 23 (9 men, 14 women) in the waiting control group underwent a standardized psychosocial stress test combining public speaking and mental arithmetic in front of an audience. Salivary cortisol and α-amylase, heart rate, and psychological responses to psychosocial stress were compared between the study groups. RESULTS: Stress induced characteristic changes in all psychological and physiological measures. Compared to controls, Taiji participants exhibited a significantly lower stress reactivity of cortisol (p=.028) and heart rate (p=.028), as well as lower α-amylase levels (p=.049). They reported a lower increase in perceived stressfulness (p=.006) and maintained a higher level of calmness (p=.019) in response to psychosocial stress. CONCLUSION: Our results consistently suggest that practicing Taiji attenuates psychobiological stress reactivity in healthy subjects. This may underline the role of Taiji as a useful mind-body practice for stress prevention.
Erratic control of breathing during exercise in patients with systemic lupus erythematosus: a pilot-study. Lupus. 2011 Dec;20(14):1535-40. by do Prado DM, Gualano B, Miossi R, Lima FR, Roschel H, Borba E, Bonfa E, de Sá Pinto AL. from Division of Rheumatology, School of Medicine, University of Sao Paulo, Brazil.
PURPOSE: The aim of this study was to provide a comprehensive evaluation of the pattern and timing of breathing during incremental exercise in a sample of women living with systemic lupus erythematosus (SLE). METHODS: In this cross-sectional study, 20 women with SLE without pulmonary involvement were compared with 20 gender-, body mass index- (BMI), and age-matched healthy individuals. By using a cardiopulmonary incremental exercise test, the following parameters were assessed: tidal volume (VT); breathing frequency (BF); total respiratory time (TOT); inspiratory time (TI); expiratory time (TE); inspiratory time to total time (TI/TOT); mean inspiratory flow (VT/TI); ventilatory equivalent for carbon dioxide (VE/VCO2) and end-tidal carbon dioxide pressure (PETCO2). RESULTS: BF and BF/VT were significantly higher in patients with SLE versus controls, whereas VT, TE, TI and TOT were significantly lower in the former group ( p<0.05). Additionally, patients with SLE presented higher VE/VCO2 and lower PETCO2 than controls ( p<0.05), suggesting a ventilatory inefficiency. CONCLUSION: We reported compelling evidence of abnormal pattern and timing of breathing during incremental exercise in SLE. Considering that an erratic control of breathing may play an important role in exercise intolerance and fatigue, respiratory exercises emerge as a potential treatment for these symptoms in patients with SLE.
Effects of an 8-week meditation program on mood and anxiety in patients with memory loss. J Altern Complement Med. 2012 Jan;18(1):48-53. by Moss AS, Wintering N, Roggenkamp H, Khalsa DS,Waldman MR, Monti D, Newberg AB. From Jefferson-Myrna Brind Center of Integrative Medicine , Philadelphia, PA.
Abstract: Background: This study assesses changes in mood and anxiety in a cohort of subjects with memory loss who participated in an 8-week Kirtan Kriya meditation program. Perceived spirituality also was assessed. Previous reports from this cohort showed changes in cognitive function and cerebral blood flow (CBF). The purpose of this analysis was to assess outcome measures of mood and affect, and also spirituality, and to determine whether or not results correlated with changes in CBF. Methods: Fifteen (15) subjects (mean age 62±7 years) with memory problems were enrolled in an 8-week meditation program. Before and after the 8-week meditation, subjects were given a battery of neuropsychologic tests as well as measures of mood, anxiety, and spirituality. In addition, they underwent single photon emission computed tomography scans before and after the program. A region-of-interest template obtained counts in several brain structures that could also be compared to the results from the affect and spirituality measures. Results: The meditation training program resulted in notable improvement trends in mood, anxiety, tension, and fatigue, with some parameters reaching statistical significance. All major trends correlated with changes in CBF. There were nonsignificant trends in spirituality scores that did not correlate with changes in CBF. Conclusions: An 8-week, 12 minute a day meditation program in patients with memory loss was associated with positive changes in mood, anxiety, and other neuropsychologic parameters, and these changes correlated with changes in CBF. A larger-scale study is needed to confirm these findings and better elucidate mechanisms of change.
Treatment of fibromyalgia at the Maharishi Ayurveda Health Centre in Norway II-a 24-month follow-up pilot study. Clin Rheumatol. 2012 Jan 27. [Epub ahead of print] by Rasmussen LB, Mikkelsen K, Haugen M, Pripp AH, Fields JZ, Førre OT. From Maharishi Ayurveda Health Centre, Sjusjøvegen 1332, 2610, Mesnali, Norway, email@example.com .
Treatments offered at the Maharishi Ayurveda Health Centre in Norway are based on Maharishi Vedic Medicine (MVM). MVM is a consciousness-based revival by Maharishi Mahesh Yogi, the founder of the Transcendental Meditation (TM) program of the ancient Ayurvedic medicine tradition in India. To extend from 6 to 24 months, a pilot study of the effects of the treatment program at the Health Centre on fibromyalgia. Retesting 2 years after a clinical trial. In this intention to treat study, 31 women with a diagnosis of fibromyalgia received an individually tailored program of (1) physiological purification therapy (Maharishi Panchakarma) and (2) Ayurvedic recommendations regarding daily routine and diet including a novel approach to food intolerance. Five subjects chose to learn TM for stress reduction, pain management and personal development. All were recommended Ayurvedic herbal products for follow-up treatment. A modified Fibromyalgia Impact Questionnaire (FIQ) that included seven dimensions. Scores at 24 months follow-up were compared with pre-treatment scores. At 24-months follow-up, there were significant reductions (26% to 44%) in six of the seven fibromyalgia dimensions: impairment of working ability, pain, tiredness, morning tiredness, stiffness and anxiety. The 7th, depression, decreased 32% (borderline significant). At 24 months, the four subjects who continued practicing TM, had almost no symptoms and significantly lower FIQ change scores (-92% to 97%) than the non-meditators on all outcomes. This pilot study suggests that the treatments and health promotion programs offered at the Maharishi Ayurveda Health Centre in Norway lead to long-term reductions in symptoms of fibromyalgia, which is considered a treatment-resistant condition, and further studies are warranted.
A comparative randomized controlled trial of the effects of brain wave vibration training, Iyengar yoga, and mindfulness on mood, well-being, and salivary cortisol. Evid Based Complement Alternat Med. 2012;2012:234713. by Bowden D, Gaudry C, An SC, Gruzelier J. from Psychology Department, Goldsmiths, University of London, ITC Building, New Cross, London SE14 6NW, UK.
This randomised trial compared the effects of Brain Wave Vibration (BWV) training, which involves rhythmic yoga-like meditative exercises, with Iyengar yoga and Mindfulness. Iyengar provided a contrast for the physical components and mindfulness for the "mental" components of BWV. 35 healthy adults completed 10 75-minute classes of BWV, Iyengar, or Mindfulness over five weeks. Participants were assessed at pre- and post intervention for mood, sleep, mindfulness, absorption, health, memory, and salivary cortisol. Better overall mood and vitality followed both BWV and Iyengar training, while the BWV group alone had improved depression and sleep latency. Mindfulness produced a comparatively greater increase in absorption. All interventions improved stress and mindfulness, while no changes occurred in health, memory, or salivary cortisol. In conclusion, increased well-being followed training in all three practices, increased absorption was specific to Mindfulness, while BWV was unique in its benefits to depression and sleep latency, warranting further research.
Compiled by Kevin Chen, Ph.D., MPH