Mind-Body Medicine Research Update (Pilot study 2/11)

Mind-Body Medicine Research Updates

Qigong versus Exercise versus no Therapy for Patients with Chronic Neck Pain – a Randomized Controlled Trial.  Spine. 2010 Dec 20; by Rendant D, Pach D, Lüdtke R, Reisshauer A, Willich S, Witt CM. from Institute of Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany.

ABSTRACT: Study Design: Randomized controlled trial Objective: To evaluate whether qigong is more effective than no treatment and not inferior to exercise therapy. Summary of Background Data: Life time prevalence of chronic neck pain is close to 50%. Qigong is often used by patients, although the evidence is still unclear. Methods: Patients (age 20-60 years) with chronic neck pain (VAS ≥ 40 mm) were randomized to 1) qigong or 2) exercise therapy (18 sessions over six months) or 3) waiting list (no treatment). At baseline and after three and six months, patients completed standardized questionnaires assessing neck pain (VAS), neck pain and disability (NPAD), and quality of life (SF-36). The primary endpoint was average pain in the last seven days on VAS at six month follow-up. Statistical analysis included GEE models adjusted for baseline values and patient expectation. Results: A total of 123 patients (age 46 ± 11 years, 88% women) suffering from chronic neck pain for 3.2 (SD ± 1.6) years were included. After six months a significant difference was seen between the qigong and waiting list control groups (VAS mean difference: -14 mm [95% CI, -23.1;-5.4], P= 0.002). Mean improvements in the exercise group were comparable to those in the qigong group (difference between groups -0.7 mm [CI: -9.1; 7.7]) but failed to show statistical significance (p=0.092). NPAD and SF-36 results also yielded superiority of qigong over no treatment and similar results in the qigong and exercise therapy groups. Conclusion: Qigong was more effective than no treatment in patients with chronic neck pain. Further studies could be designed without waiting list control and should use a larger sample to clarify the value of qigong compared to exercise therapy.

Effects of yoga on balance and gait properties in women with musculoskeletal problems: A pilot study. Complement Ther Clin Pract. 2011 Feb;17(1):13-5. by Ulger O, Yağlı NV. Hacettepe University Health Sciences Faculty, Physical Therapy and Rehabilitation Department, Samanpazarı, 06100 Ankara, Turkey.

OBJECTIVES: The purpose of the present study is to investigate the effects of yoga on balance and gait properties in women with musculoskeletal problems. DESIGN: Twenty-seven women (30-45 years old) with musculoskeletal problems, such as osteoarthritis and low-back pain, were included in the present study. The patients participated in 8 sessions (twice weekly for 4 weeks) of a yoga program which included asanas, stretching exercises, and breathing techniques.  MAIN OUTCOME MEASURES: Patients’ static balance measurements and gait parameters were determined before and after the study using a stabilometer and a gait trainer, respectively.  RESULTS: Post-study values of patients’ gait parameters were found to be statistically higher than their pre-study values (p < 0.05) The values of patients’ balance addressed anterior and right positions with patients’ eyes open and subsequently closed pre-treatment. However, it was notable that balance post-treatment was minimal when subjects eyes were open or closed. Anterior-posterior values and right-left values were almost equal after treatment.  DISCUSSION: The results showed that yoga has a positive effect on balance and gait parameters of women with gait and balance disturbances that are caused by musculoskeletal problems. It is feasible to conclude that asanas and stretching exercises included in the yoga program brought about such a positive effect, and therefore it is possible to use yoga programs to solve problems caused by musculoskeletal disorders.

The role of breathing training in asthma management. Curr Opin Allergy Clin Immunol. 2011 Feb; 11(1): 53-7. by Bruton A, Thomas M. Faculty of Health Sciences, Highfield Campus, University of Southampton, Southampton, UK.

PURPOSE OF REVIEW: There is considerable public interest in the use of breathing modification techniques in the treatment of asthma. Surveys suggest many people with asthma use them, often without the knowledge of their medical attendants. Extravagant claims have been made about the effectiveness of some techniques, resulting in scepticism from orthodox clinicians. The evidence supporting breathing training for asthma was previously weak, and limited by the small size and methodological limitations of published research.  RECENT FINDINGS: The evidence base for the effectiveness of breathing training has recently improved, with reports from several larger and more methodologically robust controlled trials. These trials are reviewed in this study, and the findings placed in context. Trials have investigated a variety of breathing training programmes delivered by different therapists in different ways. All incorporate some instruction in breathing pattern, usually focusing on slow, regular, nasal, abdominal breathing and reduced ventilation, with patients instructed to practise exercises at home and when symptomatic.  SUMMARY: Current evidence suggests that breathing training programmes can be effective in improving patient-reported outcomes such as symptoms, quality of life and psychological impact; and may reduce the use of rescue bronchodilator medication. There is little evidence that airways physiology, hyper-responsiveness or inflammation is affected by such training. The optimal way of providing breathing training within the context of routine asthma care is still uncertain.

Does mindfulness training improve cognitive abilities? A systematic review of neuropsychological findings. Clin Psychol Rev. 2010 Dec 1. by Chiesa A, Calati R, Serretti A.

Mindfulness meditation practices (MMPs) are a subgroup of meditation practices which are receiving growing attention. The present paper reviews current evidence about the effects of MMPs on objective measures of cognitive functions. Five databases were searched. Twenty three studies providing measures of attention, memory, executive functions and further miscellaneous measures of cognition were included. Fifteen were controlled or randomized controlled studies and 8 were case-control studies. Overall, reviewed studies suggested that early phases of mindfulness training, which are more concerned with the development of focused attention, could be associated with significant improvements in selective and executive attention whereas the following phases, which are characterized by an open monitoring of internal and external stimuli, could be mainly associated with improved unfocused sustained attention abilities. Additionally, MMPs could enhance working memory capacity and some executive functions. However, many of the included studies show methodological limitations and negative results have been reported as well, plausibly reflecting differences in study design, study duration and patients’ populations. Accordingly, even though findings here reviewed provided preliminary evidence suggesting that MMPs could enhance cognitive functions, available evidence should be considered with caution and further high quality studies investigating more standardized mindfulness meditation programs are needed.

Treating fibromyalgia with mindfulness-based stress reduction: Results from a 3-armed randomized controlled trial. Pain. 2010 Dec 10.  by Schmidt S, Grossman P, Schwarzer B, Jena S, Naumann J, Walach H.  From Department of Environmental Health Sciences, University Medical Center, Freiburg, Germany; Institute for Transcultural Health Studies, European University Viadrina, Frankfurt (Oder), Germany.

Mindfulness-based stress reduction (MBSR) is a structured 8-week group program teaching mindfulness meditation and mindful yoga exercises. MBSR aims to help participants develop nonjudgmental awareness of moment-to-moment experience. Fibromyalgia is a clinical syndrome with chronic pain, fatigue, and insomnia as major symptoms. Efficacy of MBSR for enhanced well-being of fibromyalgia patients was investigated in a 3-armed trial, which was a follow-up to an earlier quasi-randomized investigation. A total of 177 female patients were randomized to one of the following: (1) MBSR, (2) an active control procedure controlling for nonspecific effects of MBSR, or (3) a wait list. The major outcome was health-related quality of life (HRQoL) 2 months post-treatment. Secondary outcomes were disorder-specific quality of life, depression, pain, anxiety, somatic complaints, and a proposed index of mindfulness. Of the patients, 82% completed the study. There were no significant differences between groups on primary outcome, but patients overall improved in HRQoL at short-term follow-up (P=0.004). Post hoc analyses showed that only MBSR manifested a significant pre-to-post-intervention improvement in HRQoL (P=0.02). Furthermore, multivariate analysis of secondary measures indicated modest benefits for MBSR patients. MBSR yielded significant pre-to-post-intervention improvements in 6 of 8 secondary outcome variables, the active control in 3, and the wait list in 2. In conclusion, primary outcome analyses did not support the efficacy of MBSR in fibromyalgia, although patients in the MBSR arm appeared to benefit most. Effect sizes were small compared to the earlier, quasi-randomized investigation. Several methodological aspects are discussed, e.g., patient burden, treatment preference and motivation, that may provide explanations for differences. In a 3-armed randomized controlled trial in female patients suffering from fibromyalgia, patients benefited modestly from a mindfulness-based stress reduction intervention.

Green tea polyphenols supplementation and Tai Chi exercise for postmenopausal osteopenic women: safety and quality of life report. BMC Complement Altern Med. 2010 Dec 9;10(1):76. By Shen CL, Chyu MC, Pence BC, Yeh JK, Zhang Y, Felton CK, Doctolero S, Wang JS.

BACKGROUND: Evidence suggests that both green tea polyphenols (GTP) and Tai Chi (TC) exercise may benefit bone health in osteopenic women. However, their safety in this population has never been systematically investigated. In particular, there have been hepatotoxicity concerns related to green tea extract. This study was to evaluate the safety of 24 weeks of GTP supplementation combined with TC exercise in postmenopausal osteopenic women, along with effects on quality of life in this population. METHODS: 171 postmenopausal women with osteopenia were randomly assigned to 4 treatment arms for 24 weeks: (1) Placebo (500 mg starch/day), (2) GTP (500 mg GTP/day), (3) Placebo + TC (placebo plus TC training at 60 min/session, 3 sessions/week), and (4) GTP + TC (GTP plus TC training). Safety was examined by assessing liver enzymes (aspartate aminotransferase, alanine aminotransferase), alkaline phosphatase, and total bilirubin at baseline and every 4 weeks. Kidney function (urea nitrogen and creatinine), calcium, and inorganic phosphorus were also assessed at the same times. Qualify of life using SF-36 questionnaire was evaluated at baseline, 12, and 24 weeks. A mixed model of repeated measures ANOVA was applied for analysis. RESULTS: 150 subjects completed the study (12% attrition rate). The compliance rates for study agents and TC exercise were 89% and 83%, respectively. Neither GTP supplementation nor TC exercise affected liver or kidney function parameters throughout the study. No adverse event due to study treatment was reported by the participants. TC exercise significantly improved the scores for role-emotional and mental health of subjects, while no effect on quality of life was observed due to GTP supplementation. CONCLUSIONS: GTP at a dose of 500 mg/day and/or TC exercise at 3 hr/week for 24 weeks appear to be safe in postmenopausal osteopenic women, particularly in terms of liver and kidney functions. TC exercise for 24 weeks (3 hr/wk) significantly improved quality of life in terms of role-emotional and mental health in these subjects. ClinicalTrials.gov identifier: NCT00625391.

Role of naturopathy and yoga treatment in the management of hypertension. Complement Ther Clin Pract. 2011 Feb; 17(1):9-12. by Murthy SN, Rao NS, Nandkumar B, Kadam A. from NYS Medical Research Society, Jindal Naturecure Institute, Jindal Nagar, Bangalore 560073, India.

AIM: The primary aim was to study the effect of naturopathy and yoga interventions in treatment of mild to moderate hypertension.  DESIGN: The variables of interest were measured at the beginning and end of the intervention using a pre-post design.  SETTING: The study was conducted by INYS medical research society in Jindal Nature Cure Institute, Bangalore.  SUBJECTS: A total of 104 subjects, already diagnosed with mild to moderate hypertension and on treatment with antihypertensive medicines were included in study. INTERVENTIONS: The intervention consisted of various inpatient administration of different naturopathy treatments, yoga therapies, low calorie and low sodium diet for 21 days. Antihypertensive medicines were withdrawn for some patients in one week based upon response to the treatment.  OUTCOME MEASURES: The outcome measures were values of diastolic and systolic blood pressure and body weight. Subjects were followed for a period of one year after every 3 months.  RESULTS: After starting nonpharmacological approach of naturopathy and yoga, Systolic blood pressure came down from mean of 139.6 to 129.6 where as it came down from 91.2 to 86.1 for diastolic blood pressure. At the same time favorable effect was also seen in other variables like lipid profile and body weight. At the end of one year out of 57 patients who came for follow-up, 14 cases were found to have blood pressure within normal ranges without any medication over the previous 12 months. CONCLUSION: Naturopathy and yoga therapy can be considered as a valuable nonpharmacoloical approach in treatment of hypertension.

Tai chi exercise for patients with chronic obstructive pulmonary disease: a pilot study. Respir Care. 2010 Nov;55(11):1475-82.  by Yeh GY, Roberts DH, Wayne PM, Davis RB, Quilty MT, Phillips RS. From Division for Research and Education in Complementary and Integrative Medical Therapies, Osher Research Center, Harvard Medical School, Boston, MA 02215, USA. gyeh@hms.harvard.edu

OBJECTIVE: To determine the feasibility of a randomized controlled trial of the effect of a tai chi program on quality of life and exercise capacity in patients with COPD.  METHODS: We randomized 10 patients with moderate to severe COPD to 12 weeks of tai chi plus usual care (n = 5) or usual care alone (n = 5). The tai chi training consisted of a 1-hour class, twice weekly, that emphasized gentle movement, relaxation, meditation, and breathing techniques. Exploratory outcomes included disease-specific symptoms and quality-of-life, exercise capacity, pulmonary function tests, mood, and self-efficacy. We also conducted qualitative interviews to capture patient narratives regarding their experience with tai chi. RESULTS: The patients were willing to be randomized. Among 4 of the 5 patients in the intervention group, adherence to the study protocol was excellent. The cohort’s baseline mean ± SD age, percent-of-predicted FEV₁, and ratio of FEV₁ to forced vital capacity were 66 ± 6 y, 50 ± 12%, and 0.63 ± 0.14, respectively. At 12 weeks there was significant improvement in Chronic Respiratory Questionnaire score among the tai chi participants (1.4 ± 1.1), compared to the usual-care group (-0.1 ± 0.4) (P = .03). There were nonsignificant trends toward improvement in 6-min walk distance (55 ± 47 vs -13 ± 64 m, P = .09), Center for Epidemiologic Studies Depression Scale (-9.0 ± 9.1 vs -2.8 ± 4.3, P = .20), and University of California, San Diego Shortness of Breath score (-7.8 ± 3.5 vs -1.2 ± 11, P = .40). There were no significant changes in either group’s peak oxygen uptake.  CONCLUSIONS: A randomized controlled trial of tai chi is feasible in patients with moderate to severe COPD. Tai chi exercise as an adjunct to standard care warrants further investigation.

[Compiled by Kevin Chen ]

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