Mind-Body Medicine Research Update
compiled by Dr. Kevin Chen, Ph. D.
The Evolution of Mindfulness-Based Physical Interventions in Breast Cancer Survivors. Evidence Based Complementary & Alternative Medicine. 2012:758641. By Stan DL, Collins NM, Olsen MM, Croghan I, Pruthi S. from Mayo Clinic, Rochester, MN, USA.
Survivors of breast cancer are faced with a multitude of medical and psychological impairments during and after treatment and throughout their lifespan. Physical exercise has been shown to improve survival and recurrence in this population. Mind-body interventions combine a light-moderate intensity physical exercise with mindfulness, thus having the potential to improve both physical and psychological sequelae of breast cancer treatments. We conducted a review of mindfulness-based physical exercise interventions which included yoga, tai chi chuan, Pilates, and qigong, in breast cancer survivors. Among the mindfulness-based interventions, yoga was significantly more studied in this population as compared to tai chi chuan, Pilates, and qigong. The participants and the outcomes of the majority of the studies reviewed were heterogeneous, and the population included was generally not selected for symptoms. Yoga was shown to improve fatigue in a few methodologically strong studies, providing reasonable evidence for benefit in this population. Improvements were also seen in sleep, anxiety, depression, distress, quality of life, and post chemotherapy nausea and vomiting in the yoga studies. Tai chi chuan, Pilates, and qigong were not studied sufficiently in breast cancer survivors in order to be implemented in clinical practice.
Psycho-Physical and Neurophysiological Effects of Qigong on Depressed Elders with Chronic Illness. Aging Mental Health. 2012 Oct 16 [Epub ahead of print] by Tsang HW, Tsang WW, Jones AY, et al. From the Hong Kong Polytechnic University, Kowloon , Hong Kong.
This randomized controlled trial examined the psychological, physical, and neurophysiological effects of a qigong exercise program on depressed elders with chronic medical illness. The experimental group (n = 21, 80 ± 7 years) was given a 12-week qigong exercise program, while the comparison group (n = 17, 81 ± 8 years) participated in a newspaper reading program with the same duration and frequency. Measurement of depression symptoms, psychosocial functioning, muscle strengths, salivary cortisol, and serum serotonin was conducted. At 12 weeks, the qigong group had significant reduction in depressive symptoms (F = 11.68; p < 0.025). Improvement in self-efficacy (F = 4.30; p < 0.050), self-concept of physical well-being (F = 6.82; p < 0.025), and right-hand grip strength (F = 5.25; p = 0.034) was also found when compared with the comparison group. A change in salivary cortisol level was found marginally insignificant between groups (F = 3.16; p = 0.087). However, a decreasing trend of cortisol level was observed. The results provided preliminary evidence for the hypotheses that the anti-depressive effect of qigong exercise could be explained by improvement in psychosocial functioning and possibly down-regulation of hyperactivity of the hypothalamic-pituitary-adrenal axis.
Adding Integrative Meditation with Ear Acupressure to Outpatient Treatment of Cocaine Addiction: A Randomized Controlled Pilot Study. Journal Alternative & Complementary Medicine. 2012 Oct 12 [Epub ahead of print] By Chen KW, Berger CC, Gandhi D, Weintraub E, Lejuez CW. From Center for Integrative Medicine, University of Maryland School of Medicine , Baltimore, MD.
Abstract: Objectives: Cocaine addiction continues to be a major public health problem in the United States. With no U.S. Food and Drug Administration-approved pharmaceutical therapy, treatment often relies on psychosocial interventions. This pilot therapy development study attempts to examine the feasibility and preliminary efficacy of adding breathing-based Integrative Meditation and Ear Acupressure (IMEA) to outpatient treatment of cocaine addiction. Design: Fifty-six (56) cocaine-dependent patients were recruited from an outpatient addiction treatment facility in Baltimore, MD and randomized into either an IMEA or a treatment as usual (TAU) group for the 12 weeks of study, with weekly meetings to monitor treatment outcomes and to facilitate meditative therapy. Outcome measures: The outcome measures consisted of treatment retention rates by week 8 and 12; abstinence rates measured by 6 continuous weeks of negative urinalysis for cocaine, and addiction-related symptoms such as anxiety, craving, depression, and withdrawal symptoms. Results: With the assistance of simplified breath training and a portable MP4 device, 80% of IMEA participants self-reported practicing breathing or meditation 5+ days a week with acceptable compliance and showed strong interest in meditative techniques. Compared to TAU, IMEA participants reported significantly higher treatment completion rates by week 8 (89% versus 63%) and week 12 (81% versus 58%), higher abstinence rates (66% versus 34%), and significantly greater reduction in craving, anxiety, and other addiction-related symptoms. Some participants continued meditation after study completion. Conclusion: It is feasible to add breathing-based IMEA to outpatient treatment of cocaine addiction. Although a number of limitations exist for this pilot study, further large-scale clinical trials and therapy-development studies of IMEA for addiction are warranted.
Breathing Exercises in Upper Abdominal Surgery: A Systematic Review and Meta-Analysis. Rev Bras Fisioter. 2012 Oct;16(5):345-53. By Grams ST, Ono LM, Noronha MA, Schivinski CI, Paulin E. from Universidade do Estado de Santa Catarina, Florianópolis, SC, Brazil.
There is currently no consensus on the indication and benefits of breathing exercises for the prevention of postoperative pulmonary complications PPCs and for the recovery of pulmonary mechanics.
To undertake a systematic review of randomized and quasi-randomized studies that assessed the effects of breathing exercises on the recovery of pulmonary function and prevention of PCCs after upper abdominal surgery UAS.
Search Strategy: We searched the Physiotherapy Evidence Database PEDro, Scientific Electronic Library Online SciELO, MEDLINE, and Cochrane Central Register of Controlled Trials. Selection Criteria: We included randomized controlled trials and quasi-randomized controlled trials on pre- and postoperative UAS patients, in which the primary intervention was breathing exercises without the use of incentive inspirometers. Data Collection and Analysis: The methodological quality of the studies was rated according to the PEDro scale. Data on maximal respiratory pressures MIP and MEP, spirometry, diaphragm mobility, and postoperative complications were extracted and analyzed. Data were pooled in fixed-effect meta-analysis whenever possible.
Six studies were used for analysis. Two meta-analyses including 66 participants each showed that, on the first day post-operative, the breathing exercises were likely to have induced MEP and MIP improvement treatment effects of 11.44 mmH2O (95%CI 0.88 to 22) and 11.78 mmH2O (95%CI 2.47 to 21.09), respectively.
Breathing exercises are likely to have a beneficial effect on respiratory muscle strength in patients submitted to UAS, however the lack of good quality studies hinders a clear conclusion on the subject.
Health and Gross National Happiness: Review of Current Status in Bhutan. Journal Multidisciplinary Health. 2011;4:293-8. By Tobgay T, Dophu U, Torres CE, Na-Bangchang K. from Department of Public Health, Ministry of Health, Kawajangsa, Bhutan;
Worldwide, contemporary measures of the success of health development programs have been mostly in terms of the reduction of mortality and morbidity as well as increasing longevity. While these goals have yielded much-needed health improvements, the subjective outcomes of these improvements, as experienced by individuals and the communities, have not been considered. Bhutan, under the overarching policy of Gross National Happiness, has provided due consideration to these subjective indicators. Here, we report on the current status of health and happiness in Bhutan as revealed by conventional objective indicators and subjective Gross National Happiness indicators. The current literature on health in Bhutan in relation to the Gross National Happiness Survey conducted by the Centre of Bhutan Studies has been reviewed. Bhutan has made great strides within a short period of modernization, as shown by both objective and subjective indicators. Tremendous challenges lie ahead to achieve the ultimate goal of health and happiness, and how Bhutan articulates its path to modernization may be a lesson for the rest of the world.
The Acute Effects of Yogic Breathing Exercises on Craving and Withdrawal Symptoms in Abstaining Smokers. Psychopharmacology (Berl). 2012 Sep 20. [Epub ahead of print] by Shahab L, Sarkar BK, West R. from
University College London, London, UK, firstname.lastname@example.org.
Breathing exercises have been proposed as a way of combating cigarette cravings, potentially presenting a low-cost, easily scalable smoking cessation aid.
The aim of this study is to evaluate the acute impact of breathing exercises based on yogic pranayama on cravings in abstaining smokers.
Participants visited the laboratory on two occasions 24 h apart and were asked to abstain from smoking12 h prior to the first visit until the end of the second visit. Smokers (N = 96) were randomly allocated to a yogic breathing exercise (YBG) or video control (VCG) group. The former was instructed on breathing exercises, practised these for 10 min and asked to use these when experiencing cravings until the next visit. The latter was shown a breathing exercise video for 10 min and asked to concentrate on their breathing. Strength of urges to smoke, other craving measures and mood and physical symptoms associated with cigarette withdrawal were assessed at the beginning and end of the first visit, and again at the second visit.
At immediate follow-up, in the laboratory, all craving measures were reduced in YBG compared with VCG (strength of urges: F(1, 96) = 16.1, p < 0.001; cigarette craving: F(1, 96) = 11.3, p = 0.001; desire to smoke: F(1, 96) = 6.6, p = 0.012). There was no effect on mood or physical symptoms. Adherence to the breathing exercise regimen in the following 24 h was low, and at 24 h follow-up, there was no evidence of reduced cravings in YBG compared with VCG.
Simple yogic-style breathing exercises can reduce cigarette craving acutely in the laboratory. Further research is needed to determine how far this translates into field settings.
Effect of laughter yoga on mood and heart rate variability in patients awaiting organ transplantation: a pilot study. Altern Ther Health Med. 2012 Sep-Oct;18(5):61-6. By Dolgoff-Kaspar R, Baldwin A, Johnson MS, Edling N, Sethi GK. From Department of Surgery and Medicine, University of Arizona, USA. email@example.com
Research shows that laughter has myriad health benefits, yet the medical community has not implemented it formally as a treatment. Patients awaiting organ transplantation have significant physical disabilities and are at risk for psychological distress. Attenuated heart rate variability (HRV) is a risk factor for a negative long-term outcome in some patients.
The study intended to evaluate the clinical utility of laughter yoga in improving psychological and physiological measures in outpatients awaiting organ transplantation. Positive results would indicate promising areas to pursue in a follow-up study.
Six participants met for 10 sessions over 4 weeks. The research team measured each participant’s heart rate, HRV, blood pressure (BP), and immediate mood before and after the laughter and control interventions. The team assessed participants’ longer-term mood (anxiety and depression) at the study’s initiation, after a no-treatment control week, and at the end of the study.
The study occurred at the Department of Surgery and Medicine at the University of Arizona Health Sciences Center, Tucson.
Participants were patients awaiting transplants (three heart and three lung), two women and four men (ages 51-69 y). Participants had received no major surgery in the 3 months prior to the intervention, did not have a hernia or uncontrolled hypertension, and did not fall into the New York Heart Association function class 4.
The 20-minute laughter intervention involved breathing and stretching exercises, simulated laughter (ie, unconditional laughter that is not contingent on the environment), chanting, clapping, and a meditation. The 20-minute control intervention involved the study’s personnel discussing health and study-related topics with the participants.
The research team measured BP, heart rate, and HRV and administered the Profile of Mood States, Beck Anxiety Inventory, and Beck Depression Inventory-II to evaluate immediate and longer-term mood. The team had planned quantitative statistical analysis of the data at the study’s initiation but did not complete it because the number of enrolled participants was too low for the analysis to be meaningful. The team visually examined the data, however, for trends that would indicate areas to examine further in a follow-up study.
Participants showed improved immediate mood (vigor-activity and friendliness) and increased HRV after the laughter intervention. Both the laughter and control interventions appeared to improve longer-term anxiety. Two participants awaiting a lung transplant dropped out of the study, and no adverse events occurred.
This pilot study suggests that laughter yoga may improve HRV and some aspects of mood, and this topic warrants further research.
Subjective wellbeing and longevity: a co-twin control study. Twin Res Hum Genet. 2011 (3):249-56. By Sadler ME, Miller CJ, Christensen K, McGue M. from Roosevelt University, USA. firstname.lastname@example.org
Mental health is increasingly defined not only by the absence of illness but by the presence of subjective well-being (SWB). Previous cohort studies have consistently shown that indicators of SWB predict favorable life outcomes, including better mental and somatic health, and longevity. The favorable effects associated with SWB have prompted new research aimed at raising happiness and wellbeing through individual interventions and public health initiatives. Standard observational studies of individual-level associations, however, are subject to potential confounding of exposure and outcome by shared genes and environment. The present study explored the association between SWB and increased longevity, using twin pair analyses to determine whether the association is consistent with causality or is due to genetic or environmental confounding. The study sample of 3,966 twins aged 70 or older, followed for a median time period of 9 years, was drawn from the population-based Longitudinal Study of Aging Danish Twins (LSADT). The association between SWB, operationalized as affect and life satisfaction, and all-cause mortality risk was examined using between-individual and within-pair survival analyses. As expected, at the individual level, SWB predicted increased longevity. Exposure effects were also present in unadjusted and adjusted within-pair analyses of 400 dizygotic (DZ) pairs and 274 monozygotic (MZ) pairs, indicating that SWB is associated with increased longevity independent of familial factors of genes and shared environment.
Objective: The objective of this research was to examine the evidence for delivering yoga-based interventions in schools. Methods: An electronic literature search was conducted to identify peer-reviewed, published studies in which yoga and a meditative component (breathing practices or meditation) were taught to youths in a school setting. Pilot studies, single cohort, quasi-experimental, and randomized clinical trials were considered. Research: quality was evaluated and summarized. Results: Twelve published studies were identified. Samples for which yoga was implemented as an intervention included youths with autism, intellectual disability, learning disability, and emotional disturbance, as well as typically developing youths. Conclusion: Although effects of participating in school-based yoga programs appeared to be beneficial for the most part, methodological limitations, including lack of randomization, small samples, limited detail regarding the intervention, and statistical ambiguities curtailed the ability to provide definitive conclusions or recommendations. Findings speak to the need for greater methodological rigor and an increased understanding of the mechanisms of success for school-based yoga interventions.
Meditation-related increases in GABA(B) modulated cortical inhibition. Brain Stimul. 2012 Sep 7. [Epub ahead of print] by Guglietti CL, Daskalakis ZJ, Radhu N, Fitzgerald PB, Ritvo P. from York University, Department of Kinesiology and Health Science, Toronto, Ontario, Canada.
Recent reports suggest meditation practice improves attentional performance and emotional regulation. The process of meditation apparently increases activation in the prefrontal cortex (PFC) and stimulates the reticular nucleus of the thalamus, implicating the production and delivery of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). GABAergic inhibitory interneurons have a central role in cortical inhibition (CI), modulating cortical excitability and neural plasticity.
Changes in CI, after completion of a single meditation session, were investigated and compared to a non-meditating control activity.
Transcranial magnetic stimulation (TMS), a non-invasive method of examining CI, was used to evaluate changes before and after a 60 min meditation session. Seventy right-handed healthy subjects (n = 35 meditators, n = 35 non-meditators) were assessed using TMS related measures of cortical silent period (CSP) and short intra cortical inhibition (SICI), with stimulation of the motor cortex coordinated with EMG recording of peripheral hand muscles.
For the meditators, CSP and SICI were measured before and after meditation sessions while age-sex matched healthy control subjects were identically assessed after a non-meditating activity (television watching). The meditators showed a statistically significant increase in CSP after meditation compared to non-meditators after an equivalent period of television watching (P = 0.02) while no significant between-group differences were observed in the SICI.
These findings indicate meditation processes are linked to GABAergic cortical inhibition, a mechanism previously implicated in improved cognitive performance and enhanced emotional regulation.
Meditation as a potential therapy for autism: a review. Autism Res Treat. 2012;2012:835847. By Sequeira S, Ahmed M. from Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Autism is a chronic neurodevelopmental disorder of unknown cause that affects approximately 1-3 percent of children and four times more boys than girls. Its prevalence is global and its social impact is devastating. In autism, the brain is unable to process sensory information normally. Instead, simple stimuli from the outside world are experienced as overwhelmingly intense and strain the emotional centers of the brain. A stress response to the incoming information is initiated that destabilizes cognitive networks and short-circuits adequate behavioral output. As a result, the child is unable to respond adequately to stimulation and initiate social behavior towards family, friends, and peers. In addition, these children typically face immune-digestive disorders that heighten social fears, anxieties, and internal conflicts. While it is critical to treat the physical symptoms, it is equally vital to offer an evidence-based holistic solution that harmonizes both their emotional and physical well-being as they move from childhood into adult life. Here, we summarize evidence from clinical studies and neuroscience research that suggests that an approach built on yogic principles and meditative tools is worth pursuing. Desired outcomes include relief of clinical symptoms of the disease, greater relaxation, and facilitated expression of feelings and skills, as well as improved family and social quality of life.