Mind-Body Medicine Research Update

Research update

Tai chi exercise for treatment of pain and disability in people with persistent low back pain: a randomized controlled trial. Arthritis Care Res. 2011 Nov;63(11):1576-83.; by Hall AM, Maher CG, Lam P, Ferreira M, Latimer J.from The George Institute for Global Health and University of Sydney, New South Wales, Australia. amandahall@georgeinstitute.org.au

OBJECTIVE: To determine the effect of tai chi exercise on persistent low back pain.  METHODS: We performed a randomized controlled trial in a general community setting in Sydney, New South Wales, Australia. Participants consisted of 160 volunteers between ages 18 and 70 years with persistent nonspecific low back pain. The tai chi group (n = 80) consisted of 18 40-minute sessions over a 10-week period delivered in a group format by a qualified instructor. The waitlist control group continued with their usual health care. Bothersome-ness of back symptoms was the primary outcome. Secondary outcomes included pain intensity and pain-related disability. Data were collected at pre- and post intervention and analyzed by intent-to-treat.  RESULTS: Tai chi exercise reduced l evels of back symptoms by 1.7 points on a 0-10 scale, reduced pain intensity by 1.3 points on a 0-10 scale, and improved self-report disability by 2.6 points on the 0-24 Roland-Morris Disability Questionnaire scale. The follow up rate was >90% for all outcomes. These results were considered a worthwhile treatment effect by researchers and participants. CONCLUSION: This is the first pragmatic randomized controlled trial of tai chi exercise for people with low back pain. It showed that a 10-week tai chi program improved pain and disability outcomes and can be considered a safe and effective intervention for those experiencing long-term low back pain symptoms.

Yoga for persistent fatigue in breast cancer survivors: A randomized controlled trial. Cancer. 2011 Dec 16. by Bower JE, Garet D, Sternlieb B, Ganz PA, Irwin MR, Olmstead R, Greendale G.. from Department of Psychology, University of California-Los Angeles, Los Angeles, California; jbower@ucla.edu.

BACKGROUND: Cancer-related fatigue afflicts up to 33% of breast cancer survivors, yet there are no empirically validated treatments for this symptom. METHODS: The authors conducted a 2-group randomized controlled trial to determine the feasibility and efficacy of an Iyengar yoga intervention for breast cancer survivors with persistent post-treatment fatigue. Participants were breast cancer survivors who had completed cancer treatments (other than endocrine therapy) at least 6 months before enrollment, reported significant cancer-related fatigue, and had no other medical conditions that would account for fatigue symptoms or interfere with yoga practice. Block randomization was used to assign participants to a 12-week, Iyengar-based yoga intervention or to 12 weeks of health education (control). The primary outcome was change in fatigue measured at baseline, immediately post-treatment, and 3 months after treatment completion. Additional outcomes included changes in vigor, depressive symptoms, sleep, perceived stress, and physical performance. Intent-to-treat analyses were conducted with all randomized participants using linear mixed models.  RESULTS: Thirty-one women were randomly assigned to yoga (n = 16) or health education (n = 15). Fatigue severity declined significantly from baseline to post-treatment and over a 3-month follow-up in the yoga group relative to controls (P = .032). In addition, the yoga group had significant increases in vigor relative to controls (P = .011). Both groups had positive changes in depressive symptoms and perceived stress (P < .05). No significant changes in sleep or physical performance were observed. CONCLUSIONS: A targeted yoga intervention led to significant improvements in fatigue and vigor among breast cancer survivors with persistent fatigue symptoms.

External Qi of Yan Xin Qigong induces cell death and gene expression alterations promoting apoptosis and inhibiting proliferation, migration and glucose metabolism in small-cell lung cancer cells. Mol Cell Biochem. 2011 Dec 10. by Yan X, Li F, Dozmorov I, Frank MB, Dao M, Centola M, Cao W, Hu D. from the Institute of Chongqing Traditional Chinese Medicine, Chongqing, China.

Abstract: Small-cell lung cancer (SCLC) is a highly malignant carcinoma with poor long-term survival. Effective treatment remains highly demanded. In the present study, we demonstrated that External Qi of Yan Xin Qigong (YXQ-EQ) exerted potent cytotoxic effect towards SCLC cell line NCI-H82 via induction of apoptosis. Global gene expression profiling identified 39 genes whose expression was altered by YXQ-EQ in NCI-82 cells. Among them, semi-quantitative RT-PCR and real-time qPCR analyses confirmed that the gene expression levels of apoptotic proteins death-associated protein kinase 2 and cell death-inducing DFFA-like effector b were upregulated, whereas that of oncoproteins DEK and MYCL1, cell migration-promoting proteins CD24 and integrin-alpha 9, and glycolytic enzyme aldolase A were downregulated. These findings suggest that YXQ-EQ may exert anticancer effect through modulating gene expression in a way that facilitates cancer cell apoptosis while represses proliferation, metastasis, and glucose metabolism.

Effects of yoga interventions on pain and pain-associated disability: a meta-analysis. J Pain. 2012 Jan;13(1):1-9. By Büssing A, Ostermann T, Lüdtke R, Michalsen A. from Center for Integrative Medicine, Faculty of Medicine, University of Witten/Herdecke, Herdecke, Germany.

We searched databases for controlled clinical studies, and performed a meta-analysis on the effectiveness of yoga interventions on pain and associated disability. Five randomized studies reported single-blinding and had a higher methodological quality; 7 studies were randomized but not blinded and had moderate quality; and 4 nonrandomized studies had low quality. In 6 studies, yoga was used to treat patients with back pain; in 2 studies to treat rheumatoid arthritis; in 2 studies to treat patients with headache/migraine; and 6 studies enrolled individuals for other indications. All studies reported positive effects in favor of the yoga interventions. With respect to pain, a random effect meta-analysis estimated the overall treatment effect at SMD = -.74 (CI: -.97; -.52, P < .0001), and an overall treatment effect at SMD = -.79 (CI: -1.02; -.56, P < .0001) for pain-related disability. Despite some limitations, there is evidence that yoga may be useful for several pain-associated disorders. Moreover, there are hints that even short-term interventions might be effective. Nevertheless, large-scale further studies have to identify which patients may benefit from the respective interventions. PERSPECTIVE: This meta-analysis suggests that yoga is a useful supplementary approach with moderate effect sizes on pain and associated disability.

Positive Effect of Abdominal Breathing Exercise on Gastroesophageal Reflux Disease: A Randomized, Controlled Study. Am J Gastroenterol. 2011 Dec 6. By Eherer AJ, Netolitzky F, Högenauer C, Puschnig G, Hinterleitner TA, Scheidl S, Kraxner W, Krejs GJ, Hoffmann KM. from Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University Graz, Graz, Austria.

OBJECTIVES: The lower esophageal sphincter (LES), surrounded by diaphragmatic muscle, prevents gastroesophageal reflux. When these structures become incompetent, gastric contents may cause gastroesophageal reflux disease (GERD). For treatment, lifestyle interventions are always recommended. We hypothesized that by actively training the crura of the diaphragm as part of the LES using breathing training exercises, GERD can be positively influenced.  METHODS: A prospective randomized controlled study was performed. Patients with non-erosive GERD or healed esophagitis without large hernia and/or previous surgery were included. Patients were randomized and allocated either to an active breathing training program or to a control group. Quality of life (QoL), pH-metry, and on-demand proton pump inhibitor (PPI) usage were assessed at baseline and after 4 weeks of training. For long-term follow-up, all patients were invited to continue active breathing training and were further assessed regarding QoL and PPI usage after 9 months. Paired and unpaired t-test was used for statistical analysis.  RESULTS: Nineteen patients with non-erosive GERD or healed esophagitis were randomized into two groups (10 training group and 9 control group). There was no difference in baseline patient characteristics between the groups and all patients finished the study. There was a significant decrease in time with a pH<4.0 in the training group (9.1±1.3 vs. 4.7±0.9%; P<0.05), but there was no change in the control group. QoL scores improved significantly in the training group (13.4±1.98 before and 10.8±1.86 after training; P<0.01), but no changes in QoL were seen in the control group. At long-term follow-up at 9 months, patients who continued breathing exercise (11/19) showed a significant decrease in QoL scores and PPI usage (15.1±2.2 vs. 9.7±1.6; 98±34 vs. 25±12 mg/week, respectively; P<0.05), whereas patients who did not train had no long-term effect.  CONCLUSIONS: We show that actively training the diaphragm by breathing exercise can improve GERD as assessed by pH-metry, QoL scores and PPI usage. This non-pharmacological lifestyle intervention could help to reduce the disease burden of GERD.

Reducing Stress in School-age Girls through Mindful Yoga. J Pediatr Health Care. 2012 Jan;26(1):45-56. By White LS.

INTRODUCTION: School-age children report much stress in their daily lives, which may lead to psychological and physical problems. Mindfulness-based Stress Reduction is a program of awareness-based practices effective with adults. The purpose of this study was to investigate the efficacy of mindfulness training through yoga with school-age girls to reduce perceived stress, enhance coping abilities, self-esteem, and self-regulation, and explore the relationship between the dose of the intervention and outcomes. METHOD: Fourth- and fifth-grade girls were recruited from two public schools and randomly assigned to intervention and wait-list control groups. The intervention group met 1 hour a week for 8 weeks and completed 10 minutes of daily homework. RESULTS: Self-esteem and self-regulation increased in both groups. The intervention group was more likely to report greater appraisal of stress (p < .01) and greater frequency of coping (p < .05). Homework accounted for 7% of the variance in reported stress.  DISCUSSION: Consistent with reports of mindfulness training, greater awareness of the feelings associated with stress may enhance coping abilities. However, it is possible that the increasing awareness of stressors in itself increased stress, possibly as part of the process of developing mindfulness or related to cognitive, emotional, or social development. Mindfulness in children may differ from mindfulness in adults and warrants further investigation.

Effectiveness of yoga therapy as a complementary treatment for major psychiatric disorders: a meta-analysis. Prim Care Companion CNS Disord. 2011;13(4). By Cabral P, Meyer HB, Ames D. from Department of Psychology, California State University, Northridge

Objective: To examine the efficacy of yoga therapy as a complementary treatment for psychiatric disorders such as schizophrenia, depression, anxiety, and posttraumatic stress disorder (PTSD).Data Sources: Eligible trials were identified by a literature search of PubMed/MEDLINE, Cochrane Control Trials Register, Google Scholar, and EBSCO on the basis of criteria of acceptable quality and relevance. The search was performed using the following terms: yoga for schizophrenia, yoga for depression, yoga for anxiety, yoga for PTSD, yoga therapy, yoga for psychiatric disorders, complementary treatment, and efficacy of yoga therapy. Trials both unpublished and published with no limitation placed on year of publication were included; however, the oldest article included in the final meta-analysis was published in 2000.Study Selection: All available randomized, controlled trials of yoga for the treatment of mental illness were reviewed, and 10 studies were eligible for inclusion. As very few randomized, controlled studies have examined yoga for mental illness, this meta-analysis includes studies with participants who were diagnosed with mental illness, as well as studies with participants who were not diagnosed with mental illness but reported symptoms of mental illness. Trials were excluded due to the following: (1) insufficient information, (2) inadequate statistical analysis, (3) yoga was not the central component of the intervention, (4) subjects were not diagnosed with or did not report experiencing symptoms of one of the psychiatric disorders of interest (ie, schizophrenia, depression, anxiety, and PTSD), (5) study was not reported in English, and (6) study did not include a control group.Data Extraction: Data were extracted on participant diagnosis, inclusion criteria, treatment and control groups, duration of intervention, and results (pre-post mean and standard deviations, t values, and f values). Number, age, and sex ratio of participants were also obtained when available.Data Synthesis: The combined analysis of all 10 studies provided a pooled effect size of -3.25 (95% CI, -5.36 to -1.14; P = .002), indicating that yoga-based interventions have a statistically significant effect as an adjunct treatment for major psychiatric disorders. Findings in support of alternative and complementary interventions may especially be an aid in the treatment of disorders for which current treatments are found to be inadequate or to carry severe liabilities. Conclusions: As current psychopharmacologic interventions for severe mental illness are associated with increased risk of weight gain as well as other metabolic side effects that increase patients’ risk for cardiovascular disease, yoga may be an effective, far less toxic adjunct treatment option for severe mental illness.

Effect of a single-session meditation training to reduce stress and improve quality of life among health care professionals: a “dose-ranging” feasibility study. Altern Ther Health Med. 2011 May-Jun;17(3):46-9. By Prasad K, Wahner-Roedler DL, Cha SS, Sood A. from Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

OBJECTIVE: The primary aim of the study was to assess the feasibility of incorporating a single-session meditation-training program into the daily activities of healthy employees of a tertiary-care academic medical center. The study also assessed the most preferred duration of meditation and the effect of the meditation program on perceived stress, anxiety, and overall quality of life (QOL).  POPULATION: Seventeen healthy clinic employees were recruited for this study. INTERVENTION: After an initial group instruction session covering basic information about meditation, Paced Breathing Meditation (PBM) was taught to the participants. Participants were instructed to self-practice meditation with the help of a DVD daily for a total of 4 weeks. The DVD had three different programs of 5, 15, and 30 minutes with a menu option to choose one of the programs. OUTCOME MEASURES: (1) Patient diary, (2) Perceived Stress Scale (PSS), (3) Linear Analogue Self-Assessment (LASA), (4) Smith Anxiety Scale (SAS). Primary outcome measures were compared using the paired t-test. RESULTS: All participants were female; median age was 48 years (range 33-60 y). The 5-minute meditation session was practiced by 14 participants a total of 137 times during the 4-week trial period, the 15-minute session by 16 participants a total of 223 times, and the 30-minute session by 13 participants 71 times. The median number of days practiced was 25 (range 10-28 d); the average total time practiced was 394 minutes (range 55-850 min). After 4 weeks of practice, the scores of the following instruments improved significantly from baseline: PSS (P < .0001), SAS (P = .0005), LASA (P = .0005). No relationship was noted between the length of time practiced and improvement of PSS, SAS, and LASA scores. CONCLUSION:  This pilot study indicates the feasibility of teaching meditation in a single training session to health care employees. The study shows that 15 minutes once or twice a day is the most feasible duration of meditation practice. The study also provides promising preliminary efficacy data of this program for improving stress, anxiety, and QOL.

Meditation experience is associated with differences in default mode network activity and connectivity. Proc Natl Acad Sci U S A. 2011 Dec 13;108(50):20254-9. By Brewer JA, Worhunsky PD, Gray JR, Tang YY, Weber J, Kober H. from Department of Psychiatry, Yale University School of Medicine, New Haven, CT.

Many philosophical and contemplative traditions teach that “living in the moment” increases happiness. However, the default mode of humans appears to be that of mind-wandering, which correlates with unhappiness, and with activation in a network of brain areas associated with self-referential processing. We investigated brain activity in experienced meditators and matched meditation-naive controls as they performed several different meditations (Concentration, Loving-Kindness, Choice-less Awareness). We found that the main nodes of the default-mode network (medial prefrontal and posterior cingulate cortices) were relatively deactivated in experienced meditators across all meditation types. Furthermore, functional connectivity analysis revealed stronger coupling in experienced meditators between the posterior cingulate, dorsal anterior cingulate, and dorsolateral prefrontal cortices (regions previously implicated in self-monitoring and cognitive control), both at baseline and during meditation. Our findings demonstrate differences in the default-mode network that are consistent with decreased mind-wandering. As such, these provide a unique understanding of possible neural mechanisms of meditation.

(Compiled by Kevin W Chen)


Kevin Chen, Ph.D., MPH is an associate professor at the Center for Integrative Medicine and Department of Psychiatry, University of Maryland School of Medicine (USA).  Dr. Chen was educated in the universities of both China and the United States, and has years of experience and training in blending eastern and western perspectives, and in the practice of life-nurturing methods. As a long-time practitioner of Qigong Yang Sheng, he is one of the few scientists in the U.S. to have both hands-on knowledge of mind-body practice, and an active research career in mind-body medicine, which is funded through grants by the National Institutes of Health (NIH) and various foundations.  Dr. Chen devotes his career and life to the practice of Yang Sheng, and promotion of self-healing and mind-body-spirit integration through the non-profit organization, World Institute for Self Healing (WISH) (http://www.wishus.org).]
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