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Full Lifestyle Changes

 

Effect of comprehensive lifestyle changes on telomerase activity and telomere length in men with biopsy-proven low-risk prostate cancer: 5-year follow-up of a descriptive pilot study.

CONCLUSIONS:

In this community sample of patients with coronary heart disease declining enrollment in cardiac rehabilitation, a 6-month tai chi program was safe and improved PA, weight, and quality of life compared with a 3-month intervention. Tai chi could be an effective option to improve PA in this high-risk population.

Abstract

BACKGROUND:

Telomere shortness in human beings is a prognostic marker of ageing, disease, and premature morbidity. We previously found an association between 3 months of comprehensive lifestyle changes and increased telomerase activity in human immune-system cells. We followed up participants to investigate long-term effects.

 

INTERPRETATION:

Our comprehensive lifestyle intervention was associated with increases in relative telomere length after 5 years of follow-up, compared with controls, in this small pilot study. Larger randomised controlled trials are warranted to confirm this finding.

 

 

Meditation Studies

Meditation and Cardiovascular Risk Reduction: A Scientific Statement From the American Heart Association.

Abstract

Despite numerous advances in the prevention and treatment of atherosclerosis, cardiovascular disease remains a leading cause of morbidity and mortality. Novel and inexpensive interventions that can contribute to the primary and secondary prevention of cardiovascular disease are of interest. Numerous studies have reported on the benefits of meditation. Meditation instruction and practice is widely accessible and inexpensive and may thus be a potential attractive cost-effective adjunct to more traditional medical therapies. Accordingly, this American Heart Association scientific statement systematically reviewed the data on the potential benefits of meditationon cardiovascular risk. Neurophysiological and neuroanatomical studies demonstrate that meditation can have long-standing effects on the brain, which provide some biological plausibility for beneficial consequences on the physiological basal state and on cardiovascular risk. Studies of the effects of meditation on cardiovascular risk have included those investigating physiological response to stress, smoking cessation, blood pressure reduction, insulin resistance and metabolic syndrome, endothelial function, inducible myocardial ischemia, and primary and secondary prevention of cardiovascular disease. Overall, studies of meditation suggest a possible benefit on cardiovascular risk, although the overall quality and, in some cases, quantity of study data are modest. Given the low costs and low risks of this intervention, meditation may be considered as an adjunct to guideline-directed cardiovascular risk reduction by those interested in this lifestyle modification, with the understanding that the benefits of such intervention remain to be better established. Further research on meditation and cardiovascular risk is warranted. Such studies, to the degree possible, should utilize randomized study design, be adequately powered to meet the primary study outcome, strive to achieve low drop-out rates, include long-term follow-up, and be performed by those without inherent bias in outcome.

KEYWORDS:

AHA Scientific Statements; cardiovascular disease; cardiovascular risk; meditation; primary prevention; secondary prevention

 

Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA).

Abstract

OBJECTIVE:

This study tests the hypothesis that stress reduction methods based on mindfulness meditation can positively influence the rate at which psoriasis clears in patients undergoing phototherapy or photochemotherapy treatment.

METHODS:

Thirty-seven patients with psoriasis about to undergo ultraviolet phototherapy (UVB) or photochemotherapy (PUVA) were randomly assigned to one of two conditions: a mindfulness meditation-based stress reduction intervention guided by audiotaped instructions during light treatments, or a control condition consisting of the light treatments alone with no taped instructions. Psoriasis status was assessed in three ways: direct inspection by unblinded clinic nurses; direct inspection by physicians blinded to the patient’s study condition (tape or no-tape); and blinded physician evaluation of photographs of psoriasis lesions. Four sequential indicators of skin status were monitored during the study: a First Response Point, a Turning Point, a Halfway Point, and a Clearing Point.

RESULTS:

Cox-proportional hazards regression analysis showed that subjects in the tape groups reached the Halfway Point (p = .013) and the Clearing Point (p = .033) significantly more rapidly than those in the no-tape condition, for both UVB and PUVA treatments.

CONCLUSIONS:

A brief mindfulness meditation-based stress reduction intervention delivered by audiotape during ultraviolet light therapy can increase the rate of resolution of psoriatic lesions in patients with psoriasis.

Benefits of mindfulness meditation in reducing blood pressure and stress in patients with arterial hypertension.

Abstract

The objective of this randomized controlled trial is to evaluate the benefits of mindfulness meditation in controlling ambulatory blood pressure (BP) and the impact of the intervention on anxiety, stress and depression levels in a Mediterranean population. Twenty-four and 18 patients [n = 42; mean age 56.5 (7.7) years; similar men and women proportions] with high-normal BP or grade I hypertension were enrolled to an intervention and a control group, respectively. For 2 h/week over 8 weeks, the intervention group received mindfulness training and the control group attended health education talks. The patients attended pre-intervention, week 4, week 8 and week 20 follow-up visits. 61.9% of the patients had anxiety, 21.4% depression, 19.0% were smokers and 14.2% were diabetic (no significant differences between the 2 groups). At baseline, the intervention group had non-significant higher clinically measured BP values, whereas both groups had similar ambulatory BP monitoring (ABPM) values. At week 8, the intervention group had statistically significant lower ABPM scores than the control group (124/77 mmHg vs 126/80 mmHg (p < 0.05) and 108/65 mmHg vs 114/69 mmHg (p < 0.05) for 24-h and night-time systolic BP (SBP), respectively) and also had lower clinically measured SBP values (130 mmHg vs 133 mmHg; p = 0.02). At week 20 (follow-up), means were lower in the intervention group (although not statistically significant). Improvements were observed in the intervention group in terms of being less judgemental, more accepting and less depressed. In conclusion, by week 8 the mindfulness group had lower clinically measured SBP, 24-h SBP, at-rest SBP and diastolic BP values.

Mindfulness Studies

Mindfulness-based stress reduction and physiological activity during acute stress: a randomized controlled trial.

Nyklíček I1, Mommersteeg PM, Van Beugen S, Ramakers C, Van Boxtel GJ.

RESULTS:

Compared to the control group and controlling for age, sex, body mass index, and beta-blockers, the MBSR group showed larger pre- to postintervention decreases in overall SBP (F(1, 58) = 4.99, p = .029, partial η² = .08) and DBP (F(1, 58) = 11.09, p = .002, partial η² = .16). In addition, the MBSR group exhibited smaller SBP and DBP stress-related changes from pre- to postintervention (F(2, 116) = 4.89, p = .012, partial η² = .08; F(2, 116) = 6.07, p = .007, partial η² = .10, respectively). No effects were obtained on other physiological measures.

2007 Jul-Aug;69(6):560-5. Epub 2007 Jul 18.

Neural correlates of dispositional mindfulness during affect labeling.

Abstract

OBJECTIVE:

Mindfulness is a process whereby one is aware and receptive to present moment experiences. Although mindfulness-enhancing interventions reduce pathological mental and physical health symptoms across a wide variety of conditions and diseases, the mechanisms underlying these effects remain unknown. Converging evidence from the mindfulness and neuroscience literature suggests that labeling affect may be one mechanism for these effects.

METHODS:

Participants (n = 27) indicated trait levels of mindfulness and then completed an affect labeling task while undergoing functional magnetic resonance imaging. The labeling task consisted of matching facial expressions to appropriate affect words (affect labeling) or to gender-appropriate names (gender labeling control task).

RESULTS:

After controlling for multiple individual difference measures, dispositional mindfulness was associated with greater widespread prefrontal cortical activation, and reduced bilateral amygdala activity during affect labeling, compared with the gender labeling control task. Further, strong negative associations were found between areas of prefrontal cortex and right amygdala responses in participants high in mindfulness but not in participants low in mindfulness.

CONCLUSIONS:

The present findings with a dispositional measure of mindfulness suggest one potential neurocognitive mechanism for understanding how mindfulness meditation interventions reduce negative affect and improve health outcomes, showing that mindfulness is associated with enhanced prefrontal cortical regulation of affect through labeling of negative affective stimuli.

2003 Jul-Aug;65(4):564-70.
. Author manuscript; available in PMC 2006 Feb 6.
Published in final edited form as:
PMCID: PMC1361002
NIHMSID: NIHMS6696
PMID: 16272874

Meditation experience is associated with increased cortical thickness

Abstract

Previous research indicates that long-term meditation practice is associated with altered resting electroencephalogram patterns, suggestive of long lasting changes in brain activity. We hypothesized that meditation practice might also be associated with changes in the brain’s physical structure. Magnetic resonance imaging was used to assess cortical thickness in 20 participants with extensive Insight meditation experience, which involves focused attention to internal experiences. Brain regions associated with attention, interoception and sensory processing were thicker in meditation participants than matched controls, including the prefrontal cortex and right anterior insula. Between-group differences in prefrontal cortical thickness were most pronounced in older participants, suggesting that meditation might offset age-related cortical thinning. Finally, the thickness of two regions correlated with meditation experience. These data provide the first structural evidence for experience-dependent cortical plasticity associated with meditation practice.

Keywords: insula, meditation, plasticity, prefrontal cortex

Introduction

Meditation is a form of mental exercise that has become a popular US health practice. Regular practice of meditation is reported to produce changes in mental state and resting electroencephalogram patterns that persist beyond the time-period of active practice []. We hypothesized that regular meditation practice should also result in significant changes in the cortical structure in regions that are routinely engaged during this mental exercise. To test this hypothesis, we used magnetic resonance imaging to visualize differences in the thickness of the cerebral cortex of experienced Buddhist Insight meditation practitioners. This form of meditation does not utilize mantra or chanting. Rather, the main focus of Insight meditation is the cultivation of attention and a mental capacity termed ‘mindfulness’, which is a specific nonjudgmental awareness of present-moment stimuli without cognitive elaboration []. Formal practice involves sustained mindful attention to internal and external sensory stimuli. Thus, we tested the hypothesis that between-group and experience-dependent differences in cortical thickness would be found in brain regions involved in attention and sensory processing, thereby showing evidence of cortical plasticity.

Participants and methods

Twenty participants with extensive training in Insight meditation were recruited from local meditation communities. These participants were not monks, but rather typical Western meditation practitioners who incorporate their practice into a daily routine involving career, family, friends and outside interests. Two participants were full-time meditation teachers, three were part-time yoga or meditation teachers and the rest meditated an average of once a day for 40 min, while pursuing traditional careers in fields such as healthcare and law. On average, participants had 9.1 ± 7.1 years of meditation experience and practiced 6.2 ± 4.0 h per week. Participants were required to have participated in at least 1 week-long Insight meditation retreat, which entails approximately 10 h of meditation per day. Fifteen control participants with no meditation or yoga experience were also recruited. The meditation and control participants were matched for sex (meditators 65% male, controls 67%), age (meditators 38.2 years old, controls 36.8 years old), race (both groups 100% Caucasian) and years of education (meditators 17.3 years, controls 17.4 years). All participants were physically and psychologically healthy. Two meditation participants were left-handed; exclusion of the left-handed participants did not significantly alter results. All participants provided written, informed consent and the study was approved by the Institutional Review Board at the Massachusetts General Hospital.

The present methods utilized a well-validated computational approach to measure the thickness of the cerebral cortex [,]. Cortical thickness was estimated from two magnetization prepared rapid gradient echo (MPRAGE) structural images collected from each participant that were then motion-corrected and averaged together to form a single high-resolution image []. An initial estimate of the gray/white matter boundary was constructed by classifying all white matter voxels in a magnetic resonance imaging volume using a combination of geometric and intensity-based information. A surface-deformation procedure was then used to obtain subvoxel resolution in the gray/white boundary and in the pial surface using a combination of smoothness constraints and intensity terms. The resulting cortical surface models for all participants were aligned to an atlas of cortical folding patterns using a high-dimensional nonlinear registration technique.

Results

The mean thickness across the entire cortex did not differ significantly between the groups for either hemisphere (P>0.10), indicating that it was not the case that the cortex of meditators is nonspecifically thicker everywhere. Statistical thickness-difference maps constructed using the Kolmogorov-Smirnoff statistics (one-tailed, α-level P=0.05), however, indicated that significant differences in the ‘distribution’ of thickness existed between groups across both hemispheres (k=3.89, P=0.0001), and in each hemisphere separately (k=3.02, P=0.0025 for left hemisphere; k=2.49, P=0.013 for right hemisphere). This finding indicates that the pattern of relative thickness across each hemisphere was different between groups. Protected by significant unidirectional results for the omnibus test for each hemisphere, an unpaired t-test was performed to test for specific loci of significant between-group differences in regional cortical thickness. Specifically, we tested the a priori hypotheses that differences would be observed within prefrontal, interoceptive and unimodal sensory cortical regions. A false discovery rate of 0.05 corresponding to an uncorrected P=3.5 × 10-4 was used to correct for multiple comparisons [].

Within the search territory, a large region of right anterior insula (P=1.2 × 10-5) and right middle and superior frontal sulci corresponding approximately to Brodmann areas (BA) 9 and 10 (P=1.8 × 10-5) were significantly thicker in meditators than in controls (Fig. 1). The left superior temporal gyrus (auditory cortex, P=3.7 × 10-4) and a small region in the fundus of the central sulcus, (BA 3a, somatosensory cortex, P=6.0 × 10-4) showed trends towards a significantly thicker cortex in meditation participants than in controls. Analysis of the right frontal BA 9/10 subregion resulted in a significant age by group interaction, F(1,31)=10.85, P=0.002, with typical age-related decreases observed in the control group [r(13)=-0.76, P=0.001] but not in the meditation group [r(18)=-0.05, P=0.83]. Significant interactions were not observed in any other brain region.

Alterations in brain and immune function produced by mindfulness meditation.

Abstract

OBJECTIVE:

The underlying changes in biological processes that are associated with reported changes in mental and physical health in response to meditation have not been systematically explored. We performed a randomized, controlled study on the effects on brain and immune function of a well-known and widely used 8-week clinical training program in mindfulness meditation applied in a work environment with healthy employees.

METHODS:

We measured brain electrical activity before and immediately after, and then 4 months after an 8-week training program in mindfulness meditation. Twenty-five subjects were tested in the meditation group. A wait-list control group (N = 16) was tested at the same points in time as the meditators. At the end of the 8-week period, subjects in both groups were vaccinated with influenza vaccine.

RESULTS:

We report for the first time significant increases in left-sided anterior activation, a pattern previously associated with positive affect, in the meditators compared with the nonmeditators. We also found significant increases in antibody titers to influenza vaccine among subjects in the meditation compared with those in the wait-list control group. Finally, the magnitude of increase in left-sided activation predicted the magnitude of antibody titer rise to the vaccine.

CONCLUSIONS:

These findings demonstrate that a short program in mindfulness meditation produces demonstrable effects on brain and immune function. These findings suggest that meditation may change brain and immune function in positive ways and underscore the need for additional research.

Foureur, M., et al., “Enhancing the Resilience of Nurses and Midwives: Pilot of Mindfulness-Based Program for Increased Health, Sense of Coherence and Decreased Depression, Anxiety and Stress,” Contemporary Nurse 45, no. 1 (August 2013): 114–125.

 

Enhancing the resilience of nurses and midwives: pilot of a mindfulness-based program for increased health, sense of coherence and decreased depression, anxiety and stress.

Abstract

Health workers in general, and midwives and nurses in particular, experience high levels of stress/distress due to the nature of their work and workplaces; and, their socialization into ways of working that minimizes the likelihood of self-care. Increasing interest in the development of resilient workers has meant an enormous growth in interest in the role of holistic practices such as mindfulness meditation. Kabat-Zinn’s mindfulness-based stress reduction (MBSR) is one of the most commonly used by those seeking to practise, theorize or research mindfulness across multiple contexts. The primary aim of this study was to pilot the effectiveness of an adapted mindfulness-based stress reduction intervention on the psychological wellbeing of nurses and midwives. More specifically, we sought to test the acceptability and feasibility of a modified MBSR intervention to inform a future randomized controlled trial (RCT). The pilot study used a pre and post intervention design. Twenty midwives and 20 nurses participated in a one-day workshop, undertook to meditate daily for 8 weeks and completed pre and post intervention measures: general health questionnaire (GHQ-12); sense of coherence(SOC) – orientation to life and the depression, anxiety and stress scale (DASS). A subgroup took part in interviews or focus group discussions of their experiences of the program and their ongoing mindfulness practice. The quantitative findings included significant improvements on the GHQ-12, SOC and the stress subscale of the DASS. Qualitative findings support the acceptability of the intervention, and highlighted a number of issues related to feasibility of any future RCT. In conclusion, mindfulness practice holds promise for increasing individual and workplace resilience, however, meaningful research evidence from carefully constructed studies will be required to engage and motivate participation and organizational support.

 

Qigong (Chi Gung) Studies

Efficacy of Tai Chi and qigong for the prevention of stroke and stroke risk factors: A systematic review with meta-analysis.

RESULTS:

Twenty-one trials with n = 1604 patients with hypertension, hyperlipidaemia, diabetes, overweight or obesity, or metabolic syndrome were included. No trials were found that examined the effects of Tai Chi/qigong on stroke incidence. Meta-analyses revealed significant, but not robust, benefits of Tai Chi/qigong over no interventions for hypertension (systolic blood pressure: -15.55 mm Hg (95% CI: -21.16; -9.95); diastolic blood pressure: -10.66 mm Hg (95% CI: -14.90, -6.43); the homeostatic model assessment (HOMA) index (-2.86%; 95% CI: -5.35, -0.38) and fasting blood glucose (-9.6 mg/dL; 95% CI: -17.28, -1.91), and for the body mass index compared with exercise controls (-1.65 kg/m; 95% CI: -3.11, -0.20). Risk of bias was unclear or high for the majority of trials and domains, and heterogeneity between trials was high. Only 6 trials adequately reported safety. No recommendation for the use of Tai Chi/qigong for the prevention of stroke can be given.

CONCLUSION:

Although Tai Chi and qigong show some potential more robust studies are required to provide conclusive evidence on the efficacy and safety of Tai Chi and qigong for reducing major stroke risk factors.

Tai Chi Studies:

Elderly:

The impact of Tai Chi and Qigong mind-body exercises on motor and non-motor function and quality of life in Parkinson’s disease: A systematic review and meta-analysis.

Tai Chi and fall reductions in older adults: a randomized controlled trial.

Li F1, Harmer P, Fisher KJ, McAuley E, Chaumeton N, Eckstrom E, Wilson NL.

CONCLUSIONS:
A three-times-per-week, 6-month Tai Chi program is effective in decreasing the number of falls, the risk for falling, and the fear of falling, and it improves functional balance and physical performance in physically inactive persons aged 70 years or older.

 

Effects of t’ai chi on balance: a population-based meta-analysis.

CONCLUSION:

The findings of this meta-analysis suggest that persons with a low risk of falling should practice t’ai chi for 3 months to improve their balance. The effects of t’ai chi on balance in those with a high risk of falling were small but significant at 3 months, supporting the safety and effectiveness of t’ai chi. It is important to select reliable and sensitive measures for balance to examine the effects of t’ai chi.

 

 

 

Tai Chi versus brisk walking in elderly women.

CONCLUSIONS:

a short style of TCC was found to be an effective way to improve many fitness measures in elderly women over a 3-month period. TCC was also found to be significantly better than brisk walking in enhancing certain measures of fitness including lower extremity strength, balance and flexibility.

2003 Sep;30(9):2039-44.

Effects of tai chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with osteoarthritis: a randomized clinical trial.

Conclusions:
Older women with OA were able to safely perform the 12 forms of Sun-style tai chi exercise for 12 weeks, and this was effective in improving their arthritic symptoms, balance, and physical functioning. A longitudinal study with a larger sample size is now needed to confirm the potential use of tai chi exercise in arthritis management.
2010 Mar;16(3):227-33. doi: 10.1089/acm.2009.0165.

A randomized study of the effects of t’ai chi on muscle strength, bone mineral density, and fear of falling in women with osteoarthritis.

CONCLUSIONS:

T’ai chi increased knee extensor muscle endurance and bone mineral density in older women with osteoarthritis, and decreased their fear of falling during daily activities. Further study with long-term follow-up is needed to substantiate the role of t’ai chi exercise in the prevention of fall and its related fracture.

The efficacy of the ROM Dance Program for adults with rheumatoid arthritis.

Abstract

This study examined the efficacy of an exercise and relaxation program for adults with rheumatoid arthritis. The program integrates principles of occupational therapy and T’ai-Chi Ch’uan and was expected to be more effective than traditional exercise and rest regimens because of its expressive and pleasurable elements. There were significant differences between 17 experimental and 16 control subjects on two categories of dependent variables after the former group’s participation in the experimental program. These dependent variables were range of motion measures and subject self-reports of frequency, enjoyment, and benefits of home exercise and rest routines. Pretest, posttest, and 4-month follow-up data were analyzed. Program participants showed significantly greater upper extremity range of motion 4 months after completing the program although the reported frequency of exercise and rest was greater in the control group. Postprogram reports of enjoyment were significantly higher for experimental than for control subjects. If these initial results are confirmed in further studies, the efficacy of the use of purposeful activity for exercise and rest will be supported. This study also supports the integration of Eastern and Western frames of reference in the treatment of patients with chronic illness.

Stress:

1989;33(2):197-206.

Changes in heart rate, noradrenaline, cortisol and mood during Tai Chi.

Changes in psychological and physiological functioning following participation in Tai Chi were assessed for 33 beginners and 33 practitioners. The variables in the three-way factorial design were experience (beginners vs practitioners), time (morning vs afternoon vs evening), and phase (before Tai Chi vs during Tai Chi vs after Tai Chi). Phase was a repeated measures variable. Relative to measures taken beforehand, practice of Tai Chi raised heart rate, increased noradrenaline excretion in urine, and decreased salivary cortisol concentration. Relative to baseline levels, subjects reported less tension, depression, anger, fatigue, confusion and state-anxiety, they felt more vigorous, and in general they had less total mood disturbance. The data suggest that Tai Chi results in gains that are comparable to those found with moderate exercise. There is need for research concerned with whether participation in Tai Chi has effects over and above those associated with physical exercise.

 

 

Tai Chi Is a Promising Exercise Option for Patients With Coronary Heart Disease Declining Cardiac Rehabilitation.

CONCLUSIONS:

In this community sample of patients with coronary heart disease declining enrollment in cardiac rehabilitation, a 6-month tai chi program was safe and improved PA, weight, and quality of life compared with a 3-month intervention. Tai chi could be an effective option to improve PA in this high-risk population.

Breathing Technique Studies

The Use of Breathing Exercises in the Treatment of Chronic, Nonspecific Low Back Pain.

Abstract

Clinical Scenario: Research has shown a link between poor core stability and chronic, nonspecific low back pain, with data to suggest that alterations in core muscle activation patterns, breathing patterns, lung function, and diaphragm mechanics may occur. Traditional treatment approaches for chronic, nonspecific low back pain focus on exercise and manual therapy interventions, however it is not clear whether breathing exercises are effective in treating back pain. Focused Clinical Question: In adults with chronic, nonspecific low back pain, are breathing exercises effective in reducing pain, improving respiratory function, and/or health related quality of life? Summary of Key Findings: Following a literature search, 3 studies were identified for inclusion in the review. All reviewed studies were critically appraised at level 2 evidence and reported improvements in either low back pain or quality of life following breathing program intervention. Clinical Bottom Line: Exercise programs were shown to be effective in improving lung function, reducing back pain, and improving quality of life. Breathing program frequencies ranged from daily to 2-3 times per week, with durations ranging from 4 to 8 weeks. Based on these results, athletic trainers and physical therapists caring for patients with chronic, nonspecific low back pain should consider the inclusion of breathing exercises for the treatment of back pain when such treatments align with the clinician’s own judgment and clinical expertise and the patient’s preferences and values. Strength of Recommendation: Grade B evidence exists to support the use of breathing exercises in the treatment of chronic, nonspecific low back pain.

KEYWORDS:

core stability; diaphragm; quality of life; rehabilitation

 

Impact of breathing exercises in subjects with lung cancer undergoing surgical resection: A systematic review and meta-analysis.

CONCLUSIONS:

The results showed that breathing exercises could improve lung function, decrease the incidence of PPCs and LOS in a sample of lung cancer patients undergoing pulmonary surgery.

RELEVANCE TO CLINICAL PRACTICE:

The analysis suggests that breathing exercises should be considered as a respiratory rehabilitation programme for lung cancer patients undergoing lung surgery in clinical practice.

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