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Research update (abstracts)

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  • Kevin Chen
    A randomized trial of tai chi for fibromyalgia. New England Journal of Medicine. 2010 Aug 19;363(8):743-54. By Wang C, Schmid CH, Rones R, Kalish R, Yinh J,
    Message 1 of 1 , Oct 12, 2010
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      A randomized trial of tai chi for fibromyalgia.  New England Journal of  Medicine. 2010 Aug 19;363(8):743-54.

      By Wang C, Schmid CH, Rones R, Kalish R, Yinh J, Goldenberg DL, Lee Y, McAlindon T. from Division of Rheumatology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA. cwang2@...

      BACKGROUND: Previous research has suggested that tai chi offers a therapeutic benefit in patients with fibromyalgia.  METHODS: We conducted a single-blind, randomized trial of classic Yang-style tai chi as compared with a control intervention consisting of wellness education and stretching for the treatment of fibromyalgia (defined by American College of Rheumatology 1990 criteria). Sessions lasted 60 minutes each and took place twice a week for 12 weeks for each of the study groups. The primary end point was a change in the Fibromyalgia Impact Questionnaire (FIQ) score (ranging from 0 to 100, with higher scores indicating more severe symptoms) at the end of 12 weeks. Secondary end points included summary scores on the physical and mental components of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). All assessments were repeated at 24 weeks to test the durability of the response.  RESULTS: Of the 66 randomly assigned patients, the 33 in the tai chi group had clinically important improvements in the FIQ total score and quality of life. Mean (+/-SD) baseline and 12-week FIQ scores for the tai chi group were 62.9+/-15.5 and 35.1+/-18.8, respectively, versus 68.0+/-11 and 58.6+/-17.6, respectively, for the control group (change from baseline in the tai chi group vs. change from baseline in the control group, -18.4 points; P<0.001). The corresponding SF-36 physical-component scores were 28.5+/-8.4 and 37.0+/-10.5 for the tai chi group versus 28.0+/-7.8 and 29.4+/-7.4 for the control group (between-group difference, 7.1 points; P=0.001), and the mental-component scores were 42.6+/-12.2 and 50.3+/-10.2 for the tai chi group versus 37.8+/-10.5 and 39.4+/-11.9 for the control group (between-group difference, 6.1 points; P=0.03). Improvements were maintained at 24 weeks (between-group difference in the FIQ score, -18.3 points; P<0.001). No adverse events were observed.  CONCLUSIONS: Tai chi may be a useful treatment for fibromyalgia and merits long-term study in larger study populations. (Funded by the National Center for Complementary and Alternative Medicine and others; ClinicalTrials.gov number, NCT00515008.)

       

      Biofield therapies: helpful or full of hype? A best evidence synthesis. Int J Behav Med. 2010 Mar;17(1):1-16.  Jain S, Mills PJ. from UCLA Division of Cancer Prevention and Control Research, Los Angeles, CA, USA. sjain@...

      Abstract: BACKGROUND: Biofield therapies (such as Reiki, therapeutic touch, and healing touch) are complementary medicine modalities that remain controversial and are utilized by a significant number of patients, with little information regarding their efficacy. PURPOSE: This systematic review examines 66 clinical studies with a variety of biofield therapies in different patient populations. METHOD: We conducted a quality assessment as well as a best evidence synthesis approach to examine evidence for biofield therapies in relevant outcomes for different clinical populations. RESULTS: Studies overall are of medium quality, and generally meet minimum standards for validity of inferences. Biofield therapies show strong evidence for reducing pain intensity in pain populations, and moderate evidence for reducing pain intensity hospitalized and cancer populations. There is moderate evidence for decreasing negative behavioral symptoms in dementia and moderate evidence for decreasing anxiety for hospitalized populations. There is equivocal evidence for biofield therapies' effects on fatigue and quality of life for cancer patients, as well as for comprehensive pain outcomes and affect in pain patients, and for decreasing anxiety in cardiovascular patients. CONCLUSION: There is a need for further high-quality studies in this area. Implications and future research directions are discussed.

       

      Effects of scheduled qigong exercise on pupils' well-being, self-image, distress, and stress.  J Altern Complement Med. 2010 Sep;16(9):939-44. by Terjestam Y, Jouper J, Johansson C. from  School of Education, Psychology and Sport Science, Linnaeus University, Växjö, Sweden. yvonne.terjestam@...

      Abstract: OBJECTIVES: Psychologic problems is increasing among pupils and has become a major problem in Sweden as well as in other Western countries. The aim of this study was to explore whether scheduled qigong exercise could have an effect on well-being at school, psychologic distress, self-image, and general stress. SUBJECTS: Pupils, 13-14 years, were assigned to either a qigong group or a control group. INTERVENTION: The qigong group had scheduled qigong 2 times a week for 8 weeks. MEASURES: Self-reported well-being at school, psychologic distress, self-image, and stress were measured pre- and postintervention. RESULTS: The control group had reduced well-being at school during the semester and the qigong group was stable. The qigong group reduced psychologic distress and stress, and had a tendency to improved self-image, whereas no changes were found in the control group. Self-image explains 47% (R(2)=0.47) of well-being at school, and stress explains 29% (R(2)=0.29) of psychologic distress. Conclusions: Scheduled qigong, meditative movement, is a possible way to improve well-being at school.

       

      Qigong for the treatment of tinnitus: a prospective randomized controlled study.  J Psychosom Res. 2010 Sep;69(3):299-304.  Biesinger E, Kipman U, Schätz S, Langguth B. From ENT-Clinic and Otolaryngology Department, Klinikum Traunstein, Traunstein, Germany.

      Abstract: OBJECTIVE: Tinnitus is a frequent disorder which is very difficult to treat. Qigong is a mindful exercise and an important constituent of traditional Chinese medical practice. Here we performed a randomized controlled trial to evaluate the effect of a Qigong intervention on patients with tinnitus. We hypothesized that especially tinnitus patients with somatosensoric components may benefit from the mind-body technique of Qigong. METHODS: Eighty patients with tinnitus of at least 3 months duration were randomly assigned to an intervention group (n=40) consisting of 10 Qigong training sessions in 5 weeks or a waiting-list control group (n=40). Tinnitus severity was assessed with a visual analogue scale (VAS) and with a tinnitus questionnaire (TBF-12) before treatment, immediately after treatment, and 1 and 3 months after treatment.  RESULTS: Qigong did not cause any side effects and was completed by 80% of the assigned patients. Compared with the control group, Qigong participants experienced improvement in tinnitus severity, as reflected by a significant reduction in both the VAS and the TBF-12. In the subgroup of patients with somatosensoric tinnitus, Qigong effects were more pronounced, resulting in a highly significant improvement in both scales compared to the waiting-list group.  CONCLUSION: These findings suggest that Qigong interventions could be a useful complement to the therapeutic management of patients with tinnitus and especially for those with somatosensoric components. Satisfaction with the intervention, a high degree of completion, and stability of the effects for at least 3 months after the intervention further underscore the potential of Qigong in the treatment of tinnitus.

       

      Human prefrontal cortical response to the meditative state: a spectroscopy study.  Int J Neurosci. 2010 Jul;120(7):483-8. by Cheng RW, Borrett DS, Cheng W, Kwan HC, Cheng RS. From Department of Physiology, University of Toronto, Toronto, Ontario, Canada.

      Abstract: The effect of Qigong meditation on the hemodynamics of the prefrontal cortex was investigated by spectroscopy with a single-wavelength probe (650 nm) and confirmed by standard near-infrared spectroscopy with a dual-wavelength probe. Deoxyhemoglobin changes were recorded with the single-wavelength probe over the left prefrontal cortex during meditation by Qigong practitioners, and non-practitioners instructed in the technique. Practitioners showed a significant decrease in deoxyhemoglobin levels suggesting an increase in prefrontal activation during meditation. The results were confirmed in a second set of experiments with the standard dual-wavelength probe, in which significant differences in the decrease in deoxyhemoglobin and increase in oxyhemoglobin concentrations were observed in practitioners as compared with non-practitioners. The study thus provides evidence that Qigong meditation has a significant effect on prefrontal activation.

       

      Does different exercise have the same effect of health promotion for the elderly? Comparison of training-specific effect of Tai Chi and swimming on motor control.  Arch Gerontol Geriatr. 2010 Sep 24. [Epub ahead of print] by Wong AM, Chou SW, Huang SC, Lan C, Chen HC, Hong WH, Chen CP, Pei YC.  From Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital. Taiwan; Institute of Gerontology and Research Center, Chang Gung University, Taiwan.

      Abstract: It remains unclear whether Tai Chi Chuan (TCC) instead of swimming yields a training-specific effect on dynamic balance. The objective of the present study is to test if the practice of TCC provides a distinctive benefit of balance in the elderly. The participants in TCC (n=32) and swimming groups (n=20) practiced regular swimming and TCC respectively for at least 3 years before the recruitment. Thirty-four healthy and active elderly volunteers were also recruited as the control group. To evaluate balance, we used SMART Balance Master that yields balance parameters including maximal stability, center-of-pressure velocity, and percentage ankle strategy obtained under six different balance conditions. We evaluated eye-hand coordination by measuring the movement time required to accurately point from one target to the next. In the most challenging balance conditions, the TCC group performed significantly better than the swimming and control groups. In eye-hand coordination tasks, both the TCC and swimming groups yielded significantly shorter movement time compared with the control group; however, no significant difference was observed between them. We concluded that both TCC and swimming improve eye-hand coordination in the elderly. However, TCC yields a better training effect on dynamic balance.

       

      Tai Chi exercise versus rehabilitation for the elderly with cerebral vascular disorder: a single-blinded randomized controlled trial.  Psychogeriatrics. 2010 Sep;10(3):160-6. by Wang W, Sawada M, Noriyama Y, Arita K, Ota T, Sadamatsu M, Kiyotou R, Hirai M, Kishimoto T. from Department of Psychiatry, Nara Medical University School of Medicine, Nara Akitsu-Kounoike Hospital, Akitsu-Kounoike, Japan.

      BACKGROUND: Cerebral vascular disorder (CVD) might result in a quantifiable decrease in quality of life, which is determined not only by the neurological deficits but also by impairment of cognitive functions. There are few studies that report on the cognitive effect of Tai Chi exercise (Tai Chi) on the elderly with CVD. The purpose of the present study was to examine the cognitive effect of Tai Chi on the elderly with CVD using P300 measurement, in addition to the General Health Questionnaire (GHQ) and Pittsburgh Sleep Quality Index (PSQI).

      METHODS: A total of 34 patients with CVD were recruited from outpatient Akistu-Kounoike Hospital and randomly assigned to receive Tai Chi (n= 17) or rehabilitation (n= 17) in group sessions once a week for 12 weeks. To examine the time courses of each score (P300 amplitude, P300 latency, GHQ score and PSQI score), repeated-measures analysis of variance was carried out with groups and time as factors.  RESULTS: For the time courses of P300 amplitudes and latencies, there were no significant effects of interaction between group and time. However, significant time-by-group interactions were found for Sleep Quality (P= 0.006), GHQ total score (P= 0.005), anxiety/insomnia score (P= 0.034), and severe depression score (P= 0.020).  CONCLUSIONS: Tai Chi might therefore be considered a useful non-pharmacological approach, along with rehabilitation, for the maintenance of cognitive function in the elderly with CVD and might be a more useful non-pharmacological approach for the improvement of sleep quality and depressive symptoms in the elderly with CVD than rehabilitation.

       

      Effects of tai chi exercise on posturography, gait, physical function and quality of life in postmenopausal women with osteopaenia: a randomized clinical study.  Clin Rehabil. 2010  Aug 11. [Epub ahead of print]  by Chyu MC, James CR, Sawyer SF, Brismée JM, Xu KT, Poklikuha G, Dunn DM, Shen CL. From Graduate Healthcare Engineering, Department of Mechanical Engineering, Department of Health, Exercise, and Sport Science, Texas Tech University, Texas, USA.

      Objective: To evaluate the effects of tai chi exercise on risk factors for falls in postmenopausal women with osteopaenia through measurements of balance, gait, physical function and quality of life. Design: A randomized, controlled, single-blinded, 24-week trial with stratification by age and bone mass. Setting: General community. Participants: Sixty-one independently living elderly females aged 65 years and older with low bone mass. Interventions: Subjects were recruited and randomly assigned to 24 weeks of tai chi (60 minutes/session, three sessions/week, n = 30) or a control group (n = 31). OUTCOME MEASURES: Computerized dynamic posturography, gait, 'timed up and go', five-chair sit-to-stand and quality of life assessed at baseline, 12 and 24 weeks. Results: After 24 weeks, subjects in the tai chi group demonstrated an increase in stride width (P = 0.05) and improvement in general health (P = 0.008), vitality (P = 0.02) and bodily pain (P = 0.03) compared with those in the control group. There was no significant difference in balance parameters, 'timed up and go', five-chair sit-to-stand and other domains of quality of life. Conclusion: Tai chi exercise may reduce risk factors for falls by increasing the stride width, and may improve quality of life in terms of general health, vitality and bodily pain in postmenopausal women with osteopaenia.

       

      Tai Chi Chuan Increases Circulating Myeloid Dendritic Cells.  Immunol Invest. 2010 Aug 18.

      By Chiang J, Chen YY, Akiko T, Huang YC, Hsu ML, Jang TR, Chen YJ. From Chinese Culture University, Graduate Institute of Sport Coaching Science, Taipei, Taiwan.

      Abstract: Dendritic cells, the most potent antigen-presenting cells linking innate and adoptive immunity, are thought to be important targets of immune modulators such as exercise. We examined the effect of Tai Chi Chuan (TCC) on dendritic cells. TCC practitioners were further divided to high-level practitioners (TCC-H) and low-level practitioners (TCC-L). The quantities of myeloid and plasmacytoid dendritic cells were estimated by flow cytometry. We examined parameters including age, body weight, body length, body fat, and serum albumin level, in the controls, TCC-H and TCC-L, which did not differ significantly. The mean peak [Formula: see text] (volume of O(2) utilization) of the TCC-H group was greater than that of the sedentary control group. White blood cell (WBC) count in the entire TCC group was greater than that of the controls. The quantity of myeloid dendritic cells was significantly greater in the TCC group, whereas the quantity of plasmacytoid dendritic cells was similar for both groups. Among the TCC subgroups, the quantity of myeloid dendritic cells, but not plasmacytoid dendritic cells, in the TCC-H group was greater than that of TCC-L practitioners. TCC could increase the number of circulating myeloid dendritic cells, but not plasmacytoid dendritic cells, in a performance level-dependent manner.

       

      Mindfulness-based stress reduction for solid organ transplant recipients: a randomized controlled trial.  Altern Ther Health Med. 2010 Sep-Oct;16(5):30-8. by Gross CR, Kreitzer MJ, Thomas W, Reilly-Spong M, Cramer-Bornemann M, Nyman JA, Frazier P, Ibrahim HN. From College of Pharmacy, University of Minnesota, Minneapolis, USA. gross002@...

      CONTEXT: Patients who have received solid organ transplants continue to experience a myriad of complex symptoms related to their underlying disease and to chronic immunosuppression that reduce the quality of life. Beneficial nonpharmacologic therapies to address these symptoms have not been established in the transplant population.  OBJECTIVE: Assess the efficacy of mindfulness-based stress reduction (MBSR) in reducing symptoms of anxiety, depression, and poor sleep in transplant patients.  DESIGN, SETTING, AND PATIENTS: Controlled trial with a two-staged randomization. Recipients of kidney, kidney/pancreas, liver, heart, or lung transplants were randomized to MBSR (n=72) or health education (n=66) initially or after serving in a waitlist. Mean age was 54 years (range 21-75); 55% were men, and 91% were white.  INTERVENTIONS: MBSR, a mindfulness meditation training program consisting of eight weekly 2.5-hour classes; health education, a peer-led active control.  PRIMARY OUTCOME MEASURES: Anxiety (State-Trait Anxiety Inventory), depression (Center for Epidemiologic Studies Depression Scale), and sleep quality (Pittsburgh Sleep Quality Index) scales assessed by self-report at baseline, 8 weeks, 6 months, and 1 year.  RESULTS: Benefits of MBSR were above and beyond those afforded by the active control. MBSR reduced anxiety and sleep symptoms (P < .02), with medium treatment effects (.51 and .56) at 1 year compared to health education in intention-to-treat analyses. Within the MBSR group, anxiety, depression, and sleep symptoms decreased and quality-of-life measures improved by 8 weeks (P < .01, all), and benefits were retained at 1 year (P < .05, all). Initial symptom reductions in the health education group were smaller and not sustained. Comparisons to the waitlist confirmed the impact of MBSR on both symptoms and quality of life, whereas health education improvements were limited to quality-of-life ratings.  CONCLUSIONS: MBSR reduced distressing symptoms of anxiety, depression, and poor sleep and improved quality of life. Benefits were sustained over 1 year. A health education program provided fewer benefits, and effects were not as durable. MBSR is a relatively inexpensive, safe, and effective community-based intervention.

       

      Mindfulness based cognitive therapy for psychiatric disorders: A systematic review and meta-analysis.

      Psychiatry Res. 2010 Sep 14. [Epub ahead of print] by Chiesa A, Serretti A.

      Abstract: Mindfulness based Cognitive Therapy (MBCT) is a meditation program based on an integration of Cognitive behavioural therapy and Mindfulness based stress reduction. The aim of the present work is to review and meta-analyze current findings about the efficacy of MBCT for psychiatric patients. A literature search was undertaken using 5 electronic databases and references of retrieved articles. Main findings included: 1) MBCT in adjunct to usual care was significantly better than usual care alone for reducing major depression (MD) relapses in patients with 3 or more prior depressive episodes (4 studies), 2) MBCT plus gradual discontinuation of maintenance ADs was associated to similar relapse rates at 1year as compared with continuation of maintenance antidepressants (1 study), 3) the augmentation of MBCT could be useful for reducing residual depressive symptoms in patients with MD (2 studies) and for reducing anxiety symptoms in patients with bipolar disorder in remission (1 study) and in patients with some anxiety disorders (2 studies). However, several methodological shortcomings including small sample sizes, non randomized design of some studies and the absence of studies comparing MBCT to control groups designed to distinguish specific from non specific effects of such practice underscore the necessity for further research.

       

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