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Mind-body medicine research update

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  • Kevin Chen
    Mind-Body Medicine Research Update A randomized controlled trial of qigong for fibromyalgia. Arthritis Res Ther. 2012 Aug 3;14(4): R178. By Lynch M, Sawynok J,
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      Mind-Body Medicine Research Update

       

      A randomized controlled trial of qigong for fibromyalgia.  Arthritis Res Ther. 2012 Aug 3;14(4): R178. By Lynch M, Sawynok J, Hiew C, Marcon D.

                  INTRODUCTION:  Fibromyalgia is difficult to treat and requires the use of multiple approaches. This study is a randomized controlled trial of qigong compared with a waitlist control group in fibromyalgia. METHODS: One hundred participants were randomly assigned to immediate or delayed practice groups, with the delayed group receiving training at the end of the control period. Qigong training (level 1 Chaoyi Fanhuan Qigong, CFQ), given over 3 half-days, was followed by weekly review/practice sessions for 8 weeks; participants were also asked to practice at home for 45-60 minutes per day for this interval. Outcomes were pain, impact, sleep, physical function and mental function, and these were recorded at baseline, 8 weeks, 4 months and 6 months. Immediate and delayed practice groups were analyzed individually compared to the control group, and as a combination group. RESULTS: In both the immediate and delayed treatment groups, CFQ demonstrated significant improvements in pain, impact, sleep, physical function and mental function when compared to the waitlist/usual care control group at 8 weeks, with benefits extending beyond this time. Analysis of combined data indicated significant changes for all measures at all times to 6 months, with only one exception. Post-hoc analysis based on self-reported practice times indicated greater benefit with the per protocol group compared to minimal practice.  CONCLUSIONS: This study demonstrates that CFQ, a particular form of qigong, provides long-term benefits in several core domains in fibromyalgia. CFQ may be a useful adjuvant self-care treatment for fibromyalgia.

       

      Benefit of Qigong Exercise in Patients with Fibromyalgia: A Pilot Study.  Int J Neurosci. 2012 Aug 3.  by Liu W, Zahner L, Cornell M, Le T, Ratner J, Wang Y, Pasnoor M, Dimachkie M, Barohn R. From Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, Kansas City, Kansas, USA.

             ABSTRACT Objective: Fibromyalgia (FM) patients present with widespread chronic pain and other symptoms. Some studies in the literature have reported inconsistent results after a Qigong exercise intervention in patients with FM. The purpose of this study was to test the feasibility of a home-based Qigong exercise in patients with FM. Methods: A total of 14 subjects were randomly assigned into one of two groups. The experimental group went through a six-week Qigong exercise program involving meditation, deep breathing, and synchronized rhythmic body movements. The control group took part in a sham Qigong exercise program using the same body movements also for six weeks. Clinical assessments at baseline and end of intervention used the Short-Form McGill Pain Questionnaire, Multidimensional Fatigue Inventory, Pittsburgh Sleep Quality Index, and Fibromyalgia Impact Questionnaire. Results: Group mean scores of four measurements were significantly (p < .0125) reduced in the intervention group, but not in the control group. The percentage changes in the four measurements were 44.2%, 24.8%, 37.3%, and 44.3% in the intervention group, and 10.1%, 6.3%, 9.9%, and 11.8% in the control group. Conclusion: Qigong exercise may potentially be an effective self-management approach in controlling FM symptoms. In this pilot study, regular daily Qigong exercise, accumulated number of exercise sessions, and the specific form of Qigong exercise may all be important factors for the significant improvement in the study subjects. Future research is required to determine whether the same benefit can be obtained in a larger sample.

       

      Neurocognitive correlates of the effects of yoga meditation practice on emotion and cognition: a pilot study.  Front Integr Neurosci. 2012;6:48. Epub 2012 Jul 26. By Froeliger BE, Garland EL, Modlin LA, McClernon FJ. From Department of Psychiatry and Behavioral Sciences, Duke University Medical Center Durham, NC, USA.

             Abstract:  Mindfulness meditation involves attending to emotions without cognitive fixation of emotional experience. Over time, this practice is held to promote alterations in trait affectivity and attentional control with resultant effects on well-being and cognition. However, relatively little is known regarding the neural substrates of meditation effects on emotion and cognition. The present study investigated the neurocognitive correlates of emotion interference on cognition in Yoga practitioners and a matched control group (CG) underwent fMRI while performing an event-related affective Stroop task. The task includes image viewing trials and Stroop trials bracketed by neutral or negative emotional distractors. During image viewing trials, Yoga practitioners exhibited less reactivity in right dorsolateral prefrontal cortex (dlPFC) to negative as compared to neutral images; whereas the CG had the opposite pattern. A main effect of valence (negative > neutral) was observed in limbic regions (e.g., amygdala), of which the magnitude was inversely related to dlPFC activation. Exploratory analyses revealed that the magnitude of amygdala activation predicted decreased self-reported positive affect in the CG, but not among Yoga practitioners. During Stroop trials, Yoga practitioners had greater activation in ventrolateral prefrontal cortex (vlPFC) during Stroop trials when negative, compared to neutral, emotional distractor were presented; the CG exhibited the opposite pattern. Taken together, these data suggest that though Yoga practitioners exhibit limbic reactivity to negative emotional stimuli, such reactivity does not have downstream effects on later mood state. This uncoupling of viewing negative emotional images and affect among Yoga practitioners may be occasioned by their selective implementation of frontal executive-dependent strategies to reduce emotional interference during competing cognitive demands and not during emotional processing per se.

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3405281  

       

      A Pilot Study of Qigong for Reducing Cocaine Craving Early in Recovery.  J Altern Complement Med. 2012 Jul 3. by Smelson D, Chen KW, Ziedonis D, Andes K, Lennox A, Callahan L, Rodrigues S, Eisenberg D. From Center for Health, Quality, Outcomes & Economic Research, VA Medical Center  Bedford, MA.

             Abstract:  Objectives: This pilot study examined the feasibility, preliminary efficacy, and determined the effect sizes of external qigong therapy (EQT) in reducing cue-elicited cocaine craving and associated symptoms among recently abstinent cocaine-dependent (CD) individuals. Methods: This study randomized 101 CD subjects to either a real EQT (n=51) or sham EQT control (n=50) group. Subjects underwent a baseline assessment and a weekly cue-exposure session for 2 weeks. Total EQT or sham treatments ranged from 4 to 6 sessions in 2 weeks. Results: EQT-treated subjects displayed a greater reduction in cue-elicited craving (p=0.06) and symptoms of depression (p<0.05) with medium effect sizes. Conclusions: This study demonstrated the feasibility of delivering EQT among CD individuals early in residential treatment. Future research should include a larger sample and examine the mechanisms and potential longitudinal benefits of EQT.

       

      Tai chi diminishes oxidative stress in Mexican older adults.  J Nutr Health Aging. 2012;16(7):642-6. By Rosado-Pérez J, Santiago-Osorio E, Ortiz R, Mendoza-Núñez VM. From V.M. Mendoza-Núñez, Guelatao # 66, Col. Ejército de Oriente, 09230 México, DF, México.  mendovic@...  

             Abstract:  Objective: To determine the effect of Tai Chi on oxidative stress in a population of elderly Mexican subjects. Design: It was carried out a quasi-experimental study with a sample of 55 healthy subjects randomly divided into two age-matched groups: (i) a control group with 23 subjects and (ii) an experimental group with 32 subjects. The experimental group received daily training in Tai Chi for 50 min. Measurements: It was measured before and after 6-month of exercise period: thiobarbituric acid reactive substances (TBARS), total antioxidant status (TAS), superoxide dismutase (SOD), and glutathione peroxidase (GPx). Results: It was found that the experimental group exhibited a statistically significant decrease in glucose levels, total cholesterol, low-density lipoprotein cholesterol (LDLC), and systolic blood pressure, as well as an increase in SOD and GPx activity and TAS compared with the control group (p < 0.05). Conclusions: Our findings suggest that the daily practice of Tai Chi is useful for reducing OxS in healthy older adults.

       

      A mindfulness course decreases burnout and improves well-being among healthcare providers.  Int J Psychiatry Med. 2012;43(2):119-28. By  Goodman MJ, Schorling JB. From University of Virginia School of Medicine, Charlottesville, USA.

                  OBJECTIVE:  Healthcare providers are under increasing stress and work-related burnout has become common. Mindfulness-based interventions have a potential role in decreasing stress and burnout. The purpose of this study was to determine if a continuing education course based on mindfulness-based stress reduction could decrease burnout and improve mental well-being among healthcare providers, from different professions.  Design: This was a pre-post observational study conducted in a university medical center. A total of 93 healthcare providers, including physicians from multiple specialties, nurses, psychologists, and social workers who practiced in both university and community settings, participated. The intervention was a continuing education course based on mindfulness-based stress reduction that met 2.5 hours a week for 8 weeks plus a 7-hour retreat. The classes included training in four types of formal mindfulness practices, including the body scan, mindful movement, walking meditation and sitting meditation, as well as discussion focusing on the application of mindfulness at work. The course was offered 11 times over 6 years. The main outcome measures were work-related burnout as measured by the Maslach Burnout Inventory and self-perceived mental and physical well-being as measured by the SF-12v2.  RESULTS: Maslach Burnout Inventory scores improved significantly from before to after the course for both physicians and other healthcare providers for the Emotional Exhaustion (p < 0.03), Depersonalization (p < 0.04), and Personal Accomplishment (p < 0.001) scales. Mental well-being measured by the SF12v2 also improved significantly (p < 0.001). There were no significant changes in the SF12v2 physical health scores.  CONCLUSION: A continuing education course based on mindfulness-based stress reduction was associated with significant improvements in burnout scores and mental well-being for a broad range of healthcare providers.

       

      Mindfulness-Based Cognitive Therapy Improves Polysomnographic and Subjective Sleep Profiles in Antidepressant Users with Sleep Complaints.  Psychother Psychosom. 2012 Jul 20;81(5):296-304. By Britton WB, Haynes PL, Fridel KW, Bootzin RR. From: Dept of Psychiatry and Human Behavior, Brown University Medical School, Providence, R.I., USA.

             Background: Many antidepressant medications (ADM) are associated with disruptions in sleep continuity that can compromise medication adherence and impede successful treatment. The present study investigated whether mindfulness meditation (MM) training could improve self-reported and objectively measured polysomnographic (PSG) sleep profiles in depressed individuals who had achieved at least partial remission with ADM, but still had residual sleep complaints. Methods: Twenty-three ADM users with sleep complaints were randomized into an 8-week Mindfulness-Based Cognitive Therapy (MBCT) course or a waitlist control condition. Pre-post measurements included PSG sleep studies and subjectively reported sleep, residual depression symptoms. Results: Compared to controls, the MBCT participants improved on both PSG and subjective measures of sleep. They showed a pattern of decreased wake time and increased sleep efficiency. Sleep depth, as measured by stage 1 and slow-wave sleep, did not change as a result of mindfulness training. Conclusions: MM is associated with increases in both objectively and subjectively measured sleep continuity in ADM users. MM training may serve as more desirable and cost-effective alternative to discontinuation or supplementation with hypnotics, and may contribute to a more sustainable recovery from depression.

            

      Global and regional alterations of hippocampal anatomy in long-term meditation practitioners.  Hum Brain Mapp. 2012 Jul 19. By Luders E, Thompson PM, Kurth F, Hong JY, Phillips OR, Wang Y, Gutman BA, Chou YY, Narr KL, Toga AW. From Laboratory of Neuro Imaging, Department of Neurology, UCLA School of Medicine, Los Angeles, California. eileen@...  

             Abstract:  Studies linking meditation and brain structure are still relatively sparse, but the hippocampus is consistently implicated as one of the structures altered in meditation practitioners. To explore hippocampal features in the framework of meditation, we analyzed high-resolution structural magnetic resonance imaging data from 30 long-term meditators and 30 controls, closely matched for sex, age, and handedness. Hippocampal formations were manually traced following established protocols. In addition to calculating left and right hippocampal volumes (global measures), regional variations in surface morphology were determined by measuring radial distances from the hippocampal core to spatially matched surface points (local measures). Left and right hippocampal volumes were larger in meditators than in controls, significantly so for the left hippocampus. The presence and direction of this global effect was confirmed locally by mapping the exact spatial locations of the group differences. Altogether, radial distances were larger in meditators compared to controls, with up to 15% difference. These local effects were observed in several hippocampal regions in the left and right hemisphere though achieved significance primarily in the left hippocampal head. Larger hippocampal dimensions in long-term meditators may constitute part of the underlying neurological substrate for cognitive skills, mental capacities, and/or personal traits associated with the practice of meditation. Alternatively, given that meditation positively affects autonomic regulation and immune activity, altered hippocampal dimensions may be one result of meditation-induced stress reduction. However, given the cross-sectional design, the lack of individual stress measures, and the limited resolution of brain data, the exact underlying neuronal mechanisms remain to be established.

       

      Yogic meditation reverses NF-κB and IRF-related transcriptome dynamics in leukocytes of family dementia caregivers in a randomized controlled trial.  Psychoneuroendocrinology. 2012 Jul 13. By Black DS, Cole SW, Irwin MR, Breen E, St Cyr NM, Nazarian N, Khalsa DS, Lavretsky H. from  Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, CA,  USA

                  BACKGROUND: Although yoga and meditation have been used for stress reduction with reported improvement in inflammation, little is known about the biological mechanisms mediating such effects. The present study examined if a yogic meditation might alter the activity of inflammatory and antiviral transcription control pathways that shape immune cell gene expression.

                  METHODS: Forty-five family dementia caregivers were randomized to either Kirtan Kriya Meditation (KKM) or Relaxing Music (RM) listening for 12min daily for 8 weeks and 39 caregivers completed the study. Genome-wide transcriptional profiles were collected from peripheral blood leukocytes sampled at baseline and 8-week follow-up. Promoter-based bioinformatics analyses tested the hypothesis that observed transcriptional alterations were structured by reduced activity of the pro-inflammatory nuclear factor (NF)- κB family of transcription factors and increased activity of Interferon Response Factors (IRFs; i.e., reversal of patterns previously linked to stress).

                  RESULTS: In response to KKM treatment, 68 genes were found to be differentially expressed (19 up-regulated, 49 down-regulated) after adjusting for potentially confounded differences in sex, illness burden, and BMI. Up-regulated genes included immunoglobulin-related transcripts. Down-regulated transcripts included pro-inflammatory cytokines and activation-related immediate-early genes. Transcript origin analyses identified plasmacytoid dendritic cells and B lymphocytes as the primary cellular context of these transcriptional alterations (both p<.001). Promoter-based bioinformatic analysis implicated reduced NF-κB signaling and increased activity of IRF1 in structuring those effects (both p<.05).

                  CONCLUSION: A brief daily yogic meditation intervention may reverse the pattern of increased NF-?B-related transcription of pro-inflammatory cytokines and decreased IRF1-related transcription of innate antiviral response genes previously observed in healthy individuals confronting a significant life stressor.

       

      A Randomized Controlled Trial of Qigong Exercise on Fatigue Symptoms, Functioning, and Telomerase Activity in Persons with Chronic Fatigue or Chronic Fatigue Syndrome.  Ann Behav Med. 2012 Jun 27. By Ho RT, Chan JS, Wang CW, Lau BW, So KF, Yuen LP, Sham JS, Chan CL. From  Centre on Behavioral Health, The University of Hong Kong, Hong Kong, China, tinho@...

                  BACKGROUND:  Chronic fatigue is common in the general population. Complementary therapies are often used by patients with chronic fatigue or chronic fatigue syndrome to manage their symptoms.  PURPOSE:  This study aimed to assess the effect of a 4-month qigong intervention program among patients with chronic fatigue or chronic fatigue syndrome. METHODS: Sixty-four participants were randomly assigned to either an intervention group or a wait list control group. Outcome measures included fatigue symptoms, physical functioning, mental functioning, and telomerase activity. RESULTS: Fatigue symptoms and mental functioning were significantly improved in the qigong group compared to controls. Telomerase activity increased in the qigong group from 0.102 to 0.178 arbitrary units (p < 0.05). The change was statistically significant when compared to the control group (p<0.05).  CONCLUSION: Qigong exercise may be used as an alternative and complementary therapy or rehabilitative program for chronic fatigue and chronic fatigue syndrome.

       

      Development of Specific Aspects of Spirituality during a 6-Month Intensive Yoga Practice.  Evid Based Complement Alternat Med. 2012:981523. By Büssing A, Hedtstück A, Khalsa SB, Ostermann T, Heusser P. from  Center of Integrative Medicine, Faculty of Health, Witten/Herdecke University, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany.

             Abstract: The majority of research on yoga focuses on its psychophysiological and therapeutic benefits, while the spiritual aspects are rarely addressed. Changes of specific aspects of spirituality were thus investigated among 160 individuals (91% women, mean age 40.9 ± 8.3 years; 57% Christians) starting a 2-year yoga teacher training. We used standardized questionnaires to measure aspects of spirituality (ASP), mindfulness (FMI-Freiburg Mindfulness Inventory), life satisfaction (BMLSS-Brief Multidimensional Life Satisfaction Scale), and positive mood (lightheartedness/relief). At the start of the course, scores of the respective ASP subscales for search for insight/wisdom, transcendence conviction, and conscious interactions/compassion were high, while those for religious orientation were low. Within the 6 month observation period, both conscious interactions/compassion (effect size, Cohen's d = .33), Religious orientation (d = .21), Lightheartedness/Relief (d = .75) and mindfulness (d = .53) increased significantly. Particularly non-religious/non-spiritual individuals showed moderate effects for an increase of conscious interactions/compassion. The results from this study suggest that an intensive yoga practice (1) may significantly increase specific aspects of practitioners' spirituality, mindfulness, and mood, (2) that these changes are dependent in part on their original spiritual/religious self-perception, and (3) that there are strong correlations amongst these constructs (i.e., conscious interactions/compassion, and mindfulness).

      http://www.hindawi.com/journals/ecam/2012/981523  

       

      (Compiled by Kevin W Chen)

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