Insomnia is highly prevalent among patients with breast cancer (BC). Although cognitive behavioral therapy for insomnia (CBT-I) is available in integrative oncology settings, it poses unique ...challenges for BC survivors. Our review aimed to assess the evidence for the therapeutic effects of CBT-I on insomnia in BC. Randomized controlled trials (RCTs) that included patients/survivors with BC and insomnia, and at least one validated self-report measure of sleep quality were included in the review. Of the 14 included RCTs (total N = 1363), the most common components incorporated in CBT-I interventions were sleep hygiene, stimulus control and sleep restriction. Pooled effect sizes favored CBT-I at post-intervention (Hedges' g = −0.779, 95% CI = −0.949, −0.609), short-term follow-up (within six months, Hedges' g = −0.653, 95% CI = −0.808, −0.498), and long-term follow-up (12 mo, Hedges’ g = −0.335, 95% CI = −0.532, −0.139). In sub-analyses, CBT-I had similar effect sizes regardless of potential modifiers (comparison design, delivery formats, etc.). As an integrative oncology intervention, CBT-I is efficacious for reducing insomnia and improving sleep quality in women treated for BC, with medium-to-large effect sizes that persist after intervention delivery ends. Given the variability in the CBT-I components tested in RCTs, future studies should investigate the optimal integration of CBT-I components for managing insomnia during BC survivorship.
To qualitatively explore perceived physical and psychosocial effects and overall patient experience associated with a 12-week tai chi (TC) intervention and an education group in a clinical trial of ...patients with chronic heart failure (HF).
We randomized 100 patients with chronic systolic HF (NYHA Class 1-3, ejection fraction≤40%) to a 12-week group TC program or an education control. At 12-weeks, semi-structured interviews were conducted on a random subset (n = 32; n = 17 in TC, n = 15 in control), audiorecorded and transcribed verbatim. Two independent reviewers extracted information using grounded-theory methods for emergent themes. We explored similarities and differences in themes/sub-themes between the groups, and examined qualitative association with changes from baseline to post-intervention in previously reported quantitative measures (e.g., Minnesota Living with HF, Cardiac Exercise Self Efficacy and Profile of Mood States).
The mean age (±SD) of participants was 68±9 years, baseline ejection fraction 29±7%, and median New York Heart Association class 2 HF. We idenitifed themes related to the patient's experience of illness, perceptions of self, and relationship to others. Specific psychosocial and physical benefits were described. Common themes emerged from both groups including: social support and self-efficacy related to activity/exercise and diet. The tai chi group, however, also exhibited a more global empowerment and perceived control. Additional themes in TC included mindfulness/self-awareness, decreased stress reactivity, and renewed social role. These themes mirrored improvements in previously reported quantitative measures (quality-of-life, self-efficacy, and mood) in TC compared to control. Patients in TC also reported physical benefits (e.g., decreased pain, improved energy, endurance, flexibility).
Positive themes emerged from both groups, although there were qualitative differences in concepts of self-efficacy and perceived control between groups. Those in tai chi reported not only self efficacy and social support, but overall empowerment with additional gains such as internal locus of control, self-awareness and stress management. Future studies of mind-body exercise might further examine perceived control, self-efficacy, and locus-of-control as potential mediators of effect.
Objectives
To summarize and critically evaluate research on the effects of Tai Chi on cognitive function in older adults.
Design
Systematic review with meta‐analysis.
Setting
Community and ...residential care.
Participants
Individuals aged 60 and older (with the exception of one study) with and without cognitive impairment.
Measurements
Cognitive ability using a variety of neuropsychological testing.
Results
Twenty eligible studies with a total of 2,553 participants were identified that met inclusion criteria for the systematic review; 11 of the 20 eligible studies were randomized controlled trials (RCTs), one was a prospective nonrandomized controlled study, four were prospective noncontrolled observational studies, and four were cross‐sectional studies. Overall quality of RCTs was modest, with three of 11 trials categorized as high risk of bias. Meta‐analyses of outcomes related to executive function in RCTs of cognitively healthy adults indicated a large effect size when Tai Chi participants were compared with nonintervention controls (Hedges' g = 0.90; P = .04) and a moderate effect size when compared with exercise controls (Hedges' g = 0.51; P = .003). Meta‐analyses of outcomes related to global cognitive function in RCTs of cognitively impaired adults, ranging from mild cognitive impairment to dementia, showed smaller but statistically significant effects when Tai Chi was compared with nonintervention controls (Hedges' g = 0.35; P = .004) and other active interventions (Hedges' g = 0.30; P = .002). Findings from nonrandomized studies add further evidence that Tai Chi may positively affect these and other domains of cognitive function.
Conclusion
Tai Chi shows potential to enhance cognitive function in older adults, particularly in the realm of executive functioning and in individuals without significant impairment. Larger and methodologically sound trials with longer follow‐up periods are needed before more‐definitive conclusions can be drawn.
Yoga, a popular mind-body practice, may produce changes in cardiovascular disease (CVD) and metabolic syndrome risk factors.
This was a systematic review and random-effects meta-analysis of ...randomized controlled trials (RCTs).
Electronic searches of MEDLINE, EMBASE, CINAHL, PsycINFO, and The Cochrane Central Register of Controlled Trials were performed for systematic reviews and RCTs through December 2013. Studies were included if they were English, peer-reviewed, focused on asana-based yoga in adults, and reported relevant outcomes. Two reviewers independently selected articles and assessed quality using Cochrane's Risk of Bias tool.
Out of 1404 records, 37 RCTs were included in the systematic review and 32 in the meta-analysis. Compared to non-exercise controls, yoga showed significant improvement for body mass index (-0.77 kg/m(2) (95% confidence interval -1.09 to -0.44)), systolic blood pressure (-5.21 mmHg (-8.01 to -2.42)), low-density lipoprotein cholesterol (-12.14 mg/dl (-21.80 to -2.48)), and high-density lipoprotein cholesterol (3.20 mg/dl (1.86 to 4.54)). Significant changes were seen in body weight (-2.32 kg (-4.33 to -0.37)), diastolic blood pressure (-4.98 mmHg (-7.17 to -2.80)), total cholesterol (-18.48 mg/dl (-29.16 to -7.80)), triglycerides (-25.89 mg/dl (-36.19 to -15.60), and heart rate (-5.27 beats/min (-9.55 to -1.00)), but not fasting blood glucose (-5.91 mg/dl (-16.32 to 4.50)) nor glycosylated hemoglobin (-0.06% Hb (-0.24 to 0.11)). No significant difference was found between yoga and exercise. One study found an impact on smoking abstinence.
There is promising evidence of yoga on improving cardio-metabolic health. Findings are limited by small trial sample sizes, heterogeneity, and moderate quality of RCTs.
Chronic obstructive pulmonary disease (COPD) is associated with multiple psychosocial and behavioral factors. Prior research suggests that mind-body interventions may support the development and ...maintenance of healthy behaviors and improve health-related quality-of-life in such patients. We sought to qualitatively explore cognitive, psychosocial, and behavioral changes in patients with COPD who participated in two different mind-body interventions compared to an education control.
We analyzed semi-structured qualitative exit interviews from a prospective, randomized pilot trial (N = 123) investigating 12-weeks of Tai Chi (TC) vs. mind-body breathing (MBB) vs. education (EDU) control in patients with moderate-severe COPD. TC involved traditional movements, that integrate meditative breathing, while MBB focused mainly on meditative breathing techniques alone. Interviews were audio-recorded and transcribed verbatim. Qualitative analysis of randomly selected transcripts was performed by two independent reviewers using an iterative process to identify emergent themes informed by grounded theory methods until thematic saturation was reached.
A total of 66 transcripts were reviewed (N = 22 TC, N = 22 MBB, N = 22 EDU). Participants were mean age = 68.1 years, GOLD Stage = 2.3, baseline FEV11 percent predicted mean (SD): 58% (13.4), 42.4% female. We identified six frequently mentioned themes: 1) overall awareness and understanding, 2) self-care knowledge, skills and behaviors, 3) behavior-related neurocognitive concepts, 4) physical function, 5) psychological well-being, and 6) social support/social function. Compared to EDU, more participants in TC and MBB noted improvements in awareness of self and the mind-body connection (e.g., body and breath awareness), knowledge of breathing techniques and integration of self-care skills with daily activities, self-efficacy for symptom management (particularly managing anxiety and dyspnea), acceptance of disease, physical function improvements (e.g., endurance, dyspnea, fatigue), and psychological well-being (particularly relaxation, emotion regulation and decreased reactivity). Compared to MBB, those in TC shared more intention to continue with self-care behaviors, physical activity self-efficacy, and improved flexibility. All three groups, including EDU, noted increased social support and knowledge of disease. Those in EDU, however, had fewer mentions of processes related to behavior change, and less concrete changes in neurocognitive, psychological, and physical function domains.
Mind-body interventions including meditative breathing may impact behavior-related neurocognitive and emotional factors that improve self-care management and support positive behavioral changes in patients with COPD.
This trial is registered in Clinical Trials.gov, ID number NCT01551953.
Objective
Fear of cancer recurrence (FCR) is a common existential concern and source of distress among adults with a cancer history. Multiple randomized controlled trials (RCTs) have examined ...mind‐body approaches to mitigating FCR. We summarized characteristics of these trials and calculated their pooled effects on decreasing FCR.
Methods
Six electronic databases were systematically searched from inception to May 2017, using a strategy that included multiple terms for RCTs, cancer, mind‐body medicine, and FCR. Data extraction and reporting followed Cochrane and Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Pooled effect sizes on self‐report measures of FCR were computed by using random‐effects models.
Results
Nineteen RCTs (pooled N = 2806) were included. Most studies (53%) were published since 2015 and targeted a single cancer type (84%; mostly breast). Intervention sessions (median = 6, mode = 4) tended to last 120 minutes and occur across 1.5 months. Delivery was predominantly in‐person (63%) to either groups (42%) or individuals (42%). Most interventions incorporated multiple mind‐body components (53%), commonly cognitive‐behavioral skills (58%), or meditative practices (53%). Small‐to‐medium pooled effect sizes were observed postintervention (Hedges' g = −0.36, 95% CI = −0.49, −0.23, P < .001) and at follow‐up assessments (median = 8 months, P < .001). Potential modifiers (control group design, group/individual delivery, use of cognitive‐behavioral or mindfulness skills, number of mind‐body components, cancer treatment status, and number of sessions) did not reach statistical significance.
Conclusions
Mind‐body interventions are efficacious for reducing FCR, with small‐to‐medium effect sizes that persist after intervention delivery ends. Recommendations include testing effects among survivors of various cancers and exploring the optimal integration of mind‐body practices for managing fundamental uncertainties and fears during cancer survivorship.
To systematically review the frequency and quality of adverse event (AE) reports in randomized controlled trials (RCTs) of tai chi (TC).
Electronic searches of PubMed/MEDLINE and additional databases ...from inception through March 2013 of English-language RCTs. Search terms included tai chi, taiji, and tai chi chuan. Data were independently extracted by 2 investigators.
We included all available RCTs that were published in English and used TC as an intervention. Inclusion and exclusion criteria of studies were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Eligible RCTs were categorized with respect to AE reporting: no mention of protocol for monitoring AEs or reports of AEs, and reports of AEs either with or without explicit protocol for monitoring AEs.
There were 153 eligible RCTs identified; most targeted older adults. Only 50 eligible trials (33%) included reporting of AEs; of these, only 18 trials (12% overall) also reported an explicit AE monitoring protocol. Protocols varied with respect to the rigor of systematic monitoring in both the TC and comparison groups. Reported AEs were typically minor and expected and primarily musculoskeletal related (eg, knee and back pain); no intervention-related serious AEs were reported.
TC is unlikely to result in serious AEs, but it may be associated with minor musculoskeletal aches and pains. However, poor and inconsistent reporting of AEs greatly limits the conclusions that can be drawn regarding the safety of TC.
To conduct a systematic review evaluating the impact of stretching on inflammation and its resolution using in vivo rodent models. Findings are evaluated for their potential to inform the design of ...clinical yoga studies to assess the impact of yogic stretching on inflammation and health.
Studies were identified using four databases. Eligible publications included English original peer-reviewed articles between 1900-May 2020. Studies included those investigating the effect of different stretching techniques administered to a whole rodent model and evaluating at least one inflammatory outcome. Studies stretching the musculoskeletal and integumentary systems were considered. Two reviewers removed duplicates, screened abstracts, conducted full-text reviews, and assessed methodological quality.
Of 766 studies identified, 25 were included for synthesis. Seven (28%) studies had a high risk of bias in 3 out of 10 criteria. Experimental stretching protocols resulted in a continuum of inflammatory responses with therapeutic and injurious effects, which varied with a combination of three stretching parameters--duration, frequency, and intensity. Relative to injurious stretching, therapeutic stretching featured longer-term stretching protocols. Evidence of pro- and mixed-inflammatory effects of stretching was found in 16 muscle studies. Evidence of pro-, anti-, and mixed-inflammatory effects was found in nine longer-term stretching studies of the integumentary system.
Despite the overall high quality of these summarized studies, evaluation of stretching protocols paralleling yogic stretching is limited. Both injurious and therapeutic stretching induce aspects of inflammatory responses that varied among the different stretching protocols. Inflammatory markers, such as cytokines, are potential outcomes to consider in clinical yoga studies. Future translational research evaluating therapeutic benefits should consider in vitro studies, active vs. passive stretching, shorter-term vs. longer-term interventions, systemic vs. local effects of stretching, animal models resembling human anatomy, control and estimation of non-specific stresses, development of in vivo self-stretching paradigms targeting myofascial tissues, and in vivo models accounting for gross musculoskeletal posture.
Diminished control of standing balance, traditionally indicated by greater postural sway magnitude and speed, is associated with falls in older adults. Tai Chi (TC) is a multisystem intervention that ...reduces fall risk, yet its impact on sway measures vary considerably. We hypothesized that TC improves the integrated function of multiple control systems influencing balance, quantifiable by the multi-scale "complexity" of postural sway fluctuations.
To evaluate both traditional and complexity-based measures of sway to characterize the short- and potential long-term effects of TC training on postural control and the relationships between sway measures and physical function in healthy older adults.
A cross-sectional comparison of standing postural sway in healthy TC-naïve and TC-expert (24.5±12 yrs experience) adults. TC-naïve participants then completed a 6-month, two-arm, wait-list randomized clinical trial of TC training. Postural sway was assessed before and after the training during standing on a force-plate with eyes-open (EO) and eyes-closed (EC). Anterior-posterior (AP) and medio-lateral (ML) sway speed, magnitude, and complexity (quantified by multiscale entropy) were calculated. Single-legged standing time and Timed-Up-and-Go tests characterized physical function.
At baseline, compared to TC-naïve adults (n = 60, age 64.5±7.5 yrs), TC-experts (n = 27, age 62.8±7.5 yrs) exhibited greater complexity of sway in the AP EC (P = 0.023), ML EO (P<0.001), and ML EC (P<0.001) conditions. Traditional measures of sway speed and magnitude were not significantly lower among TC-experts. Intention-to-treat analyses indicated no significant effects of short-term TC training; however, increases in AP EC and ML EC complexity amongst those randomized to TC were positively correlated with practice hours (P = 0.044, P = 0.018). Long- and short-term TC training were positively associated with physical function.
Multiscale entropy offers a complementary approach to traditional COP measures for characterizing sway during quiet standing, and may be more sensitive to the effects of TC in healthy adults.
ClinicalTrials.gov NCT01340365.
Pre-sleep stress or hyperarousal is a known key etiological component in insomnia disorder. Despite this, physiological alterations during the sleep onset are not well-understood. In particular, ...insomnia and obstructive sleep apnea (OSA) are highly prevalent co-morbid conditions, where autonomic regulation may be altered. We aimed to characterize heart rate variability (HRV) during sleep onset as a potential measure of pre-sleep hyperarousal.
We described the profile of pre-sleep HRV measures and explore autonomic differences in participants with self-reported insomnia disorder (with no OSA, n = 69; with mild OSA, n = 70; with moderate or severe OSA, n = 66), compared to normal sleep controls (n = 123). Heart rate data during the sleep onset process were extracted for HRV analyses.
During the sleep onset process, compared to normal sleep controls, participants with insomnia had altered HRV, indicated by higher heart rate (p = 0.004), lower SDNN (p = 0.003), reduced pNN20 (p < 0.001) and pNN50 (p = 0.010) and lower powers (p < 0.001). Participants with insomnia and moderate/severe OSA may have further deteriorated HRV outcomes compared to no/mild OSA patients with insomnia but differences were not significant. Insomnia itself was associated with significantly higher heart rate, lower pNN20, and lower high frequency power even after adjustment for age, gender, BMI and OSA severity.
Participants with insomnia had lower vagal activity during the sleep onset period, which may be compounded by OSA, reflected in higher heart rates and lower HRV. These altered heart rate dynamics may serve as a physiological biomarker for insomnia during bedtime wakefulness, or as a potential tool to evaluate the efficacy of behavioral interventions which target bedtime stress.
•Altered heart rate dynamics may present in subjects with insomnia even before sleep.•HRV may be a biomarker of hyper-arousal during wakefulness before sleep onset.•Tracking HRV during sleep onset may have value in evaluation/treatments for insomnia.•Bedtime HRV is a target marker for sleep onset difficulty due to hyperarousal/stress.
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