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Khanal MK, Karimi L, Saunders P, Schneider RH, Salerno J, Livesay K, Hallam KT, de Courten B. The promising role of Transcendental Meditation in the prevention and treatment of cardiometabolic diseases: A systematic review. Obes Rev 2024:e13800. [PMID: 39072971 DOI: 10.1111/obr.13800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 06/22/2024] [Accepted: 06/23/2024] [Indexed: 07/30/2024]
Abstract
Psychological distress has a demonstrable impact on cardiovascular diseases (CVD) and risk factors. Transcendental Meditation (TM) has been shown to reduce stress and improve health and well-being. The current review aimed to synthesize the evidence on the effects of TM on cardiometabolic outcomes and identify gaps for future research. We searched PubMed/MEDLINE, EMBASE, SCOPUS, and Web of Science databases for relevant literature. Forty-five papers that reported studies of TM on cardiometabolic risk factors and diseases were included. Evidence shows that TM is effective in reducing blood pressure (BP). We found some evidence that TM can improve insulin resistance and may play a role in improving dyslipidemia, exercise tolerance, and myocardial blood flow, and in reducing carotid intima-media thickness and left ventricular mass. Studies show that long-term TM practice can reduce the risk of myocardial infarction, stroke, and CVD mortality. This review identified that certain studies have high participant drop-out rates, and fewer studies targeted comprehensive cardiometabolic outcomes beyond BP with longer follow-up periods. We found that most studies were conducted in specific populations, which may limit generalizability. In conclusion, TM has the potential to improve cardiometabolic health; however, research gaps highlight the need for larger phase III multicenter clinical trials with long-term follow-ups.
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Affiliation(s)
- Mahesh Kumar Khanal
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Leila Karimi
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Peter Saunders
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Robert H Schneider
- College of Integrative Medicine, Maharishi International University, Fairfield, Iowa, USA
- Institute for Prevention Research, Vedic City, Iowa, USA
| | - John Salerno
- Institute for Prevention Research, Vedic City, Iowa, USA
| | - Karen Livesay
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Karen T Hallam
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Barbora de Courten
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
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Khabiri R, Jahangiry L, Abbasian M, Majidi F, Farhangi MA, Sadeghi-Bazargani H, Ponnet K. Spiritually Based Interventions for High Blood Pressure: A Systematic Review and Meta-analysis. JOURNAL OF RELIGION AND HEALTH 2024:10.1007/s10943-024-02034-3. [PMID: 38565834 DOI: 10.1007/s10943-024-02034-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 04/04/2024]
Abstract
This systematic review and meta-analysis aimed to evaluate the effectiveness of spiritually based interventions on blood pressure (BP) among adults. A systematic search was performed using the PubMed, Scopus, and Cochrane databases to identify studies evaluating spiritual interventions, including meditation, transcendental meditation, mindfulness meditation, and yoga, for high BP among adults up to January 1, 2022. The inclusion criteria were (a) randomized controlled trials (RCTs), (b) studies in English or Persian, (c) studies conducted among adults (≥ 18 years), and (d) studies reporting systolic or diastolic BP. Given the high heterogeneity of these studies, a random effect model was used to calculate the effect sizes for the RCTs. In total, the systematic review included 24 studies and the meta-analysis included 23 studies. As some of studies reported two or more outcome measurements, separate estimates of each outcome were extracted for that study (24 datasets). Fifteen trials reported the mean (SD) systolic blood pressure (SBP), and 13 trials reported the mean (SD) diastolic blood pressure (DBP). In addition, 13 studies reported means (SDs) and six trials reported mean changes in DBP. A significant decrease was found in systolic BP following intervention ((WMD (weighted mean difference) = - 7.63 [- 9.61 to - 5.65; P < 0.001]). We observed significant heterogeneity among the studies (I2 = 96.9; P < 0.001). A significant decrease was observed in DBP following the interventions (WMD = - 4.75 [- 6.45 to - 3.05; P < 0.001]). Spiritually based interventions including meditation and yoga had beneficial effects in reducing both SBP and DBP. Reducing BP can be expected to reduce the risk of cardiovascular diseases.
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Affiliation(s)
- Roghayeh Khabiri
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Jahangiry
- Health Education and Health Promotion Department, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran.
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mehdi Abbasian
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Geriatric Health, Faculty of Health Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatollah Majidi
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Koen Ponnet
- Faculty of Social Sciences, Imec-Mict-Ghent University, Ghent, Belgium
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Rees K, Takeda A, Court R, Kudrna L, Hartley L, Ernst E. Meditation for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev 2024; 2:CD013358. [PMID: 38358047 PMCID: PMC10867897 DOI: 10.1002/14651858.cd013358.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Interventions incorporating meditation to address stress, anxiety, and depression, and improve self-management, are becoming popular for many health conditions. Stress is a risk factor for cardiovascular disease (CVD) and clusters with other modifiable behavioural risk factors, such as smoking. Meditation may therefore be a useful CVD prevention strategy. OBJECTIVES To determine the effectiveness of meditation, primarily mindfulness-based interventions (MBIs) and transcendental meditation (TM), for the primary and secondary prevention of CVD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases, and two trials registers on 14 November 2021, together with reference checking, citation searching, and contact with study authors to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) of 12 weeks or more in adults at high risk of CVD and those with established CVD. We explored four comparisons: MBIs versus active comparators (alternative interventions); MBIs versus non-active comparators (no intervention, wait list, usual care); TM versus active comparators; TM versus non-active comparators. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were CVD clinical events (e.g. cardiovascular mortality), blood pressure, measures of psychological distress and well-being, and adverse events. Secondary outcomes included other CVD risk factors (e.g. blood lipid levels), quality of life, and coping abilities. We used GRADE to assess the certainty of evidence. MAIN RESULTS We included 81 RCTs (6971 participants), with most studies at unclear risk of bias. MBIs versus active comparators (29 RCTs, 2883 participants) Systolic (SBP) and diastolic (DBP) blood pressure were reported in six trials (388 participants) where heterogeneity was considerable (SBP: MD -6.08 mmHg, 95% CI -12.79 to 0.63, I2 = 88%; DBP: MD -5.18 mmHg, 95% CI -10.65 to 0.29, I2 = 91%; both outcomes based on low-certainty evidence). There was little or no effect of MBIs on anxiety (SMD -0.06 units, 95% CI -0.25 to 0.13; I2 = 0%; 9 trials, 438 participants; moderate-certainty evidence), or depression (SMD 0.08 units, 95% CI -0.08 to 0.24; I2 = 0%; 11 trials, 595 participants; moderate-certainty evidence). Perceived stress was reduced with MBIs (SMD -0.24 units, 95% CI -0.45 to -0.03; I2 = 0%; P = 0.03; 6 trials, 357 participants; moderate-certainty evidence). There was little to no effect on well-being (SMD -0.18 units, 95% CI -0.67 to 0.32; 1 trial, 63 participants; low-certainty evidence). There was little to no effect on smoking cessation (RR 1.45, 95% CI 0.78 to 2.68; I2 = 79%; 6 trials, 1087 participants; low-certainty evidence). None of the trials reported CVD clinical events or adverse events. MBIs versus non-active comparators (38 RCTs, 2905 participants) Clinical events were reported in one trial (110 participants), providing very low-certainty evidence (RR 0.94, 95% CI 0.37 to 2.42). SBP and DBP were reduced in nine trials (379 participants) but heterogeneity was substantial (SBP: MD -6.62 mmHg, 95% CI -13.15 to -0.1, I2 = 87%; DBP: MD -3.35 mmHg, 95% CI -5.86 to -0.85, I2 = 61%; both outcomes based on low-certainty evidence). There was low-certainty evidence of reductions in anxiety (SMD -0.78 units, 95% CI -1.09 to -0.41; I2 = 61%; 9 trials, 533 participants; low-certainty evidence), depression (SMD -0.66 units, 95% CI -0.91 to -0.41; I2 = 67%; 15 trials, 912 participants; low-certainty evidence) and perceived stress (SMD -0.59 units, 95% CI -0.89 to -0.29; I2 = 70%; 11 trials, 708 participants; low-certainty evidence) but heterogeneity was substantial. Well-being increased (SMD 0.5 units, 95% CI 0.09 to 0.91; I2 = 47%; 2 trials, 198 participants; moderate-certainty evidence). There was little to no effect on smoking cessation (RR 1.36, 95% CI 0.86 to 2.13; I2 = 0%; 2 trials, 453 participants; low-certainty evidence). One small study (18 participants) reported two adverse events in the MBI group, which were not regarded as serious by the study investigators (RR 5.0, 95% CI 0.27 to 91.52; low-certainty evidence). No subgroup effects were seen for SBP, DBP, anxiety, depression, or perceived stress by primary and secondary prevention. TM versus active comparators (8 RCTs, 830 participants) Clinical events were reported in one trial (201 participants) based on low-certainty evidence (RR 0.91, 95% CI 0.56 to 1.49). SBP was reduced (MD -2.33 mmHg, 95% CI -3.99 to -0.68; I2 = 2%; 8 trials, 774 participants; moderate-certainty evidence), with an uncertain effect on DBP (MD -1.15 mmHg, 95% CI -2.85 to 0.55; I2 = 53%; low-certainty evidence). There was little or no effect on anxiety (SMD 0.06 units, 95% CI -0.22 to 0.33; I2 = 0%; 3 trials, 200 participants; low-certainty evidence), depression (SMD -0.12 units, 95% CI -0.31 to 0.07; I2 = 0%; 5 trials, 421 participants; moderate-certainty evidence), or perceived stress (SMD 0.04 units, 95% CI -0.49 to 0.57; I2 = 70%; 3 trials, 194 participants; very low-certainty evidence). None of the trials reported adverse events or smoking rates. No subgroup effects were seen for SBP or DBP by primary and secondary prevention. TM versus non-active comparators (2 RCTs, 186 participants) Two trials (139 participants) reported blood pressure, where reductions were seen in SBP (MD -6.34 mmHg, 95% CI -9.86 to -2.81; I2 = 0%; low-certainty evidence) and DBP (MD -5.13 mmHg, 95% CI -9.07 to -1.19; I2 = 18%; very low-certainty evidence). One trial (112 participants) reported anxiety and depression and found reductions in both (anxiety SMD -0.71 units, 95% CI -1.09 to -0.32; depression SMD -0.48 units, 95% CI -0.86 to -0.11; low-certainty evidence). None of the trials reported CVD clinical events, adverse events, or smoking rates. AUTHORS' CONCLUSIONS Despite the large number of studies included in the review, heterogeneity was substantial for many of the outcomes, which reduced the certainty of our findings. We attempted to address this by presenting four main comparisons of MBIs or TM versus active or inactive comparators, and by subgroup analyses according to primary or secondary prevention, where there were sufficient studies. The majority of studies were small and there was unclear risk of bias for most domains. Overall, we found very little information on the effects of meditation on CVD clinical endpoints, and limited information on blood pressure and psychological outcomes, for people at risk of or with established CVD. This is a very active area of research as shown by the large number of ongoing studies, with some having been completed at the time of writing this review. The status of all ongoing studies will be formally assessed and incorporated in further updates.
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Affiliation(s)
- Karen Rees
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Rachel Court
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Laura Kudrna
- Institute of Applied Health, University of Birmingham, Birmingham, UK
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Singh H, Fulton J, Mirzazada S, Saragosa M, Uleryk EM, Nelson MLA. Community-Based Culturally Tailored Education Programs for Black Communities with Cardiovascular Disease, Diabetes, Hypertension, and Stroke: Systematic Review Findings. J Racial Ethn Health Disparities 2023; 10:2986-3006. [PMID: 36508135 PMCID: PMC10645635 DOI: 10.1007/s40615-022-01474-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Community-based culturally tailored education (CBCTE) programs for chronic diseases may reduce health disparities; however, a synthesis across chronic diseases is lacking. We explored (1) the characteristics and outcomes of CBCTE programs and (2) which strategies for culturally appropriate interventions have been used in CBCTE programs, and how they have been implemented. METHODS A systematic review was conducted by searching three databases to identify empirical full-text literature on CBCTE programs for Black communities with cardiovascular disease, hypertension, diabetes, or stroke. Studies were screened in duplicate, then data regarding study characteristics, participants, intervention, and outcomes were extracted and analyzed. Cultural tailoring strategies within programs were categorized using Kreuter and colleagues' framework. RESULTS Of the 74 studies, most were conducted in the USA (97%) and delivered in one site (53%; e.g., church/home). CBCTE programs targeted diabetes (65%), hypertension (30%), diabetes and hypertension (1%), cardiovascular disease (3%), and stroke (1%). Reported program benefits included physiological, medication-related, physical activity, and literacy. Cultural tailoring strategies included peripheral (targeted Black communities), constituent-involving (e.g., community informed), evidential (e.g., integrated community resources), linguistic (e.g., delivered in community's dialect/accent), and sociocultural (e.g., integrated community members' religious practices). CONCLUSIONS CBCTE programs may have beneficial outcomes, but a small sample size limited several. The strategies identified can be adopted by programs seeking to culturally tailor. Future interventions should clearly describe community members' roles/involvement and deliver programs in multiple locations to broaden reach. TRIAL REGISTRATION PROSPERO CRD42021245772.
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue Toronto, Toronto, ON, M5G 1V7, Canada.
- KITE, Toronto Rehabilitation Institute, University Health Network, 520 Sutherland Drive, Toronto, ON, Canada.
- Temerty Faculty of Medicine, Rehabilitation Science Institute, University of Toronto, 500 University Avenue Toronto, Toronto, ON, M5G 1V7, Canada.
| | - Joseph Fulton
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- March of Dimes Canada, 10 Overlea Blvd, Toronto, ON, Canada
| | - Sofia Mirzazada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue Toronto, Toronto, ON, M5G 1V7, Canada
| | - Marianne Saragosa
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 1 Bridgepoint Drive, Toronto, ON, Canada
| | | | - Michelle L A Nelson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- March of Dimes Canada, 10 Overlea Blvd, Toronto, ON, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 1 Bridgepoint Drive, Toronto, ON, Canada
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Eleazu I, Ayers C, Navar AM, Salhadar K, Albert M, Carnethon M, Brown S, Nwobodo LO, Carter S, Bess C, Powell-Wiley TM, de Lemos JA. Associations of Cumulative Perceived Stress with Cardiovascular Risk Factors and Outcomes: Findings from The Dallas Heart Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.15.23291460. [PMID: 37398246 PMCID: PMC10312845 DOI: 10.1101/2023.06.15.23291460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Background Data remain sparse regarding the impact of chronic stress on cardiovascular disease (CVD) risk factors and outcomes. Prior work has been limited by incomplete assessments of perceived stress and focus on single stress domains. We evaluated the association between a composite measure of perceived stress and CVD risk factors and outcomes. Methods Participants from the Dallas Heart Study phase 2 (2007-2009) without prevalent CVD who completed questionnaire assessments of perceived stress were included (n=2685). Individual perceived stress subcomponents (generalized stress, psychosocial, financial, and neighborhood stress) were standardized and integrated into a single cumulative stress score (CSS) with equal weighting for each component. Associations between CSS and demographics, psychosocial variables and cardiac risk factors were assessed in univariable and multivariable analyses. Cox proportional hazards models were used to determine associations of the CSS with atherosclerotic CVD (ASCVD) and Global CVD (ASCVD, heart failure, and atrial fibrillation) after adjustment for demographics and traditional risk factors. Results Median age of the study population was 48 years, 55% were female, 49% Black and 15% Hispanic/Latinx. CSS was higher among participants who were younger, female, Black or Hispanic, and those with lower income and educational attainment (p<.0001 for each). Higher CSS was associated with self-report of racial/ethnic discrimination, lack of health insurance and last medical contact > one year previously (p<.0001 for each). In multivariable regression models adjusting for age, gender, race/ethnicity, income and education, higher CSS associated with hypertension, smoking, and higher body mass index, waist circumference Hemoglobin A1C, hs-CRP and sedentary time (p< 0.01 for each). Over a median follow-up of 12.4 years, higher CSS associated with ASCVD (adjusted HR 1.22 per SD, 95% CI 1.01-1.47) and Global CVD (HR 1.20, 95% CI 1.03-1.40). No interactions were seen between CSS, demographic factors, and outcomes. Conclusion Composite multidimensional assessments of perceived stress may help to identify individuals at risk for CVD who may be targeted for stress mitigation or enhanced prevention strategies. These approaches may be best focused on vulnerable populations, given the higher burden of stress in women, Black and Hispanic individuals, and those with lower income and education. WHAT IS NEW? A novel measure of cumulative stress was created that integrates generalized, psychosocial, financial, and neighborhood perceived stress.Cumulative stress was higher among women, Black and Hispanic participants, younger individuals and persons with lower income and educational attainment and was associated with adverse health behaviors and increased burden of cardiovascular disease (CVD) risk factors.In a diverse cohort, higher cumulative stress associated with incident CVD after adjustment for demographics and traditional risk factors. No interactions were seen based on demographic factors. CLINICAL IMPLICATIONS Although associations of chronic stress with CVD were similar across demographic subgroups, the higher burden of stress among younger individuals, women, Black and Hispanic participants, and those with lower SES suggests that CVD risk associated with higher stress affects marginalized groups disproportionately.Cumulative Stress is associated with modifiable risk factors and health behaviors. Future studies should explore targeting behavioral modification and risk factor reduction programs, as well as stress reduction strategies, to individuals with high cumulative stress.Additional research is needed to uncover mechanisms that underly the association between chronic stress and cardiovascular disease.
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Response to Commentary: Effects of Transcendental Meditation on Blood Pressure: A Meta-analysis. J Cardiovasc Nurs 2023; 38:115-116. [PMID: 36752759 DOI: 10.1097/jcn.0000000000000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Commentary. J Cardiovasc Nurs 2023; 38:114. [PMID: 36728170 DOI: 10.1097/jcn.0000000000000969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Stress Reduction to Decrease Hypertension for Black Women: A Scoping Review of Trials and Interventions. J Racial Ethn Health Disparities 2022; 9:2208-2217. [PMID: 34606073 DOI: 10.1007/s40615-021-01160-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Chronic stress is a potential root cause of racial/ethnic disparities in cardiovascular disease. This review assesses literature surrounding effective stressreduction interventions to reduce hypertension (HTN)-a cardiovascular disease (CVD) risk factor-among an understudied population, non-Hispanic black (NHB) women. METHODS We conducted an electronic search of PubMed and PsycINFO literature published between January 1, 2000 and February 1, 2020, employing the keywords: "blood pressure", "hypertension", and "women", "black", "African-American", "stress", "meditation", "stress-coping", "stress-management", and "faith-based". We manually searched the bibliographies for additional articles. Studies were excluded if they: were published before 2000; were not intervention-based; did not study Black women in the US; did not target stress reduction; or did not measure blood pressure as an outcome. Independent reviewers screened the articles, which were selected based on consensus. Effect sizes and statistical p values were reported as provided in the included articles. RESULTS We identified 109 articles in total. Of those, six articles met inclusion criteria. Stronger evidence presented by a randomized control trial supported the efficacy of transcendental meditation with reductions in systolic and diastolic blood pressure up to 7 mmHg. Relaxation exercises, support groups, and therapeutic massage emerged as potentially beneficial in non-randomized pilot trials with reductions in systolic BP up to 9 mmHg and diastolic BP up to 5 mmHg varying by type and duration of the intervention. CONCLUSIONS This scoping review found that faith-based strategies and meditation can be effective stress reduction techniques to reduce BP among NHB women. However, much remains to be known about how these strategies may be leveraged to reduce blood pressure within this highly vulnerable population.
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Abstract
BACKGROUND The World Health Organization estimates that 1.13 billion people worldwide have hypertension. Although pharmaceutical management of blood pressure is available, there are reasons why people prefer not to take medications including costs, adverse effects, and lack of access. Nonpharmacological healthy lifestyle methods are needed. One alternative method is transcendental meditation (TM). OBJECTIVE The purpose of this study was to quantitatively synthesize the effects of TM on blood pressure. In addition, we examined the moderator effects of participant, methods, and intervention characteristics. METHODS We searched 19 electronic databases without date restrictions to March 2021 including the gray literature and specific journals for primary studies evaluating TM to reduce blood pressure in adults and written in English. We coded primary studies for 5 categories (source, method, intervention, participant characteristics, and outcomes). RESULTS Across 18 primary studies (N = 1207), TM mildly improved systolic blood pressure by -3.3 mm Hg (P = .025) and diastolic blood pressure by -1.8 mm Hg (P = .008) compared with comparison groups, but the effects waned after 3 months. Transcendental meditation reduced systolic blood pressure in samples that were 65 years and older significantly more than in samples that were younger than 65 years (-1.44 vs -9.87, P = .021) but showed no differential effect on diastolic blood pressure. CONCLUSIONS Transcendental meditation mildly reduced blood pressure, but the effect waned after 3 months. Adults older than 65 years benefited more than younger adults. Transcendental meditation might be recommended as one aspect of a healthy lifestyle.
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Kim DY, Hong SH, Jang SH, Park SH, Noh JH, Seok JM, Jo HJ, Son CG, Lee EJ. Systematic Review for the Medical Applications of Meditation in Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031244. [PMID: 35162267 PMCID: PMC8834867 DOI: 10.3390/ijerph19031244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/04/2022] [Accepted: 01/21/2022] [Indexed: 11/23/2022]
Abstract
Background: Meditation has been increasingly adapted for healthy populations and participants with diseases. Its beneficial effects are still challenging to determine due to the heterogeneity and methodological obstacles regarding medical applications. This study aimed to integrate the features of therapeutic meditation in randomized controlled trials (RCTs). Methods: We conducted a systematic review of RCTs with meditation for populations with diseases using the PubMed database through June 2021. We analyzed the characteristics of the diseases/disorders, participants, measurements, and their overall benefits. Results: Among a total of 4855 references, 104 RCTs were determined and mainly applied mindfulness-based (51 RCTs), yoga-based (32 RCTs), and transcendental meditation (14 RCTs) to 10,139 patient-participants. These RCTs were conducted for participants with a total of 45 kinds of disorders; the most frequent being cancer, followed by musculoskeletal and connective tissue diseases and affective mood disorder. Seven symptoms or signs were frequently assessed: depressive mood, feeling anxious, quality of life, stress, sleep, pain, and fatigue. The RCTs showed a higher ratio of positive outcomes for sleep (73.9%) and fatigue (68.4%). Conclusions: This systematic review produced the comprehensive features of RCTs for therapeutic meditation. These results will help physicians and researchers further study clinical adaptations in the future as reference data.
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Affiliation(s)
- Do-Young Kim
- Korean Medical College, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Korea; (D.-Y.K.); (S.-H.H.); (S.-H.J.); (S.-H.P.); (J.-H.N.); (J.-M.S.); (H.-J.J.)
| | - Soo-Hwa Hong
- Korean Medical College, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Korea; (D.-Y.K.); (S.-H.H.); (S.-H.J.); (S.-H.P.); (J.-H.N.); (J.-M.S.); (H.-J.J.)
| | - Seung-Hyeon Jang
- Korean Medical College, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Korea; (D.-Y.K.); (S.-H.H.); (S.-H.J.); (S.-H.P.); (J.-H.N.); (J.-M.S.); (H.-J.J.)
| | - So-Hyeon Park
- Korean Medical College, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Korea; (D.-Y.K.); (S.-H.H.); (S.-H.J.); (S.-H.P.); (J.-H.N.); (J.-M.S.); (H.-J.J.)
| | - Jung-Hee Noh
- Korean Medical College, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Korea; (D.-Y.K.); (S.-H.H.); (S.-H.J.); (S.-H.P.); (J.-H.N.); (J.-M.S.); (H.-J.J.)
| | - Jung-Mi Seok
- Korean Medical College, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Korea; (D.-Y.K.); (S.-H.H.); (S.-H.J.); (S.-H.P.); (J.-H.N.); (J.-M.S.); (H.-J.J.)
| | - Hyun-Jeong Jo
- Korean Medical College, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Korea; (D.-Y.K.); (S.-H.H.); (S.-H.J.); (S.-H.P.); (J.-H.N.); (J.-M.S.); (H.-J.J.)
| | - Chang-Gue Son
- Department of Liver and Immunology Research Center, Daejeon Oriental Hospital of Daejeon University, 75, Daedeok-daero 176, Seo-gu, Daejeon 35235, Korea
- Correspondence: (C.-G.S.); (E.-J.L.)
| | - Eun-Jung Lee
- Department of Korean Rehabilitation Medicine, Daejeon Oriental Hospital of Daejeon University, 75, Daedeok-daero 176, Seo-gu, Daejeon 35235, Korea
- Correspondence: (C.-G.S.); (E.-J.L.)
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SCHNEIDER RH, GRIM C, KOTCHEN T, MARWAHA K, KOTCHEN J, SALERNO JW, KING CG, NIDICH S, ALEXANDER CN. Randomized controlled trial of stress reduction with meditation and health education in black men and women with high normal and normal blood pressure. Am J Prev Cardiol 2021; 8:100279. [PMID: 34729544 PMCID: PMC8546372 DOI: 10.1016/j.ajpc.2021.100279] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/20/2021] [Accepted: 10/01/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Black men and women suffer from disparities in morbidity and mortality from hypertension, cardiovascular disease, and currently, COVID-19. These conditions are associated with social determinants of health and psychosocial stress. While previous trials demonstrated that stress reduction with meditation lowered BP in the grade I range in Black adults, there is a paucity of evidence for high normal and normal BP. OBJECTIVE This randomized controlled trial was conducted to evaluate the effect of stress reduction with the Transcendental Meditation (TM) technique in Black adults with high normal BP and normal BP using international classifications. METHODS A total of 304 Black men and women with high normal (130-139/85-89 mm Hg) and normal BP (120-129/80-84 mm Hg) were randomized to either TM or health education (HE) groups. BP was recorded at 3, 6, 9, 12, 24, 30 and 36 months after baseline. Linear mixed model analysis was conducted to compare the BP change between TM and HE participants in the high-normal BP and normal-BP groups. Survival analysis for hypertensive events was conducted. RESULTS After an average of 19.9 ± 11.1 months follow-up, TM participants in the high-normal BP group showed significantly lower posttest SBP (-3.33 mm Hg, p = 0.045). There was no difference in DBP (-0.785 mm Hg, p = 0.367) compared to HE participants. In the normal BP group, the SBP and DBP were not different between the TM and HE participants. The hazard ratio for hypertensive events was 0.52 (p = 0.15) in the high normal BP group (7 TM vs 13 HE) with no difference in the normal BP group. CONCLUSION This RCT found that meditation lowered systolic BP in Black men and women with high normal BP but not in normal BP participants. These results may be relevant to reducing health disparities in CVD and related co-morbidities.
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Affiliation(s)
- Robert H. SCHNEIDER
- Institute for Prevention Research, 2100 Mansion Drive, Vedic City, Iowa 52556, USA
- College of Integrative Medicine, Institute for Natural Medicine and Prevention, Department of Physiology and Health, Maharishi International University, Fairfield, Iowa USA
| | - Clarence GRIM
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Theodore KOTCHEN
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Komal MARWAHA
- College of Integrative Medicine, Institute for Natural Medicine and Prevention, Department of Physiology and Health, Maharishi International University, Fairfield, Iowa USA
| | - Jane KOTCHEN
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - John W. SALERNO
- Institute for Prevention Research, 2100 Mansion Drive, Vedic City, Iowa 52556, USA
| | - Carolyn Gaylord KING
- Institute for Prevention Research, 2100 Mansion Drive, Vedic City, Iowa 52556, USA
| | - Sanford NIDICH
- Institute for Prevention Research, 2100 Mansion Drive, Vedic City, Iowa 52556, USA
| | - Charles N. ALEXANDER
- Institute for Prevention Research, 2100 Mansion Drive, Vedic City, Iowa 52556, USA
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12
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Kalinowski J, Kaur K, Newsome-Garcia V, Langford A, Kalejaiye A, Vieira D, Izeogu C, Blanc J, Taylor J, Ogedegbe O, Spruill T. Stress interventions and hypertension in Black women. ACTA ACUST UNITED AC 2021; 17:17455065211009751. [PMID: 34254559 PMCID: PMC8280834 DOI: 10.1177/17455065211009751] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Hypertension is a risk factor for cardiovascular disease. Black women have high
rates of hypertension compared to women of other racial or ethnic groups and are
disproportionately affected by psychosocial stressors such as racial
discrimination, gender discrimination, and caregiving stress. Evidence suggests
that stress is associated with incident hypertension and hypertension risk.
Stress management is associated with improvements improved blood pressure
outcomes. The purpose of this review is to synthesize evidence on effects of
stress management interventions on blood pressure in Black women. A
comprehensive search of scientific databases was conducted. Inclusion criteria
included studies that were: (1) primary research that tested an intervention;
(2) in the English language; (3) included African-American women; (4)
incorporated stress in the intervention; (5) included blood pressure as an
outcome; and (6) were US based. Eighteen studies met inclusion criteria. Ten
(56%) studies tested meditation-based interventions, two (11%) tested coping and
affirmation interventions, and six (33%) tested lifestyle modification
interventions that included stress management content. Thirteen of the studies
were randomized controlled trials. Reductions in blood pressure were observed in
all of the meditation-based interventions, although the magnitude and
statistical significance varied. Comprehensive lifestyle interventions were also
efficacious for reducing blood pressure, although the relative contribution of
stress management versus behavior modification could not be evaluated. Coping
and affirmation interventions did not affect blood pressure. Most of the
reviewed studies included small numbers of Black women and did not stratify
results by race and gender, so effects remain unclear. This review highlights
the urgent need for studies specifically focusing on Black women. Given the
extensive disparities in cardiovascular disease morbidity and mortality, whether
stress management can lower blood pressure and improve primary and secondary
cardiovascular disease prevention among Black women is an important question for
future research.
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Affiliation(s)
- Jolaade Kalinowski
- Department of Human Development and Family Sciences, The University of Connecticut, Storrs, CT, USA
| | - Kiran Kaur
- Department of Population Health, School of Medicine, New York University, New York, NY, USA
| | | | - Aisha Langford
- Department of Population Health, School of Medicine, New York University, New York, NY, USA
| | | | - Dorice Vieira
- Department of Population Health, School of Medicine, New York University, New York, NY, USA
| | - Chigozirim Izeogu
- Department of Population Health, School of Medicine, New York University, New York, NY, USA
| | - Judite Blanc
- Department of Population Health, School of Medicine, New York University, New York, NY, USA
| | | | - Olugbenga Ogedegbe
- Department of Population Health, School of Medicine, New York University, New York, NY, USA
| | - Tanya Spruill
- Department of Population Health, School of Medicine, New York University, New York, NY, USA
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13
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Fu J, Liu Y, Zhang L, Zhou L, Li D, Quan H, Zhu L, Hu F, Li X, Meng S, Yan R, Zhao S, Onwuka JU, Yang B, Sun D, Zhao Y. Nonpharmacologic Interventions for Reducing Blood Pressure in Adults With Prehypertension to Established Hypertension. J Am Heart Assoc 2020; 9:e016804. [PMID: 32975166 PMCID: PMC7792371 DOI: 10.1161/jaha.120.016804] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Nonpharmacologic interventions that modify lifestyle can lower blood pressure (BP) and have been assessed in numerous randomized controlled trials and pairwise meta‐analyses. It is still unclear which intervention would be most efficacious. Methods and Results Bayesian network meta‐analyses were performed to estimate the comparative effectiveness of different interventions for lowering BP. From 60 166 potentially relevant articles, 120 eligible articles (14 923 participants) with a median follow‐up of 12 weeks, assessing 22 nonpharmacologic interventions, were included. According to the surface under the cumulative ranking probabilities and Grading of Recommendations Assessment, Development and Evaluation (GRADE) quality of evidence, for adults with prehypertension to established hypertension, high‐quality evidence indicated that the Dietary Approach to Stop Hypertension (DASH) was superior to usual care and all other nonpharmacologic interventions in lowering systolic BP (weighted mean difference, 6.97 mm Hg; 95% credible interval, 4.50–9.47) and diastolic BP (weighted mean difference, 3.54 mm Hg; 95% credible interval, 1.80–5.28). Compared with usual care, moderate‐ to high‐quality evidence indicated that aerobic exercise, isometric training, low‐sodium and high‐potassium salt, comprehensive lifestyle modification, breathing‐control, and meditation could lower systolic BP and diastolic BP. For patients with hypertension, moderate‐ to high‐quality evidence suggested that the interventions listed (except comprehensive lifestyle modification) were associated with greater systolic BP and diastolic BP reduction than usual care; salt restriction was also effective in lowering both systolic BP and diastolic BP. Among overweight and obese participants, low‐calorie diet and low‐calorie diet plus exercise could lower more BP than exercise. Conclusions DASH might be the most effective intervention in lowering BP for adults with prehypertension to established hypertension. Aerobic exercise, isometric training, low‐sodium and high‐potassium salt, comprehensive lifestyle modification, salt restriction, breathing‐control, meditation and low‐calorie diet also have obvious effects on BP reduction.
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Affiliation(s)
- Jinming Fu
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Yupeng Liu
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Lei Zhang
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Lu Zhou
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Dapeng Li
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Hude Quan
- Department of Community Health Sciences University of Calgary Alberta Canada
| | - Lin Zhu
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Fulan Hu
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Xia Li
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Shuhan Meng
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Ran Yan
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Suhua Zhao
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Justina Ucheojor Onwuka
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Baofeng Yang
- Department of Pharmacology and the State-Province Key Laboratory of Biomedicine and Pharmaceutics Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Dianjun Sun
- Center for Endemic Disease Control Chinese Center for Disease Control and Prevention Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Yashuang Zhao
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
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14
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The Effect of Exercise on the Older Adult's Blood Pressure Suffering Hypertension: Systematic Review and Meta-Analysis on Clinical Trial Studies. Int J Hypertens 2020; 2020:2786120. [PMID: 33014449 PMCID: PMC7512073 DOI: 10.1155/2020/2786120] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/28/2020] [Indexed: 01/13/2023] Open
Abstract
Background Senescence refers to spontaneous and progressive irreversible degenerative changes in which both the physical and psychological power diminish significantly. Hypertension is the most common cardiovascular disease in the elderly. Several studies have been conducted regarding the effect of exercise on reducing the blood pressure of the elderly, which have found contradictory results. One of the uses of meta-analysis study is responding to these assumptions and resolving the discrepancies. Accordingly, the aim of the present study is to determine the impact of exercise on the blood pressure of older adults. Method In this research, in order to find electronic published papers from 1992 to 2019, the papers published in both domestic and foreign databases including SID, MagIran, IranMedex, IranDox, Gogole Scholar, Cohrane, Embase, Science Direct, Scopus, PubMed, and Web of Science (ISI) were used. Heterogeneity index between the studies was determined based on Cochran test Q(c) and I2. Considering existence of heterogeneity, random effects model was employed to estimate the standardized subtraction of the mean exercise test score for reduction of blood pressure in the older adults across the intervention group before and after the test. Results In this meta-analysis and systematic review, eventually 69 papers met the inclusion criteria. The total number of participants was 2272 in the pre- and postintervention groups when examining the systolic changes and 2252 subjects in the pre- and postintervention groups when inspecting the diastolic changes. The standardized mean difference in examining the systolic changes before the intervention was 137.1 ± 8.09 and 132.98 ± 0.96 after the intervention; when exploring the diastolic changes, the pre- and postintervention values were 80.3 ± 0.85 and 76.0 ± 6.56, respectively, where these differences were statistically significant (P < 0.01). Conclusion The results of this study indicated that exercise leads to significant reduction in both systolic and diastolic blood pressure. Accordingly, regular exercise can be part of the treatment plan for hypertensive elderly.
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15
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Ganesan S, Gaur GS, Negi VS, Sharma VK, Pal GK. Effect of Yoga Therapy on Disease Activity, Inflammatory Markers, and Heart Rate Variability in Patients with Rheumatoid Arthritis. J Altern Complement Med 2020; 26:501-507. [DOI: 10.1089/acm.2019.0228] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Selvakumar Ganesan
- Department of Physiology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Girwar Singh Gaur
- Department of Physiology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Vir Singh Negi
- Department of Clinical Immunology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Vivek Kumar Sharma
- Department of Physiology, Government Institute of Medical Sciences, Greater Noida, India
| | - Gopal Krushna Pal
- Department of Physiology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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16
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Peckham SB, Ionson E, Nassim M, Ojha K, Palaniyappan L, Gati J, Thebérge J, Lazosky A, Speechley M, Barušs I, Rej S, Vasudev A. Sahaj Samadhi meditation vs a Health Enhancement Program in improving late-life depression severity and executive function: study protocol for a two-site, randomized controlled trial. Trials 2019; 20:605. [PMID: 31651355 PMCID: PMC6814044 DOI: 10.1186/s13063-019-3682-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/25/2019] [Indexed: 01/29/2023] Open
Abstract
Background Recent estimates suggest an 11% prevalence of current late-life depression (LLD) and a lifetime prevalence of 16–20%. LLD leads to cognitive disturbance as well as a nearly two to three times increased risk of dementia. We conducted a recent randomized controlled trial (RCT) which demonstrated that Sahaj Samadhi meditation (SSM), an easy-to-implement, meditation-based augmentation strategy, led to higher rates of symptom remission when compared to treatment as usual (40.0 vs 16.3%; odds ratio, 3.36; 95% CI 1.06–10.64; p = 0.040). Here we present a protocol describing a two-site, blinded, RCT, comparing an SSM arm to an active-control arm – a Health Enhancement Program (HEP) intervention – in their ability to reduce depressive symptoms and improve executive functioning, among several other exploratory outcomes. Methods/design One hundred and ninety-two (n = 192) participants with LLD will be recruited at two sites (London, ON, Canada, and Montreal, QC, Canada). Participants will undergo stratified randomization with regards to site and the presence of treatment-resistant-LLD (TR-LLD) or not, to either SSM or HEP. We will assess change in (1) depression severity using the Hamilton Depression Rating Scale (HAM-D), (2) executive functioning, and (3) other exploratory physiological and mood-based measures, at baseline (0 weeks), post intervention (12 weeks), and 26 weeks after baseline. Raters, clinicians, and care providers will be blinded to group allocation while participants will be blinded to the study hypotheses. Discussion This study should more definitively assess whether SSM can be used as an augmentation strategy in routine clinical care for patients suffering from LLD and TR-LLD. If the effects of SSM are significantly better than HEP, it will offer support for the routine use of this intervention to manage LLD/TR-LLD and comorbid declines in executive dysfunction. The results of this study could also inform whether SSM can improve/prevent cognitive decline in LLD. Trial registration ClinicalTrials.gov, ID: NCT03564041. Registered on 20 June 2018.
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Affiliation(s)
- Stephen Benjamin Peckham
- Geriatric Mood Disorders Laboratory, Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Emily Ionson
- Geriatric Mood Disorders Laboratory, Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Marouane Nassim
- McGill Meditation and Mind-Body Medicine Research Clinic (MMMM-RC), Jewish General Hospital, Montréal, QC, Canada.,Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, Montréal, QC, Canada
| | | | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Robarts Research Institute, Western University, London, ON, Canada
| | - Joe Gati
- Robarts Research Institute, Western University, London, ON, Canada
| | - Jean Thebérge
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Imaging Division, Lawson Health Research Institute, London, ON, Canada.,Department of Medical Biophysics and Medical Imaging, Western University, London, ON, Canada.,Department of Diagnostic Imaging, St. Joseph's Health Care, London, ON, Canada
| | - Andrea Lazosky
- London Health Sciences Centre, #A2-607, Victoria Hospital, LHSC, 800 Commissioners Road East, N6A 5W9, London, ON, Canada
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Imants Barušs
- Department of Psychology, King's University College, Western University, London, ON, Canada
| | - Soham Rej
- McGill Meditation and Mind-Body Medicine Research Clinic (MMMM-RC), Jewish General Hospital, Montréal, QC, Canada.,Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, Montréal, QC, Canada
| | - Akshya Vasudev
- Geriatric Mood Disorders Laboratory, Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada. .,Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. .,London Health Sciences Centre, #A2-607, Victoria Hospital, LHSC, 800 Commissioners Road East, N6A 5W9, London, ON, Canada.
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17
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Gathright EC, Salmoirago-Blotcher E, DeCosta J, Balletto BL, Donahue ML, Feulner MM, Cruess DG, Wing RR, Carey MP, Scott-Sheldon LAJ. The impact of transcendental meditation on depressive symptoms and blood pressure in adults with cardiovascular disease: A systematic review and meta-analysis. Complement Ther Med 2019; 46:172-179. [PMID: 31519275 PMCID: PMC7046170 DOI: 10.1016/j.ctim.2019.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Transcendental Meditation (TM) as a stress management technique may offer an adjunctive strategy to improve health and well-being in adults with cardiovascular disease (CVD). OBJECTIVES To examine the efficacy of TM to improve aspects of cardiovascular health and psychological functioning in adults with CVD. METHOD Studies (a) evaluating TM in adults with hypertension or CVD and (b) assessing a physiological or psychological outcome were retrieved and meta-analyzed. Weighted mean effect sizes were computed to assess between- and within-group changes. RESULTS Nine studies met inclusion criteria (N = 851; mean age = 60 ± 8 years; 47% women). Between-group analyses revealed no differences between TM and control groups. However, within-group (i.e., pre- to post-intervention) analyses revealed reductions in systolic (d+ = 0.31) and diastolic (d+ = 0.53) blood pressure (BP) for the TM group. There were no changes in depressive symptoms for TM or control participants. CONCLUSIONS TM was associated with within-group (but not between-groups) improvements in BP. Continued research using randomized controlled trials with larger samples, and measuring psychophysiological outcomes at longer follow-up intervals is recommended.
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Affiliation(s)
- Emily C Gathright
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.
| | - Elena Salmoirago-Blotcher
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Julie DeCosta
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Brittany L Balletto
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Marissa L Donahue
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Melissa M Feulner
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Dean G Cruess
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA; Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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18
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Woods-Giscombe CL, Gaylord SA, Li Y, Brintz CE, Bangdiwala SI, Buse JB, Mann JD, Lynch C, Phillips P, Smith S, Leniek K, Young L, Al-Barwani S, Yoo J, Faurot K. A Mixed-Methods, Randomized Clinical Trial to Examine Feasibility of a Mindfulness-Based Stress Management and Diabetes Risk Reduction Intervention for African Americans with Prediabetes. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:3962623. [PMID: 31511777 PMCID: PMC6710811 DOI: 10.1155/2019/3962623] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 07/21/2019] [Indexed: 12/29/2022]
Abstract
African Americans have disproportionately high rates of stress-related conditions, including diabetes and diabetes-related morbidity. Psychological stress may negatively influence engagement in risk-reducing lifestyle changes (physical activity and healthy eating) and stress-related physiology that increase diabetes risk. This study examined the feasibility of conducting a randomized trial comparing a novel mindfulness-based stress management program combined with diabetes risk-reduction education versus a conventional diabetes risk-reduction education program among African American adults with prediabetes and self-reported life stress. Participants were recruited in collaboration with community partners and randomized to the mindfulness-based diabetes risk-reduction education program for prediabetes (MPD; n = 38) or the conventional diabetes risk-reduction education program for prediabetes (CPD; n = 30). The mindfulness components were adapted from the Mindfulness-based Stress Reduction Program. The diabetes risk-reduction components were adapted from the Power to Prevent Program and the Diabetes Prevention Program. Groups met for eight weeks for 2.5 hours, with a half-day retreat and six-monthly boosters. Mixed-methods strategies were used to assess feasibility. Psychological, behavioral, and metabolic data were collected before the intervention and at three and six months postintervention to examine within-group change and feasibility of collecting such data in future clinical efficacy research. Participants reported acceptability, credibility, and cultural relevance of the intervention components. Enrollment of eligible participants (79%), intervention session attendance (76.5%), retention (90%), and postintervention data collection attendance (83%, 82%, and 78%, respectively) demonstrated feasibility, and qualitative data provided information to further enhance feasibility in future studies. Both groups exhibited an A1C reduction. MPD participants had reductions in perceived stress, BMI, calorie, carbohydrate and fat intake, and increases in spiritual well-being. Considering the high prevalence of diabetes and diabetes-related complications in African Americans, these novel findings provide promising guidance to develop a larger trial powered to examine efficacy of a mindfulness-based stress management and diabetes risk-reduction education program for African Americans with prediabetes.
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Affiliation(s)
| | - Susan A. Gaylord
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
| | - Yin Li
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Carrie E. Brintz
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
| | - Shrikant I. Bangdiwala
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - John B. Buse
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - John D Mann
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
- Department of Neurology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Chanee Lynch
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
| | - Pamela Phillips
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
| | - Sunyata Smith
- Lehman College, City University of New York, New York, NY, USA
| | - Karyn Leniek
- Health Partners Central Minnesota Clinics, Sartell, MN, USA
| | - Laura Young
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Saada Al-Barwani
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeena Yoo
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Keturah Faurot
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
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19
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Acute and Subacute Triggers of Cardiovascular Events. Am J Cardiol 2018; 122:2157-2165. [PMID: 30309628 DOI: 10.1016/j.amjcard.2018.08.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/24/2018] [Accepted: 08/28/2018] [Indexed: 11/23/2022]
Abstract
Inability to predict short-term cardiovascular (CV) events and take immediate preemptive actions has long been the Achilles heel of cardiology. However, certain triggers of these events have come to light. Although these triggers are nonspecific and are part of normal life, studying their temporal relationship with the onset of CV events provides an opportunity to alert high-risk atherosclerotic patients who may be most vulnerable to such triggers, the "vulnerable patient". Herein, we review the literature and shed light on the epidemiology and underlying pathophysiology of different triggers. We describe that certain adrenergic triggers can precipitate a CV event within minutes or hours; whereas triggers that elicit an immune or inflammatory response such as infections may tip an asymptomatic "vulnerable patient" to become symptomatic days and weeks later. In conclusion, healthcare providers should counsel high-risk CV patients (e.g., in secondary prevention clinics or those with coronary artery Calcium >75th percentile) on the topic, advise them to avoid such triggers, take protective measures once exposed, and seek emergency care immediately after becoming symptomatic after such triggers. Furthermore, clinical trials targeting triggers (prevention or intervention) are needed.
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20
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Non-trauma-focused meditation versus exposure therapy in veterans with post-traumatic stress disorder: a randomised controlled trial. Lancet Psychiatry 2018; 5:975-986. [PMID: 30449712 DOI: 10.1016/s2215-0366(18)30384-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/29/2018] [Accepted: 09/18/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a complex and difficult-to-treat disorder, affecting 10-20% of military veterans. Previous research has raised the question of whether a non-trauma-focused treatment can be as effective as trauma exposure therapy in reducing PTSD symptoms. This study aimed to compare the non-trauma-focused practice of Transcendental Meditation (TM) with prolonged exposure therapy (PE) in a non-inferiority clinical trial, and to compare both therapies with a control of PTSD health education (HE). METHODS We did a randomised controlled trial at the Department of Veterans Affairs San Diego Healthcare System in CA, USA. We included 203 veterans with a current diagnosis of PTSD resulting from active military service randomly assigned to a TM or PE group, or an active control group of HE, using stratified block randomisation. Each treatment provided 12 sessions over 12 weeks, with daily home practice. TM and HE were mainly given in a group setting and PE was given individually. The primary outcome was change in PTSD symptom severity over 3 months, assessed by the Clinician-Administered PTSD Scale (CAPS). Analysis was by intention to treat. We hypothesised that TM would show non-inferiority to PE in improvement of CAPS score (Δ=10), with TM and PE superior to PTSD HE. This study is registered with ClinicalTrials.gov, number NCT01865123. FINDINGS Between June 10, 2013, and Oct 7, 2016, 203 veterans were randomly assigned to an intervention group (68 to the TM group, 68 to the PE group, and 67 to the PTSD HE group). TM was significantly non-inferior to PE on change in CAPS score from baseline to 3-month post-test (difference between groups in mean change -5·9, 95% CI -14·3 to 2·4, p=0·0002). In standard superiority comparisons, significant reductions in CAPS scores were found for TM versus PTSD HE (-14·6 95% CI, -23·3 to -5·9, p=0·0009), and PE versus PTSD HE (-8·7 95% CI, -17·0 to -0·32, p=0·041). 61% of those receiving TM, 42% of those receiving PE, and 32% of those receiving HE showed clinically significant improvements on the CAPS score. INTERPRETATION A non-trauma-focused-therapy, TM, might be a viable option for decreasing the severity of PTSD symptoms in veterans and represents an efficacious alternative for veterans who prefer not to receive or who do not respond to traditional exposure-based treatments of PTSD. FUNDING Department of Defense, US Army Medical Research.
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Ponte Márquez PH, Feliu-Soler A, Solé-Villa MJ, Matas-Pericas L, Filella-Agullo D, Ruiz-Herrerias M, Soler-Ribaudi J, Roca-Cusachs Coll A, Arroyo-Díaz JA. Benefits of mindfulness meditation in reducing blood pressure and stress in patients with arterial hypertension. J Hum Hypertens 2018; 33:237-247. [DOI: 10.1038/s41371-018-0130-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/16/2018] [Accepted: 10/23/2018] [Indexed: 11/09/2022]
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Ask TF, Lugo RG, Sütterlin S. The Neuro-Immuno-Senescence Integrative Model (NISIM) on the Negative Association Between Parasympathetic Activity and Cellular Senescence. Front Neurosci 2018; 12:726. [PMID: 30369866 PMCID: PMC6194361 DOI: 10.3389/fnins.2018.00726] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/21/2018] [Indexed: 12/26/2022] Open
Abstract
There is evidence that accumulated senescent cells drive age-related pathologies, but the antecedents to the cellular stressors that induce senescence remain poorly understood. Previous research suggests that there is a relationship between shorter telomere length, an antecedent to cellular senescence, and psychological stress. Existing models do not sufficiently account for the specific pathways from which psychological stress regulation is converted into production of reactive oxygen species. We propose the neuro-immuno-senescence integrative model (NISIM) suggesting how vagally mediated heart rate variability (HRV) might be related to cellular senescence. Prefrontally modulated, and vagally mediated cortical influences on the autonomic nervous system, expressed as HRV, affects the immune system by adrenergic stimulation and cholinergic inhibition of cytokine production in macrophages and neutrophils. Previous findings indicate that low HRV is associated with increased production of the pro-inflammatory cytokines IL-6 and TNF-α. IL-6 and TNF-α can activate the NFκB pathway, increasing production of reactive oxygen species that can cause DNA damage. Vagally mediated HRV has been related to an individual's ability to regulate stress, and is lower in people with shorter telomeres. Based on these previous findings, the NISIM suggest that the main pathway from psychological stress to individual differences in oxidative telomere damage originates in the neuroanatomical components that modulate HRV, and culminates in the cytokine-induced activation of NFκB. Accumulated senescent cells in the brain is hypothesized to promote age-related neurodegenerative disease, and previous reports suggest an association between low HRV and onset of Alzheimer's and Parkinson's disease. Accumulating senescent cells in peripheral tissues secreting senescence-associated secretory phenotype factors can alter tissue structure and function which can induce cancer and promote tumor growth and metastasis in old age, and previous research suggested that ability to regulate psychological stress has a negative association with cancer onset. We therefore conclude that the NISIM can account for a large proportion of the individual differences in the psychological stress-related antecedents to cellular senescence, and suggest that it can be useful in providing a dynamic framework for understanding the pathways by which psychological stress induce pathologies in old age.
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Affiliation(s)
- Torvald F. Ask
- Research Group on Cognition, Health, and Performance, Institute of Psychology, Inland Norway University of Applied Sciences, Lillehammer, Norway
| | - Ricardo G. Lugo
- Research Group on Cognition, Health, and Performance, Institute of Psychology, Inland Norway University of Applied Sciences, Lillehammer, Norway
| | - Stefan Sütterlin
- Faculty of Health and Welfare Sciences, Østfold University College, Halden, Norway
- Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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Tenfelde SM, Hatchett L, Saban KL. “Maybe black girls do yoga”: A focus group study with predominantly low-income African-American women. Complement Ther Med 2018; 40:230-235. [DOI: 10.1016/j.ctim.2017.11.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 01/23/2023] Open
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Clemow LP, Pickering TG, Davidson KW, Schwartz JE, Williams VP, Shaffer JA, Williams RB, Gerin W. Stress management in the workplace for employees with hypertension: a randomized controlled trial. Transl Behav Med 2018; 8:761-770. [PMID: 30202927 PMCID: PMC6128963 DOI: 10.1093/tbm/iby018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
While behavioral interventions can improve blood pressure (BP) in individuals with hypertension, getting such services to people who could benefit remains difficult. Workplace programs have potential as dissemination vehicles. The objective is to evaluate the effectiveness of a standardized stress management program delivered in groups at the workplace for reducing BP compared with enhanced usual care. This randomized controlled trial studied 92 urban medical center employees with hypertension randomized into two groups. The intervention was a 10-week group workshop on cognitive-behavioral coping skills. Enhanced usual care included self-help materials for BP reduction and physician referral. Intervention group participants' systolic BP (SBP) decreased 7.5 mm Hg over controls between baseline and follow-up, from 149.1 (95% CI: 146.0-152.1) to 140.0 (95% CI: 134.7-145.2), p < .001. The differential change between intervention and enhanced usual care groups (Group × Time interaction) was 7.5 mm Hg (t = -2.05; p = .04). Diastolic BP reductions were not significantly different. Scores on measures of emotional exhaustion and depressive rumination showed significant improvements and correlated with reductions in SBP. There was no significant change in the usual care group. A standardized worksite group intervention produced clinically meaningful reductions in SBP in participants with hypertension.
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Affiliation(s)
- Lynn P Clemow
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
- Department of Family and Community Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Thomas G Pickering
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Karina W Davidson
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Joseph E Schwartz
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | | | - Jonathan A Shaffer
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Redford B Williams
- Psychiatry and Behavioral Science, Duke University Medical Center, Durham, NC, USA
| | - William Gerin
- Department of Biobehavioral Health, Pennsylvania State University, State College, PA, USA
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Goldstein L, Nidich SI, Goodman R, Goodman D. The effect of transcendental meditation on self-efficacy, perceived stress, and quality of life in mothers in Uganda. Health Care Women Int 2018; 39:734-754. [DOI: 10.1080/07399332.2018.1445254] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Leslee Goldstein
- Center for Social Emotional Health and Consciousness, Maharishi University of Management, Fairfield, Iowa, USA
| | - Sanford I. Nidich
- Center for Social Emotional Health and Consciousness, Maharishi University of Management, Fairfield, Iowa, USA
| | - Rachel Goodman
- Department of Management, Maharishi University of Management, Fairfield, Iowa, USA
| | - David Goodman
- Department of Management, Maharishi University of Management, Fairfield, Iowa, USA
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Plotnikoff GA, Dusek J. Hypertension. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Jones LM, Rosemberg MAS, Wright KD. Opportunities for the Advanced Practice Nurse to Enhance Hypertension Knowledge and Self-management Among African American Women. CLIN NURSE SPEC 2017; 31:311-318. [PMID: 28991014 PMCID: PMC5679274 DOI: 10.1097/nur.0000000000000331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Despite increased awareness and the advent of methods to manage the disease, hypertension is poorly controlled among African American women. This study explored hypertension knowledge and blood pressure in a sample of African American women. DESIGN A descriptive, cross-sectional design was used to collect survey data on hypertension knowledge. METHODS African American women attending a church conference were invited to complete a questionnaire, which included the Check Your High Blood Pressure Prevention IQ survey, and had their blood pressures measured. RESULTS Of the 151 women who participated, 62% were diagnosed with hypertension. Many of the women, even those not diagnosed with hypertension, had elevated blood pressures. Although the average scores showed that the women scored well on the survey, there were 4 items on the survey that a percentage of the women had difficulty with: questions about (1) stress as a cause of hypertension, (2) symptoms associated with high blood pressure, (3) whether hypertension could be cured, and (4) the amount of exercise needed to help reduce blood pressure. CONCLUSION Despite efforts to increase awareness and control of hypertension, considerable misconceptions about the disease were found in this sample of African American women. To improve self-management of hypertension among this group, advanced practice nurses need to directly address these misconceptions.
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Affiliation(s)
- Lenette M Jones
- Author Affiliations: Assistant Professor (Dr Jones), Department of Health Behavior and Biological Sciences and Assistant Professor (Dr Rosemberg), Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor; and Assistant Professor (Dr Wright), the Ohio State University College of Nursing, Columbus
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Transcendental meditation for lowering blood pressure: An overview of systematic reviews and meta-analyses. Complement Ther Med 2017; 34:26-34. [DOI: 10.1016/j.ctim.2017.07.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/11/2017] [Accepted: 07/19/2017] [Indexed: 11/20/2022] Open
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Elder C. Mind-Body Training for At-Risk Populations: Preventive Medicine at its Best. Perm J 2017; 21:16-174. [PMID: 28241906 DOI: 10.7812/tpp/16-174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article is a companion to "Transcendental meditation and reduced trauma symptoms in female inmates: A randomized controlled pilot study," available at: www.thepermanentejournal.org/issues/2017/6290-meditation.html, and on page 39 and to "Reduced trauma symptoms and perceived stress in male prison inmates through the Transcendental Meditation program: A randomized controlled trial," available at: www.thepermanentejournal.org/issues/2016/fall/6227-incarcerated-healthcare.html and in the Fall 2016 issue of The Permanente Journal.
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Affiliation(s)
- Charles Elder
- Physician Lead for Integrative Medicine at Kaiser Permanente Northwest; Affiliate Investigator at the Center for Health Research in Portland, OR; and Associate Editor for Integrative Medicine at The Permanente Journal.
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Park SH, Han KS. Blood Pressure Response to Meditation and Yoga: A Systematic Review and Meta-Analysis. J Altern Complement Med 2017; 23:685-695. [DOI: 10.1089/acm.2016.0234] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Seong-Hi Park
- Department of Nursing, Soonchunhyang University, Asan-si, Korea
| | - Kuem Sun Han
- College of Nursing, Korea University, SungbukGu, Korea
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Tsitsi T, Charalambous A, Papastavrou E, Raftopoulos V. Effectiveness of a relaxation intervention (progressive muscle relaxation and guided imagery techniques) to reduce anxiety and improve mood of parents of hospitalized children with malignancies: A randomized controlled trial in Republic of Cyprus and Greece. Eur J Oncol Nurs 2016; 26:9-18. [PMID: 28069156 DOI: 10.1016/j.ejon.2016.10.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 09/22/2016] [Accepted: 10/31/2016] [Indexed: 01/30/2023]
Abstract
PURPOSE To explore the effect of Progressive Muscle Relaxation (PMR) and Guided Imagery (GI),in reducing anxiety levels among parents of children diagnosed with any type of malignancy receiving active treatment at a Paediatric Oncology Unit in Republic of Cyprus and in Greece. METHOD A randomized non-blinded control trial was conducted between April 2012 to October 2013, at two public paediatric hospitals. Fifty four eligible parents of children hospitalized with a malignancy were randomly assigned to the intervention (PMR and GI) (n = 29) and a control group (n = 25). The study evaluated the changes in anxiety levels(HAM-A) and mood changes(POMSb). RESULTS There was a statistically significant difference in the mean scores of the subjects in the intervention group in HAM-A scale between the T0 (14.67 ± 9.93) and T1 (11.70 ± 8.15) measurements (p = 0.008) compared to the control group in which a borderline difference (16.00 ± 11.52 vs 13.33 ± 8.38) was found (p = 0.066). The effect size for the intervention group was low to moderate (0.37). Regarding mood changes, there was a statistically significant difference in tension for parents in the intervention group between T0 and T1 (11.15 ± 5.39 vs 9.78 ± 4.26), (p = 0.027). Furthermore, the parents in the intervention group were significantly less sad following the intervention (T1) (2.81 ± 1.07 vs 2.19 ± 1.21), (p = 0.001), and felt significantly less tense (2.93 ± 0.91 vs 2.26 ± 0.90), (p = 0.001) and anxiety (2.63 ± 1.21 vs 2.19 ± 1.07), (p = 0.031) compared to those in the control group. CONCLUSIONS These findings provided evidence on the positive effect of the combination of PMR and GI in reducing anxiety and improving mood states in parents of children with malignancy.
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Affiliation(s)
- Theologia Tsitsi
- Cyprus University of Technology, Nursing Department, Limassol, Cyprus.
| | - Andreas Charalambous
- Cyprus University of Technology, Nursing Department, Research Centre for Oncology and Palliative Care, Limassol Cyprus. http://www.euro-mediterraneancenter.com
| | | | - Vasilios Raftopoulos
- Cyprus University of Technology, Nursing Department, Mediterranean Research Centre for Public Health and Quality of Care, Limassol, Cyprus. http://www.cut.ac.cy/medyp
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Shin CN, Soltero E, Mama SK, Sunseri C, Lee RE. Association of Discrimination and Stress With Cardiometabolic Risk Factors in Ethnic Minority Women. Clin Nurs Res 2016; 26:694-712. [PMID: 27625035 DOI: 10.1177/1054773816669448] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Psychological stressors can contribute to adverse health outcomes and lead to health disparities. To examine associations among psychological stressors, coping, blood pressure, body mass index, and body fat in ethnic minority women, we conducted a secondary analysis using data from 178 African American and Hispanic/Latina women who completed measures of perceived racial discrimination and stress, coping, blood pressure, and body composition. The mean age of participants was 45.3 (±9.3 years), and most were obese (74.2%) and had prehypertensive systolic blood pressure (125.7 ± 14.6 mmHg). Hierarchical multiple regression models indicated a significant negative relationship between racial discrimination and percent body fat, and positive associations between stress and blood pressure. Coping did not moderate the association between racial discrimination and blood pressure or body composition. Health care providers should consider psychological stressors as underlying causes for hypertension and address tailored stress-reduction coping strategies when treating African American and Hispanic/Latina women with hypertension.
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Abstract
Purpose: This pilot study examines the effects of walking a labyrinth. Method: A convenience sample of 25 community members participated in a four-group, repeated measures study to gather information about vital signs and affect before and after labyrinth walks. Because of the small sample size, results were inspected for effect size (ES) differences in pre-to postcomparisons. Mean postwalk scores were also compared to control group scores. Findings: Systolic and diastolic blood pressures showed essentially no ES differences pre to postwalk. The remaining ES comparisons showed .14 ES for pulse differences, .37 ES for respirations, and .22 and .56 ES differences for positive and negative affect measures, respectively. Conclusions: Comparisons of postwalk scores for walkers to nonwalkers showed mixed results in significance of differences. Implications: This pilot study shows the feasibility of the procedures for assessing the effects of labyrinth walking on basic parameters of health.
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Affiliation(s)
- M Kay Sandor
- University of Texas Medical Branch, School of Nursing, San Antonio, TX, USA
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Prasad K. Viewpoint: Role of Mind-body Therapies in the Management of Cardiovascular Disorders. Eur Cardiol 2016; 11:111-113. [PMID: 30310456 DOI: 10.15420/ecr.2016:17:2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Cardiovascular disorders (CVD) are the leading cause of death across the globe. The estimated cost to the National Health Service and UK economy is £30 billion. These costs continue to escalate despite major advances in pharmacotherapy and devices, which, in part, is due to improved survival, but also greater resource utilisation per patient. Hence, there is a need to develop cost-effective adjunctive therapies beyond conventional strategies. Mind-body therapies- including mindfulness and meditation, emotional regulation, practicing 'heartfelt' emotions including gratitude and compassion- may be novel low-cost approaches to reduce morbidity and mortality in CVD.
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Affiliation(s)
- Kavita Prasad
- St George's, University of London, London, UK; Mayo Clinic College of Medicine, Mayo Clinic, Rochester, USA
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Affiliation(s)
- Gerd Bönner
- , Sebastian-Kneipp-Str. 11, D-79104, Freiburg, Deutschland,
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Investigating the effect of transcendental meditation on blood pressure: a systematic review and meta-analysis. J Hum Hypertens 2015; 29:653-62. [DOI: 10.1038/jhh.2015.6] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 12/29/2014] [Accepted: 01/02/2015] [Indexed: 11/08/2022]
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Ranjbaran S, Dehdari T, Sadeghniiat-Haghighi K, Majdabadi MM. Poor Sleep Quality in Patients after Coronary Artery Bypass Graft Surgery: An Intervention Study Using the PRECEDE-PROCEED Model. J Tehran Heart Cent 2015; 10:1-8. [PMID: 26157457 PMCID: PMC4494514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 06/07/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Poor sleep quality (SQ) is common among patients after coronary artery bypass graft surgery (CABG). This study attempted to determine the status of SQ following an intervention based on the PRECEDE-PROCEED model in patients with poor SQ after CABG. METHODS This study was a randomized clinical trial. The study sample, including 100 patients referred to the Cardiac Rehabilitation Clinic of Tehran Heart Center, was assigned either to the intervention (recipient of exercise and lifestyle training plus designed intervention based on the PRECEDE-PROCEED model) or to the control group (recipient of exercise and lifestyle training). Eight training sessions over 8 weeks were conducted for the intervention group. Predisposing, enabling, and reinforcing factors as well as social support and SQ were measured in the intervention group before and one month after the intervention and compared to those in the control group at the same time points. RESULTS The mean age of the patients in the intervention (24% women) and control (24% women) groups was 59.3 ± 7.3 and 59.5 ± 9.3 years, respectively. The results showed that the mean scores of SQ (p value < 0.001), knowledge (p value < 0.001), beliefs (p value < 0.001), sleep self-efficacy (p value < 0.001), enabling factors (p value < 0.001), reinforcing factors (p value < 0.001), and social support (p value < 0.001) were significantly different between the intervention and control groups after the intervention. CONCLUSION Adding an intervention based on the PRECEDE-PROCEED model to the cardiac rehabilitation program may further improve the SQ of patients.
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Affiliation(s)
- Soheila Ranjbaran
- Department of Health Education and Health Promotion, School of Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahereh Dehdari
- Department of Health Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Tahereh Dehdari, Assistant Professor of Health Education, Department of Health Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran. P. O. Box: 146651579. Tel: +98 21 86704815. Fax: +98 21 88622707. E-mail:
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Transcendental Meditation in the prevention and treatment of cardiovascular disease and pathophysiological mechanisms: An evidence-based review. ADVANCES IN INTEGRATIVE MEDICINE 2014; 1:107-112. [DOI: 10.1016/j.aimed.2014.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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de Fátima Rosas Marchiori M, Kozasa EH, Miranda RD, Monezi Andrade AL, Perrotti TC, Leite JR. Decrease in blood pressure and improved psychological aspects through meditation training in hypertensive older adults: A randomized control study. Geriatr Gerontol Int 2014; 15:1158-64. [PMID: 25407688 DOI: 10.1111/ggi.12414] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2014] [Indexed: 12/14/2022]
Abstract
AIM The present study aimed to evaluate the effects of Zen meditation on blood pressure (BP) and quality of life in elderly subjects. METHODS A total of 59 volunteers (21 men and 38 women), aged ≥60 years with systolic BP between 130 and 159 mmHg and diastolic BP between 85 and 99 mmHg, were randomly divided into a meditation group (MG), n = 28 and a control group (CG), n = 31. The MG meditated twice a day for 20 min for 3 months, and the CG remained on a waiting list. The BP levels were measured monthly in both groups. The volunteers' medication was kept stable. A quality of life assessment instrument was applied at the beginning and end of the study. RESULTS For systolic BP, analysis of variance showed the influence of time (F(4,228) = 4.74, P < 0.01, β = 0.98) and the interaction group × time (F(4,228) = 3.07, P < 0.01, β = 0.89). The MG showed a significant decrease in systolic BP levels in the second measurement after 1 month of meditation practice when compared with the CG (Newman-Keuls test, P < 0.05). Starting at the second measurement, systolic BP levels in the MG were lower than the baseline and first measurement levels; however, the systolic BP levels were similar to those observed in the CG. In the quality of life assessment evaluation, a significant improvement in psychological aspects and overall quality of life in the MG compared with the CG was observed. CONCLUSION These results suggest that Zen meditation is an interesting tool as a complementary treatment for hypertension in elderly subjects.
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Affiliation(s)
| | - Elisa Harumi Kozasa
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | | | - André Luiz Monezi Andrade
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil.,Universidade Anhembi Morumbi-Laureate International Universities®, São Paulo, São Paulo, Brazil
| | | | - José Roberto Leite
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
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Abstract
OBJECTIVES The purpose of this study was to explore the perceptions of African American women about stroke and examine their health information seeking practices outside of medical encounters. DESIGN AND SAMPLE An exploratory-descriptive qualitative study was conducted with 48 women of age 35 years and older recruited from four Black churches. MEASURES Data were collected during focus groups and analyzed with qualitative content analysis. RESULTS Most of what participants knew about stroke came from interaction with family members or acquaintances that had strokes rather than stroke campaigns or health providers. There was confusion about the multiple symptoms of stroke, and information about stroke symptoms may not provide meaningful symptom representations. Information about breast cancer was more readily available than information about stroke. The internet, other women, and television programs were main source of health information outside of medical encounters. There was uncertainty how to assess the trustworthiness of internet health sites. CONCLUSIONS The results suggest that culturally sensitive stroke education for African American women should include stories of women with stroke and provide experiential and visual depictions of stroke warning signs. Group forums, television, and web-based education may be acceptable ways to communicate stroke information to African American women.
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Affiliation(s)
- Claudia C Beal
- Baylor University Louise Herrington School of Nursing, Dallas, Texas
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Amtul Z, Arena A, Hirjee H, Khan ZU, Maldeniya PM, Newman RI, Burhan AM, Wetmore S, Vasudev A. A randomized controlled longitudinal naturalistic trial testing the effects of automatic self transcending meditation on heart rate variability in late life depression: study protocol. Altern Ther Health Med 2014; 14:307. [PMID: 25134497 PMCID: PMC4147184 DOI: 10.1186/1472-6882-14-307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 08/14/2014] [Indexed: 01/09/2023]
Abstract
Background The prevalence and socioeconomic cost of late life depression (LLD) is on the rise, while the response rate to antidepressant trials remains poor. Various mind-body therapies are being embraced by patients as they are considered safe and potentially effective, yet little is known regarding the effectiveness of such therapies to improve LLD symptoms. Among the mind-body therapies currently in practice, the results of our pilot study have shown that a particular meditation technique called Sahaj Samadhi Meditation, which belongs to the category of meditation termed automatic self-transcending meditation (ASTM) may have some promise in improving cardiovascular autonomic disturbances associated with LLD as well as ameliorating symptoms of depression and anxiety. Methods/Design Patients between the ages of 60 and 85 with LLD will be randomized either to ASTM plus treatment as usual (TAU) or TAU alone to assess changes in cardiovascular autonomic parameters, neuropsychological symptoms of depression and anxiety as well as quality of life. The instructional phase of the intervention consists of 4 consecutive days of meditation training, after which participants are encouraged to meditate twice daily for twenty minutes each time at home. The intervention also includes once weekly follow up sessions for the subsequent 11 weeks. The planned study has one and a half year recruitment period. Participants will be assessed at baseline and at 4, 8, 12 and 24 weeks post intervention. Discussion This study should provide a unique data source from a randomized, controlled, longitudinal trial to investigate the effects of a form of ASTM on cardiovascular autonomic and neuropsychological health in LLD. Trial registration Clinicaltrials.gov NCT02149810, date registered: 05/28/2014.
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Trait mindfulness is associated with blood pressure and interleukin-6: exploring interactions among subscales of the Five Facet Mindfulness Questionnaire to better understand relationships between mindfulness and health. J Behav Med 2014; 38:28-38. [PMID: 24888477 DOI: 10.1007/s10865-014-9575-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 05/22/2014] [Indexed: 10/25/2022]
Abstract
Mindfulness based interventions have been associated with improvements in physical health; however, the mechanisms underlying these changes are unclear. The current study explored relationships between trait mindfulness, blood pressure (BP) and interleukin-6 (IL-6). Relationships between physical health variables and (1) a composite score of mindfulness, (2) individual facets of mindfulness and (3) interactions between theoretically relevant pairs of mindfulness subscales were investigated. One hundred and thirty healthy, young adults [M (SD) age = 21.7(2.7) years] reported trait levels of mindfulness (Five Facet Mindfulness Questionnaire, subscales include: observing, describing, acting with awareness (AWA), nonjudging and nonreactivity), had their resting BP measured and underwent a blood draw to assesses circulating IL-6 levels. Age, gender, body mass index, race/ethnicity, depression and perceived stress were obtained and used as covariates. A composite score of trait mindfulness was associated with lower BP and a trend suggested that it was also associated with lower IL-6. Investigation of individual facets of mindfulness revealed interactions between the subscales AWA and nonjudging, such that higher endorsement of AWA was associated with lower BP only when nonjudging was also high. A second interaction was observed between the subscales observing and nonreactivity, such that higher endorsement of observing was associated with lower IL-6 only when levels of nonreactivity were also high. Trait mindfulness was associated with both BP and IL-6. Examining interactions between facets of mindfulness variables may be important in understanding how mindfulness based interventions influence physiology.
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Yu R, Woo J, Chan AS, Sze SL. A Chinese Chan-based mind-body intervention improves psychological well-being and physical health of community-dwelling elderly: a pilot study. Clin Interv Aging 2014; 9:727-36. [PMID: 24790425 PMCID: PMC4003151 DOI: 10.2147/cia.s59985] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this study was to explore the potential benefits of the Dejian mind–body intervention (DMBI) for psychological and physical health in older Chinese adults. Methods After confirmation of eligibility, the subjects were invited to receive DMBI once a week for 12 weeks. The intervention involved components of learning self-awareness and self-control, practicing mind–body exercises, and adopting a special vegetarian diet. Intervention-related changes were measured using the Perceived Stress Scale, Geriatric Depression Scale, Pittsburgh Sleep Quality Index, Chinese Constipation Questionnaire, and self-report ratings of health. Indicators of metabolic syndrome and walking speed were also measured. Results Of the 44 subjects recruited, 42 (54.8% men) completed the study, giving an adherence rate of 95%. There was a significant reduction in perceived stress (P<0.05). A significant improvement was also found in systolic blood pressure among those who had abnormally high blood pressure at baseline (P<0.05). Physical fitness as reflected by walking speed was also significantly increased after the intervention (P<0.05). Sleep disturbances were reduced (P<0.01). Self-rated health was significantly enhanced, with the percentage rating very good health increasing from 14.3% at baseline to 42.8% after the intervention (P<0.001). No intervention effect was found for waist circumference, lipids and fasting blood glucose levels, Pittsburgh Sleep Quality Index global score, and constipation measures. Conclusion The DMBI was feasible and acceptable, and subjects showed some improvements in psychological and physical health. A larger controlled trial is needed to confirm these promising preliminary results.
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Affiliation(s)
- Ruby Yu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Jean Woo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Agnes S Chan
- Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong ; Chanwuyi Research Center for Neuropsychological Well-Being, The Chinese University of Hong Kong, New Territories, Hong Kong ; Henan Songshan Research Institute for Chanwuyi, Henan, People's Republic of China
| | - Sophia L Sze
- Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong ; Chanwuyi Research Center for Neuropsychological Well-Being, The Chinese University of Hong Kong, New Territories, Hong Kong
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The effects of a short term Stress Alleviating Intervention (SAI) on acute blood pressure responses following a natural disaster. Int J Cardiol 2013; 168:4483-4. [DOI: 10.1016/j.ijcard.2013.06.130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 06/30/2013] [Indexed: 11/23/2022]
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Hughes JW, Fresco DM, Myerscough R, van Dulmen MHM, Carlson LE, Josephson R. Randomized controlled trial of mindfulness-based stress reduction for prehypertension. Psychosom Med 2013; 75:721-8. [PMID: 24127622 PMCID: PMC3834730 DOI: 10.1097/psy.0b013e3182a3e4e5] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Mindfulness-based stress reduction (MBSR) is an increasingly popular practice demonstrated to alleviate stress and treat certain health conditions. MBSR may reduce elevated blood pressure (BP). Treatment guidelines recommend life-style modifications for BP in the prehypertensive range (systolic BP [SBP] 120-139 mm Hg or diastolic BP [DBP] 80-89 mm Hg), followed by antihypertensives if BP reaches hypertensive levels. MBSR has not been thoroughly evaluated as a treatment of prehypertension. A randomized clinical trial of MBSR for high BP was conducted to determine whether BP reductions associated with MBSR exceed those observed for an active control condition consisting of progressive muscle relaxation (PMR) training. METHODS Fifty-six men (43%) and women (57%) averaging (standard deviation) 50.3 (6.5) years of age (91% white) with unmedicated BP in the prehypertensive range were randomized to 8 weeks of MBSR or PMR delivered in a group format. Treatment sessions were administered by one treatment provider and lasted approximately 2.5 hours each week. Clinic BP was the primary outcome measure. Ambulatory BP was a secondary outcome measure. RESULTS Analyses were based on intent to treat. Patients randomized to MBSR exhibited a 4.8-mm Hg reduction in clinic SBP, which was larger than the 0.7-mm Hg reduction observed for PMR (p = .016). Those randomized to MBSR exhibited a 1.9-mm Hg reduction in DBP compared with a 1.2-mm Hg increase for PMR (p = .008). MBSR did not result in larger decreases in ambulatory BP than in PMR. CONCLUSIONS MBSR resulted in a reduction in clinic SBP and DBP compared with PMR. Trial Registration ClinicalTrials.gov identifier: NCT00440596.
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Affiliation(s)
- Joel W Hughes
- Department of Psychology, PO Box 5190, Kent, OH 44242.
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Corwin EJ, Guo Y, Pajer K, Lowe N, McCarthy D, Schmiege S, Weber M, Pace T, Stafford B. Immune dysregulation and glucocorticoid resistance in minority and low income pregnant women. Psychoneuroendocrinology 2013; 38:1786-96. [PMID: 23541234 PMCID: PMC4082825 DOI: 10.1016/j.psyneuen.2013.02.015] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 02/19/2013] [Accepted: 02/21/2013] [Indexed: 10/27/2022]
Abstract
Chronic prenatal stress contributes to poor birth outcomes for women and infants. Importantly, poor birth outcomes are most common among minority and low income women. To investigate underlying mechanisms, we tested the hypothesis that chronic stress related to minority or low income status is associated with glucocorticoid resistance as indicated by disruption in the cytokine-glucocorticoid feedback circuit. Home visits were conducted during which 3rd trimester pregnant women completed stress and depression surveys and provided blood for pro- and anti-inflammatory cytokines. Saliva was collected 5 times the preceding day for diurnal cortisol levels. For statistical analyses, women were grouped 3 ways, by race, income, and the presence or absence of either of those risk factors; this last group was labeled high or low general risk. Immune regulation was evaluated by evidence of a functioning negative feedback relationship between cytokines and cortisol. Of 96 participants, 18 were minority, 22 of low income, and 29 either minority or low income (high general risk). Pearson partial correlation identified a significant negative relationship between cortisol area under the curve (AUC) and pro- to anti-inflammatory cytokine ratios in the low general risk women (i.e., Caucasian, higher income) including IFNγ/IL10 (r=-0.73, p<0.0001), IL6/IL10 (r=-0.38, p=0.01), IL1β/IL10 (r=-0.44, p=0.004) and TNFα/IL10 (r=-0.41; p=0.005); no such correlations existed in the high general risk women (i.e., minority, low income) for (IFNγ/IL10: r=-0.25, p=0.43; IL6/IL10: r=0.12, p=0.70; IL1 β/IL10: r=0.05, p=0.87; TNFα/IL10: r=0.10; p=0.75), suggestive of glucocorticoid resistance. Cortisol levels throughout the day also were higher in minority and high general risk groups (p<0.05). Without cytokine glucocorticoid feedback, a pregnant woman's ability to regulate inflammation is limited, potentially contributing to adverse maternal and infant outcomes.
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Affiliation(s)
- Elizabeth J. Corwin
- Emory University, Nell Hodgson Woodruff School of Nursing and Department of Physiology, United States
,Corresponding author. Tel.: +1 404 712 9805., (E.J. Corwin).
| | - Ying Guo
- Emory University, Rollins School of Public Health, United States
| | | | - Nancy Lowe
- University of Colorado Denver, College of Nursing, United States
| | - Donna McCarthy
- The Ohio State University, College of Nursing, United States
| | - Sarah Schmiege
- University of Colorado Denver, College of Nursing, United States
| | - Mary Weber
- University of Colorado Denver, School of Nursing, United States
| | - Thaddeus Pace
- Emory University, College of Medicine, United States
| | - Brian Stafford
- University of Colorado Denver, College of Medicine, United States
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Parswani MJ, Sharma MP, Iyengar S. Mindfulness-based stress reduction program in coronary heart disease: A randomized control trial. Int J Yoga 2013; 6:111-7. [PMID: 23930029 PMCID: PMC3734636 DOI: 10.4103/0973-6131.113405] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Psychological risk factors such as anxiety and depression have been associated with coronary heart disease (CHD). Stress can have an impact on the risk factors for the disease, such as high blood pressure (BP), physical inactivity and being overweight. AIMS Examine the effect of the Mindfulness-Based Stress Reduction (MBSR) program on symptoms of anxiety and depression, perceived stress, BP and body mass index (BMI) in patients with CHD. SETTINGS AND DESIGN Intervention was carried out at an Outpatient clinic. Parallel group - MBSR group; and treatment-as-usual group (TAU) - randomized control design with pre- (baseline), post-intervention and follow-up assessments was adopted. MATERIALS AND METHODS Thirty male patients, age range (30-65 years) with CHD were randomly allocated to either group. The therapeutic program comprised of eight weekly sessions of structured MBSR intervention for the MBSR group and one health education session for the TAU group. Regular medical intervention and monthly consultations with the cardiologist were consistent for both groups. The main outcome measures were: Hospital Anxiety and Depression Scale, Perceived Stress Scale (perceived stress), BP and BMI. STATISTICAL ANALYSIS Independent sample t-tests, chi square test and paired sample t-test were used. RESULTS All patients completed intervention in the MBSR group. Significant reduction was observed in symptoms of anxiety and depression, perceived stress, BP and BMI in patients of the MBSR group after the completion of intervention assessment. At 3-month follow-up, therapeutic gains were maintained in patients of the MBSR group. CONCLUSION The MBSR program is effective in reducing symptoms of anxiety and depression, perceived stress, BP and BMI in patients with CHD.
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Affiliation(s)
- Manish J Parswani
- Tiaho Mai, Adult Acute Inpatient Mental Health Unit, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland, New Zealand
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Olex S, Newberg A, Figueredo VM. Meditation: should a cardiologist care? Int J Cardiol 2013; 168:1805-10. [PMID: 23890919 DOI: 10.1016/j.ijcard.2013.06.086] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 05/17/2013] [Accepted: 06/30/2013] [Indexed: 02/08/2023]
Abstract
Meditation refers to a family of practices that may share many similarities, but can have differences in underlying methods and goals. Religious and spiritual associations are common but are not requisite for meditation practice and it should be recognized that the basis of many if not all practices is the training of the brain and body, a process that appears to have profound effects on both structure and function. In recent decades there has been interest regarding the effects of these ancient practices on the cardiovascular system, as meditation has intuitive appeal for benefit in this area. Though there is a relative shortage of quality data, available evidence suggests that meditation may exert beneficial effects on autonomic tone, autonomic reflexes, and decrease blood pressure acutely and after long term practice. In addition, meditation has the potential to positively influence the cardiovascular system through the mind-heart connection and the anti-inflammatory reflex. There is limited but promising data to suggest that meditation based interventions can have beneficial effects on patients with established cardiovascular disease. More high quality and unbiased studies of meditation practices on relevant endpoints in cardiovascular disease are needed, including the effects of such practices on inflammation, baseline heart rate variability, arrhythmias, myocardial infarction, and cardiovascular mortality.
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Affiliation(s)
- Stephen Olex
- Einstein Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, PA, United States.
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Vaccarino V, Kondwani KA, Kelley ME, Murrah NV, Boyd L, Ahmed Y, Meng YX, Gibbons GH, Hooper WC, De Staercke C, Quyyumi AA. Effect of meditation on endothelial function in Black Americans with metabolic syndrome: a randomized trial. Psychosom Med 2013; 75:591-9. [PMID: 23788695 PMCID: PMC3774317 DOI: 10.1097/psy.0b013e31829ac4f4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Psychological stress may play a role in metabolic syndrome. A consequence of metabolic syndrome is endothelial dysfunction, which is also influenced by psychological stress. We sought to compare the effect of consciously resting meditation (CRM), a sound based meditation, with a control intervention of health education (HE) on endothelial function in the setting of metabolic syndrome. METHODS Sixty-eight black Americans with metabolic syndrome risk factors (age, 30-65 years) were randomized to either CRM (n = 33) or HE (n = 35); interventions were matched for frequency and duration of sessions and lasted 12 months. Endothelial function was assessed by brachial artery flow-mediated dilation at baseline and at 6 and 12 months. Arterial elasticity, metabolic risk factors, and psychosocial and behavioral variables were secondary end points. RESULTS Although flow-mediated dilation improved in the CRM group for 12 months, this increase was not significantly higher than that in the HE group (p = .51 for the interaction between group and time). Non-endothelium-dependent dilation and arterial elasticity did not change in either group. Most metabolic syndrome risk factors showed beneficial trends in the CRM group only. A risk factor score counting the number of metabolic syndrome components decreased in the CRM group only (p = .049 for the interaction between treatment group and time). CONCLUSIONS Among black Americans with metabolic syndrome risk factors, CRM, did not improve endothelial function significantly more than a control intervention of HE. CRM resulted in favorable trends in metabolic syndrome risk factors, which were examined as secondary outcomes.
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Affiliation(s)
- Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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