A Systematic Review With Meta-Analysis of Mindful Exercises on Rehabilitative Outcomes Among Poststroke Patients

Participants With Acquired Brain Injury Realized They "Could Still Do Things" After a Yoga Intervention: A Qualitative Descriptive Study

IMPORTANCE

Occupational therapy practitioners use yoga in practice to achieve holistic care, and the American Occupational Therapy Association has provided guidance on the use of yoga in occupational therapy. For people with acquired brain injury (ABI), however, it is unknown whether yoga affects occupational performance.

OBJECTIVE

To explore the perceived impact of an adapted yoga intervention on occupational performance using the Occupational Therapy Practice Framework: Domain and Process (4th ed.; OTPF-4) for participants with ABI.

DESIGN

Qualitative descriptive study using virtual, semistructured interviews. An inductive, holistic, open-coding process, followed by a deductive process to map open codes to the OTPF-4.

PARTICIPANTS

Nine individuals with ABI were recruited from a yoga intervention study.

RESULTS

The theme generated from the data-"Yoga participants with ABI realized that they could still do quite a bit"-was supported by two major categories from the OTPF-4: Occupations and Performance Skills. Participants described improvements in their functional performance (i.e., motor skills, process skills) and how these factors were synergistically connected to their occupational performance (i.e., self-care, leisure).

CONCLUSIONS AND RELEVANCE

This study provides novel insight into how functional performance improved so participants could "still do things," such as engaging in occupations. When participants described improved performance skills, they simultaneously described re-engagement with their meaningful occupations. Participants also perceived an improvement in their mind-body connection, which should be further explored in future studies. This study generated original findings about participants' perceptions of an adapted yoga intervention as they relate to the OTPF-4. Plain-Language Summary: This study reports individuals' perceptions of their re-engagement with occupations and changes in occupational performance skills after participating in an adaptive yoga intervention. We highlight the distinct contribution that adaptive yoga-an intervention modality that can be used by occupational therapy practitioners-may have, using the OTPF-4 to connect the participants' perceptions about their improvements in occupational performance.

Neurobiomechanical mechanism of Tai Chi to improve upper limb coordination function in post-stroke patients: a study protocol for a randomized controlled trial

BACKGROUND

Upper limb dysfunction seriously affects the ability of stroke patients to perform activities of daily living. As a popular exercise therapy, Tai Chi may become an alternative intervention. However, the neurophysiological mechanism by which Tai Chi improves upper limb dysfunction in stroke patients is still unclear, which limits its further promotion and application. Therefore, conducting a strict randomized clinical trial is necessary to observe how Tai Chi affects upper limb dysfunction in stroke patients and to explore its neurophysiological mechanism.

METHODS/DESIGN

This report describes a randomized, parallel-controlled trial with distributive concealment and evaluator blinding. A total of 84 eligible participants will be randomly assigned to the Tai Chi group or the control group in a 1:1 ratio. The participants in the Tai Chi group will receive 4 weeks of Tai Chi training: five 60-min sessions a week for a total of 20 sessions. The participants in the control group will not receive Tai Chi training. Both groups will receive medical treatment and routine rehabilitation training. The primary outcome measure is the mean change in the Fugl-Meyer Assessment Upper Extremity (FMA-UE) scale score between baseline and 4 weeks; the secondary outcomes are the mean changes in kinematic characteristics and the Wolf Motor Function Test (WMFT) and Stroke Impact Scale (SIS) scores. In addition, the corticomuscular coupling level and near-infrared brain functional imaging will be monitored to explore the mechanism by which Tai Chi improves upper limb function of stroke patients.

DISCUSSION

This randomized controlled trial will examine the effectiveness of Tai Chi in stroke patients with upper limb dysfunction and explore the neurophysiological mechanism. Positive results will verify that Tai Chi can improve upper limb function of stroke patients.

TRIAL REGISTRATION

Chinese Clinical Trial Registration Center, ChiCTR2200061376 (retrospectively registered). Registered June 22, 2022. http://www.chictr.org.cn/listbycreater.aspx . Manuscript Version: 3.0 Manuscript Date: October 10, 2023.

Effects of brain-Computer interface combined with mindfulness therapy on rehabilitation of hemiplegic patients with stroke: a randomized controlled trial

Aim

To explore the effects of brain-computer interface training combined with mindfulness therapy on Hemiplegic Patients with Stroke.

Background

The prevention and treatment of stroke still faces great challenges. Maximizing the improvement of patients' ability to perform activities of daily living, limb motor function, and reducing anxiety, depression, and other social and psychological problems to improve patients' overall quality of life is the focus and difficulty of clinical rehabilitation work.

Methods

Patients were recruited from December 2021 to November 2022, and assigned to either the intervention or control group following a simple randomization procedure (computer-generated random numbers). Both groups received conventional rehabilitation treatment, while patients in the intervention group additionally received brain-computer interface training and mindfulness therapy. The continuous treatment duration was 5 days per week for 8 weeks. Limb motor function, activities of daily living, mindfulness attention awareness level, sleep quality, and quality of life of the patients were measured (in T0, T1, and T2). Generalized estimated equation (GEE) were used to evaluate the effects. The trial was registered with the Chinese Clinical Trial Registry (ChiCTR2300070382).

Results

A total of 128 participants were randomized and 64 each were assigned to the intervention and control groups (of these, eight patients were lost to follow-up). At 6 months, compared with the control group, intervention group showed statistically significant improvements in limb motor function, mindful attention awareness, activities of daily living, sleep quality, and quality of life.

Conclusion

Brain-computer interface combined with mindfulness therapy training can improve limb motor function, activities of daily living, mindful attention awareness, sleep quality, and quality of life in hemiplegic patients with stroke.

Impact

This study provides valuable insights into post-stroke care. It may help improve the effect of rehabilitation nursing to improve the comprehensive ability and quality of life of patients after stroke.

Clinical review registration

https://www.chictr.org.cn/, identifier ChiCTR2300070382.

The effectiveness of mind-body approaches for enhancing resilience in older adults: A systematic review and network meta-analysis

BACKGROUND

Resilience in older adults is associated with good well-being and resilience training has been shown to be beneficial. Mind-body approaches (MBAs) combine physical and psychological training in age-appropriate exercise programs.This study aims to evaluate the comparative effectiveness of different modes of MBAs in enhancing resilience in older adults.

METHOD

Electronic databases and a manual search were searched to identify randomized controlled trials of different MBA modes. Data from the included studies were extracted for fixed-effect pairwise meta-analyses. Quality and risk were assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Cochrane's Risk of Bias tool, respectively. Pooled effect sizes with a standardized mean difference (SMD) and a 95% confidence interval (CI) were used to quantify the impact of MBAs in enhancing resilience in older adults. Network meta-analysis was employed to evaluate the comparative effectiveness of different interventions. The study was registered in PROSPERO (Registration No. CRD42022352269).

RESULTS

Nine studies were included in our analysis. Pairwise comparisons indicated that MBAs, regardless of whether they were related to yoga, could significantly enhancing resilience in older adults (SMD: 0.26, 95% CI 0.09-0.44). With strong consistency, a network meta-analysis showed that physical and psychological programs and yoga-related programs were associated with resilience improvement (SMD: 0.44, 95% CI 0.01-0.88 and SMD: 0.42, 95% CI 0.06-0.79, respectively).

CONCLUSION

High quality evidence demonstrates that two MBA modes-physical and psychological programs and yoga-related programs-enhance resilience in older adults. However, long-term clinical verification is required to confirm our results.

The Western origins of mindfulness therapy in ancient Rome

Stoic philosophy has multiple parallels with cognitive behavioural therapy interventions. In their ancient texts, the Roman Stoics present a set of theoretical principles and behavioural strategies that are directly relevant to the clinical care of patients with a wide range of neuropsychiatric conditions. Mindfulness is a key component of the 'third wave' of modern psychotherapy that closely resembles the ancient Stoic practice of attention or 'concentration on the present moment'. Stoic mindfulness draws attention to one of the main principles driving both Stoicism and modern psychotherapy: the assumption that cognitive activity (reasoning) mediates emotions and behaviours. This principle can be traced back to Epictetus' Enchiridion, where he recognises that 'men are disturbed not by things, but by the views which they take of things'. It has been shown that cognitive behavioural therapies and mindfulness-based interventions directed at patients with neuropsychiatric disorders were originally developed as Stoic-inspired treatment interventions. Both Albert Ellis and Aaron Beck (the founders of rational emotive behaviour therapy and cognitive behavioural therapy, respectively) explicitly acknowledged the role of Stoicism as the philosophical precursor of their treatment approaches. The effective implementation of evidence-based guidelines would benefit from an increased awareness of the influence of the Stoic tradition of philosophical therapy on the treatment approaches currently in use in neuropsychiatry.

Effectiveness Evaluation of Repetitive Transcranial Magnetic Stimulation Therapy Combined with Mindfulness-Based Stress Reduction for People with Post-Stroke Depression: A Randomized Controlled Trial

Background: Post-stroke depression (PSD) is most prevalent during the rehabilitative period following a stroke. Recent studies verified the effects of repetitive transcranial magnetic stimulation therapy (rTMS) and mindfulness-based stress reduction (MBSR) in patients with depression. However, the effectiveness and prospect of application in PSD patients remain unclear. This study sought to evaluate the effectiveness of a combined intervention based on rTMS and MBSR for the physical and mental state of PSD patients. Methods: A randomized, double-blind, sham-controlled study design was employed. Participants were recruited from the Rehabilitation Medicine Centre and randomly assigned to receive either MBSR combined with active or sham rTMS or sham rTMS combined with general psychological care. We used a 17-item Hamilton Depression Rating Scale (HAMD-17), a mini-mental state examination (MMSE), the Modified Barthel Index (MBI), and the Pittsburgh Sleep Quality Index (PSQI) to evaluate depressed symptoms, cognitive function, activities of daily living (ADL), and sleep quality at baseline, post-intervention, and the 8-week follow-up. A two-factor analysis of variance was used to compare differences between groups, and Pearson’s linear correlation was used to analyze the possible relationship between variables and potential predictors of depression improvement. Results: Seventy-two participants were randomized to rTMS−MBSR (n = 24), sham rTMS−MBSR (n = 24), or sham rTMS−general psychological care (n = 24). A total of 71 patients completed the questionnaire, a 99% response rate. There were significant time and group interaction effects in HAMD-17, MMSE, MBI, and PSQI scores (p < 0.001). The repeated-measure ANOVA showed a significant improvement of all variables in rTMS−MBSR compared to sham rTMS−MBSR and sham rTMS combined with general psychological care (p < 0.05). Additional results demonstrated that cognitive function, sleep quality, and activities of daily living are associated with depressive symptoms, and cognitive function is a potential variable for improved depression. Conclusion: Depressive symptoms can be identified early by assessing cognitive function, and rTMS−MBSR might be considered a potentially helpful treatment for PSD.

Persisting cognitive impairment predicts functional dependence at 1 year after stroke and transient ischemic attack: a longitudinal, cohort study

OBJECTIVE

Minor stroke or transient ischemic attack (TIA) usually have mild and nondisabling symptoms, and these functional deficits may recover fully e.g., TIA, however, part of them still suffer from cognitive impairment and poor outcomes. We conducted a study to determine the relationship between cognition evaluated by Montreal Cognitive Assessment (MoCA) and poor functional outcomes assessed by the Modified Rankin Scale (mRS) (mRS ≥ 2) and Stroke Impact Scale (SIS)-16(SIS-16<25%).

METHODS

The data of this study come from the impairment of cognition and Sleep (ICONS) after acute ischemic stroke or transient ischemic attack in Chinese patients study. A total of 1675 minor stroke patients and TIA patients were finally recruited. Patients' cognition were evaluated by Montreal Cognitive Assessment (MoCA) scale at 2-week (2w), 3 months (3 m) and 1 year(1y). Cognitive impairment (CI) was defined as MoCA score ≤ 22. According to MoCA score, patients were divided into 4 groups: no PSCI group: with MoCA-2w>22 and MoCA-3 m>22; improved PSCI group: with MoCA-2w ≤ 2 and MoCA-3 m>22;delayed PSCI group: MoCA-2w>22 and MoCA-3 m ≤ 22; persisting PSCI group: with MoCA-2w ≤ 22 and MoCA-3 m ≤ 22.

RESULTS

A total of 1675 stroke patients were recruited in this study. There were 818 patients (48.84%) who had PSCI at baseline. Of these, 123 patients (15%) had mRS ≥2 at 3 months. The persisting PSCI group was a significant predictor of functional dependence at 3 months and 1 year after stroke and when adjusted for covariates such as gender, age, history of stroke, depression and intracranial atherosclerotic stenosis, stroke subtype and acute infarction type.

CONCLUSION

Persisting PSCI increased the risk of poor functional outcome after 3 months and 1 year follow-up. These high-risk individuals should be identified for targeted rehabilitation and counseling to improve longer-term post-stroke outcome.

Stroke survivors' expectations and post-intervention perceptions of mindfulness training: A qualitative study

Depression and anxiety are common sequelae of stroke, occurring in at least one-third of patients. This study evaluated the acceptability and feasibility of providing mindfulness training (MT) to stroke survivors with the aim of reducing depression and anxiety. Following a six-week one-on-one MT course, 17 participants were interviewed. The median age of participants was 71, and 10 participants were male. This paper focuses on participants' expectations of the MT and their views about its impact on their everyday lives. Conventional content analysis was used for coding and analysis. A single theme, Seizing rehabilitation opportunities, was captured in relation to expectations of MT, and four themes provided information relating to participants' perceived impact of the course: Calming the mind, Reduced reactivity, Remedying physical symptoms, and Not quite there yet.Most participants knew little about mindfulness before the MT and did not have specific goals in mind when volunteering to take part. The findings suggest that most participants considered MT beneficial through reducing stress and giving them additional skills to cope with their everyday lives. A tailored mindfulness intervention may be a useful adjunct to other rehabilitation therapies for stroke survivors.

The effects of forest therapy on public mental health and circular economy: A policy support model in Japan

Background

Forest therapy has gained popularity in Japan and even other nations/regions due to its health benefits. In addition, forest therapy has contributed to the development of circular economy and industrial upgrading. Japanese successful practice can serve as a model for other countries in the Asia-Pacific region. To this end, the aim of this study was to determine whether forest therapy can improve the whole well-being of the participants and has a positive effect on the development of circular economy in the region.

Methods

Both empirical and inductive research methods were used; empirical approach was conducted to perform comparative analysis of regional data that was retrieved from the research project of Japanese Forestry Agency in 2015. Specifically, the efficacy of forest therapy on physical (blood glucose, blood pressure, body weight) and mental (sleep quality e.g.,) health outcomes among 815 participants was investigated. Regional data are from the statistics of Iiyama City from 1990 to 2005. After the concept of forest therapy became popular in the late 1990s, this element had a great positive impact on the economic benefits of Ishiyama City and other major forest scenic areas. We summarize and analyze a series of policies made by relevant departments of the Japanese government in the years from 2019 to 2021 to promote forest therapy and related circular industry development.

Results

Significant (pre-to-post participation) changes in physical measure was observed. Firstly, mean weight of those overweight participants decreased across three different time points (pre-test/enrollment = 79.7 kg, 3-month participation = 77.2, and 6-month participation = 76.8 kg), while overall mean weight of the participants decreased to 61, 60.5, and 60.4 kg, respectively. Secondly, Participant with normal weight showed a decrease on mean HbA1C (from 6.09 to 6.06) at Week 24, while overweight participants demonstrated a slight change 6.03-6.01 after 6 months the average HOMA-IR for overweight participants decreased from 3.5 to 2.5 at Week 24, while participants with normal weight demonstrated a decrease from 2.2 to 1.7 at Week 24. Forest Therapy has emerged in Japan since Mid-1990s and has attracted a large number of tourists all over the world due to its unique health benefits.

Conclusion

Forest therapy in Japan has positive effects on whole well-being of Japanese residents and it has helped public mental health promotion and economic growth. Under the guidance and support of government policies, it can promote the development of circular economy and industrial transformation and set a model of Japanese forest therapy development for other countries in the Asia-Pacific region.

Effects and mechanisms of mindfulness training and physical exercise on cognition, emotional wellbeing, and brain outcomes in chronic stroke patients: Study protocol of the MindFit project randomized controlled trial

Background

Post-stroke cognitive and emotional complications are frequent in the chronic stages of stroke and have important implications for the functionality and quality of life of those affected and their caregivers. Strategies such as mindfulness meditation, physical exercise (PE), or computerized cognitive training (CCT) may benefit stroke patients by impacting neuroplasticity and brain health.

Materials and methods

One hundred and forty-one chronic stroke patients are randomly allocated to receive mindfulness-based stress reduction + CCT (n = 47), multicomponent PE program + CCT (n = 47), or CCT alone (n = 47). Interventions consist of 12-week home-based programs five days per week. Before and after the interventions, we collect data from cognitive, psychological, and physical tests, blood and stool samples, and structural and functional brain scans.

Results

The effects of the interventions on cognitive and emotional outcomes will be described in intention-to-treat and per-protocol analyses. We will also explore potential mediators and moderators, such as genetic, molecular, brain, demographic, and clinical factors in our per-protocol sample.

Discussion

The MindFit Project is a randomized clinical trial that aims to assess the impact of mindfulness and PE combined with CCT on chronic stroke patients’ cognitive and emotional wellbeing. Furthermore, our design takes a multimodal biopsychosocial approach that will generate new knowledge at multiple levels of evidence, from molecular bases to behavioral changes.

Clinical trial registration

www.ClinicalTrials.gov, identifier NCT04759950.

Effects of Wu Qin Xi exercise on reactive inhibition in Parkinson’s disease: A randomized controlled clinical trial

Objective

Motor symptom in patients with Parkinson’s disease (PD) are related to reduced motor inhibitory ability (proactive and reactive inhibition). Although exercise has been shown to improve this ability, its effects on different levels of motor inhibition have not been determined.

Materials and methods

Sixty patients with PD aged 55–75 years were allocated randomly to 24-week exercise interventions [Wu Qin Xi exercise (WQX) and stretching exercise (SE)]. The stop signal task and questionnaires were administered pre and post interventions. Twenty-five age-matched healthy controls were recruited to obtain reference values for inhibition.

Results

Compared to healthy controls, patients with PD showed motor inhibition deficits in reactive inhibition, but not in proactive inhibition. Post-intervention, the WQX group showed significant improvement in reactive inhibition compared to the SE group. In both the WQX and SE groups, movement speed was improved post-intervention, accompanied by reduction in negative emotions, stable improvement of sleep quality, and high self-reported satisfaction levels.

Conclusion

This study demonstrated that Wu Qin Xi exercise can improve the reactive inhibition of patients with PD. Our results provide theoretical support for the formulation of reasonable and effective exercise prescriptions for PD rehabilitation.

Clinical trial registration

[http://www.chictr.org.cn], identifier [ChiCTR2000038517].

A protocol and novel tool for systematically reviewing the effects of mindful walking on mental and cardiovascular health

To our knowledge, no published systematic review has described the effects of mindful walking on mental and cardiovascular health. We have aimed to fill this gap by first establishing our systematic review protocol. Our protocol was adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and is registered in PROSPERO (Registration Number: CRD42021241180). The protocol is described step-by-step in this paper, which we wrote to achieve three objectives: to adhere to the best practices stated in the PRISMA guidelines, to ensure procedural transparency, and to enable readers to co-opt our protocol for future systematic reviews on mindful walking and related topics. To achieve our third objective, we provide and explain a novel tool we created to track the sources we will find and screen for our review. Ultimately, the protocol and novel tool will lead to the first published systematic review about mindful walking and will also facilitate future systematic reviews.

Connecting Mind-Body Therapy-Mediated Effects to Pathological Features of Alzheimer's Disease

Alzheimer's disease (AD) is a complex, multifactorial neurodegenerative disorder that represents a major and increasing global health challenge. In most cases, the first clinical symptoms of AD are preceded by neuropathological changes in the brain that develop years to decades before their onset. Therefore, research in the last years has focused on this preclinical stage of AD trying to discover intervention strategies that might, if implemented effectively, delay or prevent disease progression. Among those strategies, mind-body therapies such as yoga and meditation have gained increasing interest as complementary alternative interventions. Several studies have reported a positive impact of yoga and meditation on brain health in both healthy older adults and dementia patients. However, the underlying neurobiological mechanisms contributing to these effects are currently not known in detail. More specifically, it is not known whether yogic interventions, directly or indirectly, can modulate risk factors or pathological mechanisms involved in the development of dementia. In this article, we first review the literature on the effects of yogic practices on outcomes such as cognitive functioning and neuropsychiatric symptoms in patients with mild cognitive impairment and dementia. Then, we analyze how yogic interventions affect different risk factors as well as aspects of AD pathophysiology based on observations of studies in healthy individuals or subjects with other conditions than dementia. Finally, we integrate this evidence and propose possible mechanisms that might explain the positive effects of yogic interventions in cognitively impaired individuals.

Mindfulness-based interventions: an overall review

INTRODUCTION

This is an overall review on mindfulness-based interventions (MBIs).

SOURCES OF DATA

We identified studies in PubMed, EMBASE, CINAHL, PsycINFO, AMED, Web of Science and Google Scholar using keywords including 'mindfulness', 'meditation', and 'review', 'meta-analysis' or their variations.

AREAS OF AGREEMENT

MBIs are effective for improving many biopsychosocial conditions, including depression, anxiety, stress, insomnia, addiction, psychosis, pain, hypertension, weight control, cancer-related symptoms and prosocial behaviours. It is found to be beneficial in the healthcare settings, in schools and workplace but further research is warranted to look into its efficacy on different problems. MBIs are relatively safe, but ethical aspects should be considered. Mechanisms are suggested in both empirical and neurophysiological findings. Cost-effectiveness is found in treating some health conditions.

AREAS OF CONTROVERSY

Inconclusive or only preliminary evidence on the effects of MBIs on PTSD, ADHD, ASD, eating disorders, loneliness and physical symptoms of cardiovascular diseases, diabetes, and respiratory conditions. Furthermore, some beneficial effects are not confirmed in subgroup populations. Cost-effectiveness is yet to confirm for many health conditions and populations.

GROWING POINTS

Many mindfulness systematic reviews and meta-analyses indicate low quality of included studies, hence high-quality studies with adequate sample size and longer follow-up period are needed.

AREAS TIMELY FOR DEVELOPING RESEARCH

More research is needed on online mindfulness trainings and interventions to improve biopsychosocial health during the COVID-19 pandemic; Deeper understanding of the mechanisms of MBIs integrating both empirical and neurophysiological findings; Long-term compliance and effects of MBIs; and development of mindfulness plus (mindfulness+) or personalized mindfulness programs to elevate the effectiveness for different purposes.

Effects of Acute and Chronic Exercises on Executive Function in Children and Adolescents: A Systemic Review and Meta-Analysis

Background: Physical exercises can affect executive function both acutely and chronically, with different mechanisms for each moment. Currently, only a few reviews have elaborated on the premise that different types of exercises have different mechanisms for improving executive function. Therefore, the primary purpose of our systematic review was to analyze the effects of acute and chronic exercises on executive function in children and adolescents. Objective: We identified acute and chronic exercise studies and randomized controlled trials (RCTs) of executive function in children and adolescents that reported overall effect, heterogeneity, and publication bias of acute and chronic exercises on executive function. Methods: We searched for RCTs of exercise interventions in children and adolescents from databases including PubMed, Web of Science, Scopus, The Cochrane Library, CNKI (China National Knowledge Infrastructure), and Wanfang, from January 1 2009 to December 31 2019. We performed methodological quality evaluations on the included literature using the Physiotherapy Evidence Database Scale (PEDro) and graded evidence with a meta-analysis using Stata 12.0 software. Results: In total, 36 RCTs were included (14 acute exercises, 22 chronic exercises); the overall results of the meta-analysis (4,577 students) indicated that acute exercises significantly improved working memory (standardized mean difference (SMD) = -0.72; 95% confidence interval (CI) -0.89 to -0.56; p < 0.001), inhibitory control (SMD = -0.25; 95% CI -0.40 to -0.09; p = 0.002), and cognitive flexibility (SMD = -0.34; 95% CI -0.55 to -0.14; p < 0.005), whereas chronic exercises significantly improved working memory (SMD = -0.54; 95% CI -0.74 to -0.33; p < 0.001), inhibitory control (SMD = -0.30; 95% CI -0.38 to -0.22; p < 0.001), and cognitive flexibility (SMD = -0.34, 95 % CI -0.48 to -0.20, p < 0.001). Conclusion: Acute and chronic exercises can effectively improve the executive function of children and adolescents. The effects on inhibitory control and cognitive flexibility are considered as small effect sizes, while the effects on working memory are considered as moderate effect size. Limited by the quantity and quality of the included studies, the above conclusions need to be verified with more high-quality studies.

Living the Full Catastrophe: A Mindfulness-Based Program to Support Recovery from Stroke

Decades of research suggest that Mindfulness-Based Stress Reduction (MBSR) training supports a greater capacity to live with chronic medical conditions and contributes to lowering stress levels. This paper introduces a model for a Mindfulness-Based Recovery from Stroke (MBRfS) for promoting stroke recovery, informed by the lived experience of the author (a stroke survivor and certified MBSR instructor), the research literature regarding MBSR training, and the specific challenges of stroke recovery. Four themes emerged from the autoethnographic analysis that informed the proposed model: Readiness to accept the stroke event and the acquired brain injury, navigating uncertainties of stroke recovery with awareness and self-responsibility for outcomes, trusting the inherent wisdom of the body as a stroke recovery "teacher", and increased capacity to integrate complex emotions with self-compassion, and a sense of wholeness. A four-component MBRfS model is offered, which consists of an integration amongst a modified MBSR framework, emergent attitudinal themes, and insights from the autoethnographic vignettes. The MBRfS model offers a path for providing participants with a supportive experience within stroke recovery. Recommendations and suggestions for future studies are offered to support the development of MBRfS for stroke survivors and their caregivers, as well as contributing to healthcare providers.

Effects of Mind-Body Interventions Involving Meditative Movements on Quality of Life, Depressive Symptoms, Fear of Falling and Sleep Quality in Older Adults: A Systematic Review with Meta-Analysis

Background: The aim of the present systematic meta-analytical review was to quantify the effects of different mind–body interventions (MBI) involving meditative movements on relevant psychological health outcomes (i.e., quality of life (QoL), depressive symptoms, fear of falling (FoF) and sleep quality) in older adults without mental disorders. Methods: A structured literature search was conducted in five databases (Ovid, PsycINFO, PubMed, SPORTDiscus, Web of Science). Inclusion criteria were: (i) the study was a (cluster) randomized controlled trial, (ii) the subjects were aged ≥59 years without mental illnesses, (iii) an intervention arm performing MBI compared to a non-exercise control group (e.g., wait-list or usual care), (iv) psychological health outcomes related to QoL, depressive symptoms, FoF or sleep quality were assessed and (v) a PEDro score of ≥5. The interventions of the included studies were sub-grouped into Tai Chi/Qigong (TCQ) and Yoga/Pilates (YP). Statistical analyses were conducted using a random-effects inverse-variance model. Results: Thirty-seven randomized controlled trials (RCTs) (comprising 3224 participants) were included. Small to moderate-but-significant overall effect sizes favoring experimental groups (Hedges’ g: 0.25 to 0.71) compared to non-exercise control groups were observed in all outcomes (all p values ≤ 0.007), apart from one subdomain of quality of life (i.e., social functioning, p = 0.15). Interestingly, a significant larger effect on QoL and depressive symptoms with increasing training frequency was found for TCQ (p = 0.03; p = 0.004). Conclusions: MBI involving meditative movements may serve as a promising opportunity to improve psychological health domains such as QoL, depressive symptoms, FoF and sleep quality in older adults. Hence, these forms of exercise may represent potential preventive measures regarding the increase of late-life mental disorders, which need to be further confirmed by future research.

Associations between changes in gait parameters, balance, and walking capacity during the first 3 months after stroke: a prospective observational study

BACKGROUND

Independent ambulation is a common rehabilitation goal after stroke, requiring adequate balance and efficiency of gait. Spatiotemporal gait parameters are expected to improve in the first 3 months and their association with balance and efficiency of gait may provide useful insights into the recovery of safe and independent mobility.

OBJECTIVE

Examine the associations between changes in spatiotemporal gait parameters, balance, and walking capacity during the first 3 months after stroke.

METHODS

This prospective observational study included participants diagnosed with stroke. Within the first 2 weeks after stroke onset and again 3 months (±2 weeks) later, gait was assessed using a GAITRite mat at self-selected gait speed, balance using the Berg Balance Scale (BBS), and walking capacity using the 6-minute walk test (6 MWT). Changes in gait parameters, balance, and walking capacity were assessed using paired sample t-tests, and linear regression analyses were used to assess associations between changes in spatiotemporal gait parameters, BBS, and 6MWT.

RESULTS

Seventy-nine participants (mean (SD) age 75.4 (8.5) years; 44 men) were included. Gait parameters, balance, and walking capacity all improved during follow-up. The bivariate regression analyses showed associations between improvements in all gait parameters, except walk ratio, with improvement in balance, and in all gait parameters with improvement in walking capacity. Only gait speed was associated with balance (13.8 points, 95% CI 0.5, 27.8, p = .0042) and walking capacity (256 m, 95% CI 173,340, p < .001) in the multivariate analyses.

CONCLUSION

Improved spatiotemporal gait parameters were associated with improved balance and walking capacity within the first 3 months after stroke.

The Rehabilitative Effects of Virtual Reality Games on Balance Performance among Children with Cerebral Palsy: A Meta-Analysis of Randomized Controlled Trials

This research aims to evaluate the effect of virtual reality (VR) games on balance recovery of children with cerebral palsy (CP) by quantitatively synthesizing the existing literature, and to further determine the impact of VR game intervention (the duration of each intervention, intervention frequency, intervention cycle, and total intervention time) on the balance recovery of children with CP. To this end, relevant literature up until 3 August 2019 was retrieved from Chinese databases (CNKI and Wanfang Data) and the databases in other languages (Web of Science, Pubmed, EBSCOhost, Informit, Scopus, Science Direct, and ProQuest), and bias analysis was conducted with the PEDro scale in this research. Randomized controlled trials (RCTs) were selected and underwent meta-analysis, and combined effect size was calculated with a random effects model. The results showed that VR games may improve the balance of children with CP (Hedge’s g = 0.29; 95% CI 0.10–0.48), and no significant influence of the intervention on balance of children with CP was shown in the subgroup analysis. In conclusion, VR games played a positive role in the improvement of balance of children with CP, but these results should be viewed with caution owing to current methodological defects (difference in measurement, heterogeneity of control groups, intervention combined with other treatments, etc.).

The Effect of Virtual Reality Games on the Gross Motor Skills of Children with Cerebral Palsy: A Meta-Analysis of Randomized Controlled Trials

This review aimed to systematically evaluate the rehabilitatitive effect of Virtual Reality Games (VRGs) for gross motor skills of children with cerebral palsy (CP), and to give scientific grounds for the formulation of rehabilitation therapy for these children. To this end, the literature in Chinese databases (CNKI and Wanfang Data) as well as the databases of other countries (Web of Science, PubMed, EBSCOhost, Informit, Scopus, Science Direct and ProQuest) from the establishment dates of these databases to June 3rd 2019 was retrieved in order to collect randomized controlled trials with regard to the intervention effect of VRGs and traditional therapy on gross motor skills of children with CP, and the literature was screened as per inclusion and exclusion criteria. The PEDro scale was then used to evaluate the methodological quality of the included literature, and the software Review Manager 5.3 was employed to analyze the combined effect size. As a result, 7 randomized controlled trials and 234 children with CP were included. Meta-analysis showed that VRGs could improve gross motor skills of children with CP. Combined effect size of gross motor skills SMD = 0.37 [95% CI = (0.06, 0.68), p = 0.02)]. In conclusion, the VRG intervention program can enhance gross motor skills of children with CP to some extent. In view of the limitations regarding methodologies and the quality and quantity of the literature in this research, more quality randomized controlled trials are needed so as to draw convincing conclusions of effect of VRG intervention on gross motor skill development of children with CP in future studies.

The Effect of Tai Chi Chuan on Negative Emotions in Non-Clinical Populations: A Meta-Analysis and Systematic Review

Tai Chi Chuan (TCC) as a typical mind-body practice has been investigated for its preventive role on negative emotions and has demonstrated its efficacy in healthy populations. However, the results are not consistent. We performed a meta-analysis and systematically evaluated the effect of TCC on selected negative emotions (i.e., anxiety and depression). Fourteen experimental studies from three English-and two Chinese-language databases were evaluated. The results showed that the positive effects of TCC on negative emotions were moderately to largely significant. In addition, although TCC significantly improved negative emotions in both the young adults and the older adults, old adults benefited more from TCC than young adults. These findings suggest that TCC is a worthy complementary non-pharmacological resource towards depression and anxiety and, thus, has great implications for the public health domain.

Are Mindful Exercises Safe and Beneficial for Treating Chronic Lower Back Pain? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: Chronic low back pain (CLBP) is a common health issue worldwide. Tai Chi, Qigong, and Yoga, as the most widely practiced mindful exercises, have promising effects for CLBP-specific symptoms. Objective: We therefore conducted a comprehensive review investigating the effects of mindful exercises versus active and/or non-active controls while evaluating the safety and pain-related effects of mindful exercises in adults with CLBP. Methods: We searched five databases (MEDLINE, EMBASE, SCOPUS, Web of Science, and Cochrane Library) from inception to February 2019. Two investigators independently selected 17 eligible randomized controlled trials (RCT) against inclusion and exclusion criteria, followed by data extraction and study quality assessment. Standardized mean difference (SMD) was used to determine the magnitude of mindful exercises versus controls on pain- and disease-specific outcome measures. Results: As compared to control groups, we observed significantly favorable effects of mindful exercises on reducing pain intensity (SMD = −0.37, 95% CI −0.5 to −0.23, p < 0.001, I² = 45.9 %) and disability (SMD = −0.39, 95% CI −0.49 to −0.28, p < 0.001, I² = 0 %). When compared with active control alone, mindful exercises showed significantly reduced pain intensity (SMD = −0.40, p < 0.001). Furthermore, of the three mindful exercises, Tai Chi has a significantly superior effect on pain management (SMD= −0.75, 95% CI −1.05 to −0.46, p < 0.001), whereas Yoga-related adverse events were reported in five studies. Conclusion: Findings of our systematic review suggest that mindful exercises (Tai Chi and Qigong) may be beneficial for CLBP symptomatic management. In particular, Tai Chi appears to have a superior effect in reducing pain intensity irrespective of non-control comparison or active control comparison (conventional exercises, core training, and physical therapy programs). Importantly, training in these mindful exercises should be implemented with certified instructors to ensure quality of movement and injury prevention.

Superior Effects of Modified Chen-Style Tai Chi versus 24-Style Tai Chi on Cognitive Function, Fitness, and Balance Performance in Adults over 55

Background: Cognitive decline and balance impairment are prevalent in the aging population. Previous studies investigated the beneficial effects of 24-style Tai Chi (TC-24) on either cognitive function or balance performance of older adults. It still remains largely unknown whether modified Chen-style TC (MTC) that includes 18 complex movements is more beneficial for these age-related health outcomes, as compared to TC-24. Objective: We investigated if MTC would show greater effects than TC-24 on global cognitive function and balance-related outcomes among older adults. Methods: We conducted a randomized trial where 80 eligible adults aged over 55 were allocated into two different styles of Tai Chi (TC) arms (sixty-minute session × three times per week, 12 weeks). Outcome assessments were performed at three time periods (baseline, Week 6, and Week 12) and included the Chinese Version of the Montreal Cognitive Assessment (MoCA) for overall cognitive function, One-leg Standing Test (LST) for static balance, Timed Up and Go Test (TUGT) for dynamic balance, chair Stand Test (CST) for leg power, and the six-meter Walk Test (6MWT) for aerobic exercise capacity. Results: Compared to TC-24 arm, MTC arm demonstrated significantly greater improvements in MoCA, LST, TUGT, CST, and 6MWT (all p < 0.05). Conclusions: Both forms of TC were effective in enhancing global cognitive function, balance, and fitness. Furthermore, MTC was more effective than TC-24 in enhancing these health-related parameters in an aging population.

Wuqinxi Qigong as an Alternative Exercise for Improving Risk Factors Associated with Metabolic Syndrome: A Meta-Analysis of Randomized Controlled Trials

Background: The improvement of living standards has led to increases in the prevalence of hypokinetic diseases. In particular, multifactorial complex diseases, such as metabolic syndrome, are becoming more prevalent. Currently, developing effective methods to combat or prevent metabolic syndrome is of critical public health importance. Thus, we conducted a systematic review to evaluate the existing literature regarding the effects of Wuqinxi exercise on reducing risk factors related to metabolic syndrome. Methods: Both English- and Chinese-language databases were searched for randomized controlled trials investigating the effects of Wuqinxi on these outcomes. Meanwhile, we extracted usable data for computing pooled effect size estimates, along with the random-effects model. Results: The synthesized results showed positive effects of Wuqinxi exercise on systolic blood pressure (SBP, SMD = 0.62, 95% CI 0.38 to 0.85, p < 0.001, I² = 24.06%), diastolic blood pressure (DBP, SMD = 0.62, 95% CI 0.22 to 1.00, p < 0.001, I² = 61.28%), total plasma cholesterol (TC, SMD = 0.88, 95% CI 0.41 to 1.36, p < 0.001, I² = 78.71%), triglyceride (TG, SMD = 0.87, 95% CI 0.49 to 1.24, p < 0.001, I² = 67.22%), low-density lipoprotein cholesterol (LDL-C, SMD = 1.24, 95% CI 0.76 to 1.72, p < 0.001, I² = 78.27%), and high-density lipoprotein cholesterol (HDL, SMD = 0.95, 95% CI 0.43 to 1.46, p < 0.001, I² = 82.27%). In addition, regression results showed that longer-duration Wuqinxi intervention significantly improved DBP (β = 0.00016, Q = 5.72, df = 1, p = 0.02), TC (β = −0.00010, Q = 9.03, df = 1, p = 0.01), TG (β = 0.00012, Q = 6.23, df = 1, p = 0.01), and LDL (β = 0.00011, Q = 5.52, df = 1, p = 0.02). Conclusions: Wuqinxi may be an effective intervention to alleviate the cardiovascular disease risk factors of metabolic syndrome.

The Beneficial Effects of Mind-Body Exercises for People With Mild Cognitive Impairment: a Systematic Review With Meta-analysis

OBJECTIVE

To objectively evaluate the most common forms of mind-body exercise (MBE) (tai chi, yoga, qigong) on cognitive function among people with mild cognitive impairment (MCI).

DATA SOURCES

We searched 6 electronic databases (Scopus, PubMed, PsycINFO, WanFang, Web of Science, CNKI) from inception until September 2018.

STUDY SELECTION

Nine randomized controlled trials and 3 nonrandomized controlled trials were included for meta-analysis.

DATA EXTRACTION

Two researchers independently performed the literature searches, study selection, data extraction, and methodological quality assessment using the revised Physiotherapy Evidence Database (PEDro) scale.

DATA SYNTHESIS

The pooled effect size (standardized mean difference [SMD]) was calculated while random-effect model was selected. Overall results of the meta-analysis (N=1298 people with MCI) indicated that MBE significantly improved attention (SMD=0.39, 95% confidence interval [CI] 0.07-0.71, P=.02, I²=31.6%, n=245), short-term memory (SMD=0.74, 95% CI 0.57-0.90, P<.001, I²=0%, n=861), executive function (SMD=-0.42, 95% CI -0.63 to -0.21, P<.001, I²=38.54%, n=701), visual-spatial/executive function (SMD=0.35, 95% CI 0.07-0.64, P<.05, I²=0%, n=285), and global cognitive function (SMD=0.36, 95% CI 0.2-0.52, P<.001, I²=15.12%, n=902). However, the significant positive effect on cognitive processing speed was not observed following MBE interventions (SMD=0.31, 95% CI -0.01 to 0.63, P=.054, I²=28.66%, n=233).

CONCLUSIONS

Study findings of this meta-analysis suggest that MBE have the potential to improve various cognitive functions in people with MCI.

Tai Chi as an Alternative Exercise to Improve Physical Fitness for Children and Adolescents with Intellectual Disability

Objective: The purpose of this study was to investigate the effects of Tai Chi (TC) on anthropometric parameters and physical fitness among children and adolescents with intellectual disabilities (ID). Methods: Sixty-six Chinese individuals engaged in sport-related extracurricular activities (TC and aerobic exercise (AE)) as exercise interventions or arts/crafts activities as a control condition (CON). The experimental protocol consisted of a baseline assessment, a 12-week intervention period, and a post-intervention assessment. Results: Significant interaction effect was only observed in the performance of a 6-min walk test. After 12 weeks of intervention, the AE group had significant changes in body mass index (p = 0.006, d = 0.11), sit-ups (p = 0.030 and d = 0.57), and 6-min walk test (p = 0.005, d = 0.89). Significant increases in vertical jump (p = 0.048, d = 0.41), lower-limb coordination (p = 0.008, d = 0.53), and upper-limb coordination (p = 0.048, d = 0.36) were observed in the TC group. Furthermore, the TC group demonstrated significantly greater improvements on balance compared to the control group (p = 0.011). Conclusions: TC may improve leg power and coordination of both lower and upper limbs, while AE may be beneficial for body mass index, sit-ups and cardiorespiratory fitness.

Qigong-Based Therapy for Treating Adults with Major Depressive Disorder: A Meta-Analysis of Randomized Controlled Trials

This current meta-analysis review was conducted to examine the effectiveness of Qigong-based therapy on individuals with major depressive disorder. Six electronic databases (PubMed, PsycINFO, Cochrane Library, and Web of Science, Chinese National Knowledge Infrastructure, and Wangfang) were employed to retrieve potential articles that were randomized controlled trials. The synthesized effect sizes (Hedges' g) were computerized to explore the effectiveness of Qigong-based therapy. Additionally, a moderator analysis was performed based on the control type. The pooled results indicated that Qigong-based therapy has a significant benefit on depression severity (Hedges' g = -0.64, 95% CI -0.92 to -0.35, p < 0. 001, I² = 41.73%). Specifically, Qigong led to significantly reduced depression as compared to the active control groups (Hedges' g = -0.47, 95% CI -0.81 to -0.12, p = 0.01, I² = 22.75%) and the passive control groups (Hedges' g = -0.80, 95% CI -1.23 to -0.37, p < 0.01, I² = 48.07%), respectively. For studies which reported categorical outcomes, Qigong intervention showed significantly improved treatment response rates (OR = 4.38, 95% CI 1.26 to 15.23, p = 0.02) and remission rates (OR = 8.52, 95% CI 1.91 to 37.98, p = 0.005) in comparison to the waitlist control group. Conclusions: Qigong-based exercises may be effective for alleviating depression symptoms in individuals with major depressive disorder. Future well-designed, randomized, controlled trials with large sample sizes are needed to confirm these findings.

The Effects of Tai Chi Chuan Versus Core Stability Training on Lower-Limb Neuromuscular Function in Aging Individuals with Non-Specific Chronic Lower Back Pain

Objectives: For this paper, we aimed to investigate the effects of Tai Chi Chuan (TCC) versus the Core Stability Training (CST) program on neuromuscular function (NF) in the lower extremities among aging individuals who suffered from non-specific chronic lower back pain (NLBP). Regarding the design, during a 12-week intervention, a single-blinded randomized controlled trial was used to compare two intervention groups with a control group on the parameters of NF. Methods: Forty-three Chinese community-dwellers were randomly assigned into two intervention groups (three sessions per week, with each session lasting 60 min in TCC and CST) and a control group. The patient-based Visual Analogue Scale (VAS) was used to measure the level of perceived pain, while parameters of NF as primary outcomes were measured by the Biodex System 3 Isokinetic Dynamometer. Results: For the knee joint, we observed significant differences in the endurance of left extension at a speed of 60°/s: (1) between TCC and control groups (p < 0.01); (2) between CST and control groups (p < 0.01). For the ankle joint, significant differences between CST and control groups were observed on the peak torque of left dorsiflexion (p < 0.05) and the endurance of the left plantar flexion at a speed of 60°/s (p < 0.05). In addition, we observed a significant difference between TCC and control groups in the endurance of the right plantar flexion (p < 0.05). Conclusions: Chen-style TCC and CST were found to have protective effects on NF in aging individuals with NLBP, while alleviating non-specific chronic pain.

The Effects of Tai Chi on Markers of Atherosclerosis, Lower-limb Physical Function, and Cognitive Ability in Adults Aged Over 60: A Randomized Controlled Trial

Objective: The purpose of this study was to investigate the effects of Tai Chi (TC) on arterial stiffness, physical function of lower-limb, and cognitive ability in adults aged over 60. Methods: This study was a prospective and randomized 12-week intervention trial with three repeated measurements (baseline, 6, and 12 weeks). Sixty healthy adults who met the inclusion criteria were randomly allocated into three training conditions (TC-24, TC-42, and TC-56) matched by gender, with 20 participants (10 males, 10 females) in each of the three groups. We measured the following health outcomes, including markers of atherosclerosis, physical function (leg power, and static and dynamic balance) of lower-limb, and cognitive ability. Results: When all three TC groups (p < 0.05) have showed significant improvements on these outcomes but overall cognitive ability at 6 or 12 weeks training period, TC-56 appears to have superior effects on arterial stiffness and static/dynamic balance in the present study. Conclusions: Study results of the present study add to growing body of evidence regarding therapeutic TC for health promotion and disease prevention in aging population. Future studies should further determine whether TC-42 and TC-56 are beneficial for other non-Chinese populations, with rigorous research design and follow-up assessment.

Chen-Style Tai Chi for Individuals (Aged 50 Years Old or Above) with Chronic Non-Specific Low Back Pain: A Randomized Controlled Trial

Tai Chi (TC) can be considered safe and effective intervention to improve pain and pain-related functional disability. However, it is unclear that whether aging individuals with Chronic Non-Specific Low Back Pain (CNS-LBP) can achieve positive results. This study, therefore, attempted to explore the effects of TC on pain and functional disability in CNS-LBP patients aged 50 years old or above. Forty-three individuals (aged 50 years old or above) with CNS-LBP were randomly assigned into three groups: Chen-Style TC group (n = 15), Core Stabilization training (CST) group (n = 15), and control group (n = 13). Participants in the TC group participated in Chen-style TC training program (three 60-min sessions per week for 12 weeks), individuals in CST group received 12-week Core Stabilization exercise on the Swiss ball, whereas individuals in the control group maintained their unaltered lifestyle. Pain intensity as primary outcome was measured using the Visual Analogue Scale (VAS), A BiodexSystem 3 isokinetic dynamometer was used to measure knee and ankle joint position sense (JPS) as secondary outcomes at baseline and after the 12-week intervention. TC and CST have significant effects in VAS for CNS-LBP patients (p< 0.01, TC group OR CST group versus control group in mean of the post-minus-pre assessment). However, the feature of joint position sense (JPS) of ankle inversion, ankle eversion and knee flexion did not occur, it showed no significant effects with TC and CST. TC was found to reduce pain, but not improve lower limb proprioception in patients with CNS-LBP. Future research with larger sample sizes will be needed to achieve more definitive findings on the effects of TC on both pain and lower limb proprioception in this population.

Mind-Body Exercise (Wuqinxi) for Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective: This study is the first meta-analysis investigating the rehabilitative effects of Wuqinxi for patients with chronic obstructive pulmonary disease (COPD). Methods: Five electronic databases (PubMed, Web of Science, Scopus, CNKI, and Wanfang) from inception until early November 2018 were searched. All randomized controlled trials (RCT) using Wuqinxi as the main intervention component were included for meta-analysis. The pooled effect sizes (Standardized mean difference, SMD) were calculated to determine the magnitude of the Wuqinxi intervention effect. Moderator analysis was only conducted for total training time. Results: Overall results of the meta-analysis indicated that Wuqinxi exercise significantly improved exercise capability (SMD = 1.18, 95% CI 0.53 to 1.84, e < 0.001, I² = 84.97%), FEV1 (SMD = 0.44, 95% CI 0.12 to 0.77, e < 0.001, I² = 33.77%), FEV1% (SMD = 0.59, 95% CI 0.24 to 0.93, e < 0.001, I² = 63.79%), FEV1/FVC (SMD = 0.65, 95% CI 0.37 to 0.93, e = 0.006, I² = 44.32%) and CCQ (SMD = 1.23, 95% CI 0.31 to 2.14, e = 0.01, I² = 93.32%). Conclusions: With no occurrence of adverse event, clinicians could try to incorporate Wuqinxi exercise into their first-line rehabilitation regime for COPD patients.

The Effects of Tai Chi on Heart Rate Variability in Older Chinese Individuals with Depression

Background Very little research has been done to simultaneously investigate the effects of Tai Chi (TC) on depression and heart rate variability (HRV). This study, therefore, attempted to explore the effects of TC on depression and on HRV parameters. Methods Sixty older individuals with depression score of 10 or above (the Geriatric Depression Scale, GDS) were randomly assigned into two groups: TC (n = 30) and control group (n = 30). Participants in the experimental group participated in a 24-week TC training program (three 60-min sessions per week), whereas individuals in the control group maintained their unaltered lifestyle. Depression and HRV were measured using the GDS and digital electrocardiogram at baseline and after the 24-week intervention. Results The TC had produced significant positive chances in depression and some HRV parameters (mean heart rate, RMSSD, HF, LFnorm, and HFnorm) (p < 0.05), whereas these positive results were not observed in the control group. Conclusions The results of this study indicated that TC may alleviate depression of the elderly through modulating autonomous nervous system or HRV parameters. This study adds to a growing body of research showing that TC may be effective in treating depression of the elderly. Tai Chi as a mild to moderate mind-body exercise is suitable for older individuals who suffer from depression.

Effects of Mind⁻Body Exercises (Tai Chi/Yoga) on Heart Rate Variability Parameters and Perceived Stress: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

Background: Heart rate variability (HRV) as an accurate, noninvasive measure of the Autonomous Nervous System (ANS) can reflect mental health (e.g., stress, depression, or anxiety). Tai Chi and Yoga (Tai Chi/Yoga), as the most widely practiced mind–body exercises, have shown positive outcomes of mental health. To date, no systematic review regarding the long-lasting effects of Tai Chi/Yoga on HRV parameters and perceived stress has been conducted. Objective: To critically evaluate the existing literature on this topic. Methods: Five electronic databases (Web of Science, PubMed, Scopus, SportDiscus and Cochrane Library) were searched from the start of the research project to July 2018. Study selection, data extraction, and study quality assessment were independently carried out by two reviewers. The potentially identified randomized controlled trials (RCT) reported the useful quantitative data that were included only for meta-analysis. Results: meta-analysis of 17 medium-to-high quality RCTs showed significantly beneficial effects on HRV parameters (normalized low-frequency, Hedge’s g = −0.39, 95% CI −0.39 to −0.56, p < 0.001, I2 = 11.62%; normalized high-frequency, Hedge’s g = 0.37, 95% CI 0.22 to −0.52, p < 0.001, I2 = 0%; low-frequency to high-frequency ratio, Hedge’s g = −0.58, 95% CI −0.81 to −0.35, p < 0.001, I2 = 53.78%) and stress level (Hedge’s g = −0.80, 95% CI −1.17 to −0.44, p < 0.001, I2 = 68.54%). Conclusions: Stress reduction may be attributed to sympathetic-vagal balance modulated by mind–body exercises. Tai Chi/Yoga could be an alternative method for stress reduction for people who live under high stress or negative emotions.

Mind⁻Body (Baduanjin) Exercise Prescription for Chronic Obstructive Pulmonary Disease: A Systematic Review with Meta-Analysis

Baduanjin exercise is a traditional Chinese health Qigong routine created by an ancient physician for health promotion. Its mild-to-moderate exercise intensity is suitable for individuals with medical conditions. Recently, a large number of trials have been conducted to investigate the effects of Baduanjin exercise in patients with chronic obstructive pulmonary disease (COPD). It remains to be determined whether Baduanjin exercise prescription is beneficial for the management of COPD patients. Thus, we conducted a systematic review to objectively evaluate the existing literature on this topic. We searched six databases (PubMed, Web of Science, Cochrane Library, Scopus, China National Knowledge Infrastructure, and Wanfang) from inception until early May 2018. The adapted Physical Therapy Evidence Database (PEDro) scale was used for study quality assessment of all randomized controlled trials (RCTs). Based on 95% confidence interval (CI), the pooled effect size (Hedge's g) of exercise capability (6-Minute Walking Test, 6-MWT), lung function parameters (forced expiratory volume in one second, FEV₁; forced volume vital capacity, FVC; FEV₁/FVC ratio), and quality of life were calculated based on the random-effects model. Twenty RCTs (n = 1975 COPD patients) were included in this review, with sum scores of the adapted PEDro scale between 5 and 9. Study results of the meta-analysis indicate that Baduanjin is effective in improving exercise capability (Hedge's g = 0.69, CI 0.44 to 0.94, p < 0.001, I² = 66%), FEV₁ (Hedge's g = 0.47, CI 0.22 to 0.73, p < 0.001, I² = 68.01%), FEV₁% (Hedge's g = 0.38, CI 0.21 to 0.56, p < 0.001, I² = 54.74%), FVC (Hedge's g = 0.39, CI 0.22 to 0.56, p < 0.001, I² = 14.57%), FEV₁/FVC (Hedge's g = 0.5, CI 0.33 to 0.68, p < 0.001, I² = 53.49%), and the quality of life of COPD patients (Hedge's g = -0.45, CI -0.77 to -0.12, p < 0.05, I² = 77.02%), as compared to control groups. Baduanjin exercise as an adjunctive treatment may potentially improve exercise capability and pulmonary function of COPD patients as well as quality of life. Baduanjin exercise could be tentatively prescribed for COPD in combination with the conventional rehabilitation program to quicken the process of recovery. To confirm the positive effects of Baduanjin exercise for COPD patients, future researchers need to consider our suggestions mentioned in this article.

Effects of Mind⁻Body Movements on Balance Function in Stroke Survivors: A Meta-Analysis of Randomized Controlled Trials

Objective: We performed a systematic review with meta-analysis and meta-regression to determine if mind⁻body movements (MBM) could be effective in rehabilitating balance function among stroke survivors. Methods: A literature search was conducted using major Chinese and English electronic databases from an inception until January 2018. Randomized controlled studies were included in our meta-analysis. Data was independently extracted by two review authors using a pre-developed table and confirmed by a third party to reach a consensus. Pooled effect size (Hedge’s g) was computed while the random-effect model was set. Results: The meta-analytic results showed a significant benefit of the MBM intervention on increased balance function compared to the control groups (Hedge’s g = 1.59, CI 0.98 to 2.19, p < 0.001, I² = 94.95%). Additionally, the meta-regression indicated that the total number of sessions (β = 0.00142, 95% CI 0.0039 to 0.0244, p = 0.0067) and dose of weekly training (β = 0.00776, 95% CI 0.00579 to 0.00972, p = 0.00) had significantly positive effects on balance function. Conclusions: The study encouraging findings indicate the rehabilitative effect of a MBM intervention for balance function in stroke survivors. However, there were significant limitations in the design among several of the included trials. Additional studies with more robust methodologies are needed to provide a more definitive conclusion.