Biochemical and psychometric evaluation of Self-Healing Qigong as a stress reduction tool among first year nursing and midwifery students

Qigong Therapy for Stress Management: A Systematic Review of Randomized Controlled Trials

BACKGROUND/OBJECTIVE

Althouth Qigong is commonly used to manage stress, anxiety, and depression, there have been no systematic reviews on Qigong therapy for stress management. This study aimed to analyze the clinical evidence of Qigong therapy for perceived stress.

METHODS

We conducted a systematic search for randomized controlled trials (RCTs) of Qigong using 11 electronic databases, namely MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, CINAHL, and Korean Medical databases (Korea Institute of Science and Technology Information, Korean traditional knowledge portal, KoreaMed, OASIS, RISS, and the National Library of Korea). We considered RCTs in which participants with perceived stress with no restrictions on age, gender, or ethnicity. Two reviewers independently assessed risk of bias of the included RCTs using the Cochrane risk of bias tool. Nine RCTs (China: n = 5, South Korea: n = 2, United States: n = 1, Brunei Darussalam: n = 1) were included in the systematic review.

RESULTS

The quality of the included trials was generally low, as only one was rated as high quality. For the primary outcome, a meta-analysis of two RCTs showed statistically significant results on the perceived stress scale comparing the Qigong therapy group with the no-treatment group (OR -0.60; 95% CI -1.02 to -0.17; p = 0.006). The results of three other studies showed that Qigong therapy had no significant effect compared to active-control therapy on the perceived stress scale outcome (OR -2.10; 95% CI -4.68 to 0.47; p = 0.11). Regarding the secondary outcomes, including depression, anxiety scale, and quality of life, the Qigong group showed statistical improvements in most studies; however, there was no difference in the pain scale between the two groups. In two studies, no adverse events occurred, whereas in one study, six cases (24% of participants) of mild muscle soreness were reported.

CONCLUSIONS

This systematic review suggests the potential of Qigong therapy for stress management; however, it is difficult to draw specific conclusions. Future studies should standardize Qigong interventions and outcomes, establish sham control groups, and include larger sample sizes in RCTs.

Perceived stress and life satisfaction: the mediating roles of sport commitment and mobile phone addiction

This study aimed to investigate the relationship between perceived stress and life satisfaction under the influence of mobile phone addiction and sport commitment. Participants were recruited from eight universities located in six Chinese cities, naming Chongqing, Maoming, Nanjing, Suzhou, Shijiazhuang, and Zhengzhou. The sample consisted of 575 participants enrolled in Chinese universities, with 309 (53.7%) being female students. The mediation model was tested under the structural equation modeling framework using Mplus. Results showed that (1) perceived stress had a direct and negative impact on life satisfaction, and it also had indirect effects through the two mediators; (2) perceived stress positively predicted mobile phone addiction, which, in turn, negatively impacted life satisfaction; (3) perceived stress negatively predicted sport commitment, which, in turn, positively impacted life satisfaction. By emphasizing the mediating roles of mobile phone addiction and sport commitment, our findings highlight the importance of addressing these factors in interventions aimed at encouraging college students' well-being. Implications for intervention design to promoter health among university students should take into account the mediating roles of mobile phone addiction and sport commitment.

Effectiveness of interventions on occupational stress, health and well-being, performance, and job satisfaction for midwives: A systematic mixed methods review

BACKGROUND

Work-related stress is high in midwifery with negative implications for midwives' health and performance. This systematic review therefore examined which stress management interventions (SMIs) are most effective at reducing occupational stress and improving midwives' health and well-being, performance, and job satisfaction.

METHODS

A systematic review included studies if they were: investigating midwives or student midwives; examining an individual- or organisation-level intervention; reporting the intervention effects on at least one outcome (e.g., job performance); peer-reviewed; and published in English. Methodological quality was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was conducted and data were presented by SMI level (i.e., individual vs. organisation) and modality type (e.g., mindfulness, care model). Sum codes were used to compare the effects of individual- and organisation-level SMIs on outcomes.

FINDINGS

From 2605 studies identified, 30 were eligible (18 individual- and 12 organisation-level SMIs). Eight studies were deemed low quality. While individual- and organisation-level SMIs were equally effective in improving job satisfaction and performance, there was a trend for organisation-level SMIs more effectively reducing work stress and improving health and well-being. Specific individual- (i.e., mindfulness, simulation training) and organisation-level (i.e., reflective groups, midwifery care models) SMIs were most beneficial.

CONCLUSION

It is recommended that health practitioners and policy makers implement interventions that target both individual- and organisation-levels to optimally support midwives' work stress, health, well-being, and performance. Notwithstanding these findings and implications, some studies had poor methodological quality; thus, future research should better follow intervention reporting guidelines.

Comprehensive Review of Chronic Stress Pathways and the Efficacy of Behavioral Stress Reduction Programs (BSRPs) in Managing Diseases

The connection between chronic psychological stress and the onset of various diseases, including diabetes, HIV, cancer, and cardiovascular conditions, is well documented. This review synthesizes current research on the neurological, immune, hormonal, and genetic pathways through which stress influences disease progression, affecting multiple body systems: nervous, immune, cardiovascular, respiratory, reproductive, musculoskeletal, and integumentary. Central to this review is an evaluation of 16 Behavioral Stress Reduction Programs (BSRPs) across over 200 studies, assessing their effectiveness in mitigating stress-related health outcomes. While our findings suggest that BSRPs have the potential to enhance the effectiveness of medical therapies and reverse disease progression, the variability in study designs, sample sizes, and methodologies raises questions about the generalizability and robustness of these results. Future research should focus on long-term, large-scale studies with rigorous methodologies to validate the effectiveness of BSRPs.

Participant Perspectives on Community Qigong for People with Multiple Sclerosis

Introduction

Multiple sclerosis (MS) is a progressive neurodegenerative disorder affecting motor and nonmotor function including physical and cognitive decline, fatigue, anxiety, and depression. Qigong is a mind-body self-care practice with the potential to address MS symptoms. Publicly available community qigong classes may provide opportunities for people with MS to access qigong, but little is known about the risks and benefits. A mixed methods study of community qigong was conducted for people with MS. In this article, the results of this qualitative analysis to identify benefits and challenges faced by people with MS attending community qigong classes were presented.

Methods

Qualitative data were collected from an exit survey of 14 study participants with MS who enrolled in a pragmatic trial of community qigong classes for 10 weeks. Participants were new to community-based classes offered but some had experience with qigong/tai chi/other martial arts or yoga. Data were analyzed using reflexive thematic analysis.

Results and Discussion

Seven common themes were identified from this analysis: (1) physical function, (2) motivation/energy, (3) learning, (4) dedicating time for self, (5) meditation/centering/focus, (6) relaxation/stress relief, and (7) psychological/psychosocial. These themes reflected both positive and negative experiences with community qigong classes and home practice. Self-reported benefits centered around improved flexibility, endurance, energy, and focus; stress relief; and psychological/psychosocial benefits. Challenges included physical discomfort including short-term pain, balance difficulty, and heat intolerance.

Conclusion

The qualitative findings provide evidence to support qigong as a self-care practice that may benefit people with MS. The challenges identified in the study will help to inform future clinical trials of qigong for MS.

Trial Registration

ClinicalTrials.gov (CTR#: NCT04585659).

Effectiveness of interventions for academic burnout among nursing students: A systematic review

BACKGROUND

Nursing students experience higher stress and burnout compared to students in other health professions, with a prevalence rate of as high as 20%. More recently, they have been affected by changes in nursing education due to the COVID-19 pandemic, such as requirements for social isolation and distance learning. Although there are existing studies on interventions that address academic burnout among nursing students, there is no synthesis of randomized trials on this topic.

AIM

This study aimed to systematically synthesize studies of interventions for academic burnout among nursing students.

METHODS

A systematic search for randomized controlled trials was performed in PubMed, CINAHL, CENTRAL, Web of Science, and Scopus. Eligibility criteria were based on study directness in relation to the Patient, Intervention, Comparison, and Outcome (PICO) question. Two review authors independently screened articles for inclusion, collected data from the included studies, and performed risk of bias assessments using the Cochrane Risk of Bias Tool 2.0. A narrative synthesis was performed. This review was registered a priori in PROSPERO (CRD42022350196).

RESULTS

Six papers were included in this review. Various interventions were studied: Qigong exercises, progressive muscle relaxation, autogenic therapy and laughter therapy, didactic behavioral sessions focusing on personal and professional development, and coping skills enhancement. The effects of these interventions on academic burnout, depression, and stress among nursing students were short term and their benefits over time remain uncertain.

LINKING EVIDENCE TO ACTION

Progressive muscle relaxation and cognitive behavioral interventions demonstrated short-term positive effects on academic burnout, depression, and stress among nursing students. These findings may support the development of individual-level and organizational-level initiatives for nursing students aimed to lessen or prevent academic burnout. Large-scale, high-quality studies on the effect of interventions on academic burden in various settings and cultures are needed.

The effectiveness of interventions and behaviour change techniques to reduce stress in student nurses: A systematic review

BACKGROUND

Student nurses experience stress leading to poor health and course attrition (Lovegrove, 2018).

OBJECTIVES AND DESIGN

This systematic review aimed to evaluate the effectiveness of interventions and 'behaviour change techniques' (BCTs) to reduce student nurse stress. BCTs are active components of interventions that are observable, replicable, irreducible and designed to change behaviour (Michie et al., 2013).

DATA SOURCES

Thirteen databases were searched from inception to May 2020.

REVIEW METHODS

The interventions were classified according to their target: 'stressors', 'coping', 'cognitive reappraisal' or a combination of these (Lazarus and Folkman, 1984). BCTs were coded using the BCT taxonomy: a hierarchical framework of BCTs (Michie et al., 2013).

RESULTS

28 interventions reported in 23 articles were included in the review. A positive effect was identified in 22 interventions. There were no studies addressing the stressors in isolation and the interventions targeting stressors in combination with coping (n = 1) or cognitive reappraisal (n = 1) found no significant effects. In contrast, 74% of those targeting coping alone (n = 14/19), 100% of those addressing coping and cognitive reappraisal together (n = 4/4) and 66% addressing all three targets together (n = 2/3) were successful. The most common BCTs provided students with information and skills relating to stress management, with 18/21 being successful >50% of the time.

CONCLUSIONS

Overall, most interventions aimed to teach students skills to cope with stress, with the majority having a short-term effect. However, as some interventions and BCTs were infrequently used or poorly described and all studies had a medium-high risk of bias, there is a need for longitudinal high-quality studies.

The Effects of Tai Chi and Qigong Exercise on Psychological Status in Adolescents: A Systematic Review and Meta-Analysis

Background: The purpose of this study was to systematically review the effectiveness of Tai Chi and Qigong exercise on adolescents' symptoms of depression and anxiety, and psychological status based on clinical evidences, and to calculate the pooled results using meta-analysis. Methods: A systematic search using seven English and three Chinese databases was initiated to identify randomized controlled trials (RCT) and non-randomized comparison studies (NRS) assessing the effect of Tai Chi and Qigong exercise on psychological status among adolescents. Standardized mean differences (SMD) and their 95% confidence intervals (CI) were used to determine the pooled effect of the intervention. Study quality was evaluated using a Checklist to Evaluate a Report of a Non-pharmacological Trial (CLEAR-NPT) designed for non-pharmacological trials. Results: Four RCTs and six NRS were identified, including 1,244 adolescents. The results suggested a potential beneficial effect of Tai chi and Qigong exercise on reducing anxiety (SMD = 0.386, 95 CI% [0.233, 0.538]) and depression (SMD = 1.937 [95 CI%, 1.392-2.546]) symptoms, and reducing cortisol level (SMD = 0.621 [95 CI%, 0.18-1.062]) in adolescents. Conversely, non-significant effects were found for stress, mood, and self-esteem. Conclusions: The findings of this review suggest Qigong appears to be an effective therapeutic modality to improve psychological well-being in adolescents. Hope future studies will have rigorously designed, well-controlled randomized trials with large sample sizes in order to confirm these findings.

Potential therapeutic effect and methods of traditional Chinese medicine on COVID-19-induced depression: A review

COVID‐19 (coronavirus) has spread all over the world with a high infection rate. Currently, there are no targeted therapeutic drugs for COVID‐19 as well as for stress induced by COVID‐19. The unpredictable events of COVID‐19 can trigger feelings of fear, worry, or unease in people, leading to stress‐related disorders such as depression and anxiety. It has been reported that individuals, including COVID‐19 patients, medical staff, and ordinary people, are under both physical and psychological pressure, and many of them have developed depression or anxiety during this pandemic. Traditional Chinese medicine (TCM) has been widely used in treating depression with relatively better safety and efficacy and may have an important role in treating stress‐related disorders induced by COVID‐19. In this review, we collected the common TCM treatment methods including Qigong, Acupuncture, Five Elements Musical Therapy, Five Elements Emotional Therapy, and Chinese herbal medicine from the databases of PubMed and the China National Knowledge Internet to illustrate the effect of TCM on depression. The better knowledge of TCM and implementation of TCM in COVID‐19 clinics may help to effectively improve depression induced by COVID‐19, may assist people to maintain a healthy physical and mental quality, and may alleviate the current shortage of medical resources.

The Effect of a Web-Based Deep Breathing App on Stress of Direct Care Workers: Uncontrolled Intervention Study

Objectives: Studies have demonstrated success in reducing stress levels in complex interventions including deep breathing components. Breathing exercise interventions, however, tend not to be studied in isolation. The aim of the study was to examine the impact of a breathing exercise using a web-based app on the stress levels of direct care workers (DCWs) who serve people with intellectual and developmental disabilities. Design: Uncontrolled one-group intervention. Settings/Location: DCWs were recruited from intellectual and developmental disability service providers in a US Midwestern state. Subjects: Sixty-four DCWs who used the breathing exercise app at least 2 times. Interventions: Breathing exercise using a web-based app for a month. Outcome measures: Five measures were obtained from the data recorded in the app: initial stress level before exercise, exercise duration in minutes, change in stress level between before and after each breathing exercise, and frequency and number of days the app was used during a month. Participants' self-report of the number of days of app use was collected in a 1-month follow-up survey. Results: The participants appear to have a moderate stress level indicated by the initial stress level 5 out of 10. After the breathing exercise, the stress level decreased by 1.2 points from 5.0 (standard deviation [SD] = 1.8) to 3.7 (SD = 1.6) on average (paired t-test, p < 0.00005). Cohen's d 0.72 indicates a large effect size. Among within-individual factors, a higher initial stress level and longer app use per occasion were significantly associated with stress reduction. Among between-individual factors, only race was associated with stress reduction. Although there was no effect of being an African American alone on stress level change (coefficient = 0.44, 95% confidence interval = -0.29 to 1.18, p > 0.05), there was an additional reduction among African Americans in relation to the initial stress level, controlling for exercise duration. The number of breathing exercise days recorded in the app was not correlated with that of self-report (Pearson's correlation r = 0.12, p > 0.05). Although the app was used for 4.4 (SD = 4.2) days, participants reported using it for 10.7 (SD = 8.2) days on average in the follow-up survey. Conclusions: The findings suggest the benefit of breathing exercises using an app for reducing DCWs' stress levels. Regular use of such apps may assist with stress management and bolster overall health and well-being among DCWs.

Mind-Body Interventions for Anxiety Disorders: A Review of the Evidence Base for Mental Health Practitioners

Mind-body interventions have gained increasing popularity for use with anxiety symptoms; however, it is unclear what role they play in the treatment of anxiety disorders, such as generalized anxiety disorder, panic disorder, and social anxiety disorder. Although psychopharmacology and psychotherapy treatment interventions are available, mind-body interventions may be low-stigma options that can serve as effective alternatives. The goal of this review is to provide clinicians with an overview of high-quality studies for the most well researched mind-body interventions. This review involved a search of the primary literature, including meta-analyses, systematic reviews, and randomized controlled trials (RCTs), that evaluated mind-body interventions for the treatment of anxiety disorders. When published evidence was limited, lower-quality studies were reviewed. Overall, data were limited on the efficacy of most mind-body modalities for anxiety disorders. The highest-quality data existed for yoga, mindfulness-based interventions, and applied relaxation for anxiety disorders. However, findings were sometimes inconsistent across studies, and some studies were limited by small sample sizes, poorly defined randomization and blinding procedures, and inadequate control groups. Although not enough data exist to recommend mind-body interventions as primary treatment options, they may be considered as part of a larger treatment plan given their relatively low levels of risk. Future steps for researchers include conducting additional RCTs with adequate control groups, comparing mind-body treatments with existing treatments, and examining long-term effects of mind-body interventions.

Mind-Body Physical Activity Interventions and Stress-Related Physiological Markers in Educational Settings: A Systematic Review and Meta-Analysis

Mind–Body Physical Activity (MBPA) in educational settings is one possible preventive strategy for ameliorating stress-related physiological health parameters. The objectives of this study were to conduct a systematic review of the literature with meta-analyses on the effects of MBPA on stress-related physiological health markers in primary, secondary, and higher education students. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the search for peer-reviewed articles published in English was conducted in PubMed, EBSCOhost, PsychInfo, Scopus, and Cochrane Library databases. Criteria for inclusion consisted of empirical studies targeting the student population (primary, secondary, higher education), studies examining the effectiveness of an MBPA intervention, studies including a control or comparison group (pre-test/post-test studies excluded), studies targeting physiological marker outcomes such as heart rate, blood glucose, cortisol, and blood pressure, and finally, studies examining interventions implemented within educational settings. Twenty-six interventions were eligible for the review and quantitative synthesis, which comprised a total of 1625 participants, with 783 students serving within the control/comparison group. There were statistically significant and large pooled effects for MBPA effectiveness for lowering heart rate (Hedges’ g = −1.71, 95% Confidence Interval (CI): −2.43, −0.98), cortisol (Hedges’ g = −1.32, 95% CI: −2.50, −0.16), and systolic and diastolic blood pressure (Hedges’ g = −1.04, 95% CI: −1.53, −0.58). These effects tended to be stronger in older students compared to younger students. Most analyses were characterized as having high heterogeneity and only 10 of the 26 studies were characterized as good quality (38.4%). MBPA interventions may have a positive impact on specific physiological health markers in students, especially in students within higher education. However, higher-quality research is needed in this area.

Qigong for the treatment of depressive symptoms: Preliminary evidence of neurobiological mechanisms

OBJECTIVES

Qigong has been shown to effectively reduce depressive symptoms in older adults with chronic physical illness. Here, we sought to evaluate the effects of qigong on serotonin, cortisol, and Brain-derived Neurotropic Factors (BDNF) levels and test their roles as potential mediators of the effects of qigong on depressive symptoms.

METHODS

Thirty older adults with chronic physical illness participated in a randomized clinical trial. They were randomly assigned to a qigong group (n = 14) or a control group for cognitive training of executive function and memory (n = 16). The participants provided blood and saliva samples at baseline and post-intervention. Levels of cortisol were measured from the salvia samples, and serotonin and BDNF were measured from the blood samples.

RESULTS

Consistent with the study findings presented in the primary outcome paper, a significant Group × Time interaction effect emerged on depressive symptoms, explained by greater reductions in the qigong group than the control group. Qigong participants had significantly larger increases in serotonin and BDNF, and decreases in cortisol levels, compared with control group participants. Moreover, treatment-related changes in cortisol levels (but not serotonin or BDNF) fully mediated the beneficial effects of qigong on depressive symptoms.

CONCLUSION

The findings provide preliminary evidence that treatment-related changes in cortisol may mediate the benefits of qigong on depressive symptoms. Given the limitation of small sample size of the present study, future studies with larger sample sizes and more extended follow-up assessment are warranted to determine the reliability of these findings.

Individual Stress Prevention through Qigong

Owing to work intensification and an accelerated pace of life in general, individuals in many Western countries are often overactivated and find it difficult to switch off. However, recovery from physiological and mental activation is critical to prevent stress symptoms and maintain one’s physiological and mental well-being. Extensive research evidence indicates that Qigong, a traditional Chinese movement practice for promoting health, provides an effective means to recover from work and off-work demands. The main objective of this paper is to offer a comprehensive, narrative review of the effects of Qigong and its core components. Attention is first paid to the outcomes of work and off-work demands and stress, and the role of recovery for individuals’ well-being. Then, Qigong and its components are explained, followed by the results of scientific research. Finally, limitations and implications for research and practiced are discussed.

Hormonal Function Responses to Moderate Aerobic Exercise in Older Adults with Depression

Background

Poor daily life physical activities among older people were related to depressive mood especially memory loss. In addition to that, the change in physical ability is significantly associated with the score of depression among older age.

Objective

The present study aimed to evaluate the effects of a supervised aerobic training program with moderate intensity for 12 weeks on mood profiles and hormonal levels of the hypothalamus-pituitary-adrenal axis (HPA axis) of older adults.

Methods

A total of 80 individuals of both gender (90 males, 110 females) of ages ranged between 65 and 95 years were recruited for this study. Based upon the profile of mood states (POMS) analysis, the participants were classified into two groups: control group (n=30) and depressive group (n=50). Leisure-time physical activity (LTPA), adrenal hormones such as ACTH, corticosterone (CORT), cortisol, DHEA/S, and cortisol:DHEA/S ratio were measured at baseline and post-intervention of moderate aerobic exercise for 12 weeks.

Results

Older adults with higher depressive scores showed a remarkable change in the level of adrenal hormones compared to control. There was a significant increase in the level of ACTH, CORT, cortisol, and cortisol:DHEA/S ratio, and decrease in DHEA/S. Compared to females, males showed an improvement in depressive mood score along with an increase in LPTA, DHEA/S and decrease in ACTH, CORT, cortisol, cortisol:DHEA/S ratio following 12 weeks of supervised aerobic training, respectively.

Conclusion

The findings of this study showed that 12 weeks of supervised exercise interventions are promising non-drug therapeutic strategies in improving depression among older adults. The potential performance in a psychological state occurs physiologically via optimizing the levels of the hormones of the HPA axis.

Positive intervention for depression and teacher-student relationship in Iranian high school girl students with moderate/mild depression: a pilot randomized controlled trial

BACKGROUND

Positive intervention (PI) is a modern and therapeutic approach broadly based on the principles of positive psychology (Rashid in J Posit Psychol 1:25-40, 2014). PI effects at schools have received little attention to date. However, since PI offers a focus on the positive aspects of human experience (Seligman and Csikszentmihalyi in Am Psychol 55:5-14, 2000), we hypothesized that it could exert positive changes in the teacher-student relationship (TSR) and depression symptoms. Therefore, the mentioned pilot study conducted in this article aimed at evaluating PI effects on depression and TSR among Iranian high school girl students with moderate/mild depression.

METHOD

In this research, 60 eligible female students (aged 15-18) with a Beck Depression Inventory-II (BDI-II) mild-moderate depression diagnosis, were randomly divided into PI (n = 30) and control groups (n = 30) at the time of entering the study and 2 months later following their assessments through the Inventory of TSR (IT-SR) and BDI-II. The intervention group participated in 8-week 2 h group sessions of PI and the control group was evaluated without any intervention.

RESULTS

The study was completed with a total number of 49 girls [PI group (n = 24), and control group (n = 25)] and everybody participate in 8 sessions. The intervention group was effective on the variables of BDI-II and IT-SR in a way that the involved girls increased their communication (p = 0.001, d = 0.17), trust (p = 0.001 d = 0.14) after PI training and decreased alienation (p = 0.012, d = 0.11) and depression (p = 0.001, d = 0.15) among other high school students.

CONCLUSION

This intervention could function as an unspecific component of a stepped care approach for teenage girls suffering from depression. This study recommends more RCT with large sample sizes among high school boys students and follow-up.

Spiritual Coping with Stress Among Emergency and Critical Care Nurses: A Cross-Sectional Study

A cross-sectional study using Spiritual Coping Questionnaire (SCQ) to explore the spiritual stress coping among Muslim Emergency and Critical Care nurses. 113 Participants were recruited. SCQ demonstrated good validation estimates. Positive religious behavior was the main spiritual coping with job stress. Likewise, spiritual coping was highly perceived as religious. Critical care nurses reported significantly higher positive social coping. Nurses with longer work experiences were significantly better in positive spiritual coping. Spiritual coping practices are highly prevalent in healthcare settings despite still lacking integration of spiritual components in its physical infrastructure, health policy and management.

The Use of Tai-Chi to Reduce Anxiety Among Nursing Students Undergoing Simulation

This study sought to examine tai-chi as an anxiety-reducing method to increase self-efficacy and improve performance among baccalaureate nursing students experiencing a patient care simulation. The sample included 63 nursing students enrolled in a traditional or second-degree nursing program. The study used a randomized control group pretest-posttest design. Students in the experimental group experienced significant reductions in cognitive and somatic anxiety, along with an increase in self-efficacy and improved performance. Tai-chi can be an effective technique to reduce anxiety and improve self-efficacy and performance among nursing students in simulations.

The beneficial effects of Qigong on elderly depression

Health Qigong, especially the Eight-Section Brocades (or Baduanjin), has been well established as an effective adjunct intervention to alleviate depressive symptoms of older adults. The easy to learn and safe format of health Qigong allows the promotion and employment by health care professionals to improve the physical and psychosocial wellness of older adults. The cultural relevance of Qigong practice enhances its popularity as a health maintenance practice in Chinese community. In general, the antidepressive effects of Qigong are put forward through psychosocial, physiological, and neurobiological mechanisms. More specific, the beneficial effects of Qigong can be further substantiated by findings of several research studies.

Can physical exercise modulate cortisol level in subjects with depression? A systematic review and meta-analysis

INTRODUCTION

Major depressive disorder (MDD) is a prevalent medical illness that is associated with chronic stress. Patients with MDD can show an imbalance in cortisol levels, which can be restored with the remission of symptoms. Physical exercise training has been used as a tool to promote changes in cortisol levels in healthy individuals. However, it is unknown if exercise can produce the same results in individuals with MDD.

OBJECTIVE

To review evidence of cortisol changes after exercise training in individuals with MDD.

METHODS

We conducted a search on PubMed, SciELO, LILACS, ISI Web of Knowledge, Scopus, and PsycInfo databases. Random effects meta-analysis was performed and standardized mean difference (SMD) effect size was calculated. Analyses of forest and funnel plots was conducted using Stata v.11.0 software.

RESULTS

At first, 463 studies were obtained in the search. After completion of the selection procedure, five articles with seven analyses were included. Type of exercise, frequency of training, cortisol measurement, and type of control group were analyzed. There was a reduction of cortisol levels in the exercise group (SMD = -0.65, 95%CI 1.30-0.01). Moreover, sensitivity analysis and subgroup analyses revealed an effect of type (aerobic exercise) and frequency (five times per week) of exercise on reduction of cortisol levels. However, these results should be interpreted cautiously due to the small number of studies and a substantial heterogeneity among them.

CONCLUSION

Physical exercise promotes a reduction in cortisol levels in individuals with MDD. However, this finding can be influenced by type of exercise, weekly frequency, and type of cortisol measurement.

The Neurophysiological and Psychological Mechanisms of Qigong as a Treatment for Depression: A Systematic Review and Meta-Analysis

Objective: An increasing number of studies have shown the anti-depressive effect of qigong. However, its underlying mechanism remains poorly understood. This study aims to systematically review and meta-analyze existing literature on the mechanism of qigong in reducing depression. Method: The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials of qigong were searched from PsycINFO, PubMed, Embase, ScienceDirect, and Academic Search Premier from inception to December 2018. Studies which involved depression and any neurophysiological or psychological mechanisms as outcomes were included. Publication bias was tested before conducting meta-analysis. Two independent raters were involved for the entire review process. Results: A total of nine studies were identified which covered both neurophysiological and psychological mechanisms. Among these selected studies, seven were involved in meta-analysis, which suggested that qigong was effective in alleviating depression (standardized mean difference, SMD = -0.27, p < 0.05, I ² = 27%). A significant effect was also found for diastolic blood pressure (SMD = -1.64, p < 0.05, I ² = 31%). However, no significant effect was found for cortisol level and systolic blood pressure. Conclusions: This review shows that qigong is effective in reducing depression through activating the parasympathetic nervous system. Future studies with higher quality of research methodology with less selection and attrition bias should be conducted to unravel the possible anti-depressive effect of qigong.

Assessment of hormonal parameters and psychological well-being in healthy subjects after a Taoist qigong program: An exploratory study

Qigong is an ancient form of health maintenance, which is part of Traditional China Medicine. Numerous beneficial mental and physical effects have been classically ascribed to this traditional psychosomatic method. The purpose of this work has been to assess the effects of Taoist qigong practice on several hormonal parameters of the Hipotalamic-Pituitary-Adrenal axis and specific measures of psychological well-being in healthy subjects. Forty-three healthy volunteers participated in the study, of whom 22 were randomly allocated to the experimental group, and 21 were assigned to the control group. Experimental participants underwent a qigong training program for one month. Blood samples for the quantification of hormonal parameters, and several instruments to assess anxiety and depression symptoms as well as subjective sleep quality, were obtained before and after the program. Statistically significant differences were found between the experimental and control groups, with the experimental group showing lower blood levels of adrenocorticotropic hormone (ACTH). This study shows that Taoist qigong is a psychosomatic method able to exert a modulatory action on ACTH levels in healthy subjects. We consider the need to continue exploring the psychobiological modulation of this qigong method and its possible repercussion for human health care.

The effect of Imaginary Working Qigong on the psychological well-being of college students: Study protocol for a randomized controlled trial

INTRODUCTION

College students are special populations that are particularly prone to have significantly high level of psychological distress than their community peers. Apparently, the best way to manage stress and mental state is through self-care. The characteristic of Qigong is self-directed and self-healing, which is a traditional Chinese mind-body exercise, which has the potential as a stress management intervention. Imaginary Working Qigong, as a kind of static Qigong, is more perception-oriented and can bring about benign sensations of mind and body so as to eliminate stress completely and induce physiological and mental relaxation. In this study protocol, we will systematically examine the feasibility and acceptability of Imaginary Working Qigong on psychological outcomes of the college students and deeply explore molecular biological mechanisms underlying the effects of mind adjustment induced Imaginary Working Qigong.

METHODS/DESIGNS

We will conduct a randomized, assessor and statistician-blinded, parallel-controlled trial exploring the beneficial mind adjustment of Imaginary Working Qigong in college students.A total of 80 eligible college students from Beijing University of Chinese Medicine will be recruited and randomly allocated into Imaginary Working Qigong training or unaltered lifestyle control group according 1:1 allocation ratio with allocation concealment. Imaginary Working Qigong training will last 8 weeks. The study period is 12 weeks including a 4-week supervised training, 4-week independence training, and a 4-week follow-up. Relevant psychological outcomes measurement will take place at baseline, 5 weeks (at the end of supervised training), 9 weeks (at the end of independence training), and 13 weeks (after the 4-week follow-up period) by blinded independent outcome assessors.

CONCLUSION

This is the first randomized controlled trial protocol from the perspective of Qigong connotation to systematically evaluate the effects and relevant molecular mechanism of Imaginary Working Qigong for the mental health of a college student population. If our study demonstrates a significant intervention effect, this would provide preliminary higher-quality evidence and establish a further guidance for the application of Imaginary Working Qigong program among a college student population.

ETHICS AND DISSEMINATION

The study protocol and consent forms have been approved by the medical and animal experiment ethic committee of BUCM (approval number: BJZYYDX-LL2014005).

The effect of Three-Circle Post Standing (Zhanzhuang) Qigong on the physical and psychological well-being of college students: Study protocol for a randomized controlled trial

BACKGROUND

The physical and mental health of college students tends to continuously decline around the world due to lifestyle or behavior habits changes, and pervasive presence of the Internet. Thus it is urgent to improve their health in college life. As a traditional Qigong form is practiced mainly in a standing posture. Three-Circle Post Standing Qigong (TCPSQ) is suitable for regular practicing and has beneficial effects on improving the physiological function and psychological emotion by adjusting body, breathing, and mind. The aim of the 3 adjustments is to achieve a state of harmonious unity-integrating these adjustments into "one." In this study protocol article, we will systematically explore the effectiveness and safety, feasibility of TCPSQ on physical and psychological outcomes of the college students and deeply understand the state of harmonious unity-integrating adjustments of body, breath, and mind into "one."

METHOD/DESIGN

We will conduct a randomized, assessor, and statistician blinded, parallel-controlled trial comparing the beneficial effect of TCPSQ in college students. A total of 80 eligible college students from the Beijing University of Chinese Medicine (BUCM) will be recruited and randomly allocated into TCPSQ training or unaltered lifestyle control group according 1:1 allocation ratio with allocation concealment. TCPSQ intervention will last 10 weeks. The study period is 18 weeks including a 10-week supervised intervention and a 8-week follow-up. The relevant physical and psychological outcomes, adverse events, and safety will be evaluated at baseline, 6 weeks (at the mid-point of intervention), 11 weeks (at the end of intervention), and 19 weeks (after the 8-week follow-up period) by blinded independent outcome assessors.

DISCUSSION

This is the first randomized controlled trial protocol from the perspective of Qigong connotation to systematically investigate the effect of TCPSQ for the physical and mental health of a college student population. If the results in our study prove a significant intervention effect, this would provide preliminary higher-quality evidence and establish an optimal guidance for the application of TCPSQ exercise program among a college student population.

ETHICS AND DISSEMINATION

The study was approved by the ethics committee of the Beijing University of Chinese Medicine (approval number: 2018BZHYLL0109). A SPIRIT checklist is available for this protocol. The trial was registered in Chinese Clinical Trial Registry (WHO ICTRP member). Registration number: ChiCTR-BON-17010840.

The influence of ball-juggling on emotional states, blood pressure and sleep-quality among medical students during end-of-year exam preparation

Juggling-exposure therapy has been employed in the management of anxiety and post-traumatic stress disorder. However, there is little evidence of the effectiveness of juggling-exposure in improving emotional states in subclinical conditions. This study aimed at evaluating the effect of a course of juggling on emotional states, sleep quality and blood pressure among medical students at a critical stage of their academic training. Blood pressure, psychometric and quality of sleep assessments were performed pre- and post-examination period for two groups of students: juggling-exposed (n = 9) and non-juggling-exposed (n = 11). Juggling exposure consisted of practice-drills for one hour per week during the period spanning the student's scheduled exams. Comparisons were made between quantitative measures that were collected pre- and post-the course of juggling drills. Differences in scores and measures were expressed as percentage-change and compared between non-juggling and juggling groups. Overall, there was a decrease in depression and anxiety scores between the pre-to post-exam periods. This decrease was statistically significant for both non-juggling and juggling groups with respect to anxiety, but only the juggling-exposed group had a significant reduction regarding depression scores. However, when calculated as percentage-change over the pre-to post-exam period, there was no significant difference in any of the parameters for either of the two groups. Practicing juggling drills had an influence on emotional states.

Positive psychotherapy for depression and self-efficacy in undergraduate nursing students: A randomized, controlled trial

Nursing students across the globe experience depressive symptoms, and many interventions have been used to alleviate their depression. However, few interventions focus on students' personal strengths and advantages. The aim of the present study was to explore the effects of an 8-week group positive psychotherapy (PPT) programme on depression and self-efficacy in full-time undergraduate nursing students. A randomized, controlled trial was conducted for 76 nursing students (34 in the experimental group, 42 in the control group). The Beck Depression Inventory-II and the General Self-Efficacy Scale were used to collect data prior to, immediately after PPT, 3 months', and 6 months' post-PPT. Repeated-measures analysis of variance indicated that the intervention significantly alleviated depression and improved self-efficacy (each P < 0.05); the effect of time and time-group interaction was also significant (each P < 0.05). The findings suggest that PPT could significantly relieve depressive symptoms and improve self-efficacy. We recommend that PPT is effective in alleviating depression and improving self-efficacy in undergraduate nursing students. Academic mental health nurses should appreciate the value of PPT and consider incorporating it in psychological support methods in order to facilitate nursing students' mental health.

The Effect of Stress Management Training through PRECEDE-PROCEED Model on Occupational Stress among Nurses and Midwives at Iran Hospital, Iranshahr

INTRODUCTION

Occupational stress is a major factor in hindering the performance of nurses and midwives and developing physical and mental complications in them. Given that these two groups are in direct contact with patients more than other medical staff and stress management training can be effective in the reduction of occupational stress among the nurses and midwives.

AIM

This study was set out to compare the effect of a PRECEDE-PROCEED based stress management training program on the occupational stress of the nurses and midwives.

MATERIALS AND METHODS

This quasi-experimental study was conducted on the aforementioned nurses and midwives. Data collection instruments included the Nursing Stress Scale (NSS). The training program was held in two 4-hour-long sessions for three months from 1^st January to 31^st March 2013.

RESULTS

The results showed a significant increase in the PRECEDE scores of both groups by the end of the program, as compared to the baseline. A significant decrease was also observed in the stress scores of both groups. There was no difference between groups in these regards.

CONCLUSION

The PRECEDE-based stress management training is effective in the reduction of occupational stress among the nurses and midwives.

Effects of a Stress-Management Program for Inpatients With Mental Disorders: A Feasibility Study

Stress-management interventions have been integrated into treatments for people with mental disorders. Nevertheless, most studies on these interventions have been conducted on patients with schizophrenia in Western countries, and limited studies have used objective measurements of stress. We developed a group-based, four-session stress-management (S-Manage) program for people with mental disorders, consisting of two major components: psychoeducation and relaxation practice. This single-group, pretest-posttest, quasi-experimental study was undertaken to test the initial effects and determine the effect sizes of the program. A convenience sample of 55 inpatients were recruited from a mental health ward at a tertiary hospital in Singapore. Self-report questionnaires and physiological measures of stress (skin temperature and salivary immunoglobulin A [SIgA]) were used for data collection. Data were analyzed by descriptive statistics and repeated-measures analysis of variance. Most participants were Singaporean, female, single, and employed. Diagnoses included schizophrenia, depression, bipolar disorder, anxiety disorder, and mixed diagnoses. All received standard care provided by the hospital. Participants had significant reductions in objective stress, measured by skin temperature (effect size = 0.54) and SIgA (effect size = 0.16), and subjective stress (effect size = 0.16) as well as improved psychological health (effect size = 0.40) in response to the intervention. This study provides preliminary evidence to support the positive effects of the S-Manage program on people with mental disorders. Future studies should further test the efficacy of the program using more rigorous methods such as randomized controlled trial and multicenter study.

A study of the effect of relaxing music on heart rate recovery after exercise among healthy students

BACKGROUND

Music has been employed in various clinical settings to reduce anxiety. However, meta-analysis has shown music to have little influence on haemodynamic parameters. This study aimed at investigating the effect of relaxing music on heart rate recovery after exercise.

METHOD

Twenty-three student volunteers underwent treadmill exercise and were assessed for heart rate recovery and saliva analysis; comparing exposure to sedative music with exposure to silence during the recovery period immediately following exercise.

RESULTS

No differences were found between music and non-music exposure regarding: heart rate recovery, resting pulse rate, and salivary cortisol. Music was no different to silence in affecting these physiological measures, which are all associated with anxiety.

CONCLUSIONS

Relaxing music unaccompanied by meditation techniques or other such interventions may not have a major role in reducing anxiety in certain experimental settings.