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Khanal MK, Karimi L, Saunders P, Schneider RH, Salerno J, Livesay K, Hallam KT, de Courten B. The promising role of Transcendental Meditation in the prevention and treatment of cardiometabolic diseases: A systematic review. Obes Rev 2024:e13800. [PMID: 39072971 DOI: 10.1111/obr.13800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 06/22/2024] [Accepted: 06/23/2024] [Indexed: 07/30/2024]
Abstract
Psychological distress has a demonstrable impact on cardiovascular diseases (CVD) and risk factors. Transcendental Meditation (TM) has been shown to reduce stress and improve health and well-being. The current review aimed to synthesize the evidence on the effects of TM on cardiometabolic outcomes and identify gaps for future research. We searched PubMed/MEDLINE, EMBASE, SCOPUS, and Web of Science databases for relevant literature. Forty-five papers that reported studies of TM on cardiometabolic risk factors and diseases were included. Evidence shows that TM is effective in reducing blood pressure (BP). We found some evidence that TM can improve insulin resistance and may play a role in improving dyslipidemia, exercise tolerance, and myocardial blood flow, and in reducing carotid intima-media thickness and left ventricular mass. Studies show that long-term TM practice can reduce the risk of myocardial infarction, stroke, and CVD mortality. This review identified that certain studies have high participant drop-out rates, and fewer studies targeted comprehensive cardiometabolic outcomes beyond BP with longer follow-up periods. We found that most studies were conducted in specific populations, which may limit generalizability. In conclusion, TM has the potential to improve cardiometabolic health; however, research gaps highlight the need for larger phase III multicenter clinical trials with long-term follow-ups.
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Affiliation(s)
- Mahesh Kumar Khanal
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Leila Karimi
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Peter Saunders
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Robert H Schneider
- College of Integrative Medicine, Maharishi International University, Fairfield, Iowa, USA
- Institute for Prevention Research, Vedic City, Iowa, USA
| | - John Salerno
- Institute for Prevention Research, Vedic City, Iowa, USA
| | - Karen Livesay
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Karen T Hallam
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Barbora de Courten
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
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Khabiri R, Jahangiry L, Abbasian M, Majidi F, Farhangi MA, Sadeghi-Bazargani H, Ponnet K. Spiritually Based Interventions for High Blood Pressure: A Systematic Review and Meta-analysis. JOURNAL OF RELIGION AND HEALTH 2024:10.1007/s10943-024-02034-3. [PMID: 38565834 DOI: 10.1007/s10943-024-02034-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 04/04/2024]
Abstract
This systematic review and meta-analysis aimed to evaluate the effectiveness of spiritually based interventions on blood pressure (BP) among adults. A systematic search was performed using the PubMed, Scopus, and Cochrane databases to identify studies evaluating spiritual interventions, including meditation, transcendental meditation, mindfulness meditation, and yoga, for high BP among adults up to January 1, 2022. The inclusion criteria were (a) randomized controlled trials (RCTs), (b) studies in English or Persian, (c) studies conducted among adults (≥ 18 years), and (d) studies reporting systolic or diastolic BP. Given the high heterogeneity of these studies, a random effect model was used to calculate the effect sizes for the RCTs. In total, the systematic review included 24 studies and the meta-analysis included 23 studies. As some of studies reported two or more outcome measurements, separate estimates of each outcome were extracted for that study (24 datasets). Fifteen trials reported the mean (SD) systolic blood pressure (SBP), and 13 trials reported the mean (SD) diastolic blood pressure (DBP). In addition, 13 studies reported means (SDs) and six trials reported mean changes in DBP. A significant decrease was found in systolic BP following intervention ((WMD (weighted mean difference) = - 7.63 [- 9.61 to - 5.65; P < 0.001]). We observed significant heterogeneity among the studies (I2 = 96.9; P < 0.001). A significant decrease was observed in DBP following the interventions (WMD = - 4.75 [- 6.45 to - 3.05; P < 0.001]). Spiritually based interventions including meditation and yoga had beneficial effects in reducing both SBP and DBP. Reducing BP can be expected to reduce the risk of cardiovascular diseases.
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Affiliation(s)
- Roghayeh Khabiri
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Jahangiry
- Health Education and Health Promotion Department, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran.
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mehdi Abbasian
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Geriatric Health, Faculty of Health Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatollah Majidi
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Koen Ponnet
- Faculty of Social Sciences, Imec-Mict-Ghent University, Ghent, Belgium
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Dillbeck MC, Cavanaugh KL. Empirical Evaluation of the Possible Contribution of Group Practice of the Transcendental Meditation and TM-Sidhi Program to Reduction in Drug-Related Mortality. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020195. [PMID: 36837397 PMCID: PMC9962702 DOI: 10.3390/medicina59020195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 01/21/2023]
Abstract
Background and Objectives: CDC data indicate that the U.S. is experiencing a sustained epidemic of drug-related mortality, with such deaths exceeding a record 100,000 in 2021, up 47% from 2019. Opioids, especially the synthetic opioid fentanyl, account for approximately 75% of this mortality. This study evaluates a proposed Consciousness-Based® approach that may possibly help reduce trends in drug-related fatalities by mitigating what WHO refers to as an "epidemic of stress" in society that helps fuel drug misuse and other negative public health trends. This approach involves providing support in public and private sector public health initiatives for individual and group practice of a subjective, evidence-based meditation procedure suitable for those of all educational, cultural, and religious backgrounds: the Transcendental Meditation® (TM®) technique and its advanced aspect, the TM-Sidhi® program. Materials and Methods: Segmented-trend regression analysis of monthly CDC data on U.S. drug-related fatality rates (dfr) from a prospective social experiment (2002-2016) was used to replicate and extend prior peer-reviewed research. Results: As hypothesized, (1) practice of the TM and TM-Sidhi program by a group of theoretically predicted size (√1% of the U.S. population) was associated with a statistically and practically significant reduction in dfr trend during the five-year "demonstration period" of the quasi-experiment; and (2) monthly dfr trend subsequently increased during the five-year follow-up period when the group fell below the required size (both p's < 0.0001). The estimated total percent decrease in dfr during the demonstration period was 35.5%, calculated relative to the baseline mean. This decline was followed by total dfr increases of 11.8% and 47.4% relative to the demonstration-period mean during the two phases of the follow-up period. Conclusion: Existing evidence warrants implementation and further evaluation of this approach in U.S. public health initiatives.
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Abstract
BACKGROUND The World Health Organization estimates that 1.13 billion people worldwide have hypertension. Although pharmaceutical management of blood pressure is available, there are reasons why people prefer not to take medications including costs, adverse effects, and lack of access. Nonpharmacological healthy lifestyle methods are needed. One alternative method is transcendental meditation (TM). OBJECTIVE The purpose of this study was to quantitatively synthesize the effects of TM on blood pressure. In addition, we examined the moderator effects of participant, methods, and intervention characteristics. METHODS We searched 19 electronic databases without date restrictions to March 2021 including the gray literature and specific journals for primary studies evaluating TM to reduce blood pressure in adults and written in English. We coded primary studies for 5 categories (source, method, intervention, participant characteristics, and outcomes). RESULTS Across 18 primary studies (N = 1207), TM mildly improved systolic blood pressure by -3.3 mm Hg (P = .025) and diastolic blood pressure by -1.8 mm Hg (P = .008) compared with comparison groups, but the effects waned after 3 months. Transcendental meditation reduced systolic blood pressure in samples that were 65 years and older significantly more than in samples that were younger than 65 years (-1.44 vs -9.87, P = .021) but showed no differential effect on diastolic blood pressure. CONCLUSIONS Transcendental meditation mildly reduced blood pressure, but the effect waned after 3 months. Adults older than 65 years benefited more than younger adults. Transcendental meditation might be recommended as one aspect of a healthy lifestyle.
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SCHNEIDER RH, GRIM C, KOTCHEN T, MARWAHA K, KOTCHEN J, SALERNO JW, KING CG, NIDICH S, ALEXANDER CN. Randomized controlled trial of stress reduction with meditation and health education in black men and women with high normal and normal blood pressure. Am J Prev Cardiol 2021; 8:100279. [PMID: 34729544 PMCID: PMC8546372 DOI: 10.1016/j.ajpc.2021.100279] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/20/2021] [Accepted: 10/01/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Black men and women suffer from disparities in morbidity and mortality from hypertension, cardiovascular disease, and currently, COVID-19. These conditions are associated with social determinants of health and psychosocial stress. While previous trials demonstrated that stress reduction with meditation lowered BP in the grade I range in Black adults, there is a paucity of evidence for high normal and normal BP. OBJECTIVE This randomized controlled trial was conducted to evaluate the effect of stress reduction with the Transcendental Meditation (TM) technique in Black adults with high normal BP and normal BP using international classifications. METHODS A total of 304 Black men and women with high normal (130-139/85-89 mm Hg) and normal BP (120-129/80-84 mm Hg) were randomized to either TM or health education (HE) groups. BP was recorded at 3, 6, 9, 12, 24, 30 and 36 months after baseline. Linear mixed model analysis was conducted to compare the BP change between TM and HE participants in the high-normal BP and normal-BP groups. Survival analysis for hypertensive events was conducted. RESULTS After an average of 19.9 ± 11.1 months follow-up, TM participants in the high-normal BP group showed significantly lower posttest SBP (-3.33 mm Hg, p = 0.045). There was no difference in DBP (-0.785 mm Hg, p = 0.367) compared to HE participants. In the normal BP group, the SBP and DBP were not different between the TM and HE participants. The hazard ratio for hypertensive events was 0.52 (p = 0.15) in the high normal BP group (7 TM vs 13 HE) with no difference in the normal BP group. CONCLUSION This RCT found that meditation lowered systolic BP in Black men and women with high normal BP but not in normal BP participants. These results may be relevant to reducing health disparities in CVD and related co-morbidities.
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Affiliation(s)
- Robert H. SCHNEIDER
- Institute for Prevention Research, 2100 Mansion Drive, Vedic City, Iowa 52556, USA
- College of Integrative Medicine, Institute for Natural Medicine and Prevention, Department of Physiology and Health, Maharishi International University, Fairfield, Iowa USA
| | - Clarence GRIM
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Theodore KOTCHEN
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Komal MARWAHA
- College of Integrative Medicine, Institute for Natural Medicine and Prevention, Department of Physiology and Health, Maharishi International University, Fairfield, Iowa USA
| | - Jane KOTCHEN
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - John W. SALERNO
- Institute for Prevention Research, 2100 Mansion Drive, Vedic City, Iowa 52556, USA
| | - Carolyn Gaylord KING
- Institute for Prevention Research, 2100 Mansion Drive, Vedic City, Iowa 52556, USA
| | - Sanford NIDICH
- Institute for Prevention Research, 2100 Mansion Drive, Vedic City, Iowa 52556, USA
| | - Charles N. ALEXANDER
- Institute for Prevention Research, 2100 Mansion Drive, Vedic City, Iowa 52556, USA
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Bokhari S, Schneider RH, Salerno JW, Rainforth MV, Gaylord-King C, Nidich SI. Effects of cardiac rehabilitation with and without meditation on myocardial blood flow using quantitative positron emission tomography: A pilot study. J Nucl Cardiol 2021; 28:1596-1607. [PMID: 31529385 PMCID: PMC9178923 DOI: 10.1007/s12350-019-01884-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/21/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Psychosocial stress is recognized as a risk factor for coronary heart disease (CHD). High rates of CHD in African-Americans may be related to psychosocial stress. However, standard cardiac rehabilitation (CR) usually does not include a systematic stress-reduction technique. Previous studies suggest that the Transcendental Meditation (TM) technique may reduce CHD risk factors and clinical events. This pilot study explored the effects of standard CR with and without TM on a measure of CHD in African-American patients. METHODS Fifty-six CHD patients were assigned to CR, CR + TM, TM alone, or usual care. Testing was done at baseline and after 12 weeks. The primary outcome was myocardial flow reserve (MFR) assessed by 13N-ammonia positron emission tomography (PET). Secondary outcomes were CHD risk factors. Based on guidelines for analysis of small pilot studies, data were analyzed for effect size (ES). RESULTS For 37 patients who completed posttesting, there were MFR improvements in the CR + TM group (+20.7%; ES = 0.64) and the TM group alone (+12.8%; ES = 0.36). By comparison, the CR-alone and usual care groups showed modest changes (+ 5.8%; ES = 0.17 and - 10.3%; ES = - 0.31), respectively. For the combined TM group, MFR increased (+ 14%, ES = 0.56) compared to the combined non-TM group (- 2.0%, ES = - 0.08). CONCLUSIONS These pilot data suggest that adding the TM technique to standard cardiac rehabilitation or using TM alone may improve the myocardial flow reserve in African-American CHD patients. These results may be applied to the design of controlled clinical trials to definitively test these effects. TRIAL REGISTRATION ClinicalTrials.gov registration # NCT01810029.
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Affiliation(s)
- Sabahat Bokhari
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Robert H Schneider
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, 2100 Mansion Drive, Maharishi Vedic City, IA, 52556, USA.
| | - John W Salerno
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, 2100 Mansion Drive, Maharishi Vedic City, IA, 52556, USA
| | - Maxwell V Rainforth
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, 2100 Mansion Drive, Maharishi Vedic City, IA, 52556, USA
| | - Carolyn Gaylord-King
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, 2100 Mansion Drive, Maharishi Vedic City, IA, 52556, USA
| | - Sanford I Nidich
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, 2100 Mansion Drive, Maharishi Vedic City, IA, 52556, USA
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Gardiner P, McGonigal L, Villa A, Kovell LC, Rohela P, Cauley A, Rinker D, Olendzki B. Our Whole Lives for Hypertension and Cardiac Risk Factors (OWL-H)—Combining a Teaching Kitchen Group Visit with an Online Platform: A Feasibility Trial (Preprint). JMIR Form Res 2021; 6:e29227. [PMID: 35576575 PMCID: PMC9152723 DOI: 10.2196/29227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Hypertension (HTN) affects millions of Americans. Our Whole Lives: an eHealth toolkit for Hypertension and Cardiac Risk Factors (OWL-H) is an eHealth platform that teaches evidence-based lifestyle strategies, such mindfulness and cooking skills, to improve self-management of HTN. Objective The primary goal of this pilot study was to evaluate the feasibility of OWL-H combined with teaching kitchen medical group visits (TKMGVs) in a low-income population of participants with HTN. Methods We conducted a pre-post 8-week study to assess the feasibility of a hybrid program (a web-based 9-module self-management program, which includes mindfulness and Mediterranean and Dietary Approaches to Stop Hypertension diet) accompanied by 3 in-person TKMGVs among patients with HTN. Data including demographics, platform use, and satisfaction after using OWL-H were examined. Outcome data collected at baseline and 8 weeks included the Mediterranean Diet Questionnaire, Hypertension Self-Care Profile Self-Efficacy Instrument, Blood Pressure Knowledge Questionnaire, and the number of self-reported blood pressure readings. For the statistical analysis, we used descriptive statistics, paired sample t tests (1-tailed), and qualitative methods. Results Of the 25 enrolled participants, 22 (88%) participants completed the study. Participants’ average age was 57 (SD 12.1) years, and 46% (11/24) of them reported a household income <US $30,000 per year. Among the 22 participants who logged in to OWL-H, the average number of mindfulness practices completed was 7 and the average number of module sessions accessed was 4. In all, 73% (16/22) of participants reported that they were “very satisfied” with using OWL-H to help manage their HTN. Participants’ blood pressure knowledge significantly increased from baseline (mean 5.58, SD 1.44) to follow-up (mean 6.13, SD 1.23; P=.03). Participants significantly increased their adherence to a Mediterranean diet from baseline (mean 7.65, SD 2.19) to follow-up (mean 9, SD 1.68; P=.004). Participants’ self-efficacy in applying heart-healthy habits, as measured by the Hypertension Self-Care Profile Self-Efficacy Instrument, increased from baseline (mean 63.67, SD 9.06) to follow-up (mean 65.54, SD 7.56; P=.14). At the 8-week follow-up, 82% (18/22) of the participants had self-reported their blood pressure on the OWL-H platform at least once during the 8 weeks. Conclusions The eHealth platform for HTN self-management, OWL-H, and accompanying in-person TKMGVs have the potential to effectively improve lifestyle management of HTN. Trial Registration ClinicalTrials.gov NCT03974334; https://clinicaltrials.gov/ct2/show/NCT03974334
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Affiliation(s)
- Paula Gardiner
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Lisa McGonigal
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Ariel Villa
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Lara C Kovell
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Pallavi Rohela
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Andrew Cauley
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Diana Rinker
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Barbara Olendzki
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
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Wilson NA, Kenny MA, Peña AS. Role of meditation to improve children's health: Time to look at other strategies. J Paediatr Child Health 2021; 57:178-181. [PMID: 33217077 DOI: 10.1111/jpc.15275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 01/18/2023]
Abstract
In the United States, it is reported that up to 7 million of the population practice some form of meditation with the main purpose of improving emotional wellbeing and reducing stress. As the prevalence of mental health conditions continues to climb, other forms of health management strategies, including meditation practices, are increasingly used in adults. The evidence continues to emerge for the use of meditation as a way of managing health conditions in adults as demonstrated in systematic reviews and randomised controlled trials. There is also growing evidence evaluating the use of meditation practices and their potential benefits for child and adolescent health. Studies have identified improvements in mood and mental health conditions, school attendance and attention in the classroom in children and adolescents. This article aims to provide a perspective on commonly evaluated meditation types, such as Transcendental Meditation and mindfulness-based stress reduction. The article also aims to discuss the available evidence for the use of meditation to improve health and general wellbeing of children, including the use of meditation programs in schools, the current downfalls and limitations to the existing literature around meditation, and important points that healthcare practitioners need to consider when discussing the use of meditation as an additional strategy to manage and improve health and wellbeing in children and adolescents.
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Affiliation(s)
- Nina A Wilson
- Discipline of Paediatrics, Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Endocrinology and Diabetes, Women's and Children's Hospital, SA Health, Government of South Australia, Adelaide, South Australia, Australia
| | - Maura A Kenny
- Centre for the Treatment of Anxiety and Depression, Central Adelaide Local Health Network, SA Health, Government of South Australia, Thebarton, South Australia, Australia
| | - Alexia S Peña
- Discipline of Paediatrics, Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Endocrinology and Diabetes, Women's and Children's Hospital, SA Health, Government of South Australia, Adelaide, South Australia, Australia
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Levine GN, Cohen BE, Commodore-Mensah Y, Fleury J, Huffman JC, Khalid U, Labarthe DR, Lavretsky H, Michos ED, Spatz ES, Kubzansky LD. Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association. Circulation 2021; 143:e763-e783. [PMID: 33486973 DOI: 10.1161/cir.0000000000000947] [Citation(s) in RCA: 233] [Impact Index Per Article: 77.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As clinicians delivering health care, we are very good at treating disease but often not as good at treating the person. The focus of our attention has been on the specific physical condition rather than the patient as a whole. Less attention has been given to psychological health and how that can contribute to physical health and disease. However, there is now an increasing appreciation of how psychological health can contribute not only in a negative way to cardiovascular disease (CVD) but also in a positive way to better cardiovascular health and reduced cardiovascular risk. This American Heart Association scientific statement was commissioned to evaluate, synthesize, and summarize for the health care community knowledge to date on the relationship between psychological health and cardiovascular health and disease and to suggest simple steps to screen for, and ultimately improve, the psychological health of patients with and at risk for CVD. Based on current study data, the following statements can be made: There are good data showing clear associations between psychological health and CVD and risk; there is increasing evidence that psychological health may be causally linked to biological processes and behaviors that contribute to and cause CVD; the preponderance of data suggest that interventions to improve psychological health can have a beneficial impact on cardiovascular health; simple screening measures can be used by health care providers for patients with or at risk for CVD to assess psychological health status; and consideration of psychological health is advisable in the evaluation and management of patients with or at risk for CVD.
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Igarashi NS, Karam CH, Afonso RF, Carneiro FD, Lacerda SS, Santos BF, Kozasa EH, Rangel ÉB. The effects of a short-term meditation-based mindfulness protocol in patients receiving hemodialysis. PSYCHOL HEALTH MED 2021; 27:1286-1295. [PMID: 33449820 DOI: 10.1080/13548506.2021.1871769] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Mindfulness-based approaches that promote health, improve quality of life, and reduce the impact of comorbidities are key aspects in chronic diseases management. We aimed to verify the impact of a short-term meditation protocol on psychosocial and physiological parameters in chronic hemodialysis patients. We enrolled twenty-two patients, median age of 69.5 years old, into a 12-week meditation protocol that occurred during each hemodialysis session for 10-20 minutes, 3x/week, in a private tertiary hospital. We then evaluated clinical, psychological, and laboratorial parameters pre- and post-meditation. Patients exhibited a better control of serum phosphorus (-0.72 mg/dL; P = 0.002), a decrease in systolic blood pressure (-1.90 mmHg; P = 0.009), a 23% decrease in depressive symptoms (P = 0.014), and an increase of 7% in the self-compassion scale (P = 0.048) after meditation. To note, we observed an increase in 13% of the mindfulness score (P = 0.019). Our preliminary study describes the effects of a short-term meditation protocol in chronic hemodialysis setting. We observed a decrease in depressive symptoms and in blood pressure values, an improvement in self-compassion and serum phosphorous levels. In conjunction with the promising results of meditation in chronic kidney disease setting, this encouraging preliminary study supports the need for additional clinical trials.
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Affiliation(s)
- Nadja S Igarashi
- Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Christiane H Karam
- Einstein Dialysis Center, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Rui F Afonso
- Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Fabiana D Carneiro
- Einstein Dialysis Center, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Shirley S Lacerda
- Psychology Service, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Bento F Santos
- Einstein Dialysis Center, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Elisa H Kozasa
- Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Érika B Rangel
- Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Department of Medicine, Nephrology Division , Federal University of São Paulo, São Paulo, SP, Brazil
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Lee EKP, Yeung NCY, Xu Z, Zhang D, Yu CP, Wong SYS. Effect and Acceptability of Mindfulness-Based Stress Reduction Program on Patients With Elevated Blood Pressure or Hypertension: A Meta-Analysis of Randomized Controlled Trials. Hypertension 2020; 76:1992-2001. [PMID: 33131316 DOI: 10.1161/hypertensionaha.120.16160] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The mindfulness-based stress reduction program (MBSR) may reduce blood pressure (BP) in patients with hypertension or elevated BP. However, some important parameters (such as asleep BP) have not been investigated in previous reviews, and a well-conducted meta-analysis is lacking. This meta-analysis investigates the effect and acceptability of MBSR on patients with elevated BP or hypertension. Relevant articles were searched in multiple databases, including MEDLINE, EMBASE, and APA PsycInfo. Included studies were randomized controlled trials that involved patients with an elevated BP, had a control group, and investigated the effect of MBSR. The mean office and out-of-office (including 24-hour, daytime, and asleep) systolic BP and diastolic BP, psychological outcomes (depression/anxiety/stress), and dropout rate were compared between the MBSR arm and the control arm using a random-effects model. Quality assessment was conducted based on the Cochrane risk-of-bias tool. Twelve studies were included, and only one was considered having low risk of bias. MBSR decreased the office systolic BP and diastolic BP by 6.64 and 2.47 mm Hg at postintervention, respectively; the reduction in diastolic BP was sustained until 3 to 6 months after the recruitment. Our meta-analyses did not find a significant reduction in out-of-office BP after MBSR. MBSR reduced depressive, anxiety, and stress symptoms. The dropout rate from MBSR arm was 15% and was similar to that of control arm. The current evidence is limited by lack of high-quality and adequately powered trials with long-term follow-up. Furthermore, out-of-office BP was only reported by few trials.
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Affiliation(s)
- Eric K P Lee
- From the Jockey Club School of Public Health and Primary Care, Faculty of Medicine (E.K.P.L., N.C.Y.Y., Z.X., D.Z., S.Y.S.W.), The Chinese University of Hong Kong
| | - Nelson C Y Yeung
- From the Jockey Club School of Public Health and Primary Care, Faculty of Medicine (E.K.P.L., N.C.Y.Y., Z.X., D.Z., S.Y.S.W.), The Chinese University of Hong Kong
| | - Zijun Xu
- From the Jockey Club School of Public Health and Primary Care, Faculty of Medicine (E.K.P.L., N.C.Y.Y., Z.X., D.Z., S.Y.S.W.), The Chinese University of Hong Kong
| | - Dexing Zhang
- From the Jockey Club School of Public Health and Primary Care, Faculty of Medicine (E.K.P.L., N.C.Y.Y., Z.X., D.Z., S.Y.S.W.), The Chinese University of Hong Kong
| | - Chun-Pong Yu
- Li Ping Medical Library (C.-P.Y.), The Chinese University of Hong Kong
| | - Samuel Y S Wong
- From the Jockey Club School of Public Health and Primary Care, Faculty of Medicine (E.K.P.L., N.C.Y.Y., Z.X., D.Z., S.Y.S.W.), The Chinese University of Hong Kong
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12
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2020 International Society of Hypertension global hypertension practice guidelines – lifestyle modification. J Hypertens 2020; 38:2340-2341. [DOI: 10.1097/hjh.0000000000002625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fazia T, Bubbico F, Iliakis I, Salvato G, Berzuini G, Bruno S, Bernardinelli L. Short-Term Meditation Training Fosters Mindfulness and Emotion Regulation: A Pilot Study. Front Psychol 2020; 11:558803. [PMID: 33192816 PMCID: PMC7649763 DOI: 10.3389/fpsyg.2020.558803] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/28/2020] [Indexed: 12/18/2022] Open
Abstract
The practice of meditation has been historically linked to beneficial effects, not only in terms of spirituality but also in terms of well-being, general improvement of psychophysiological conditions and quality of life. The present study aims to assess the beneficial effects of a short-term intervention (a combination of 12 practical 1-h sessions of meditation, called Integral Meditation, and lectures on neuroscience of meditation) on psychological indicators of well-being in subjects from the general population. We used a one-group pretest-posttest quasi-experimental design, in which all participants (n = 41, 17 men and 24 women, with a mean age of 41.1 years) underwent the same intervention. Out of these, 24 had already experienced meditation practice, but only 12 in a continuative way. Effects were assessed by the standardized Italian version of three self-report questionnaires: Core Outcome in Routine Evaluation-Outcome Measure (CORE-OM), Five-Facet Mindfulness Questionnaire (FFMQ), and Emotion Regulation Questionnaire (ERQ). The questionnaires were filled in at baseline and immediately after the last meditation session. Linear mixed effect models were used to evaluate pre-post treatment changes on each outcome. Participants showed a general, close to a statistically significant threshold, improvement in the total score of CORE-OM and its different domains. The total score of FFMQ (β = 0.154, p = 0.012) indicates a statistically significant increase in the level of mindfulness as well as in the domains acting with awareness (β = 0.212, p = 0.024), and non-judging of inner experiences (β = 0.384, p < 0.0001). Lastly, we observed a statistically significant improvement in the cognitive reappraisal ERQ domain (β = 0.541, p = 0.0003). Despite some limitations (i.e., small sample size, lack of a randomised control group and sole use of "soft" measurements, such as self-report questionnaires), this study offers promising results regarding the within-subject effectiveness of our intervention that includes a meditation practice on psychological indicators, thus providing interesting preliminary results.
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Affiliation(s)
- Teresa Fazia
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Francesco Bubbico
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ioannis Iliakis
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Gerardo Salvato
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Cognitive Neuropsychology Centre, ASST "Grande Ospedale Metropolitano" Niguarda, Milan, Italy
| | - Giovanni Berzuini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Luisa Bernardinelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Hewawasam E, Brennan L, Giles L, Hull ML, Short A, Norman R, Peña AS. Assessing Whether Meditation Improves Quality of Life for Adolescent Girls With Polycystic Ovary Syndrome: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e14542. [PMID: 32012099 PMCID: PMC7013635 DOI: 10.2196/14542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 02/03/2023] Open
Abstract
Background Polycystic Ovary Syndrome (PCOS) is a common endocrine condition characterized by irregular periods and hyperandrogenism. Adolescents with PCOS have impaired quality of life (QOL) and increased psychological distress. Transcendental Meditation (TM) is a well-established self-management strategy that has been used to improve stress and well-being. A meta-analysis of TM trials has shown beneficial effects on stress and blood pressure in adults. Recent data are suggesting that another self-management strategy called a mindfulness stress management program has a role in improving QOL in women with PCOS, but there are no studies in adolescents. Objective This study aims to evaluate the effect of TM on QOL and psychological distress in adolescent girls with PCOS. Methods This study is a randomized controlled trial that will be conducted over eight weeks at the Women’s and Children’s Hospital in Adelaide, South Australia, to determine the effect of TM on QOL and psychological distress in adolescent girls (aged 12-20 years) with PCOS. A total of 40 girls will be randomized into either the TM (n=20) or control group (n=20). The TM group will be asked to practice TM in a comfortable sitting position with the eyes closed, for 15 minutes twice daily over eight weeks. The control group will be asked to sit quietly for 15 minutes twice daily for eight weeks. The primary outcomes are any effects on improving QOL and psychological distress, and the secondary outcomes are any effects on lowering blood pressure and salivary cortisol levels. Results The recruitment of study participants began in May 2019 and is expected to be completed by June 2020. It is expected that the adolescent girls with PCOS practicing TM over eight weeks will have a significant improvement in QOL and psychological distress compared to adolescents in the control group. Also, it is expected that adolescent girls in the TM group will have lower salivary cortisol levels and lower blood pressure. Conclusions This study will be the first to evaluate the effect of TM on QOL in adolescent girls with PCOS. The study will provide valuable information on a potential self-management strategy to improve QOL and well-being in adolescent girls with PCOS. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN1261900019010; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376657&amp;isReview=true International Registered Report Identifier (IRRID) PRR1-10.2196/14542
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Affiliation(s)
- Erandi Hewawasam
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, Adelaide, Australia.,Department of Endocrinology and Diabetes, Women's and Children's Hospital, North Adelaide, Australia
| | - Leah Brennan
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Australia.,Centre for Eating, Weight and Body Image, Melbourne, Australia.,School of Psychology and Public Health, La Trobe University, Wodonga, Australia
| | - Lynne Giles
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Mary Louise Hull
- Department of Obstetrics and Gynaecology, Women's and Children's Hospital, North Adelaide, Australia.,Obstetrics and Gynaecology, Robinson Research Institute, The University of Adelaide, North Adelaide, Australia
| | - Asha Short
- Department of Obstetrics and Gynaecology, Women's and Children's Hospital, North Adelaide, Australia
| | - Robert Norman
- Obstetrics and Gynaecology, Robinson Research Institute, The University of Adelaide, North Adelaide, Australia
| | - Alexia S Peña
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, Adelaide, Australia.,Department of Endocrinology and Diabetes, Women's and Children's Hospital, North Adelaide, Australia
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15
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Schnaubelt S, Hammer A, Koller L, Niederdoeckl J, Kazem N, Spiel A, Niessner A, Sulzgruber P. Expert Opinion: Meditation and Cardiovascular Health: What is the Link? Eur Cardiol 2020; 14:161-164. [PMID: 31933684 PMCID: PMC6950207 DOI: 10.15420/ecr.2019.21.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 10/02/2019] [Indexed: 01/29/2023] Open
Abstract
Meditation as a form of body–mind interaction for primary and secondary prevention in cardiovascular disease has been discussed critically in the past. However, data that aimed to link this intervention to a reduction of various aspects of cardiovascular disease, rendering it a potential part of a cost-effective treatment approach in patients at risk, remain scarce and inconclusive. This article aims to provide an overview of currently available evidence in the literature and the potential impact of meditation on cardiovascular health. However, the data highlighted in this article cannot render with certainty directly reproducible effects of meditation on patients’ cardiovascular disease profiles. Meditation may be suggested only as an additional link in the chain of primary and secondary prevention until future research provides sufficient data on this topic.
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Affiliation(s)
| | - Andreas Hammer
- Department of Medicine II, Division of Cardiology, Medical University of Vienna Austria
| | - Lorenz Koller
- Department of Medicine II, Division of Cardiology, Medical University of Vienna Austria
| | - Jan Niederdoeckl
- Department of Emergency Medicine, Medical University of Vienna Austria
| | - Niema Kazem
- Department of Medicine II, Division of Cardiology, Medical University of Vienna Austria
| | - Alexander Spiel
- Department of Emergency Medicine, Medical University of Vienna Austria
| | - Alexander Niessner
- Department of Medicine II, Division of Cardiology, Medical University of Vienna Austria
| | - Patrick Sulzgruber
- Department of Medicine II, Division of Cardiology, Medical University of Vienna Austria
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16
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Gathright EC, Salmoirago-Blotcher E, DeCosta J, Balletto BL, Donahue ML, Feulner MM, Cruess DG, Wing RR, Carey MP, Scott-Sheldon LAJ. The impact of transcendental meditation on depressive symptoms and blood pressure in adults with cardiovascular disease: A systematic review and meta-analysis. Complement Ther Med 2019; 46:172-179. [PMID: 31519275 PMCID: PMC7046170 DOI: 10.1016/j.ctim.2019.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Transcendental Meditation (TM) as a stress management technique may offer an adjunctive strategy to improve health and well-being in adults with cardiovascular disease (CVD). OBJECTIVES To examine the efficacy of TM to improve aspects of cardiovascular health and psychological functioning in adults with CVD. METHOD Studies (a) evaluating TM in adults with hypertension or CVD and (b) assessing a physiological or psychological outcome were retrieved and meta-analyzed. Weighted mean effect sizes were computed to assess between- and within-group changes. RESULTS Nine studies met inclusion criteria (N = 851; mean age = 60 ± 8 years; 47% women). Between-group analyses revealed no differences between TM and control groups. However, within-group (i.e., pre- to post-intervention) analyses revealed reductions in systolic (d+ = 0.31) and diastolic (d+ = 0.53) blood pressure (BP) for the TM group. There were no changes in depressive symptoms for TM or control participants. CONCLUSIONS TM was associated with within-group (but not between-groups) improvements in BP. Continued research using randomized controlled trials with larger samples, and measuring psychophysiological outcomes at longer follow-up intervals is recommended.
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Affiliation(s)
- Emily C Gathright
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.
| | - Elena Salmoirago-Blotcher
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Julie DeCosta
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Brittany L Balletto
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Marissa L Donahue
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Melissa M Feulner
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Dean G Cruess
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA; Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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17
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Lee SW. A Copernican Approach to Brain Advancement: The Paradigm of Allostatic Orchestration. Front Hum Neurosci 2019; 13:129. [PMID: 31105539 PMCID: PMC6499026 DOI: 10.3389/fnhum.2019.00129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/28/2019] [Indexed: 01/16/2023] Open
Abstract
There are two main paradigms for brain-related science, with different implications for brain-focused intervention or advancement. The paradigm of homeostasis (“stability through constancy,” Walter Cannon), originating from laboratory-based experimental physiology pioneered by Claude Bernard, shows that living systems tend to maintain system functionality in the direction of constancy (or similitude). The aim of physiology is to elucidate the factors that maintain homeostasis, and therapeutics aim to correct abnormal factor functions. The homeostasis paradigm does not formally recognize influences outside its controlled experimental frames and it is variable in its modeling of neural contributions. The paradigm of allostatic orchestration (PAO) extends the principle of allostasis (“stability through change”) as originally put forth by Peter Sterling. The PAO originates from an evolutionary perspective and recognizes that biological set points change in anticipation of changing environments. The brain is the organ of central command, orchestrating cross-system operations to support optimal behavior at the level of the whole organism. Alternative views of blood pressure regulation and posttraumatic stress disorder (PTSD) illustrate differences between the paradigms. For the PAO, complexities of top-down neural effects and environmental context are foundational (not to be “factored out”), and anticipatory regulation is the principle of their interface. The allostatic state represents the integrated totality of brain-body interactions. Health itself is an allostatic state of optimal anticipatory oscillation, hypothesized to relate to the state of criticality, a mathematical point of poise between phases, on the border between order and disorder (or the “edge of chaos”). Diseases are allostatic states of impaired anticipatory oscillations, demonstrated as rigidifications of set points across the brain and body (disease comorbidity). Conciliation of the paradigms is possible, with “reactive homeostasis” resolved as an illusion stemming from the anticipation of environmental monotony. Considerations are presented with respect to implications of the two paradigms for brain-focused intervention or advancement; the hypothesis that the state of criticality is a vehicle for evolutionary processes; concordance with a philosophy of freedom based on ethical individualism as well as self-creativity, non-obsolescence, empowerment, and citizenship; and concluding reflections on the science and ethics of the placebo, and the potential for virtuous cycles of brain-Anthropocene interactions.
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Affiliation(s)
- Sung W Lee
- Scholarly Projects Unit, Department of Academic Affairs, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States
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Schneider RH, Fields JZ, Brook RD. The 2017 ACC/AHA Hypertension Guidelines: Should they have included proven nonpharmacological blood pressure-lowering strategies such as Transcendental Meditation? J Clin Hypertens (Greenwich) 2019; 21:434. [PMID: 30714296 DOI: 10.1111/jch.13488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Robert H Schneider
- College of Integrative Medicine, Maharishi University of Management, Fairfield, Iowa
| | | | - Robert D Brook
- University of Michigan Medical School, Ann Arbor, Michigan
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Non-trauma-focused meditation versus exposure therapy in veterans with post-traumatic stress disorder: a randomised controlled trial. Lancet Psychiatry 2018; 5:975-986. [PMID: 30449712 DOI: 10.1016/s2215-0366(18)30384-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/29/2018] [Accepted: 09/18/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a complex and difficult-to-treat disorder, affecting 10-20% of military veterans. Previous research has raised the question of whether a non-trauma-focused treatment can be as effective as trauma exposure therapy in reducing PTSD symptoms. This study aimed to compare the non-trauma-focused practice of Transcendental Meditation (TM) with prolonged exposure therapy (PE) in a non-inferiority clinical trial, and to compare both therapies with a control of PTSD health education (HE). METHODS We did a randomised controlled trial at the Department of Veterans Affairs San Diego Healthcare System in CA, USA. We included 203 veterans with a current diagnosis of PTSD resulting from active military service randomly assigned to a TM or PE group, or an active control group of HE, using stratified block randomisation. Each treatment provided 12 sessions over 12 weeks, with daily home practice. TM and HE were mainly given in a group setting and PE was given individually. The primary outcome was change in PTSD symptom severity over 3 months, assessed by the Clinician-Administered PTSD Scale (CAPS). Analysis was by intention to treat. We hypothesised that TM would show non-inferiority to PE in improvement of CAPS score (Δ=10), with TM and PE superior to PTSD HE. This study is registered with ClinicalTrials.gov, number NCT01865123. FINDINGS Between June 10, 2013, and Oct 7, 2016, 203 veterans were randomly assigned to an intervention group (68 to the TM group, 68 to the PE group, and 67 to the PTSD HE group). TM was significantly non-inferior to PE on change in CAPS score from baseline to 3-month post-test (difference between groups in mean change -5·9, 95% CI -14·3 to 2·4, p=0·0002). In standard superiority comparisons, significant reductions in CAPS scores were found for TM versus PTSD HE (-14·6 95% CI, -23·3 to -5·9, p=0·0009), and PE versus PTSD HE (-8·7 95% CI, -17·0 to -0·32, p=0·041). 61% of those receiving TM, 42% of those receiving PE, and 32% of those receiving HE showed clinically significant improvements on the CAPS score. INTERPRETATION A non-trauma-focused-therapy, TM, might be a viable option for decreasing the severity of PTSD symptoms in veterans and represents an efficacious alternative for veterans who prefer not to receive or who do not respond to traditional exposure-based treatments of PTSD. FUNDING Department of Defense, US Army Medical Research.
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20
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Ambavane RA, Khademi A, Zhang D, Shi L. Modeling the Impact of Transcendental Meditation on Stroke Incidence and Mortality. J Stroke Cerebrovasc Dis 2018; 28:577-586. [PMID: 30482488 DOI: 10.1016/j.jstrokecerebrovasdis.2018.10.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 10/04/2018] [Accepted: 10/29/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Meditation has shown promise in clinical trials in reducing systolic blood pressure, one of the main risk factors for stroke. We aim to estimate the potential benefits of popularizing meditation on stroke incidence and mortality in the United States (U.S.). METHODS We developed a dynamic population-based microsimulation model to simulate the disease progression of each individual and compute disease burden. We calibrated the microsimulation model for stroke incidence and further validated it by comparing the stroke-related mortality for each age group generated by the model with that observed in the U.S. We used the population simulation model to estimate the effects of meditation intervention on the number of stroke cases and deaths over a course of 15 years. RESULTS Our results show that we could avert nearly 200,000 stroke cases and 50,000 stroke-related deaths over the course of 15 years. Our sensitivity analysis reveals that most of the benefits come from applying the intervention for individuals older than 60 years. In addition, meditation acceptance and adherence rate play a critical role in its effectiveness. CONCLUSIONS The practice of meditation, if properly utilized along with the regular antihypertensive medication, could substantially alleviate the burden of stroke in the U.S. In order to design an effective meditation program, policymakers may prioritize funding to the programs that aim to encourage older individuals to practice meditation.
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Affiliation(s)
- Raj Anil Ambavane
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina.
| | - Amin Khademi
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina.
| | - Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia.
| | - Lu Shi
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina.
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21
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Ponte Márquez PH, Feliu-Soler A, Solé-Villa MJ, Matas-Pericas L, Filella-Agullo D, Ruiz-Herrerias M, Soler-Ribaudi J, Roca-Cusachs Coll A, Arroyo-Díaz JA. Benefits of mindfulness meditation in reducing blood pressure and stress in patients with arterial hypertension. J Hum Hypertens 2018; 33:237-247. [DOI: 10.1038/s41371-018-0130-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/16/2018] [Accepted: 10/23/2018] [Indexed: 11/09/2022]
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22
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Niu JF, Zhao XF, Hu HT, Wang JJ, Liu YL, Lu DH. Should acupuncture, biofeedback, massage, Qi gong, relaxation therapy, device-guided breathing, yoga and tai chi be used to reduce blood pressure?: Recommendations based on high-quality systematic reviews. Complement Ther Med 2018; 42:322-331. [PMID: 30670261 DOI: 10.1016/j.ctim.2018.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/04/2018] [Accepted: 10/19/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This review aims to rate the quality of evidence and the strength of recommendations in high-quality systematic reviews of non-drug therapies. Hypertensive patients who are resistant or non-adherent to antihypertensive drugs may be easier to manage if they choose alternative non-drug therapies for hypertension, based on this review. METHODS P: Adults (>18 years), except pregnant women, with essential hypertension. I: Cupping, moxibustion, acupuncture, acupoint stimulation, yoga, meditation, tai chi, Qi gong, Chinese massage, massage, spinal manipulation, biofeedback, device-guided breathing therapy, aromatherapy, music therapy, and relaxation approaches. C: 1. No treatment. 2. Sham therapy. 3. Conventional treatment, including antihypertensive drugs and lifestyle modification (e.g., exercise). O: 1. Change in the incidence of cardiovascular death. 2. Change in the incidence of myocardial infarction. 3. Change in the incidence of stroke. 4. Change in blood pressure (BP). 5. Efficacy rate of BP lowering. 6. Adverse effects (review specific). S: Systematic reviews of randomized controlled trials, including meta-analyses and assessments of the methodological quality/risk of bias. INFORMATION SOURCES Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane library, PubMed, Web of Science, China National Knowledge Infrastructure, and Chinese Scientific Journal Database were searched. The bibliographies of the included articles were also searched for relevant systematic reviews. GRADE criteria were used to rate the quality of evidence in systematic reviews considering 6 factors, including risk of bias. RESULTS This review ultimately included 13 systematic reviews of 14 non-drug therapies (acupuncture, wet cupping, Baduanjin, blood letting, auricular acupuncture, music, massage, Qi gong, moxibustion, relaxation therapies, biofeedback, device-guided breathing, yoga and tai chi) based on the inclusion criteria. The quality of evidence was generally low, and weak recommendations were given for most therapies except massage and acupuncture plus antihypertensive drug. Based on the analyzed evidence, massage and acupuncture plus antihypertensive drug could benefit people who want to lower their BP and do not have contraindications for massage and acupuncture plus antihypertensive drug. DISCUSSION/STRENGTH The GRADE approach makes this review a unique reference for people who are considering the grade of quality of evidence in systematic reviews, the balance of desirable and undesirable consequences and the strength of recommendations to decide which intervention should be used to reduce BP. LIMITATIONS Many non-drug therapies were excluded due to the low methodological quality of their systematic reviews, and only 14 therapies were evaluated in this review. As no patient-important outcomes were reviewed, surrogate outcomes were used to rate the strength of recommendations. This approach may cause a decrease in evidence quality according to GRADE, but we argue that this is appropriate in the context of this review.
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Affiliation(s)
- Jian-Fei Niu
- VIP Ward of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiao-Feng Zhao
- VIP Ward of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
| | - Han-Tong Hu
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejing Province, China
| | - Jia-Jie Wang
- Department of Traditional Chinese Medicine, Peoples' Hospital of Shuozhou, Shanxi Province, China
| | - Yan-Ling Liu
- The Affiliated Hospital of Shandong University of TCM, Shandong Province, China
| | - De-Hua Lu
- The Second hospital of Dalian Medical University, Liaoning Province, China
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23
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Corlin L, Ball S, Woodin M, Patton AP, Lane K, Durant JL, Brugge D. Relationship of Time-Activity-Adjusted Particle Number Concentration with Blood Pressure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15092036. [PMID: 30231494 PMCID: PMC6165221 DOI: 10.3390/ijerph15092036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/08/2018] [Accepted: 09/13/2018] [Indexed: 11/24/2022]
Abstract
Emerging evidence suggests long-term exposure to ultrafine particulate matter (UFP, aerodynamic diameter < 0.1 µm) is associated with adverse cardiovascular outcomes. We investigated whether annual average UFP exposure was associated with measured systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and hypertension prevalence among 409 adults participating in the cross-sectional Community Assessment of Freeway Exposure and Health (CAFEH) study. We used measurements of particle number concentration (PNC, a proxy for UFP) obtained from mobile monitoring campaigns in three near-highway and three urban background areas in and near Boston, Massachusetts to develop PNC regression models (20-m spatial and hourly temporal resolution). Individual modeled estimates were adjusted for time spent in different micro-environments (time-activity-adjusted PNC, TAA-PNC). Mean TAA-PNC was 22,000 particles/cm3 (sd = 6500). In linear models (logistic for hypertension) adjusted for the minimally sufficient set of covariates indicated by a directed acyclic graph (DAG), we found positive, non-significant associations between natural log-transformed TAA-PNC and SBP (β = 5.23, 95%CI: −0.68, 11.14 mmHg), PP (β = 4.27, 95%CI: −0.79, 9.32 mmHg), and hypertension (OR = 1.81, 95%CI: 0.94, 3.48), but not DBP (β = 0.96, 95%CI: −2.08, 4.00 mmHg). Associations were stronger among non-Hispanic white participants and among diabetics in analyses stratified by race/ethnicity and, separately, by health status.
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Affiliation(s)
- Laura Corlin
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, 200 College Ave, Medford, MA 02155, USA.
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, 801 Massachusetts Avenue, Suite 470, Boston, MA 02118, USA.
| | - Shannon Ball
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, 200 College Ave, Medford, MA 02155, USA.
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA.
| | - Mark Woodin
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, 200 College Ave, Medford, MA 02155, USA.
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA.
| | - Allison P Patton
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, 200 College Ave, Medford, MA 02155, USA.
- Health Effects Institute, 75 Federal Street, Suite 1400, Boston, MA 02110, USA.
| | - Kevin Lane
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA.
| | - John L Durant
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, 200 College Ave, Medford, MA 02155, USA.
| | - Doug Brugge
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, 200 College Ave, Medford, MA 02155, USA.
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA.
- Tufts University Jonathan M. Tisch College of Civic Life, 35 Professors Row, Medford, MA 02155, USA.
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Gryczynski J, Schwartz RP, Fishman MJ, Nordeck CD, Grant J, Nidich S, Rothenberg S, O'Grady KE. Integration of Transcendental Meditation® (TM) into alcohol use disorder (AUD) treatment. J Subst Abuse Treat 2018; 87:23-30. [DOI: 10.1016/j.jsat.2018.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 01/22/2023]
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Torkamani F, Aghayousefi A, Alipour A, Nami M. Effects of Single-Session Group Mantra-meditation on Salivary Immunoglobulin A and Affective State: A Psychoneuroimmunology Viewpoint. Explore (NY) 2018; 14:114-121. [DOI: 10.1016/j.explore.2017.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 10/01/2017] [Accepted: 10/23/2017] [Indexed: 11/25/2022]
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Van Cappellen P, Rice EL, Catalino LI, Fredrickson BL. Positive affective processes underlie positive health behaviour change. Psychol Health 2018; 33:77-97. [PMID: 28498722 PMCID: PMC5682236 DOI: 10.1080/08870446.2017.1320798] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Positive health behaviours such as physical activity can prevent or reverse many chronic conditions, yet a majority of people fall short of leading a healthy lifestyle. Recent discoveries in affective science point to promising approaches to circumvent barriers to lifestyle change. Here, we present a new theoretical framework that integrates scientific knowledge about positive affect with that on implicit processes. The upward spiral theory of lifestyle change explains how positive affect can facilitate long-term adherence to positive health behaviours. The inner loop of this spiral model identifies nonconscious motives as a central mechanism of behavioural maintenance. Positive affect experienced during health behaviours increases incentive salience for cues associated with those behaviours, which in turn, implicitly guides attention and the everyday decisions to repeat those behaviours. The outer loop represents the evidence-backed claim, based on Fredrickson's broaden-and-build theory, that positive affect builds a suite of endogenous resources, which may in turn amplify the positive affect experienced during positive health behaviours and strengthen the nonconscious motives. We offer published and preliminary evidence in favour of the theory, contrast it to other dominant theories of health behaviour change, and highlight attendant implications for interventions that merit testing.
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Transcendental meditation for lowering blood pressure: An overview of systematic reviews and meta-analyses. Complement Ther Med 2017; 34:26-34. [DOI: 10.1016/j.ctim.2017.07.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/11/2017] [Accepted: 07/19/2017] [Indexed: 11/20/2022] Open
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Levine GN, Lange RA, Bairey-Merz CN, Davidson RJ, Jamerson K, Mehta PK, Michos ED, Norris K, Ray IB, Saban KL, Shah T, Stein R, Smith SC. Meditation and Cardiovascular Risk Reduction: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2017; 6:e002218. [PMID: 28963100 PMCID: PMC5721815 DOI: 10.1161/jaha.117.002218] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Despite numerous advances in the prevention and treatment of atherosclerosis, cardiovascular disease remains a leading cause of morbidity and mortality. Novel and inexpensive interventions that can contribute to the primary and secondary prevention of cardiovascular disease are of interest. Numerous studies have reported on the benefits of meditation. Meditation instruction and practice is widely accessible and inexpensive and may thus be a potential attractive cost-effective adjunct to more traditional medical therapies. Accordingly, this American Heart Association scientific statement systematically reviewed the data on the potential benefits of meditation on cardiovascular risk. Neurophysiological and neuroanatomical studies demonstrate that meditation can have long-standing effects on the brain, which provide some biological plausibility for beneficial consequences on the physiological basal state and on cardiovascular risk. Studies of the effects of meditation on cardiovascular risk have included those investigating physiological response to stress, smoking cessation, blood pressure reduction, insulin resistance and metabolic syndrome, endothelial function, inducible myocardial ischemia, and primary and secondary prevention of cardiovascular disease. Overall, studies of meditation suggest a possible benefit on cardiovascular risk, although the overall quality and, in some cases, quantity of study data are modest. Given the low costs and low risks of this intervention, meditation may be considered as an adjunct to guideline-directed cardiovascular risk reduction by those interested in this lifestyle modification, with the understanding that the benefits of such intervention remain to be better established. Further research on meditation and cardiovascular risk is warranted. Such studies, to the degree possible, should utilize randomized study design, be adequately powered to meet the primary study outcome, strive to achieve low drop-out rates, include long-term follow-up, and be performed by those without inherent bias in outcome.
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Malachias MVB, Franco RJS, Forjaz CLM, Pierin AMG, Gowdak MMG, Klein MRST, Matsudo V. 7th Brazilian Guideline of Arterial Hypertension: Chapter 6 - Non-pharmacological treatment. Arq Bras Cardiol 2017; 107:30-34. [PMID: 27819385 PMCID: PMC5319467 DOI: 10.5935/abc.20160156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Patwardhan AR, Lloyd LW. Decline in the Use of Medicalized Yoga Between 2002 and 2012 While the Overall Yoga Use Increased in the United States: A Conundrum. J Evid Based Complementary Altern Med 2017; 22:567-572. [PMID: 29228812 PMCID: PMC5871265 DOI: 10.1177/2156587216689183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We analyzed the National Health Institute Survey Alternative Medicine supplement yoga
data for 2002, 2007, and 2012 to answer the following questions: (1) Do the claims about
increase in the use of yoga hold true at the level of specific health problems? (2) Do
trends support a proposition that yoga is believed to be helpful in amelioration of
disease conditions? (3) Do the prescribing patterns of health care providers correspond
with the increasing popularity of yoga? Data were analyzed using SAS software, version
9.4. Response percentages were compared using chi-square test after adjusting for age.
Between 2002 and 2012, use of yoga increased but adherence failed to increase, and use for
specific health problems and for back pain declined; use of health care providers’
referral–driven yoga declined between 2007 and 2012. All results were statistically
significant. Our results suggest that the use of medicalized yoga declined between 2002
and 2012.
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Mental and physical health outcomes following the Relaxation Response Resiliency Program (3RP) in a clinical practice setting. Eur J Integr Med 2016. [DOI: 10.1016/j.eujim.2016.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Mahtani KR, Beinortas T, Bauza K, Nunan D. Device-Guided Breathing for Hypertension: a Summary Evidence Review. Curr Hypertens Rep 2016; 18:33. [PMID: 27059041 DOI: 10.1007/s11906-016-0631-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Persistently raised blood pressure is one of the major risk factors for diseases such as myocardial infarction and stroke. Uncontrolled hypertension is also associated with high rates of mortality, particularly in middle and high-income countries. Lifestyle factors such as poor diet, obesity, physical inactivity and smoking are all thought to contribute to the development of hypertension. As a result, the management of hypertension should begin with modifying these lifestyle factors. Beyond this, drug interventions are used as the predominant form of management. However, adherence to medications can be highly variable, medication side effects are common, and may require regular monitoring or, in some individuals may be ineffective. Therefore, additional non-pharmacologic interventions that lower blood pressure may be advantageous when combined with lifestyle modifications. Such interventions may include relaxation therapies such as slow breathing exercises, which can be initiated by means of specific devices. The technique of device-guided breathing (DGB) has been considered by guideline developers in the management of hypertension. One specific device, the Resperate, has received US FDA and UK NHS approval over the last few years. In this review, we summarise the evidence base on efficacy and find that although some clinical trials exist that demonstrate a BP-lowering effect, others do not. There is currently insufficient evidence from pooled data to recommend the routine use of device-guided breathing in hypertensive patients.
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Affiliation(s)
- Kamal R Mahtani
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Tumas Beinortas
- Centre of Evidence-Based Medicine, Clinic of Internal Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Karolis Bauza
- Centre of Evidence-Based Medicine, Clinic of Internal Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - David Nunan
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Trudel-Fitzgerald C, Gilsanz P, Mittleman MA, Kubzansky LD. Dysregulated Blood Pressure: Can Regulating Emotions Help? Curr Hypertens Rep 2016; 17:92. [PMID: 26520446 DOI: 10.1007/s11906-015-0605-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Despite having identified key physiological and behavioral risk factors, the prevalence of hypertension continues to rise, affecting two thirds of American adults 60 years or older. An important condition in its own right, hypertension is also a leading risk factor for cardiovascular diseases; thus, identifying additional modifiable determinants remains a public health priority. Psychological states and negative emotions more specifically have been proposed as risk factors, but the research findings are inconsistent. Additional prospective studies have recently been published increasing the availability of longitudinal data. The aim of this literature review is to evaluate these findings focusing on those from the last 3 years. We synthesize current research on whether negative (e.g., depression, anxiety) or positive (e.g., optimism) emotion-related factors are associated with high blood pressure onset. We discuss discrepant findings and propose considering emotion regulation as a novel approach to explain inconsistencies. Finally, we provide thoughts on future research directions.
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Affiliation(s)
- Claudia Trudel-Fitzgerald
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building, Boston, MA, 02115, USA.
| | - Paola Gilsanz
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building, Boston, MA, 02115, USA
| | - Murray A Mittleman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02215, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building, Boston, MA, 02115, USA
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Duraimani S, Schneider RH, Randall OS, Nidich SI, Xu S, Ketete M, Rainforth MA, Gaylord-King C, Salerno JW, Fagan J. Effects of Lifestyle Modification on Telomerase Gene Expression in Hypertensive Patients: A Pilot Trial of Stress Reduction and Health Education Programs in African Americans. PLoS One 2015; 10:e0142689. [PMID: 26571023 PMCID: PMC4646647 DOI: 10.1371/journal.pone.0142689] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 10/25/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND African Americans suffer from disproportionately high rates of hypertension and cardiovascular disease. Psychosocial stress, lifestyle and telomere dysfunction contribute to the pathogenesis of hypertension and cardiovascular disease. This study evaluated effects of stress reduction and lifestyle modification on blood pressure, telomerase gene expression and lifestyle factors in African Americans. METHODS Forty-eight African American men and women with stage I hypertension who participated in a larger randomized controlled trial volunteered for this substudy. These subjects participated in either stress reduction with the Transcendental Meditation technique and a basic health education course (SR) or an extensive health education program (EHE) for 16 weeks. Primary outcomes were telomerase gene expression (hTERT and hTR) and clinic blood pressure. Secondary outcomes included lifestyle-related factors. Data were analyzed for within-group and between-group changes. RESULTS Both groups showed increases in the two measures of telomerase gene expression, hTR mRNA levels (SR: p< 0.001; EHE: p< 0.001) and hTERT mRNA levels (SR: p = 0.055; EHE: p< 0.002). However, no statistically significant between-group changes were observed. Both groups showed reductions in systolic BP. Adjusted changes were SR = -5.7 mm Hg, p< 0.01; EHE = -9.0 mm Hg, p < 0.001 with no statistically significant difference between group difference. There was a significant reduction in diastolic BP in the EHE group (-5.3 mm Hg, p< 0.001) but not in SR (-1.2 mm Hg, p = 0.42); the between-group difference was significant (p = 0.04). The EHE group showed a greater number of changes in lifestyle behaviors. CONCLUSION In this pilot trial, both stress reduction (Transcendental Meditation technique plus health education) and extensive health education groups demonstrated increased telomerase gene expression and reduced BP. The association between increased telomerase gene expression and reduced BP observed in this high-risk population suggest hypotheses that telomerase gene expression may either be a biomarker for reduced BP or a mechanism by which stress reduction and lifestyle modification reduces BP. TRIAL REGISTRATION ClinicalTrials.gov NCT00681200.
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Affiliation(s)
- Shanthi Duraimani
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America
- Department of Physiology and Health, Maharishi University of Management, Fairfield, Iowa, United States of America
- MUM Molecular Biology Laboratory, Maharishi University of Management, Fairfield Iowa, United States of America
| | - Robert H. Schneider
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America
- Department of Physiology and Health, Maharishi University of Management, Fairfield, Iowa, United States of America
| | - Otelio S. Randall
- Howard University College of Medicine, Department of Internal Medicine, Division of Cardiology, Washington DC, United States of America
| | - Sanford I. Nidich
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America
- Department of Physiology and Health, Maharishi University of Management, Fairfield, Iowa, United States of America
| | - Shichen Xu
- Howard University College of Medicine, Department of Internal Medicine, Division of Cardiology, Washington DC, United States of America
| | - Muluemebet Ketete
- Howard University College of Medicine, Department of Internal Medicine, Division of Cardiology, Washington DC, United States of America
| | - Maxwell A. Rainforth
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America
| | - Carolyn Gaylord-King
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America
| | - John W. Salerno
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America
| | - John Fagan
- Department of Physiology and Health, Maharishi University of Management, Fairfield, Iowa, United States of America
- MUM Molecular Biology Laboratory, Maharishi University of Management, Fairfield Iowa, United States of America
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Comment on 'Investigating the effect of the Transcendental Meditation Technique on blood pressure: a systematic review and meta-analysis'. J Hum Hypertens 2015; 30:412. [PMID: 26538382 DOI: 10.1038/jhh.2015.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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