Blood Pressure Response to Meditation and Yoga: A Systematic Review and Meta-Analysis

Effect of mindfulness-based meditation on blood pressure among adults with elevated blood pressure and hypertension: A systematic review of randomized controlled trials

BACKGROUND

Hypertension is a leading contributor to cardiovascular disorders globally. There has been a recent upsurge in non-pharmacological management involving mindfulness-based meditation (MBM) in lowering blood pressure (BP) among the hypertensive population; however, the level of supportive evidence among patients primarily diagnosed with hypertension remain limited. Therefore, this systematic review aimed to synthesize the evidence of randomized controlled trials (RCTs) on the effect of MBM on BP explicitly in adults primarily diagnosed with elevated blood pressure or hypertension.

METHODS

A database search of RCTs was conducted in PubMed, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science until December 2023. The effect size score was calculated for variables of interest followed by qualitative analysis.

RESULTS

Nine studies with 543 participants (mean age 54.9±9.0) met the pre-specified eligibility criteria. Eight trials reported MBM convincing in lowering the systolic BP (p=0.001-0.020) and 6 in reducing the diastolic BP (p=0.001-0.01) among this target population. There was a disparity of gender in 7 studies and 4 trials did not report the ethnicity of participants. The methodological quality of the trials was gratifying, however, most studies presented with absence of allocation concealment and blinding of outcome assessors, fragmentary reporting of data, and high attrition rate that potentially affected the validity of trials.

CONCLUSION

MBM interventions may serve as an early preventive and supportive measure for adults with elevated BP or hypertension. However, more robust and rigorous trials with a larger, homogeneous sample and long-term follow-up are necessary to quantify the magnitude of this intervention. Moreover, the methodological issues may affect the overall quality and reliability of MBM interventions; hence, future studies must also address the risk of bias due to inadequate blinding and high attrition through treatment concealment and personalized engagement measures.

Supplementation with l-arginine and nitrates vs age and individual physiological reactivity

Ageing is a natural ontogenetic phenomenon that entails a decrease in the adaptive capacity of the organism, as a result of which the body becomes less adaptable to stressful conditions. Nitrate and nitrite enter the body from exogenous sources and from nitrification of ammonia nitrogen by intestinal microorganisms. This review considers the mechanisms of action of l-arginine, a known inducer of nitric oxide (NO) biosynthesis, and nitrates as supplements in the processes of ageing and aggravated stress states, in which mechanisms of individual physiological reactivity play an important role. This approach can be used as an element of individual therapy or prevention of premature ageing processes depending on the different levels of initial reactivity of the functional systems. A search was performed of the PubMed, Scopus, and Google Scholar databases (n = 181 articles) and the author's own research (n = 4) up to May 5, 2023. The review presents analyses of data on targeted treatment of NO generation by supplementation with l-arginine or nitrates, which is a promising means for prevention of hypoxic conditions frequently accompanying pathological processes in an ageing organism. The review clarifies the role of the individual state of physiological reactivity, using the example of individuals with a high predominance of cholinergic regulatory mechanisms who already have a significant reserve of adaptive capacity. In studies of the predominance of adrenergic influences, a poorly trained organism as well as an elderly organism correspond to low resistance, which is an additional factor of damage at increased energy expenditure.

CONCLUSION

It is suggested that the role of NO synthesis from supplementation of dietary nitrates and nitrites increases with age rather than from oxygen-dependent biosynthetic reactions from l-arginine supplementation.

Effectiveness of Alternative Nostril Breathing on Blood Pressure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

INTRODUCTION

Hypertension, a significant risk factor for cardiovascular disease, has a high prevalence rate globally. While drug use is the most common approach, lifestyle improvements are crucial. Recently, there has been a notable upsurge of interest in various breathing methods, including device-induced breathing techniques like Resperate. However, the reliance on a device for these techniques has prompted the popularity of alternative breathing methods that can be performed without any external devices. One such method that has gained significant attention is alternative nostril breathing, which serves as an alternative medical treatment known for its effectiveness in reducing blood pressure. Therefore, this study aimed to systematically investigate the therapeutic effects of alternate nostril breathing.

METHODS

We selected 16 articles published in English, Korean, and Chinese databases, of which 14 met the eligibility criteria, and a systematic literature review was conducted. A meta-analysis was conducted on six qualified studies. Meta and sensitivity analyses were conducted using a random effects model of six randomized clinical trials (RCTs).

RESULTS

Results of alternative nostril breathing (ANB) on 1,377 participants have been reported based on the effects of systolic and diastolic blood pressure (SBP and DBP). Both the lone ANB and combined yoga programs resulted in significant reductions in SBP and DBP. Meta-analysis of the 6 trials with 525 participants demonstrated that ANB was better in reducing SBP than that of the control group (nonintervention or placebo) (mean difference [MD]: -7.16, 95% confidence interval [CI]: -7.86 to -6.45, I2: 93%). Moreover, ANB was better in reducing DBP than that of the control group (nonintervention or placebo) (MD: -5.16, 95% CI: -5.89 to -4.44, I2: 87%).

CONCLUSION

The results of the study are valid; however, attention is needed when interpreting the results because the heterogeneity exceeds 75%. A systematic review of 14 studies found that ANB can improve cardiovascular indicators, such as SBP and DBP, as well as non-cardiovascular factors, such as fatigue, intraocular pressure, and memory. However, the review noted that implementing double blinding in studies on yoga breathing intervention is difficult, and most studies were not double-blinded, suggesting the need for high-quality RCTs in the future.

Education of complementary and alternative medicine in adult education centers in Germany: a web-based survey

BACKGROUND

Adult education centers are an important part of health education worldwide. Our aim was to evaluate the courses offered by German adult education centers with regard to complementary medicine and nutrition.

METHODS

A systematic web-based search was done for the websites of German adult education centers and courses were analyzed considering topics, scientific soundness, and qualification of instructors.

RESULTS

Our search revealed 502 courses, 360 (71.7%) related to complementary and alternative medicine (CAM) and 176 courses on nutrition (35.1%). CAM courses most often presented methods with a focus on traditional Eastern medicine with yoga and similar mind-body practices (41.9%), traditional Chinese medicine (TCM; 13.3%), and ayurvedic medicine (11.4%). Content concerning nutrition mainly included controversial fasting methods like alkaline fasting, detox diets, and therapeutic fasting (43.8%), as well as Eastern traditional diets from TCM and ayurveda (21.7%). Most of the courses were given by non-medical practitioners (NMPs; 36.4%), while only very few physicians were engaged.

CONCLUSION

There are substantial doubts on the scientific background of many courses offered for lay adult health education. Besides direct misinformation, many courses reinforce alternative and non-evidence-based notions in society. Adult education centers should reconsider the topics of their courses as well as the professional qualifications of the instructors.

Yoga Nidra for hypertension: A systematic review and meta-analysis

BACKGROUND

Hypertension is a prevalent chronic condition that affects a substantial proportion of the world's population. Medications are commonly prescribed for hypertension management, but non-pharmacological interventions like yoga are gaining popularity.

OBJECTIVE

The purpose of this systematic review and meta-analysis is to assess the efficacy of Yoga Nidra (YN) for the management of hypertension.

METHODS

A systematic review and meta-analysis of clinical trials, i.e., non-randomized and randomized controlled trials (RCTs) was conducted to investigate the effects of YN on hypertension. PubMed, the Cochrane Library, SCOPUS, and EBSCO were searched for relevant studies published up to September 2022. The quality of the included studies was assessed using the Cochrane risk of bias tool. The primary outcome measure was the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) after YN intervention, analyzed as weighted mean difference (WMD), in comparison to control groups. The random-effects model was used for the meta-analysis. Risk of bias was assessed for RCTs and non-RCTs using Cochrane's RoB-2 and ROBINS-I tools, respectively.

RESULTS

Five RCTs and three Non-RCTs involving a total of 482 participants (239 for YN vs 243 for controls) were included in this review. The meta-analysis indicated that YN significantly reduced SBP (WMD = 12.03 mm Hg, 95% CI [7.12, 16.93], Z = 4.80, p < 0.00001) and DBP (WMD = 6.32 mm Hg, 95% CI [3.53, 9.12], Z = 4.43, p < 0.00001) compared to control groups. The overall risk of bias for the three RCTs was high, whereas for the five non-RCTs, one had an overall moderate risk while the other four had an overall serious risk of bias.

DISCUSSION

This systematic review and meta-analysis provides evidence supporting the efficacy of YN as a complementary therapy for hypertension management. YN is a safe, cost-effective, and easily accessible intervention that primarily relies on interoception and induces a deep relaxation response in practitioners, aiding them in coping with various components of high blood pressure, such as stress, vascular inflammation, peripheral vascular resistance, etc. Our understanding of the mechanisms of YN is constantly evolving, and there is a need for further research to fully explore and appreciate the significance of this ancient science and its potential efficacy on BP. Considering the results and the multifactorial role of YN, it can act as a safe and reliable adjuvant therapy to complement the pharmacological treatment of hypertension. However, further studies with larger sample sizes, longer follow-up periods, and homogenous populations are warranted.

CONCLUSION

This meta-analysis suggests that YN is effective in reducing SBP and DBP, particularly in individuals with hypertension. The results highlight the potential of YN as a complementary therapy for hypertension management. Healthcare providers may consider recommending YN to patients with hypertension as an adjuvant therapy to medication. Further studies are required to identify standardized optimal forms and durations of YN best suited for hypertension management.

Effect of breathing exercises on blood pressure and heart rate: A systematic review and meta-analysis

Background

Breathing exercises have been reported to have positive physiological effects on the body. The incidence of hypertension has become a major risk factor for cardiac complications leading to higher morbidity and mortality. Our aim was to conduct a systematic review and meta-analysis to study the effect of breathing exercises on blood pressure (BP) and heart rate (HR).

Methods

A systematic review and meta-analysis analyzing randomized clinical trials (RCTs) about the effect of breathing exercises on blood pressure was conducted (PROSPERO Registration ID: CRD42022316413). PubMed, ScienceDirect, WebofScience, and Cochrane Library databases were screened for RCTs from January 2017 to September 2022. The main search terms included "breathing exercise", "Pranayam", "Bhramari", "alternate nostril breathing", "deep breathing", "slow breathing", "hypertension", and "high blood pressure". The primary outcome was the value of the systolic blood pressure and diastolic blood pressure after the intervention. The effect on heart rate was also analyzed as a secondary outcome.

Results

A total of 15 studies were included in the meta-analysis. Breathing exercises have a modest but significant effect on decreasing systolic blood pressure (-7.06 [-10.20, -3.92], P = <0.01) and diastolic blood pressure (-3.43 [-4.89, -1.97], P = <0.01) mm Hg. Additionally, breathing exercises were also observed to cause a significant decrease in the heart rate (-2.41 [-4.53, -0.30], P = 0.03) beats/minute.

Conclusion

In a comprehensive systematic review and meta-analysis of breathing exercises and its effect on BP and HR, there is a moderate but significant positive effect. The studies are not deprived of bias.

The impact of yoga on aging physiology: A review

Frailty represents diminished reserve across multiple physiologic systems, accompanied by increased vulnerability to stressors and increased morbidity and mortality. With population aging, strategies to prevent and manage frailty are priorities in clinical medicine and public health. Current evidence-based approaches to frailty management are multimodal in nature. Yoga, an increasingly popular and highly adaptable mind-body practice, is multi-component, incorporating physical postures, breathing practices, meditation, and other elements, and may be a strategy for frailty management. Here, we summarize the evidence linking yoga practice to mitigation of age-related degradation across multiple physiologic systems, including cardiovascular, pulmonary, musculoskeletal, and nervous systems. We discuss putative mechanisms of action including modulation of the hypothalamic-pituitary-adrenal axis. Finally, we consider implications for clinical practice and future research.

Āsana for Back, Hips and Legs to Prevent Musculoskeletal Disorders among Dental Professionals: In-Office Yóga Protocol

Dental professionals are exposed to significant unavoidable physical stress, and theoretical ergonomic recommendations for a sitting workplace are inapplicable in many dental activities. Work-related musculoskeletal disorders (WMSDs) represent a serious health problem among dental professionals (prevalence: 64-93%), showing involvement of 34-60% for the low back and 15-25% for the hips. Muscle stress; prolonged sitting; forward bending and twisting of the torso and head; unbalanced working postures with asymmetrical weight on the hips and uneven shoulders; and others are inevitable for dental professionals. Therefore, the approach for the prevention and treatment of WMSDs must be therapeutic and compensatory. This project was conceived to provide a Yoga protocol for dental professionals to prevent or treat WMSDs from a preventive medicine perspective, and it would represent a Yoga-based guideline for the self-cure and prevention of musculoskeletal problems.

METHODS

Specific Yoga positions (āsana, such as Virāsana, Virabhadrāsana, Garudāsana, Utkatāsana, Trikonāsana, Anuvittāsana, Chakrāsana, Uttanāsana, Pashimottanāsana) have been selected, elaborated on and adapted to be practiced in a dental office using a dental stool or the dental office walls or a dental unit chair. The protocol is specifically devised for dental professionals (dentists, dental hygienists and dental assistants) and targeted for the low back, hips and legs (including knees and ankles). The protocol includes Visranta Karaka Sthiti (supported positions) in sitting (Upavistha Sthiti) and standing (Utthistha Sthiti) positions, twisting/torsions (Parivrtta), flexions/forward bend positions (Pashima) and extensions/arching (Purva) for musculo-articular system decompression and mobilization.

RESULTS

Over 60 Yogāsana-specifically ideated for back detensioning and mobilization, lumbar lordosis restoration, trunk side elongation, hip release and leg stretches and decontraction-are shown and described. The paper provides a meticulous description for each position, including the detailed movement, recommendations and mistakes to avoid, and the breathing pattern (breath control) in all the breath-driven movements (āsana in vinyāsa). An exhaustive analysis of posture-related disorders affecting the lower body among dental professionals is reported, including low-back pain, hip pain and disorders, piriformis syndrome and quadratus femoris dysfunction (gluteal pain), iliopsoas syndrome, multifidus disorders, femoroacetabular and ischiofemoral impingement, spinopelvic mobility, lumbopelvic rhythm, impairment syndromes, lower crossed syndrome, leg pain, knee pain and ankle disorders.

CONCLUSIONS

A detailed guideline of āsana for low-back decompression, hip joint destress, piriformis and gluteal muscle release, lumbar lordosis recovery and a spinopelvic mobility increase has been elaborated on. The designed Yogāsana protocol represents a powerful tool for dental professionals to provide relief to retracted stiff muscles and unbalanced musculoskeletal structures in the lower body.

Mechanisms of improved body composition among perimenopausal women practicing Meditative Movement: a proposed biobehavioral model

OBJECTIVES

Weight gain and unfavorable body composition are prevalent among midlife/older women throughout menopause. These shifts may negatively impact health, well-being, and longevity. Efforts to attenuate weight and body composition changes are traditionally driven by manipulation of diet and/or exercise; however, sustained results are limited, possibly because the full spectrum of biobehavioral systems is not addressed by diet and exercise alone. We propose a biobehavioral model detailing mechanisms of body composition decline among perimenopausal women and the associated components of Meditative Movement (ie, tai chi, qigong, yoga) that address each of these factors.

METHODS

Based on our previous work and extensive review of the literature, we developed a multifactorial and multidimensional biobehavioral model including factors that most directly relate to body composition among perimenopausal women: 1) psychological (ie, stress and mood, mindfulness and self-compassion, body awareness), 2) behavioral (ie, sleep, physical activity, eating behaviors), and 3) physiological (ie, cortisol, estrogen). Relationships between each factor, Meditative Movement practice components, and predicted effects on body composition were explored in detail.

RESULTS

Our model describes select psychological, behavioral, and physiological factors, and potential mechanistic pathways of Meditative Movement practice driving improved changes in body composition and weight outcomes for perimenopausal women.

CONCLUSIONS

The proposed model details a novel, evidence-supported means to reduce the risk of deleterious shifts in body composition throughout perimenopause and menopause thereafter. We suggest that these changes may occur directly and/or indirectly through psychological, behavioral, and physiological mechanisms that facilitate the desired changes in body composition.

Statistical heterogeneity in meta-analysis of hypertension and exercise training: A meta-review

We aim to evaluate the prevalence of reporting and the extent of statistical heterogeneity of systematic reviews with meta-analyses (SRMAs) of exercise training for hypertension and to provide practical recommendations for dealing with statistical heterogeneity. We systematically searched on four databases (from 2002 to September of 2023) for SRMAs comparing exercise interventions vs. a non-exercise control on blood pressure (BP) control in adults with hypertension. Fifty-nine SRMAs, with a median of 14 studies, were analysed. Cochran's Q (41%), I2 (24%), forest plots (44%), and particularly τ2 (54%) and prediction intervals (96.6%) frequently were not reported for the hypertension subgroup. The recalculated prediction intervals were discrepant (i.e., crossed the null effect) of significant 95% confidence intervals of most meta-analyses (systolic BP: 65%; diastolic BP: 92%). This suggests substantial heterogeneity across studies, which was often not acknowledged by authors' conclusions (78%). Consequently, downgrading the certainty of the available evidence may be justified alone due to heterogeneity across studies. Finally, we illustrate areas for improving I2 interpretation and provide practical recommendations on how to address statistical heterogeneity across all stages of a SRMA.

Cost-effectiveness and potential budget impact of non-pharmacological interventions for early management in prehypertensive people: an economic evaluation for China

BACKGROUND

Non-pharmacological interventions (NPIs) could be considered in the early management of prehypertensive population. This study aimed to evaluate the potential cost-effectiveness of NPIs and the budget impact of implementing NPIs on prehypertensive population in China and provide evidence of chronic disease management innovation for decision-makers.

METHODS

Five NPIs including usual care, lifestyle, strengthen exercise, relaxation, and diet therapy were selected based on the practice of hypertension management in China. A nine-state Markov model was constructed to evaluate the lifetime costs and health outcomes of five NPIs and a non-intervention group from the perspective of Chinese healthcare system. The effectiveness of NPIs was obtained from a published study. Parameters including transition probabilities, costs and utilities were extracted or calculated from published literature and open-access databases. Sensitivity analyses were conducted to test the uncertainty of all parameters. The impact of duration of intervention was considered in scenario analyses. A budget impact analysis (BIA) was conducted to evaluate the total cost and the medical cost saving of a hypothetical nationwide implementation of potential cost-effective NPI in prehypertensive people. Management strategies including focusing on patients with specific ages or different CVE risk levels, and different duration of implementation were taken into consideration.

RESULTS

Strengthen exercise was the most cost-effective intervention with a probability of 78.1% under the given WTP threshold. Our results were sensitive to the cost of interventions, and the utility of prehypertension and hypertension. The duration of implementation had limited impact on the results. BIA results showed that the program cost was hefty and far more than the medical cost saving with the course of simulation time. Applying management strategies which focused on individual characteristics could largely reduce the program cost despite it remained higher than medical cost saving.

CONCLUSIONS

Strengthen exercise was a potential NPI that can be considered in priority for early management in prehypertensive population. Although early management can acquire medical cost saving, the related program cost can be quite hefty. Precise strategies which may help reduce the cost of early management should be taken into consideration in program design.

Management of Hypertension With Non-pharmacological Interventions: A Narrative Review

Hypertension (HTN) is a condition that affects nearly half of the adult population in the United States. HTN is the elevation of blood pressure (BP) 130/80 mm Hg or higher. Untreated high blood pressure may increase the risk of myocardial infarction, stroke, and other serious complications. BP over 180/120 mm Hg with end-organ damage is called a hypertensive emergency. Despite advancements in medicine and treatment options, the global burden of HTN has been increasing due to the advancing age of the population and an increasing prevalence of obesity. Non-pharmacological management of HTN has gained prominence worldwide due to its additional benefits and positive impact on the overall health of individuals, having almost no side effects and reducing the financial burden of medication expenses. This article has compiled studies like systematic reviews, meta-analyses, and randomized controlled trials and reviewed the role of non-pharmacological management of HTN, including lifestyle modifications like exercise, weight loss, dietary interventions like dietary approaches to stop hypertension (DASH) diet, low sodium diet, limiting alcohol consumption, smoking cessation and stress management to help control blood pressure. However, non-pharmacological interventions should be initiated in an early phase, and for proper management of HTN, we may need to include both pharmacological and non-pharmacological interventions. This article explored and integrated various studies to highlight the role of non-pharmacological interventions to manage HTN. We also examined the need for more research studies for strategies to alleviate morbidity and mortality associated with HTN.

Delivering yoga to people with hypertension in the UK: A qualitative study to explore yoga providers' knowledge, experiences, and attitudes

Background and Aims

Yoga has become increasingly popular in the world and the UK for improving health and well-being. A growing body of research suggests that yoga could be used to improve the management of hypertension in addition to current management strategies. Previous cross-sectional studies have also reported that hypertension is one of the most commonly disclosed health conditions in yoga sessions in the United Kingdom. Therefore, semi-structured qualitative interviews were conducted with yoga providers in the United Kingdom (n = 19) to explore their knowledge, experiences, and attitudes toward delivering yoga to people with hypertension.

Methods

Interviews were audio-recorded, transcribed verbatim, and analyzed thematically.

Results

Eight themes were identified. Yoga providers were generally aware of the health conditions of their attendees, and they had a reasonable knowledge of the causes, signs and symptoms, and management of hypertension. While most had received some information about hypertension as part of their initial yoga teaching training, this was generally felt to be limited. They mentioned the biopsychosocial benefits of yoga on hypertension but also expressed their concerns about the lack of regulation, the wide disparity in what is being delivered under the label of yoga, and the competency of some yoga providers.

Conclusion

The findings suggest that yoga provision in the United Kingdom should be regulated with a better link with health service providers. A manual and training for yoga providers in the United Kingdom for managing hypertension using yoga would be helpful to address the training needs of yoga providers. However, there is a need for more robust studies before recommending the implementation of yoga in the management of hypertension in the United Kingdom.

Pilot study of Qigong/Tai Chi Easy acute effects of meditative movement, breath focus and "flow" on blood pressure, mood and oxytocin in older adults

BACKGROUND

Older adults are increasingly lonely and at risk for hypertension. Endogenous oxytocin levels are associated with lowering blood pressure (BP), suggesting value in increasing oxytocin. Regular practice of Tai Chi improves BP and mood; we explored a single session of Tai Chi Easy (TCE) with older adults and feasibility of measuring oxytocin as a key biomarker.

METHOD

In a single-arm pre-post design pilot study, 21 older adults (age 55-80) with mild-moderate hypertension practiced a single session (50-min) TCE. BP, psychosocial measures, and saliva samples were collected pre/post to examine feasibility of acute measures of oxytocin and explore effect sizes of outcomes. Participants (N = 21; 19 % Latinx, 76.2 % female, mean age 66.76).

RESULTS

BP systolic: 138.43-134.86; diastolic 78.48-78.00 (p > .05; Cohen's d -0.23; -0.08 respectively). Total Mood Disturbance (TMD) and Connection (CN) improved [TMD mean pre 41.891 (SD=19.60) to post 35.00 (SD=10.21), p = .01; Cohen's d - 0.67); CN mean 7.85 (SD=2.01) to post 9.05 (SD=1.00), p = .01; Cohen's d 0.70]. Baseline oxytocin was positively correlated with baseline loneliness (N = 14, r = .599); pre/post oxytocin changes were negatively correlated with baseline loneliness (N = 14, r = -.585). BP decrease was associated with characteristics of the intervention: "flow" (coef=.=0.58N = 17) and meditative/breath focus (coef=-1.78; N = 17).

DISCUSSION/CONCLUSION

Medium to large effect sizes indicating change in mood and connection were found for this single session intervention. Knowing that Tai Chi improves BP when practiced over time, this TCE intervention shows promise for planning a fully powered, randomized controlled study of BP, mood and perceptions of connection in hypertensive older adults. Feasibility of assessing acute salivary oxytocin is less promising. Increase in oxytocin levels occurred for those less lonely, but declined for lonelier participants. With different responses based on baseline loneliness scores, no mean change in oxytocin levels was found. Seemingly unstable levels (possibly related to interaction with study staff) suggests the need for further testing in more controlled study designs. Finally, BP associations with meditative/breath focus and flow could be further explored in future study designs addressing mediation.

Āsana for Neck, Shoulders, and Wrists to Prevent Musculoskeletal Disorders among Dental Professionals: In-Office Yóga Protocol

Extensive literature reports an increase in physical disorders (pain, pathologies, dysfunctions) and mental malaise/uneasiness (stress, burnout) affecting dental professionals in relation to fast and pressing rhythms of work, long working hours, increasingly demanding patients, ever-evolving technologies, etc. This project has been conceived to bring the science of yoga around the world to dental professionals as a preventive (occupational) medicine and to provide knowledge and means for self-care. Yoga is a concentrative self-discipline of the mind, senses, and physical body, that requires regular daily exercise (or meditation), attention, intention, and disciplined action. M&M: The study aimed to design a Yoga protocol specifically devised for dental professionals (dentists, dental hygienists, and dental assistants) including positions (āsana) to be practiced/used in the dental office. The protocol is targeted for the upper body, namely neck, upper back, chest, shoulder girdle, and wrists, being areas greatly affected by work-related musculoskeletal disorders. This paper represents a yoga-based guideline for the self-cure of musculoskeletal disorders among dental professionals. Results: The protocol includes both sitting (Upavistha position) and standing (Utthana or Sama position) āsana, with twisting (Parivrtta), side bending (Parsva), flexion and forward bending (Pashima), and extension and arching (Purva) āsana to mobilize and decompress, and to provide nourishment and oxygen to the musculo-articular system. The paper delivers different concepts and theories developed and deepened by the authors and introduces and spreads yoga as a medical science among dental professionals for the prevention and treatment of work-related musculoskeletal disorders. We articulate notions ranging from stretching out using the vinyāsa method (breath-driven movement) and inward-focused attention to contemplative/concentrative science, interoceptive attention, self-awareness, the mind-body connection, and receptive attitude. The theory of "muscles are bone ties" is coined and delivered with regard to tensegrity musculoskeletal fascial structures connecting, pulling together, and nearing the bone segments where they are anchored. The paper describes over 60 āsana envisaged to be performed on dental stools or using the walls of a dental office or a dental unit chair. A detailed guideline on the work-related disorders that can find relief with the protocol is provided, including the description of breath control for the practice of āsana in vinyāsa. The foundations of the technique reside in the IyengarYoga method and ParināmaYoga method. Conclusions: This paper represents a guideline for self-cure in the prevention or treatment of musculoskeletal disorders affecting dental professionals. Yoga is a powerful concentrative self-discipline able to provide physical and mental well-being, representing great help and support in daily life and business for dental professionals. Yógāsana restores retracted and stiff muscles, giving relief to the strained and tired limbs of dental professionals. Yoga is not intended for flexible or physically performing persons but for people who decide to take care of themselves. The practice of specific āsana represents a powerful tool for the prevention or treatment of MSDs related to poor posture, forward head, chronic neck tension (and related headache), depressed chest, compressive disorders on wrists and shoulders as carpal tunnel, impingement syndromes, outlet syndrome, subacromial pain syndrome and spinal disc pathologies. Yoga, as an integrative science in medicine and public health, represents a powerful tool for the prevention and treatment of occupational musculoskeletal disorders and an extraordinary path for the self-care of dental professionals, sitting job workers, and healthcare providers suffering from occupational biomechanical stresses and awkward postures.

Short-term efficacy of non-pharmacological interventions for global population with elevated blood pressure: A network meta-analysis

Background

This study aims to compare the potential short-term effects of non-pharmacological interventions (NPIs) on prehypertensive people, and provide evidence for intervention models with potential in future community-based management.

Methods

In this Bayesian network meta-analysis, Pubmed, Embase, and Web of science were screened up to 16 October 2021. Prehypertensive patients (systolic blood pressure, SBP 120-139 mmHg/diastolic blood pressure, DBP 80-89 mmHg) with a follow-up period longer than 4 weeks were targeted. Sixteen NPIs were identified during the scope review and categorized into five groups. Reduction in SBP and DBP was selected as outcome variables and the effect sizes were compared using consistency models among interventions and intervention groups. Grade approach was used to assess the certainty of evidence.

Results

Thirty-nine studies with 8,279 participants were included. For SBP, strengthen exercises were the most advantageous intervention group when compared with usual care (mean difference = -6.02 mmHg, 95% CI -8.16 to -3.87), and combination exercise, isometric exercise, and aerobic exercise were the three most effective specific interventions. For DBP, relaxation was the most advantageous intervention group when compared with usual care (mean difference = -4.99 mmHg, 95% CI -7.03 to -2.96), and acupuncture, meditation, and combination exercise were the three most effective specific interventions. No inconsistency was found between indirect and direct evidence. However, heterogeneity was detected in some studies.

Conclusion

NPIs can bring short-term BP reduction benefits for prehypertensive patients, especially exercise and relaxation. NPIs could potentially be included in community-based disease management for prehypertensive population once long-term real-world effectiveness and cost-effectiveness are proven.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=151518, identifier: CRD42020151518.

The Effects of Yoga Exercise on Blood Pressure and Hand Grip Strength in Chronic Stroke Patients: A Pilot Controlled Study

BACKGROUND

We investigated the beneficial effect of add-on yoga with rehabilitation on blood pressure (BP) and hand grip strength in patients with chronic stroke (more than 90 days).

METHODS

The study included patients 30-80 years of age who could stand independently for 1 min. Patients with psychiatric diseases or undergoing other therapies (like acupuncture) were excluded. The yoga group received training (1 h session twice weekly) with standard rehabilitation for 8 weeks. The control group received standard rehabilitation only. There were no differences in age, gender, hand grip strength, or BP between the two groups (16 subjects in each group) at baseline.

RESULTS

The systolic BP (p = 0.01) decreased significantly, and the diastolic BP also decreased but not significantly in the yoga group (p = 0.11). For hand grip strength, both the unaffected hand (p = 0.00025) and the affected hand (p = 0.027) improved significantly. The control group showed no significant change in systolic or diastolic BP, nor did the grip strength change in both hands. Gender and age also affected the results of overall rehabilitation in that women benefited more from a decrease in BP, while men and young people (lower than the mean age of 60) benefited from hand grip strength improvement.

CONCLUSIONS

Combining yoga with rehabilitation in chronic stroke patients can improve hand grip strength and decrease systolic BP.

What Brings Young Adults to the Yoga Mat? Cross-Sectional Associations Between Motivational Profiles and Physical and Psychological Health Among Participants in the Project EAT-IV Survey

Objectives: This study examines motivations for yoga and identifies unique motivational profiles among a sample of young adult yoga practitioners. This study further determines how young adult yoga practitioners' motivational profiles associate with physical health behaviors and psychological factors. Subjects/Setting: Survey data were drawn from the fourth wave of a large, population-based study (Project EAT-IV; Eating and Activity in Teens and Young Adults). Design: Latent class analysis (LCA) was used to identify motivational profiles among Project EAT-IV participants practicing yoga (n = 297; mean age: 30.8-1.7 years; 79.7 % female). Cross-sectional associations between latent motivational profiles, physical health behaviors, and psychological factors were determined with unadjusted and adjusted (gender, race/ethnicity, and body mass index) general linear models. Results: Across motivational profiles, most young adult yoga practitioners were motivated by enhanced fitness and stress reduction/relaxation. Additional motivations for yoga clustered by appearance (desire to change body appearance or weight) or mindfulness (desire to increase present moment awareness) underpinnings. The LCA characterized motivational profiles as "Low Appearance, Low Mindfulness" (Class 1; n = 77), "Low Appearance, High Mindfulness" (Class 2; n = 48), "High Appearance, Low Mindfulness" (Class 3; n = 79), and "High Appearance, High Mindfulness" (Class 4; n = 93). Having a profile with high mindfulness and low appearance motivations (Class 2) was associated with higher body satisfaction in comparison to the other classes (p < 0.001). Relative to Class 2, those with low mindfulness motivations (Class 1; Class 3) reported less total physical activity (p = 0.002) and those with high appearance motivations (Class 3; Class 4) reported higher compulsive exercise scores (p = 0.002). Conclusions: In this sample, high mindfulness and low appearance motivations for yoga appeared optimal for physical and psychological health. Cross-sectional findings suggest that young adult yoga practitioners' mind-body health may be supported by motivational underpinnings that emphasize yoga's internal (mindfulness) rather than external (appearance) benefits.

Exercise to Treat Hypertension: Late Breaking News on Exercise Prescriptions That FITT

ABSTRACT

Hypertension is the leading risk factor for cardiovascular disease and an independent predictor of mortality. The prevalence of hypertension has doubled in the last two decades and evidence suggests that almost half the individuals are unaware of their condition. The antihypertensive effects of exercise are now undisputable, and exercise training is recommended by the major professional and scientific societies, including the American College of Sports Medicine (ACSM), as first-line treatment to prevent, treat, and control hypertension. This review aims to overview the evidence supporting the current ACSM Frequency, Intensity, Time, and Type exercise recommendations for hypertension, discuss new and emerging evidence on exercise in the treatment of hypertension from our laboratories; and propose future directions of research integrating this new and emerging evidence.

Risk of Hypertension and Use of Antihypertensive Drugs in the Physically Active Population under-70 Years Old—Spanish Health Survey

Introduction: Reducing the prevalence of hypertension is a major priority of the World Health Organization (WHO). Its high prevalence and associated risks generate high economic and social costs. Physical activity (PA) is associated with a decrease in hypertension and in the use of antihypertensive drugs. Objective: To explore the association between PA levels (PAL), prevalence of hypertension and the use of antihypertensive drugs in Spanish population. To calculate risks of hypertension and use of antihypertensive in the inactive versus physically active population. Method: This cross-sectional study used data from 17717 individuals, sampled in the 2017 National Health Survey. Interaction by sex, age groups, body mass index (BMI), hypertension prevalence, antihypertensive drugs use and PAL, using a pairwise z-test, and dependence relationships between variables, were studied using a chi square test. Odds ratios of hypertension and antihypertensive drug use were calculated among the inactive and the physically active populations. Results: The findings showed a significant inverse association between prevalence of hypertension, antihypertensive use, and PAL in both sexes and different age and BMI groups, with lower prevalence of hypertension and antihypertensive use when PAL were higher. The risks of hypertension and antihypertensive use seems to be reduced when related to higher PAL compared to inactive people. Conclusions: High PAL is associated with lower prevalence of hypertension and lower antihypertensive use. Thus, being physically active or very active may reduce the risks of suffering from hypertension and the need to use antihypertensives compared to inactive people or walkers.

Intense positive affect without arousal is possible: Subjective and physiological reactivity during a partnered sexual meditative experience

Though common models suggest that affect intensity can be thought of as orthogonal to arousal, examples of intensely pleasant low arousal stimuli remain rare. To support this orthogonal model, we examined whether a specific meditative sexual practice, Orgasmic Meditation (OM), induces such a state. Thus, this study measured changes in subjective affect as well as skin conductance responses (SCR), as a proxy for physiological arousal associated with sympathetic nervous system activity, during a single 15-minute partnered sexual meditative practice (Orgasmic Meditation; OM) in 93 participants. Almost all participants experienced sustained positive affect during the task. Whereas seconds after OM start approximately half the participants experienced sustained increased SCR, the other half experienced sustained decreased SCR. . This observation suggests that the experience of sustained positive affect in intimate interactions may be associated with multiple mechanistic profiles including both decreased and increased arousal.

Effects of Transcendental Meditation on Blood Pressure

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.

Content, Structure, and Delivery Characteristics of Yoga Interventions for Managing Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objectives

This systematic review aimed to synthesize the content, structure, and delivery characteristics of effective yoga interventions used for managing hypertension and to compare these characteristics with ineffective interventions.

Design and Method

The JBI and the PRISMA guidelines were followed in this systematic review. RCTs conducted among hypertensive adults were included. RCTs reporting at least one of the major components of yoga (i.e., asana, pranayama, and dhyana and relaxation practices) and comparing them with no intervention or any intervention were eligible. Sixteen databases were searched for published and unpublished studies without any date and language restrictions till March 15, 2021.

Results

The literature search yielded 13,130 records. 34 RCTs (evaluating 38 yoga interventions) met the inclusion criteria. Overall, included studies had low methodological quality mostly due to inadequate reporting. Yoga reduced SBP and DBP compared to a control intervention (MD -6.49 and -2.78; 95CI% -8.94- -4.04 and -4.11- -1.45, respectively). Eighteen, 14 and 20 interventions were effective in improving SBP, DBP, or either, respectively. 13 out of 20 effective interventions incorporated all the 3 major components of yoga and allocated similar durations to each component whereas ineffective interventions were more focused on the asana and duration of asana practice was longer. The most common duration and frequency of effective interventions were 45 min/session (in 5 interventions), 7 days/week (in 5 interventions), and 12 weeks (in 11 interventions) whereas the most common session frequency was 2 days a week (in 7 interventions) in ineffective interventions. Effective interventions were mostly center-based (in 15 interventions) and supervised (in 16 interventions) and this was similar with ineffective interventions.

Conclusion

Despite the low quality and heterogeneity of included studies, our findings suggest yoga interventions may effectively manage hypertension. The differences between the effective and ineffective interventions suggest that effective yoga interventions mostly incorporated asana, pranayama, and dhyana and relaxation practices and they had a balance between these three components and included regular practice. They were mostly delivered in a center and under supervision. Future studies should consider developing and evaluating an intervention for managing hypertension using the synthesized findings of the effective interventions in this review.

Systematic Review Registration

[PROSPERO], identifier [CRD42019139404].

Salat Dhuha Improves Haemodynamic: A Randomized Controlled Study

BACKGROUND: The prevalence of hypertension increases with age, more than 1 in every two elderly have hypertension, dominated by women. The primary prevention of hypertension is a worldwide public health concern. Salat Dhuha is a moderate-intensity physical activity. Salat with a two-movement cycle (rakaat) demonstrated improved hemodynamic in adults. AIM: Our study purpose was to asses the effects of 2 and 8 rakaats of Salat Dhuha in improving systolic and diastolic blood pressure and heart rate in healthy elderly women. METHODS: Elderly women in the Senior Care Residence (aged 60–74 years) participated in a 6-week controlled study. We completed a formal physical, clinical, and blood assessments before admission. Participants with a history of hypertension were excluded from the study. The participants were randomized into 2 groups, i.e., “8 rakaats group” (n = 13) and “2 rakaats group” (n = 13) of Salat Dhuha. Two participants dropped out from the present study. At baseline and at the end of 6 weeks study period, blood pressure and heart rate were recorded. All data obtained were statistically analyzed. RESULTS: Both groups demonstrated the benefits of Salat Dhuha in improving hemodynamic parameters (systolic and diastolic blood pressure and heart rate). However, the reduction of systolic blood pressure in the “2 rakaats group” (2.16 mmHg) was less than in the “8 rakaats group” (5.50 mmHg), the reduction of diastolic blood pressure in the “2 rakaats group” (0.75 mmHg) was less than the “8 rakaats group” (2.41 mmHg) and the reduction of heart rate in “2 rakaats group” (2.08 bpm) was less than the “8 rakaats group” (6.08 bpm). All differences were statistically significant (p < 0.05). CONCLUSION: This study demonstrated that the Salat Dhuha has a significant potential in improving hemodynamic parameters for elderly women which the more frequent rakaat will give more benefit than less frequent rakaat.

Meta-Analysis of the Effect of Yoga Practice on Physical Fitness in the Elderly

The purpose of this study was to meta-analyze the effects of yoga intervention on physical fitness in the elderly. The following databases were systematically searched in 25 March 2021: Cochrane, PubMed and Embase. A total of 656 papers was identified through key word combinations, finally, 12 studies were included in the meta-analysis. The main conclusions are as follows. First, yoga practice showed moderately positive effects on muscle strength, balance, mobility, and lower body flexibility, but had no significant effect on cardiorespiratory endurance and upper body flexibility. Second, sub-group analysis showed that subjects in their 60s and 70s and yoga practice for 9–12 weeks had a large positive effect on physical fitness. Yoga is a multimodal activity that improves muscle strength, balance, and flexibility in the elderly, and physical activity policies should continue to promote yoga as an activity that enhances physical and mental wellbeing in this population.

Effect of Yoga on Blood Pressure in Prehypertension: A Systematic Review and Meta-Analysis

Introduction

Prehypertension is a precursor for developing hypertension and is a risk factor for cardiovascular diseases. Yoga therapy may have a role in lowering the blood pressures in prehypertension and hypertension. This systematic review aims to synthesize the available literature for the same. Methodology. Databases such as PubMed, Embase, Scopus, and Web of Science were searched for randomised control trials only in the time duration of 2010–2021. The main outcome of interest was systolic and diastolic blood pressures. Articles were screened based on the inclusion criteria, and 8 articles were recruited for the review. Meta-analysis was done for suitable articles. RevMan 5.4 by Cochrane was used for meta-analysis and forest plot construction. Risk of bias was determined using the Downs and Black checklist by three independent authors.

Results

The meta-analysis of the articles favoured yoga intervention over the control intervention. Yoga therapy had significantly reduced the systolic pressure (−0.62 standard mean difference, at IV fixed 95% CI: −0.83, −0.41) and diastolic pressure (−0.81 standard mean difference, at IV random 95% CI: −1.39, −0.22). Secondary outcome measures studied were heart rate, weight, BMI, waist circumference, and lipid profile. The main protocol of yoga therapy included postures, breathing exercises, and different meditation techniques. A significant reduction in secondary outcomes was observed, except for HDL values in lipid profile which showed a gradual increase in yoga group in comparison with alternative therapy.

Conclusion

Yoga therapy has shown to be significant in the reduction of systolic and diastolic pressure in prehypertensive population. Supporting evidence lacks in providing a proper structured dosage of yoga asanas and breathing techniques. Considering the existing literature and evidence, Yoga therapy can be used and recommended in prehypertensive population and can be beneficial in reducing the chances of developing hypertension or cardiovascular diseases.

Capnometric feedback training decreases 24-h blood pressure in hypertensive postmenopausal women

BACKGROUND

High normal resting pCO₂ is a risk factor for salt sensitivity of blood pressure (BP) in normotensive humans and has been associated with higher resting systolic BP in postmenopausal women. To date, however, no known studies have investigated the effects of regular practice of voluntary mild hypocapnic breathing on BP in hypertensive patients. The objective of the present research was to test the hypothesis that capnometric feedback training can decrease both resting pCO₂ and 24-h BP in a series of mildly hypertensive postmenopausal women.

METHODS

A small portable end tidal CO₂ (etCO₂) monitor was constructed and equipped with software that determined the difference between the momentary etCO₂ and a pre-programmed criterion range. The monitor enabled auditory feedback for variations in CO₂ outside the criterion range. 16 mildly hypertensive postmenopausal women were individually trained to sustain small decreases in etCO₂ during six weekly sessions in the clinic and daily sessions at home. 24-h BP monitoring was conducted before and after the intervention, and in 16 prehypertensive postmenopausal women in a control group who did not engage in the capnometric training.

RESULTS

Following the intervention, all 16 capnometric training participants showed decreases in resting etCO₂ (- 4.3 ± 0.4 mmHg; p < .01) while 15 showed decreases in 24-h systolic BP (- 7.6 ± 2.0 mmHg; p < .01). No significant changes in either measure was observed in the control group. In addition, nighttime (- 9.5 ± 2.6; p < .01) and daytime (- 6.7 ± 0.2 mmHg) systolic BP were both decreased following capnometric training, while no significant changes in nighttime (- 2.8 ± 2.2 mmHg; p = .11) or daytime (- 0.7 ± 1.0 mmHg; p ≤ .247) systolic BP were observed in the control group.

CONCLUSIONS

These findings support the hypothesis that regular practice of mild hypocapnic breathing that decreases resting etCO₂ reliably decreases 24-h blood pressure in hypertensive postmenopausal women. The extent to which these effects persist beyond the training period or can be observed in other hypertensive subgroups remains to be investigated.

Applying the S-ART Framework to Yoga: Exploring the Self-Regulatory Action of Yoga Practice in Two Culturally Diverse Samples

Mindfulness practices form the core of numerous therapeutic programs and interventions for stress reduction and the treatment of different health conditions related to stress and life habits. Ways and means to regulate oneself effectively also form the foundation of the path of yoga in the accomplishment of holistic health and well-being. The self-awareness, self-regulation, and self-transcendence (S-ART) model can be considered as an overarching neurobiological framework to explain the self-regulatory mechanisms of well-being present in mindfulness-based practices. The current study, by connecting and applying the S-ART framework to the self-regulatory mechanisms in yoga and generating related hypotheses, provides a theory-led explanation of the action of yoga practices, which is sparse in the literature. Testing the S-ART model in yoga in two culturally diverse samples, assessing the model-mapped psychological mechanisms of action, and exploring the influence of perseverance in yoga practice are the original contributions of this study. The study sample comprised 362 yoga practitioners and non-practitioners (197 Indian and 165 Spanish), who completed four tests of psychological variables indicative of the aforementioned three S-ART abilities. These tests were Multidimensional Assessment of Interoceptive Awareness (MAIA), Experiences Questionnaire-Decentering (EQ-D) subscale, Difficulties in Emotion Regulation Scale (DERS), and Relational Compassion Scale (RCS). The results indicated significantly better self-awareness and self-regulatory abilities in yoga practitioners (Indian and Spanish in a combination) than non-practitioners, reflected in higher levels of interoceptive awareness and decentering abilities. Moreover, perseverance in yoga practice acted as a significant predictor of self-awareness and self-regulation in practitioners. An analysis of each cultural sample revealed some differences. Yoga practice and perseverance in it acted as a significant predictor of interoceptive awareness and decentering in Indian practitioners having more than 1 year of sustained yoga practice, but for the Spanish participants, physical exercise and frequency of yoga practice acted as better predictors of interoceptive awareness and decentering in comparison to yoga practice and perseverance in it. The obtained results suggested that the S-ART model provided preliminary but promising evidence for the self-regulatory mechanisms of action in yoga practice within a culturally diverse sample of yoga practitioners. This study also widens the scope of generating further hypotheses using the S-ART theoretical framework for testing the self-regulatory mechanisms of action in yoga practice.

Effects of Integrated Amrita Meditation Technique on Anxiety, Depression, and Plasma Neurotransmitters on a Healthy Population: A Randomized Controlled Trial Followed by a Case-Control Study

Objective: We aimed to study the short-term effects of Integrated Amrita Meditation (IAM) technique in anxiety and depression states and to have a better understanding on the underlying physiological changes related to short-term and long-term IAM practice. Design: Short-term IAM practitioners (ST-IAM) and long-term IAM practitioners (LT-IAM) were compared to control groups of the same age and naïve to yoga and meditation (ST-control and LT-control, respectively). Settings/Location: Kerala, India. Subjects: People that did not suffer from any major medical condition. All participants were naïve to yoga and meditation practices, except for the 5 LT-IAM practitioners. Intervention: ST-IAM practitioners underwent 2 community IAM practices and 5 individual IAM practices. LT-IAM practitioners (performing IAM regularly for more than 4 years) underwent a community IAM practice before the study. Outcome measures: Anxiety and depression states and physiological parameters from ST-IAM and ST-control groups were assed in two different visits (before and after the week of IAM practice or control condition). LT-IAM and LT-control subjects' physiological measurements were taken in only one visit. Results: Short-term IAM practice significantly decreased anxiety and depression states; two way ANOVA indicated differences on anxiety and depression scores across visits between ST-IAM and ST-control groups (Group effect: F_{(1, 25)} = 6.083, p = 0.0209; F_{(1, 25)} = 4.449, p = 0.0451). However, no changes were observed on their physiological parameters (heart rate, blood pressure, oxygen saturation, and dopamine and GABA plasma levels). Interestingly, LT-IAM practitioners showed increased GABA plasma levels than the LT-control group (p = 0.0358, t = 2.521, df = 8). Conclusions: Our study indicates the possible role of IAM technique on modulations of the plasma GABAergic levels and shows that one week of IAM practice is accompanied by a significant decrease of anxiety and depression states in the healthy population.

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)

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

Stress-Reducing Effects of Playing a Casual Video Game among Undergraduate Students

To assess the potential effectiveness of playing a simple, casual video game (Flower) in reducing stress relative to participating in a mindfulness-meditation session (body scan) among undergraduate students. Eighty undergraduate student participants (mean age = 19.46 years, SD = 1.43; gender: 48 females, 29 males, 3 preferred not to answer) were assigned to one of two groups in alternating order: one who played Flower and the comparison group who participated in a body scan, each lasting 20 min. Psychological and physiological stress measurements were made before and after each intervention. Self-perceived psychological stress was measured using a modified version of the nine-item Psychological Stress Measure (PSM-9), and physiological stress (heart rate, systolic and diastolic blood pressure) was measured using an electronic blood-pressure cuff. The results were analyzed with a 2 (measurement: pre, post) × 2 (intervention: video game, mindfulness-meditation) mixed model analysis of variance (ANOVA) for each of the four outcome measures. There was a statistically significant reduction (pre- to post-intervention) across all outcome measures. Notably, there was a significant measurement × intervention interaction (p < .001) for the psychological stress measure; participants in the mindfulness-meditation group reported greater stress reduction after the intervention than participants in the video game group. Although these results suggest mindfulness-meditation provides a slight advantage for stress reduction than casual video games, the similarity in reduction across all physiological measures between the two interventions nevertheless suggests casual video games may also be an effective medium. This finding is especially promising given casual video games’ accessibility, ease of use, and popularity among students. These results may inform initiatives by colleges and universities to better support students during peak times of stress and especially during the current COVID-19 pandemic.

Is Mindfulness-Based Stress Reduction Effective for People with Hypertension? A Systematic Review and Meta-Analysis of 30 Years of Evidence

Background: Hypertension is among the most important risk factors for cardiovascular diseases, which are considered high mortality risk medical conditions. To date, several studies have reported positive effects of mindfulness-based stress reduction (MBSR) interventions on physical and psychological well-being in other medical conditions, but no meta-analysis on MBSR programs for hypertension has been conducted. Objectives: The objective of this study was to determine the effectiveness of MBSR programs for hypertension. Methods: A systematic review and meta-analysis of randomized controlled trials examining the effects of MBSR on systolic and diastolic blood pressure (BP), anxiety, depression, and perceived stress in people with hypertension or pre-hypertension was conducted. The PubMed/MEDLINE and PsycINFO databases were searched in November 2020 to identify relevant studies. Results: Six studies were included. The comparison of MBSR versus control conditions on diastolic BP was associated with a statistically significant mean effect size favoring MBSR over control conditions (MD = -2.029; 95% confidence interval (CI): -3.676 to -0.383, p = 0.016, k = 6; 22 effect sizes overall), without evidence of heterogeneity (I2 = 0.000%). The comparison of MBSR versus control conditions on systolic BP was associated with a mean effect size which was statistically significant only at a marginal level (MD = -3.894; 95% CI: -7.736-0.053, p = 0.047, k = 6; 22 effect sizes overall), without evidence of high heterogeneity (I2 = 20.772%). The higher the proportion of participants on antihypertensive medications was, the larger the effects of MBSR were on systolic BP (B = -0.750, z = -2.73, p = 0.003). Conclusions: MBSR seems to be a promising intervention, particularly effective on the reduction of diastolic BP. More well-conducted trials are required.

Changes Induced by Mind-Body Intervention Including Epigenetic Marks and Its Effects on Diabetes

Studies have evidenced that epigenetic marks associated with type 2 diabetes (T2D) can be inherited from parents or acquired through fetal and early-life events, as well as through lifelong environments or lifestyles, which can increase the risk of diabetes in adulthood. However, epigenetic modifications are reversible, and can be altered through proper intervention, thus mitigating the risk factors of T2D. Mind-body intervention (MBI) refers to interventions like meditation, yoga, and qigong, which deal with both physical and mental well-being. MBI not only induces psychological changes, such as alleviation of depression, anxiety, and stress, but also physiological changes like parasympathetic activation, lower cortisol secretion, reduced inflammation, and aging rate delay, which are all risk factors for T2D. Notably, MBI has been reported to reduce blood glucose in patients with T2D. Herein, based on recent findings, we review the effects of MBI on diabetes and the mechanisms involved, including epigenetic modifications.

Yoga Practice Is Beneficial for Maintaining Healthy Lifestyle and Endurance Under Restrictions and Stress Imposed by Lockdown During COVID-19 Pandemic

Uncertainty about Coronavirus disease 2019 (COVID-19) and resulting lockdown caused widespread panic, stress, and anxiety. Yoga is a known practice that reduces stress and anxiety and may enhance immunity. This study aimed to (1) investigate that including Yoga in daily routine is beneficial for physical and mental health, and (2) to evaluate lifestyle of Yoga practitioners that may be instrumental in coping with stress associated with lockdown. This is a pan-India cross-sectional survey study, which was conducted during the lockdown. A self-rated scale, COVID Health Assessment Scale (CHAS), was designed by 11 experts in 3 Delphi rounds (Content valid ratio = 0.85) to evaluate the physical health, mental health, lifestyle, and coping skills of the individuals. The survey was made available digitally using Google forms and collected 23,760 CHAS responses. There were 23,290 valid responses (98%). After the study's inclusion and exclusion criteria of yogic practices, the respondents were categorized into the Yoga (n = 9,840) and Non-Yoga (n = 3,377) groups, who actively practiced Yoga during the lockdown in India. The statistical analyses were performed running logistic and multinomial regression and calculating odds ratio estimation using R software version 4.0.0. The non-Yoga group was more likely to use substances and unhealthy food and less likely to have good quality sleep. Yoga practitioners reported good physical ability and endurance. Yoga group also showed less anxiety, stress, fear, and having better coping strategies than the non-Yoga group. The Yoga group displayed striking and superior ability to cope with stress and anxiety associated with lockdown and COVID-19. In the Yoga group, participants performing meditation reportedly had relatively better mental health. Yoga may lead to risk reduction of COVID-19 by decreasing stress and improving immunity if specific yoga protocols are implemented through a global public health initiative.

Stretching is Superior to Brisk Walking for Reducing Blood Pressure in People With High-Normal Blood Pressure or Stage I Hypertension

BACKGROUND

Aerobic exercise is recommended for reducing blood pressure; however, recent studies indicate that stretching may also be effective. The authors compared 8 weeks of stretching versus walking exercise in men and women with high-normal blood pressure or stage 1 hypertension (ie, 130/85-159/99 mm Hg).

METHODS

Forty men and women (61.6 y) were randomized to a stretching or brisk walking exercise program (30 min/d, 5 d/wk for 8 wk). Blood pressure was assessed during sitting and supine positions and for 24 hours using a portable monitor before and after the training programs.

RESULTS

The stretching program elicited greater reductions than the walking program (P < .05) for sitting systolic (146 [9] to 140 [12] vs 139 [9] to 142 [12] mm Hg), supine diastolic (85 [7] to 78 [8] vs 81 [7] to 82 [7] mm Hg), and nighttime diastolic (67 [8] to 65 [10] vs 68 [8] to 73 [12] mm Hg) blood pressures. The stretching program elicited greater reductions than the walking program (P < .05) for mean arterial pressure assessed in sitting (108 [7] to 103 [6] vs 105 [6] vs 105 [8] mm Hg), supine (102 [9] to 96 [9] vs 99 [6] to 99 [7] mm Hg), and at night (86 [9] to 83 [10] vs 88 [9] to 93 [12] mm Hg).

CONCLUSIONS

An 8-week stretching program was superior to brisk walking for reducing blood pressure in individuals with high-normal blood pressure or stage 1 hypertension.

Effect and Acceptability of Mindfulness-Based Stress Reduction Program on Patients With Elevated Blood Pressure or Hypertension: A Meta-Analysis of Randomized Controlled Trials

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.

Meta-Analysis of Randomized Controlled Trials of the Effects of Tai Chi on Blood Pressure

Objectives

The purpose of this study was to investigate the influences of Tai Chi on blood pressure (BP) using the meta-analysis.

Methods

This paper used 6 e-resource databases, and randomized controlled trials on the role of Tai Chi on blood pressure were retrieved. Besides, the meta-analysis was conducted according to the guidelines of the Moose-recommendations and applied with Review Manager 5.3, and the risk of bias assessment was performed with the Cochrane Collaboration's tool. The inclusion, data extraction, and risk of bias assessment were independently finished by two researchers.

Results

There are 24 trials meeting the criteria of inclusion and the results were reviewed. The meta-analysis indicates that, compared with no exercise, Tai Chi had the influence of lowering systolic blood pressure (mean difference = −6.07, 95%CI (−8.75, −3.39), P < 0.00001) and diastolic blood pressure (mean difference MD = −3.83, 95%CI (−4.97, −2.69), P < 0.00001). No significant discrepancies in all outcomes between Tai Chi and other aerobic exercises were discovered.

Conclusion

Tai Chi can significantly reduce systolic and diastolic pressure than inactivity. However, Tai Chi does not show advantages in reducing blood pressure compared to other aerobic exercises. The trial is registered with CRD42020175306.

Ethnicity Differences in Sleep Changes Among Prehypertensive Adults Using a Smartphone Meditation App: Dose-Response Trial

Background

African Americans (AAs) experience greater sleep quality problems than non-Hispanic Whites (NHWs). Meditation may aid in addressing this disparity, although the dosage levels needed to achieve such benefits have not been adequately studied. Smartphone apps present a novel modality for delivering, monitoring, and measuring adherence to meditation protocols.

Objective

This 6-month dose-response feasibility trial investigated the effects of a breathing awareness meditation (BAM) app, Tension Tamer, on the secondary outcomes of self-reported and actigraphy measures of sleep quality and the modulating effects of ethnicity of AAs and NHWs.

Methods

A total of 64 prehypertensive adults (systolic blood pressure <139 mm Hg; 31 AAs and 33 NHWs) were randomized into 3 different Tension Tamer dosage conditions (5,10, or 15 min twice daily). Sleep quality was assessed at baseline and at 1, 3, and 6 months using the Pittsburgh Sleep Quality Index (PSQI) and 1-week bouts of continuous wrist actigraphy monitoring. The study was conducted between August 2014 and October 2016 (IRB #Pro00020894).

Results

At baseline, PSQI and actigraphy data indicated that AAs had shorter sleep duration, greater sleep disturbance, poorer efficiency, and worse quality of sleep (range P=.03 to P<.001). Longitudinal generalized linear mixed modeling revealed a dose effect modulated by ethnicity (P=.01). Multimethod assessment showed a consistent pattern of NHWs exhibiting the most favorable responses to the 5-min dose; they reported greater improvements in sleep efficiency and quality as well as the PSQI global value than with the 10-min and 15-min doses (range P=.04 to P<.001). Actigraphy findings revealed a consistent, but not statistically significant, pattern in the 5-min group, showing lower fragmentation, longer sleep duration, and higher efficiency than the other 2 dosage conditions. Among AAs, actigraphy indicated lower sleep fragmentation with the 5-min dose compared with the 10-min and 15-min doses (P=.03 and P<.001, respectively). The 10-min dose showed longer sleep duration than the 5-min and 15-min doses (P=.02 and P<.001, respectively). The 5-min dose also exhibited significantly longer average sleep than the 15-min dose (P=.03).

Conclusions

These findings indicate the need for further study of the potential modulating influence of ethnicity on the impact of BAM on sleep indices and user-centered exploration to ascertain the potential merits of refining the Tension Tamer app with attention to cultural tailoring among AAs and NHWs with pre-existing sleep complaints.

Short-Term Effects of Meditation on Sustained Attention as Measured by fNIRS

Cognitive abilities such as attention, memory, processing time, perception, and reasoning can be augmented using some type of intervention. Within the broad range of conventional and unconventional intervention methods used in cognitive enhancement, meditation is one of those that is safe, widely practiced by many since ancient times, and has been shown to reduce stress and improve psychological health and cognitive functioning. Various neuroimaging studies using functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) have shown functional and structural changes due to meditation in different types of meditation practices and on various groups of meditators. Recently, a few studies on meditation have used functional near infrared spectroscopy (fNIRS) to study the effects of meditation on cerebral hemodynamics. In this study, we examined the short-term effects of loving-kindness (LK) meditation on sustained attention using behavioral performance measures, physiological outcomes, and cognitive activity as measured by fNIRS in first-time meditators during Stroop color word task (SCWT) performance. Our results indicated that behavioral outcomes, assessed mainly on response time (RT) during SCWT performance, showed a significant decrease after meditation. As expected, physiological measures, primarily pulse pressure (PP) measured after meditation dropped significantly as compared to the before meditation measurement. For the hemodynamic measures of oxygenated-hemoglobin (HbO2), deoxygenated-hemoglobin (Hb), and total-hemoglobin (HbT), our findings show significant differences in SCWT performance before and after meditation. Our results suggest that LK meditation can result in improvements in cognitive, physiological, and behavioral outcomes of first-time meditators after a short-term session.

The Role of Exercise in Patients with Obesity and Hypertension

PURPOSE OF REVIEW

This review sought to evaluate the role of exercise in patients with obesity and comorbid hypertension, with a focus on contemporary literature (since January 2015).

RECENT FINDINGS

No reviews have included patients classified with both obesity and hypertension and there is a paucity of randomised controlled trials examining the benefits of exercise in this population. Moreover, just one of 19 reviews examining the role of exercise on blood pressure included studies that met pre-defined inclusion criterion for hypertension, although seven conducted subgroup analyses stratified by mean baseline blood pressure. These demonstrated significantly larger reductions in blood pressure in hypertensive than pre-hypertensive and normotensive samples. There is a significant research-practice gap for understanding and influencing the role of exercise for patients with obesity and hypertension. This review provides recommendations for future research and consensus-based recommendations that promote exercise as a principle therapy for patients with obesity and hypertension.

Physical Activity to Prevent and Treat Hypertension: A Systematic Review

PURPOSE

This systematic umbrella review examines and updates the evidence on the relationship between physical activity (PA) and blood pressure (BP) presented in the 2008 Physical Activity Guidelines Advisory Committee Scientific Report.

METHODS

We performed a systematic review to identify systematic reviews and meta-analyses involving adults with normal BP, prehypertension, and hypertension published from 2006 to February 2018.

RESULTS

In total, 17 meta-analyses and one systematic review with 594,129 adults ≥18 yr qualified. Strong evidence demonstrates: 1) an inverse dose-response relationship between PA and incident hypertension among adults with normal BP; 2) PA reduces the risk of cardiovascular disease (CVD) progression among adults with hypertension; 3) PA reduces BP among adults with normal BP, prehypertension, and hypertension; and 4) the magnitude of the BP response to PA varies by resting BP, with greater benefits among adults with prehypertension than normal BP. Moderate evidence indicates the relationship between resting BP and the magnitude of benefit does not vary by PA type among adults with normal BP, prehypertension, and hypertension. Limited evidence suggests the magnitude of the BP response to PA varies by resting BP among adults with hypertension. Insufficient evidence is available to determine if factors such as sex, age, race/ethnicity, socioeconomic status, and weight status or the frequency, intensity, time, and duration of PA influence the associations between PA and BP.

CONCLUSIONS

Future research is needed that adheres to standard BP measurement protocols and classification schemes to better understand the influence of PA on the risk of comorbid conditions, health-related quality of life, and CVD progression and mortality; the interactive effects between PA and antihypertensive medication use; and the immediate BP-lowering benefits of PA.

Default Mode Network, Meditation, and Age-Associated Brain Changes: What Can We Learn from the Impact of Mental Training on Well-Being as a Psychotherapeutic Approach?

Aging is a physiological process accompanied by cognitive decline, principally in memory and executive functions. Alterations in the connectivity of the default mode network (DMN) have been found to participate in cognitive decline, as well as in several neurocognitive disorders. The DMN has antisynchronic activity with attentional networks (task-positive networks (TPN)), which are critical to executive function and memory. Findings pointing to the regulation of the DMN via activation of TPN suggest that it can be used as a strategy for neuroprotection. Meditation is a noninvasive and nonpharmacological technique proven to increase meta-awareness, a cognitive ability which involves the control of both networks. In this review, we discuss the possibility of facilitating healthy aging through the regulation of networks through meditation. We propose that by practicing specific types of meditation, cognitive decline could be slowed, promoting a healthy lifestyle, which may enhance the quality of life for the elderly.

Yoga as Antihypertensive Lifestyle Therapy: A Systematic Review and Meta-analysis

OBJECTIVE

To investigate the efficacy of yoga as antihypertensive lifestyle therapy and identify moderators that account for variability in the blood pressure (BP) response to yoga.

METHODS

We systematically searched 6 electronic databases from inception through June 4, 2018, for articles published in English language journals on trials of yoga interventions that involved adult participants, reported preintervention and postintervention BP, and had a nonexercise/nondiet control group. Our search yielded 49 qualifying controlled trials (56 interventions). We (1) evaluated the risk of bias and methodological study quality, (2) performed meta-regression analysis following random-effects assumptions, and (3) generated additive models that represented the largest possible clinically relevant BP reductions.

RESULTS

On average, the 3517 trial participants were middle-aged (49.2±19.5 years), overweight (27.9±3.6 kg/m2) adults with high BP (systolic BP, 129.3±13.3 mm Hg; diastolic BP, 80.7±8.4 mm Hg). Yoga was practiced 4.8±3.4 sessions per week for 59.2±25.0 minutes per session for 13.2±7.5 weeks. On average, yoga elicited moderate reductions in systolic BP (weighted mean effect size, -0.47; 95% CI, -0.62-0.32, -5.0 mm Hg) and diastolic BP (weighted mean effect size, -0.47; 95% CI, -0.61 to -0.32; -3.9 mm Hg) compared with controls (P<.001 for both systolic BP and diastolic BP). Controlling for publication bias and methodological study quality, when yoga was practiced 3 sessions per week among samples with hypertension, yoga interventions that included breathing techniques and meditation/mental relaxation elicited BP reductions of 11/6 mm Hg compared with those that did not (ie, 6/3 mm Hg).

CONCLUSION

Our results indicate that yoga is a viable antihypertensive lifestyle therapy that produces the greatest BP benefits when breathing techniques and meditation/mental relaxation are included.