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Burton W, Wayne PM, Litrownik D, Long CR, Vining R, Rist P, Kilgore K, Lisi A, Kowalski MH. Integrating Chiropractic Care and Tai Chi Training for the Treatment of Chronic Nonspecific Neck Pain in Nurses: A Single-Arm Mixed-Methods Pilot Trial. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024. [PMID: 39169834 DOI: 10.1089/jicm.2024.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Objectives: Chronic nonspecific neck pain (CNNP) is prevalent among health care workers, with particularly high rates among nurses. Nurses experiencing CNNP often report decreased job satisfaction, increased absenteeism, and reduced productivity. In recent years, nonpharmacologic approaches have gained attention as effective treatments for the management of CNNP, with exercise and manual therapies representing two of the most common. Early evidence shows that multimodal treatments may be more effective than unimodal strategies. The purpose of this current study was to assess the feasibility and observe the clinical outcomes of combined multimodal chiropractic care (MCC) and Tai Chi (TC) for CNNP in nurses. Methods: A single-arm mixed-methods pilot trial was conducted including 16 weeks of MCC and TC in nurses with self-reported CNNP. Feasibility outcomes were recruitment, retention, and adherence to the interventions. Clinical outcomes of interest included neck pain and related disabilities. Secondary outcomes of interest were functional, affective, and work-related performance. Qualitative interviews were also conducted. Results: Of the 59 screened, 36 met the eligibility criteria, and 21 were enrolled. The retention rate was 71.4%, and adherence rates were 85.3% for MCC and 62.5% for TC classes. Multiple pain and disability-related outcomes exhibited modest improvement from baseline to 16-week follow-up. Qualitative analysis identified six emergent themes: (1) neck pain being an inherent part of nursing, (2) nurses push through their pain, (3) MCC relieves pain and is instructive for preventing pain, (4) TC provides overall relaxation, (5) both interventions increased body awareness and improved posture, and (6) scheduling difficulties were a key obstacle for participating. Conclusions: Observed reductions in neck pain and disability suggest the potential utility of combined MCC and TC interventions for managing CNNP. Along with qualitative feedback regarding facilitators and barriers to participation, the findings support and inform a future randomized trial evaluating the combined benefits of MCC and TC for CNNP in nurses. Clinical Trial Registration #NCT06523036.
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Affiliation(s)
- Wren Burton
- Brigham and Women's Hospital and Harvard Medical School, Osher Center for Integrative Health, Boston, MA, USA
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter M Wayne
- Brigham and Women's Hospital and Harvard Medical School, Osher Center for Integrative Health, Boston, MA, USA
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dan Litrownik
- Brigham and Women's Hospital and Harvard Medical School, Osher Center for Integrative Health, Boston, MA, USA
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Cynthia R Long
- Palmer College of Chiropractic, Palmer Center for Chiropractic Research, Davenport, IA, USA
| | - Robert Vining
- Palmer College of Chiropractic, Palmer Center for Chiropractic Research, Davenport, IA, USA
| | - Pamela Rist
- Brigham and Women's Hospital and Harvard Medical School, Osher Center for Integrative Health, Boston, MA, USA
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Karen Kilgore
- Brigham and Women's Hospital and Harvard Medical School, Osher Center for Integrative Health, Boston, MA, USA
| | - Anthony Lisi
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, USA
| | - Matthew H Kowalski
- Brigham and Women's Hospital and Harvard Medical School, Osher Center for Integrative Health, Boston, MA, USA
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Loewenthal J, Berning MJ, Wayne PM, Eckstrom E, Orkaby AR. Holistic frailty prevention: The promise of movement-based mind-body therapies. Aging Cell 2024; 23:e13986. [PMID: 37698149 PMCID: PMC10776124 DOI: 10.1111/acel.13986] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 09/13/2023] Open
Abstract
Aging is characterized by fundamental cellular and molecular hallmarks that result in physiologic decline of most body systems. This may culminate in frailty, a state of decreased reserve. Because frailty is a state of multisystem dysregulation, multimodal interventions may be necessary to mitigate and prevent progression rather than interventions targeting a single system. Movement-based mind-body therapies, such as tai chi and yoga, are promising multimodal strategies for frailty prevention and treatment given their inherent multicomponent nature. In this review, we summarize the links between hallmarks of aging and frailty and how tai chi and yoga may impact these hallmarks. We review trial evidence for the impact of tai chi and yoga on frailty in older populations and discuss opportunities for future research.
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Affiliation(s)
- Julia Loewenthal
- Division of Aging, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | | | - Peter M. Wayne
- Division of Preventive MedicineBrigham and Women's HospitalBostonMassachusettsUSA
- Osher Center for Integrative Medicine, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Elizabeth Eckstrom
- Division of General Internal Medicine & GeriatricsOregon Health & Science UniversityPortlandOregonUSA
| | - Ariela R. Orkaby
- Division of Aging, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
- New England Geriatric Research, Education, and Clinical Center (GRECC)VA Boston Healthcare SystemBostonMassachusettsUSA
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Bai X, Xiao W, Soh KG, Agudamu, Zhang Y. 12-week concurrent brisk walking and Taijiquan (Tai Chi) improve balance, flexibility, and muscular strength of Chinese older women. PLoS One 2023; 18:e0293483. [PMID: 37883372 PMCID: PMC10602331 DOI: 10.1371/journal.pone.0293483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023] Open
Abstract
Healthy aging is a global goal to enhance the quality of life for older persons. This study evaluated the benefits of 12-week concurrent brisk walking and Taijiquan. Healthy Chinese women aged 60 years and above were enrolled to the control (n = 26) and intervention (n = 25) groups. Participants in the intervention group engaged in three exercise sessions per week for 12 weeks, whereas control group engaged in free-living activities. Each exercise session consisted of 20-45 minutes of walking and 20-45 minutes of Yang style 24-form Taijiquan. 12-week exercise improved (p < 0.05) the sit and reach test (within-group mean difference: +5.6 cm; Hedges' g = 0.77), handgrip strength (mean difference: +3.1 kg; g = 0.89), arm curl (mean difference: +2.1 repetitions; g = 0.69), chair stand (mean difference: +2.6 repetitions; g = 0.63), and one-legged standing (mean difference: +2.2 seconds; g = 1.07). There was no improvement in the circulatory health, body composition, or life satisfaction. Therefore, this concurrent brisk walking and Taijiquan training, which targets major whole-body muscle groups, could improve aging-critical flexibility, muscular fitness, and balance in older women. The exercise meets the current WHO guideline, is safe to perform, and could be campaigned as a health promotion for older persons.
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Affiliation(s)
- Xiaorong Bai
- School of Physical Education, Huzhou University, Huzhou, China
| | - Wensheng Xiao
- School of Physical Education, Huzhou University, Huzhou, China
| | - Kim Geok Soh
- Department of Sports Studies, Faculty of Educational Studies, Universiti Putra Malaysia, Serdang, Malaysia
| | - Agudamu
- Graduate School of Social Welfare, Sungkyunkwan University, Seoul, South Korea
- Institute of Sports and Health Industry, HEHA CAT Fitness, Changsha, China
| | - Yang Zhang
- Independent person, Windermere, Florida, United States of America
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Buttolph L, Wooliscroft L, Bradley R, Zwickey H. Participant Perspectives on Community Qigong for People with Multiple Sclerosis. INTEGRATIVE MEDICINE REPORTS 2023; 2:26-34. [PMID: 36895618 PMCID: PMC9986858 DOI: 10.1089/imr.2022.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 02/04/2023]
Abstract
Introduction Multiple sclerosis (MS) is a progressive neurodegenerative disorder affecting motor and nonmotor function including physical and cognitive decline, fatigue, anxiety, and depression. Qigong is a mind-body self-care practice with the potential to address MS symptoms. Publicly available community qigong classes may provide opportunities for people with MS to access qigong, but little is known about the risks and benefits. A mixed methods study of community qigong was conducted for people with MS. In this article, the results of this qualitative analysis to identify benefits and challenges faced by people with MS attending community qigong classes were presented. Methods Qualitative data were collected from an exit survey of 14 study participants with MS who enrolled in a pragmatic trial of community qigong classes for 10 weeks. Participants were new to community-based classes offered but some had experience with qigong/tai chi/other martial arts or yoga. Data were analyzed using reflexive thematic analysis. Results and Discussion Seven common themes were identified from this analysis: (1) physical function, (2) motivation/energy, (3) learning, (4) dedicating time for self, (5) meditation/centering/focus, (6) relaxation/stress relief, and (7) psychological/psychosocial. These themes reflected both positive and negative experiences with community qigong classes and home practice. Self-reported benefits centered around improved flexibility, endurance, energy, and focus; stress relief; and psychological/psychosocial benefits. Challenges included physical discomfort including short-term pain, balance difficulty, and heat intolerance. Conclusion The qualitative findings provide evidence to support qigong as a self-care practice that may benefit people with MS. The challenges identified in the study will help to inform future clinical trials of qigong for MS. Trial Registration ClinicalTrials.gov (CTR#: NCT04585659).
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Affiliation(s)
- Lita Buttolph
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Lindsey Wooliscroft
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
- Department of Neurology, VA Portland Health Care System, Portland, OR, USA
| | - Ryan Bradley
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Heather Zwickey
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
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Yang G, Li X, Peel N, Klupp N, Liu JP, Bensoussan A, Kiat H, Chang D. Perceptions of Participants on Trial Participation and Adherence to Tai Chi: A Qualitative Study. Patient Prefer Adherence 2022; 16:2695-2707. [PMID: 36196067 PMCID: PMC9527000 DOI: 10.2147/ppa.s380780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Trial participation and adherence to interventions can directly influence the evaluation of outcomes in clinical trials for real world applications. The factors that influence trial participation and adherence to Tai Chi interventions in people with cardiovascular diseases remains unknown. This study aimed to explore participants' perceptions of influential factors on their trial participation and adherence to a Tai Chi intervention within a trial setting. PATIENTS AND METHODS Participants had coronary heart disease and/or hypertension in a randomized controlled trial comparing Tai Chi with a waitlist control. Data were collected via face-to-face, semi-structured interviews and analyzed using thematic analysis. RESULTS Thirty-four participants from the Tai Chi group who completed the randomized trial were interviewed. Six dominating themes and four sub-themes are discussed under the facilitators of internal and external motivation, positive feelings, benefits of Tai Chi and future practice with an overall internal motivation to improve health. Positive feelings had three sub-themes: positive feelings toward Tai Chi, the project, and the learning experience. The Tai Chi instructor(s) was found to be a crucial element in motivating participants' adherence to Tai Chi. CONCLUSION From the perception of participants, the facilitators to their trial participation and adherence to a Tai Chi intervention included internal and external motivation, positive feelings towards Tai Chi, the project and the learning experience, and perceived benefits of Tai Chi. Perceived barriers included concerns about the safety and complexity of Tai Chi practice, lack of group atmosphere outside of class, and scheduling conflicts. Future researchers can address these factors to improve trial recruitment and implementation of Tai Chi and other mind-body interventions in research and for real world applications.
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Affiliation(s)
- Guoyan Yang
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Xun Li
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, People’s Republic of China
| | - Nicole Peel
- School of Health and Sciences, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Nerida Klupp
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, 2751, Australia
- School of Health and Sciences, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Jian-Ping Liu
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, People’s Republic of China
| | - Alan Bensoussan
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Hosen Kiat
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, 2751, Australia
- Faculty of Medicine, Human and Health Sciences, Macquarie University, Macquarie, NSW, 2109, Australia
- ANU College of Health and Medicine, Australian National University, Canberra, ACT, 2600, Australia
- Cardiac Health Institute, Sydney, NSW, 2122, Australia
| | - Dennis Chang
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, 2751, Australia
- Correspondence: Dennis Chang; Guoyan Yang, NICM Health Research Institute, Western Sydney University, Locked Bag, 1797, Penrith, NSW, 2751, Australia, Tel +61 2 9685 4725, Fax +61 2 9685 4760, Email ;
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Buttolph L, Corn J, Hanes D, Bradley R, Senders A. Community qigong for People with Multiple Sclerosis: A Pragmatic Feasibility Study. J Altern Complement Med 2021; 27:506-514. [PMID: 33769837 PMCID: PMC9030260 DOI: 10.1089/acm.2020.0481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives: qigong, a traditional Chinese mind-body exercise, has been shown to improve balance and gait in several neurological conditions; however, community-delivered qigong has never been assessed for people with multiple sclerosis (MS). The authors assessed the feasibility of community qigong classes for people with MS and explored outcomes of balance, gait, and quality of life (QOL). Design: Twenty adults with MS were randomly assigned to 10 weeks of community qigong classes or wait-list control. Settings/Location: Portland, Oregon. Subjects: People with MS. Intervention: Community qigong classes. Outcome measures: Feasibility criteria included recruitment, retention, adherence, and ability to participate in qigong movements. Secondary outcome measures included physical tests of mobility, gait, and balance and participant-reported mobility, depression, anxiety, fatigue, and QOL. Results: Recruitment of eligible and interested people with MS was feasible. Retention in the trial was 60%. Completers attended a mean of 7 of 10 classes. All completers participated with no or minor modifications to qigong movements. Exploratory within-group analyses showed trends toward improved mental health, QOL, and reduced fatigue and depression. Several participants spontaneously reported improved energy, flexibility, sleep, and mobility. Conclusions: Community qigong may be a feasible form of exercise for people with MS. To improve retention and capture potential effects of qigong on physical function and quality of life, future studies might consider pragmatic trials with tiered level classes, simpler forms of qigong, and/or refined inclusion criteria (CTR#: NCT04585659).
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Affiliation(s)
- Lita Buttolph
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Joshua Corn
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
- Oregon College of Oriental Medicine, Portland, OR, USA
- AOMA School of Integrative Medicine, Austin, TX, USA
- Whole Systems Research Institute, Portland, OR, USA
| | - Douglas Hanes
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Ryan Bradley
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Angela Senders
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
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Litrownik D, Gilliam EA, Wayne PM, Richardson CR, Kadri R, Rist PM, Moy ML, Yeh GY. Development of a Novel Intervention (Mindful Steps) to Promote Long-Term Walking Behavior in Chronic Cardiopulmonary Disease: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e27826. [PMID: 33913819 PMCID: PMC8120426 DOI: 10.2196/27826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/14/2021] [Accepted: 02/22/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite current rehabilitation programs, long-term engagement in physical activity remains a significant challenge for patients with chronic obstructive pulmonary disease (COPD) and heart failure (HF). Novel strategies to promote physical activity in these populations are greatly needed. Emerging literature on the benefits of both mind-body interventions and web-based interventions provide the rationale for the development of the Mindful Steps intervention for increasing walking behavior. OBJECTIVE This study aims to develop a novel multimodal mind-body exercise intervention through adaptation of an existing web-based physical activity intervention and incorporation of mind-body exercise, and to pilot test the delivery of the new intervention, Mindful Steps, in a randomized controlled feasibility trial in older adults with COPD and/or HF. METHODS In phase 1, guided by a theoretical conceptual model and review of the literature on facilitators and barriers of physical activity in COPD and HF, we convened an expert panel of researchers, mind-body practitioners, and clinicians to inform development of the novel, multimodal intervention. In phase 2, we are conducting a pilot randomized controlled feasibility trial of the Mindful Steps intervention that includes in-person mind-body exercise classes, an educational website, online mind-body videos, and a pedometer with step-count feedback and goals to increase walking behavior in patients with COPD and/or HF. Outcomes include feasibility measures as well as patient-centered measures. RESULTS The study is currently ongoing. Phase 1 intervention development was completed in March 2019, and phase 2 data collection began in April 2019. CONCLUSIONS Through the integration of components from a web-based physical activity intervention and mind-body exercise, we created a novel, multimodal program to impact long-term physical activity engagement for individuals with COPD and HF. This developmental work and pilot study will provide valuable information needed to design a future clinical trial assessing efficacy of this multimodal approach. TRIAL REGISTRATION ClinicalTrials.gov NCT03003780; https://clinicaltrials.gov/ct2/show/NCT03003780. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/27826.
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Affiliation(s)
- Daniel Litrownik
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Elizabeth A Gilliam
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Peter M Wayne
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, United States
| | | | - Reema Kadri
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Pamela M Rist
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, United States
| | - Marilyn L Moy
- Pulmonary and Critical Care Section, Department of Medicine, Veterans Administration Boston Healthcare System, Boston, MA, United States
| | - Gloria Y Yeh
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, United States
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Oberoi D, McLennan A, Piedalue KA, Wayne PM, Jones JM, Carlson LE. Factors Influencing Preference for Intervention in a Comparative Effectiveness Trial of Mindfulness-Based Cancer Recovery and Tai Chi/ Qigong in Cancer Survivors. J Altern Complement Med 2021; 27:423-433. [PMID: 33902334 DOI: 10.1089/acm.2020.0400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2022] Open
Abstract
Introduction: An important gap between randomized efficacy research and real-world implementation of complementary therapies is the role of patient preferences in influencing engagement and outcome. Several studies have highlighted the benefits of patient preference on health outcomes, but few have investigated the factors associated with preference for interventions, which may be critical to assure the success of program implementation. The current study sought to explore the factors associated with patient preference in an ongoing randomized preference-based trial of Mindfulness-Based Cancer Recovery (MBCR) versus Tai Chi/qigong (TCQ) (the Mindfulness and Tai Chi/qigong in Cancer Health [MATCH] study). Materials and Methods: A multi-method study design was used. A subsample of participants were purposely selected from the ongoing MATCH study to have representation from both intervention arms and from both men and women across different age groups. Open-ended, semi-structured qualitative interviews were conducted to explore the factors influencing initial patient preference. Interviews were transcribed verbatim and analyzed by using inductive thematic analysis. The treatment acceptability and preference measure was administered to determine patients' ratings of acceptability and credibility of both preferred and nonpreferred interventions. Results: A total of 13 participants were interviewed prior to program attendance, with 8 (62%) preferring TCQ and 5 (38%) choosing MBCR. Major themes related to patients' preference for intervention included: (1) expectations about the preferred intervention; (2) knowledge of the intervention; (3) past experiences with the intervention; and (4) self-efficacy. Participants' mean treatment acceptability scores were higher for their preferred program than their nonpreferred program. Conclusion: Understanding the factors that influence cancer survivors' preference for mind-body interventions can augment health care providers' knowledge of the barriers and facilitators for successful implementation of interventions in clinical settings, as well as help patients make informed treatment decisions and improve satisfaction and outcomes. Clinical trial registration no.: NCT03641222.
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Affiliation(s)
- Devesh Oberoi
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Andrew McLennan
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Katherine-Ann Piedalue
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Peter M Wayne
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Jennifer M Jones
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Linda E Carlson
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Shani P, Raeesi K, Walter E, Lewis K, Wang W, Cohen L, Yeh GY, Lengacher CA, Wayne PM. Qigong mind-body program for caregivers of cancer patients: design of a pilot three-arm randomized clinical trial. Pilot Feasibility Stud 2021; 7:73. [PMID: 33741070 PMCID: PMC7976717 DOI: 10.1186/s40814-021-00793-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/08/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Informal caregivers, often family and friends, experience significant psychological and physical distress leading to reductions in health and quality of life (QOL). Mind-body interventions focused on caregivers are often limited and do not address multiple barriers, including caregivers' economic, geographic, and time constraints. Translation of in-person, community-based interventions to Internet-based delivery may offer greater accessibility for caregivers, leading to increased adherence. METHODS Caring for Caregivers with Mind-Body implements a three-arm, pilot, randomized controlled trial to evaluate the feasibility of delivering a Qigong intervention (Eight Brocades) to cancer caregivers. A total of 54 cancer caregivers will be randomized into one of three 12-week programs: (1) community-based Qigong, (2) Internet-based Qigong, or (3) a self-care control group. Study-specific aims include (1) modify intervention content for online delivery, (2) evaluate the feasibility of recruiting and retaining cancer caregivers into a 12-week clinical trial, and (3) evaluate the feasibility of collecting and managing data, and the suitability of questionnaires for this population. Several outcomes will be assessed, including caregiver QOL, caregiver burden, caregiver distress, perceived social support, physical function, and cognitive function. A 6-month follow-up will also assess longer-term changes in QOL and psychosocial well-being. DISCUSSION Findings will be used to inform the design and conduct of a large-scale comparative effectiveness trial evaluating caregivers who received Qigong training delivered through community-based vs Internet-based programs. A finding that either or both programs are effective would inform care and options for caregivers. TRIAL REGISTRATION NCT04019301 ; registered on July 15, 2019; clinicaltrials.gov.
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Affiliation(s)
- Pinky Shani
- University of Houston, College of Nursing, Houston, TX, USA.
| | - Kristin Raeesi
- Texas Woman's University, College of Nursing, Houston, TX, USA
| | - Eli Walter
- University of Houston, College of Nursing, Houston, TX, USA
| | - Kai Lewis
- Houston Martial Arts Academy, Houston, TX, USA
| | - Wanyi Wang
- Texas Woman's University, College of Nursing, Houston, TX, USA
| | - Lorenzo Cohen
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gloria Y Yeh
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | | | - Peter M Wayne
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
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Wayne PM, Gow BJ, Hou F, Ma Y, Hausdorff JM, Lo J, Rist PM, Peng CK, Lipsitz LA, Novak V, Manor B. Tai Chi training's effect on lower extremity muscle co-contraction during single- and dual-task gait: Cross-sectional and randomized trial studies. PLoS One 2021; 16:e0242963. [PMID: 33481829 PMCID: PMC7822271 DOI: 10.1371/journal.pone.0242963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 11/13/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Tai Chi (TC) mind-body exercise has been shown to reduce falls and improve balance and gait, however, few studies have evaluated the role of lower extremity muscle activation patterns in the observed benefits of TC on mobility. PURPOSE To perform an exploratory analysis of the association between TC training and levels of lower extremity muscle co-contraction in healthy adults during walking under single-task (ST) and cognitive dual-task (DT) conditions. METHODS Surface electromyography of the anterior tibialis and lateral gastrocnemius muscles was recorded during 90 sec trials of overground ST (walking normally) and DT (walking with verbalized serial subtractions) walking. A mean co-contraction index (CCI), across all strides, was calculated based on the percentage of total muscle activity when antagonist muscles were simultaneously activated. A hybrid study design investigated long-term effects of TC via a cross-sectional comparison of 27 TC experts and 60 age-matched TC-naïve older adults. A longitudinal comparison assessed the shorter-term effects of TC; TC-naïve participants were randomly allocated to either 6 months of TC training or to usual care. RESULTS Across all participants at baseline, greater CCI was correlated with slower gait speed under DT (β(95% CI) = -26.1(-48.6, -3.7)) but not ST (β(95% CI) = -15.4(-38.2, 7.4)) walking. Linear models adjusting for age, gender, BMI and other factors that differed at baseline indicated that TC experts exhibited lower CCI compared to TC naives under DT, but not ST conditions (ST: mean difference (95% CI) = -7.1(-15.2, 0.97); DT: mean difference (95% CI) = -10.1(-18.1, -2.4)). No differences were observed in CCI for TC-naive adults randomly assigned to 6 months of TC vs. usual care. CONCLUSION Lower extremity muscle co-contraction may play a role in the observed benefit of longer-term TC training on gait and postural control. Longer-duration and adequately powered randomized trials are needed to evaluate the effect of TC on neuromuscular coordination and its impact on postural control. TRIAL REGISTRATION The randomized trial component of this study was registered at ClinicalTrials.gov (NCT01340365).
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Affiliation(s)
- Peter M. Wayne
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Brian J. Gow
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Fengzhen Hou
- Key Laboratory of Biomedical Functional Materials, School of Science, China Pharmaceutical University, Nanjing, China
| | - Yan Ma
- Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jeffrey M. Hausdorff
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Sagol School of Neuroscience and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Justine Lo
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, United States of America
| | - Pamela M. Rist
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Chung-Kang Peng
- Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Lewis A. Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, United States of America
- Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Vera Novak
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, United States of America
- Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
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11
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Lee TL, Sherman KJ, Hawkes RJ, Phelan EA, Turner JA. The Benefits of T'ai Chi for Older Adults with Chronic Back Pain: A Qualitative Study. J Altern Complement Med 2020; 26:456-462. [PMID: 32379976 DOI: 10.1089/acm.2019.0455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To determine the perceived benefits of t'ai chi in older adults with chronic low-back pain (cLBP). Design: A qualitative analysis from a randomized controlled feasibility trial. Subjects: Eighteen participants (65+ years old) with cLBP of at least moderate intensity. Intervention: A 36-week intervention beginning with twice weekly classes for 12 weeks, weekly classes for 6 weeks, biweekly classes for 6 weeks, and monthly classes for 12 weeks. Participants were asked to practice at home on nonclass days and videos were provided to assist in that process. Outcome Measures: Participants in the focus groups were asked to provide feedback on their experiences with the study as well as the benefits of their t'ai chi practice. We used demographic and class attendance data to describe the sample. Results: Regarding the benefits of t'ai chi practice, five major themes were identified: functional benefits, pain reduction/pain relief, psychospiritual benefits, the importance of social support in learning t'ai chi, and the integration of t'ai chi into daily activities. The most common functional benefits were improvements in balance, flexibility, leg strength, and posture. Some reported pain reduction or pain relief, but others did not. Increased relaxation, mindfulness, and a sense of connectedness were subthemes that emerged from psychospiritual benefits. Social support benefits included motivation to attend class and group support while learning a new skill. Finally, improved body awareness allowed participants to integrate t'ai chi skills into their daily activities. Conclusions: This qualitative analysis demonstrates the multifaceted benefits of t'ai chi for older adults living with cLBP.
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Affiliation(s)
- Tamsin L Lee
- Department of Child, Family and Population Health Nursing, University of Washington, Seattle, WA, USA
| | - Karen J Sherman
- Kaiser Permanente WA Health Research Institute, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Rene J Hawkes
- Kaiser Permanente WA Health Research Institute, Seattle, WA, USA
| | - Elizabeth A Phelan
- Department of Medicine and Health Services, University of Washington, Seattle, WA, USA
| | - Judith A Turner
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.,Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
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12
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Chan SHW, Tsang HWH. The beneficial effects of Qigong on elderly depression. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 147:155-188. [PMID: 31607353 DOI: 10.1016/bs.irn.2019.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Health Qigong, especially the Eight-Section Brocades (or Baduanjin), has been well established as an effective adjunct intervention to alleviate depressive symptoms of older adults. The easy to learn and safe format of health Qigong allows the promotion and employment by health care professionals to improve the physical and psychosocial wellness of older adults. The cultural relevance of Qigong practice enhances its popularity as a health maintenance practice in Chinese community. In general, the antidepressive effects of Qigong are put forward through psychosocial, physiological, and neurobiological mechanisms. More specific, the beneficial effects of Qigong can be further substantiated by findings of several research studies.
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Affiliation(s)
- Sunny H W Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Hector W H Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
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13
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Ghare MI, Chandrasekhar J, Mehran R, Ng V, Grines C, Lansky A. Sex Disparities in Cardiovascular Device Evaluations. JACC Cardiovasc Interv 2019; 12:301-308. [DOI: 10.1016/j.jcin.2018.10.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 09/30/2018] [Accepted: 10/04/2018] [Indexed: 01/12/2023]
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14
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Osypiuk K, Thompson E, Wayne PM. Can Tai Chi and Qigong Postures Shape Our Mood? Toward an Embodied Cognition Framework for Mind-Body Research. Front Hum Neurosci 2018; 12:174. [PMID: 29765313 PMCID: PMC5938610 DOI: 10.3389/fnhum.2018.00174] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/13/2018] [Indexed: 12/19/2022] Open
Abstract
Dynamic and static body postures are a defining characteristic of mind-body practices such as Tai Chi and Qigong (TCQ). A growing body of evidence supports the hypothesis that TCQ may be beneficial for psychological health, including management and prevention of depression and anxiety. Although a variety of causal factors have been identified as potential mediators of such health benefits, physical posture, despite its visible prominence, has been largely overlooked. We hypothesize that body posture while standing and/or moving may be a key therapeutic element mediating the influence of TCQ on psychological health. In the present paper, we summarize existing experimental and observational evidence that suggests a bi-directional relationship between body posture and mental states. Drawing from embodied cognitive science, we provide a theoretical framework for further investigation into this interrelationship. We discuss the challenges involved in such an investigation and propose suggestions for future studies. Despite theoretical and practical challenges, we propose that the role of posture in mind-body exercises such as TCQ should be considered in future research.
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Affiliation(s)
- Kamila Osypiuk
- Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Evan Thompson
- Department of Philosophy, University of British Columbia, Vancouver, BC, Canada
| | - Peter M Wayne
- Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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15
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Correlates of Exercise Self-efficacy in a Randomized Trial of Mind-Body Exercise in Patients With Chronic Heart Failure. J Cardiopulm Rehabil Prev 2017; 36:186-94. [PMID: 26959498 DOI: 10.1097/hcr.0000000000000170] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE Exercise self-efficacy is one of the strongest predictors of physical activity behavior. Prior literature suggests that tai chi, a mind-body exercise, may increase self-efficacy; however, this is not extensively studied. Little is known about the factors associated with development of exercise self-efficacy in a population with heart failure. METHODS We utilized data from a randomized controlled trial of 12 weeks of group tai chi classes versus education in patients with chronic heart failure (n = 100). Multivariable linear regression was used to explore possible correlates of change in exercise self-efficacy in the entire sample and in the subgroup who received tai chi (n = 50). Covariates included baseline quality of life, social support, functional parameters, physical activity, serum biomarkers, sociodemographics, and clinical heart failure parameters. RESULTS Baseline 6-minute walk (β=-0.0003, SE = 0.0001, P = .02) and fatigue score (β= 0.03, SE = 0.01, P = .004) were significantly associated with change in self-efficacy, with those in the lowest tertile for 6-minute walk and higher tertiles for fatigue score experiencing the greatest change. Intervention group assignment was highly significant, with self-efficacy significantly improved in the tai chi group compared to the education control over 12 weeks (β= 0.39, SE = 0.11, P < .001). In the tai chi group alone, lower baseline oxygen uptake (β=-0.05, SE = 0.01, P = .001), decreased mood (β=-0.01, SE = 0.003, P = .004), and higher catecholamine level (epinephrine β= 0.003, SE = 0.001, P = .005) were significantly associated with improvements in self-efficacy. CONCLUSIONS In this exploratory analysis, our initial findings support the concept that interventions like tai chi may be beneficial in improving exercise self-efficacy, especially in patients with heart failure who are deconditioned, with lower functional status and mood.
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Carlson LE, Zelinski EL, Speca M, Balneaves LG, Jones JM, Santa Mina D, Wayne PM, Campbell TS, Giese-Davis J, Faris P, Zwicker J, Patel K, Beattie TL, Cole S, Toivonen K, Nation J, Peng P, Thong B, Wong R, Vohra S. Protocol for the MATCH study (Mindfulness and Tai Chi for cancer health): A preference-based multi-site randomized comparative effectiveness trial (CET) of Mindfulness-Based Cancer Recovery (MBCR) vs. Tai Chi/Qigong (TCQ) for cancer survivors. Contemp Clin Trials 2017; 59:64-76. [PMID: 28576734 PMCID: PMC5639905 DOI: 10.1016/j.cct.2017.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE A growing number of cancer survivors suffer high levels of distress, depression and stress, as well as sleep disturbance, pain and fatigue. Two different mind-body interventions helpful for treating these problems are Mindfulness-Based Cancer Recovery (MBCR) and Tai Chi/Qigong (TCQ). However, while both interventions show efficacy compared to usual care, they have never been evaluated in the same study or directly compared. This study will be the first to incorporate innovative design features including patient choice while evaluating two interventions to treat distressed cancer survivors. It will also allow for secondary analyses of which program best targets specific symptoms in particular groups of survivors, based on preferences and baseline characteristics. METHODS AND SIGNIFICANCE The design is a preference-based multi-site randomized comparative effectiveness trial. Participants (N=600) with a preference for either MBCR or TCQ will receive their preferred intervention; while those without a preference will be randomized into either intervention. Further, within the preference and non-preference groups, participants will be randomized into immediate intervention or wait-list control. Total mood disturbance on the Profile of mood states (POMS) post-intervention is the primary outcome. Other measures taken pre- and post-intervention and at 6-month follow-up include quality of life, psychological functioning, cancer-related symptoms and physical functioning. Exploratory analyses investigate biomarkers (cortisol, cytokines, blood pressure/Heart Rate Variability, telomere length, gene expression), which may uncover potentially important effects on key biological regulatory and antineoplastic functions. Health economic measures will determine potential savings to the health system.
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Affiliation(s)
- Linda E Carlson
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Cancer Control Board, Alberta Health Services, AB, Canada.
| | - Erin L Zelinski
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Cancer Control Board, Alberta Health Services, AB, Canada
| | - Michael Speca
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Cancer Control Board, Alberta Health Services, AB, Canada
| | - Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer M Jones
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Peter M Wayne
- Osher Center for Integrative Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Janine Giese-Davis
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Cancer Control Board, Alberta Health Services, AB, Canada
| | - Peter Faris
- Centre for Advancement of Health, Alberta Health Services, AB, Canada
| | - Jennifer Zwicker
- School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Kamala Patel
- Department of Immunology, University of Calgary, Calgary, AB, Canada
| | - Tara L Beattie
- Department of Biochemistry and Molecular Biology, University of Calgary, Calgary, AB, Canada
| | - Steve Cole
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kirsti Toivonen
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Jill Nation
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Philip Peng
- Department of Anesthesia, University of Toronto, ON, Canada
| | - Bruce Thong
- Department of Athletics and Recreation, McMaster University, Hamilton, ON, Canada
| | - Raimond Wong
- Department of Oncology, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sunita Vohra
- Department of Pediatrics, Faculty of Medicine and Dentistry, Integrative Health Institute, University of Alberta, Edmonton, AB, Canada
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17
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Zheng G, Xiong Z, Zheng X, Li J, Duan T, Qi D, Ling K, Chen L. Subjective perceived impact of Tai Chi training on physical and mental health among community older adults at risk for ischemic stroke: a qualitative study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:221. [PMID: 28427459 PMCID: PMC5397805 DOI: 10.1186/s12906-017-1694-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 03/17/2017] [Indexed: 11/10/2022]
Abstract
Background Evidence from quantitative studies suggest that Tai Chi produces a variety of health-related benefits, but few qualitative studies have investigated how older adults perceive the benefit of Tai Chi. The objective of the current study was to qualitatively evaluate the perceived benefits of Tai Chi practice among community older population. Methods This study was conducted with participants from a trial examining the effects of a 12-week Tai Chi training on ischemic stroke risk in community older adults (n = 170). A total of 20 participants were randomly selected from a convenience sample of participants who had completed 12-week Tai Chi training (n = 68) were interviewed regarding their perceived benefit on physical and mental health and whether Tai Chi exercise was suitable for the elderly. Results All participants agreed that Tai Chi training could relax their body and make them comfortable. Most of them thought Tai Chi training could promote physical health, including relieving pain, enhancing digestion, strengthening immunity, enhancing energy and improving sleep quality, enhancing their mental and emotional state (e.g. improving mood and reducing anxiety, improving concentration and promoting interpersonal relationship). Most of participants also agreed that Tai Chi exercise was appropriate for community older people. Three primary themes emerged from content analysis: Improving physical health; Enhancing mental and emotional state; Conforming with the request of the elderly. Conclusion The findings indicate that regular Tai Chi exercise may have positive benefits in terms of improved physical health and mental state among community elderly population, and may be useful and feasible body-mind exercise to community elderly population for its positive effects and advantages. Trial registration ChiCTR ChiCTR-TRC-13003601. Registered 23 July 2014. Electronic supplementary material The online version of this article (doi:10.1186/s12906-017-1694-3) contains supplementary material, which is available to authorized users.
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Yeh GY, Chan CW, Wayne PM, Conboy L. The Impact of Tai Chi Exercise on Self-Efficacy, Social Support, and Empowerment in Heart Failure: Insights from a Qualitative Sub-Study from a Randomized Controlled Trial. PLoS One 2016; 11:e0154678. [PMID: 27177041 PMCID: PMC4866692 DOI: 10.1371/journal.pone.0154678] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 04/18/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To qualitatively explore perceived physical and psychosocial effects and overall patient experience associated with a 12-week tai chi (TC) intervention and an education group in a clinical trial of patients with chronic heart failure (HF). SUBJECTS AND METHODS We randomized 100 patients with chronic systolic HF (NYHA Class 1-3, ejection fraction≤40%) to a 12-week group TC program or an education control. At 12-weeks, semi-structured interviews were conducted on a random subset (n = 32; n = 17 in TC, n = 15 in control), audiorecorded and transcribed verbatim. Two independent reviewers extracted information using grounded-theory methods for emergent themes. We explored similarities and differences in themes/sub-themes between the groups, and examined qualitative association with changes from baseline to post-intervention in previously reported quantitative measures (e.g., Minnesota Living with HF, Cardiac Exercise Self Efficacy and Profile of Mood States). RESULTS The mean age (±SD) of participants was 68±9 years, baseline ejection fraction 29±7%, and median New York Heart Association class 2 HF. We idenitifed themes related to the patient's experience of illness, perceptions of self, and relationship to others. Specific psychosocial and physical benefits were described. Common themes emerged from both groups including: social support and self-efficacy related to activity/exercise and diet. The tai chi group, however, also exhibited a more global empowerment and perceived control. Additional themes in TC included mindfulness/self-awareness, decreased stress reactivity, and renewed social role. These themes mirrored improvements in previously reported quantitative measures (quality-of-life, self-efficacy, and mood) in TC compared to control. Patients in TC also reported physical benefits (e.g., decreased pain, improved energy, endurance, flexibility). CONCLUSION Positive themes emerged from both groups, although there were qualitative differences in concepts of self-efficacy and perceived control between groups. Those in tai chi reported not only self efficacy and social support, but overall empowerment with additional gains such as internal locus of control, self-awareness and stress management. Future studies of mind-body exercise might further examine perceived control, self-efficacy, and locus-of-control as potential mediators of effect.
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Affiliation(s)
- Gloria Y. Yeh
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Caroline W. Chan
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Peter M. Wayne
- Osher Center for Integrative Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Lisa Conboy
- New England School of Acupuncture, Boston, Massachusetts, United States of America
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Folta SC, Seguin RA, Chui KKH, Clark V, Corbin MA, Goldberg JP, Heidkamp-Young E, Lichtenstein AH, Wiker N, Nelson ME. National Dissemination of StrongWomen-Healthy Hearts: A Community-Based Program to Reduce Risk of Cardiovascular Disease Among Midlife and Older Women. Am J Public Health 2015; 105:2578-85. [PMID: 26469644 PMCID: PMC4638239 DOI: 10.2105/ajph.2015.302866] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We describe the national dissemination of an evidence-based community cardiovascular disease prevention program for midlife and older women using the RE-AIM (reach effectiveness adoption implementation maintenance) framework and share key lessons learned during translation. METHODS In a 2010 to 2014 collaboration between the StrongWomen program and the National Extension Association of Family and Consumer Sciences, we assessed reach, adoption, implementation, and maintenance using survey methods, and we assessed effectiveness using a pretest-posttest within-participants design, with weight change as the primary outcome. RESULTS Overall reach into the population was 15 per 10,000. Of 85 trained leaders, 41 (48%) adopted the program. During the 12-week intervention, weight decreased by 0.5 kilograms, fruit and vegetable intake increased by 2.1 servings per day, and physical activity increased by 1238 metabolic equivalent (MET)-minutes per week (all P < .001). Average fidelity score was 4.7 (out of possible 5). Eleven of 41 adopting leaders (27%) maintained the program. CONCLUSIONS The StrongWomen-Healthy Hearts program can be implemented with high fidelity in a variety of settings while remaining effective. These data provide direction for program modification to improve impact as dissemination continues.
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Affiliation(s)
- Sara C Folta
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Rebecca A Seguin
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Kenneth K H Chui
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Valerie Clark
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Marilyn A Corbin
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Jeanne P Goldberg
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Eleanor Heidkamp-Young
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Alice H Lichtenstein
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Nancy Wiker
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Miriam E Nelson
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
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Walsh JN, Manor B, Hausdorff J, Novak V, Lipsitz L, Gow B, Macklin EA, Peng CK, Wayne PM. Impact of Short- and Long-term Tai Chi Mind-Body Exercise Training on Cognitive Function in Healthy Adults: Results From a Hybrid Observational Study and Randomized Trial. Glob Adv Health Med 2015; 4:38-48. [PMID: 26331103 PMCID: PMC4533658 DOI: 10.7453/gahmj.2015.058] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Cognitive decline amongst older adults is a significant public health concern. There is growing interest in behavioral interventions, including exercise, for improving cognition. Studies to date suggest tai chi (TC) may be a safe and potentially effective exercise for preserving cognitive function with aging; however, its short-term and potential long-term impact on physically active, healthy adults is unclear. OBJECTIVE To compare differences in cognitive function among long-term TC expert practitioners and age-matched and gender-matched TC-naïve adults and to determine the effects of short-term TC training on measures of cognitive function in healthy, nonsedentary adults. DESIGN A hybrid design including an observational comparison and a 2-arm randomized clinical trial (RCT). PARTICIPANTS Healthy, nonsedentary, TC-naive adults (50 y-79 y) and age-matched and gender-matched long-term TC experts. METHODS A cross-sectional comparison of cognitive function in healthy TC-naïve (n=60) and TC expert (24.5 y ÷ 12 y experience; n=27) adults: TC-naïve adults then completed a 6-month, 2-arm, wait-list randomized clinical trial of TC training. Six measures of cognitive function were assessed for both cross-sectional and longitudinal comparisons. RESULTS TC experts exhibited trends towards better scores on all cognitive measures, significantly so for category fluency (P=.01), as well as a composite z score summarizing all 6 cognitive assessments (P=.03). In contrast, random assignment to 6 months of TC training in TC-naïve adults did not significantly improve any measures of cognitive function. CONCLUSIONS In healthy nonsedentary adults, long-term TC training may help preserve cognitive function; however, the effect of short-term TC training in healthy adults remains unclear. TRIAL REGISTRATION ClinicalTrials.gov NCT01340365.
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Affiliation(s)
- Jacquelyn N Walsh
- Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States (Ms Walsh)
| | - Brad Manor
- Harvard Medical School, Boston, United States (Dr Manor)
| | - Jeffrey Hausdorff
- Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Dr Hausdorff)
| | - Vera Novak
- Harvard Medical School, Boston, United States (Dr Novak)
| | - Lewis Lipsitz
- Harvard Medical School, Boston, United States (Dr Lipsitz)
| | - Brian Gow
- Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States (Mr Gow)
| | - Eric A Macklin
- Harvard Medical School, Boston, United States (Dr Macklin)
| | | | - Peter M Wayne
- Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States (Dr Wayne)
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Transmitting Health Philosophies through the Traditionalist Chinese Martial Arts in the UK. SOCIETIES 2014. [DOI: 10.3390/soc4040712] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wayne PM, Gow BJ, Costa MD, Peng CK, Lipsitz LA, Hausdorff JM, Davis RB, Walsh JN, Lough M, Novak V, Yeh GY, Ahn AC, Macklin EA, Manor B. Complexity-Based Measures Inform Effects of Tai Chi Training on Standing Postural Control: Cross-Sectional and Randomized Trial Studies. PLoS One 2014; 9:e114731. [PMID: 25494333 PMCID: PMC4262457 DOI: 10.1371/journal.pone.0114731] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 11/10/2014] [Indexed: 12/02/2022] Open
Abstract
Background Diminished control of standing balance, traditionally indicated by greater postural sway magnitude and speed, is associated with falls in older adults. Tai Chi (TC) is a multisystem intervention that reduces fall risk, yet its impact on sway measures vary considerably. We hypothesized that TC improves the integrated function of multiple control systems influencing balance, quantifiable by the multi-scale “complexity” of postural sway fluctuations. Objectives To evaluate both traditional and complexity-based measures of sway to characterize the short- and potential long-term effects of TC training on postural control and the relationships between sway measures and physical function in healthy older adults. Methods A cross-sectional comparison of standing postural sway in healthy TC-naïve and TC-expert (24.5±12 yrs experience) adults. TC-naïve participants then completed a 6-month, two-arm, wait-list randomized clinical trial of TC training. Postural sway was assessed before and after the training during standing on a force-plate with eyes-open (EO) and eyes-closed (EC). Anterior-posterior (AP) and medio-lateral (ML) sway speed, magnitude, and complexity (quantified by multiscale entropy) were calculated. Single-legged standing time and Timed-Up–and-Go tests characterized physical function. Results At baseline, compared to TC-naïve adults (n = 60, age 64.5±7.5 yrs), TC-experts (n = 27, age 62.8±7.5 yrs) exhibited greater complexity of sway in the AP EC (P = 0.023), ML EO (P<0.001), and ML EC (P<0.001) conditions. Traditional measures of sway speed and magnitude were not significantly lower among TC-experts. Intention-to-treat analyses indicated no significant effects of short-term TC training; however, increases in AP EC and ML EC complexity amongst those randomized to TC were positively correlated with practice hours (P = 0.044, P = 0.018). Long- and short-term TC training were positively associated with physical function. Conclusion Multiscale entropy offers a complementary approach to traditional COP measures for characterizing sway during quiet standing, and may be more sensitive to the effects of TC in healthy adults. Trial Registration ClinicalTrials.gov NCT01340365
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Affiliation(s)
- Peter M. Wayne
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Brian J. Gow
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Madalena D. Costa
- Division of Interdisciplinary Medicine and Biotechnology and Margret and H.A. Rey Institute for Nonlinear Dynamics in Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - C.-K. Peng
- Division of Interdisciplinary Medicine and Biotechnology and Margret and H.A. Rey Institute for Nonlinear Dynamics in Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Dynamical Biomarkers and Translational Medicine, National Central University, Chungli, Taiwan
| | - Lewis A. Lipsitz
- Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- Institute for Aging Research, Hebrew SeniorLife, Roslindale, Massachusetts, United States of America
| | - Jeffrey M. Hausdorff
- Movement Disorders Unit, Department of Neurology, Tel Aviv Medical Center, Tel Aviv, Israel
- Department of Physical Therapy and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Roger B. Davis
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jacquelyn N. Walsh
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Matthew Lough
- Institute for Aging Research, Hebrew SeniorLife, Roslindale, Massachusetts, United States of America
| | - Vera Novak
- Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Gloria Y. Yeh
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Andrew C. Ahn
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Eric A. Macklin
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Brad Manor
- Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
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Pragmatic studies. Menopause 2014; 21:1167-9. [DOI: 10.1097/gme.0000000000000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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