Prevalence of Mindfulness Practices in the US Workforce: National Health Interview Survey

A Qualitative Analysis of a Mindfulness-Based Stress Management Program to Reduce Stress and Burnout for Health Care Staff

Occupational stress in the work setting can lead to burnout. Health care workers are at a higher risk of experiencing stress and burnout. Mindfulness has gained momentum as a coping mechanism for stress and feelings of burnout, although it is unknown which mindfulness practices are the most effective for reducing feelings of occupational stress. The purpose of the qualitative portion of this mixed-methods study was to explore health care staff's perceptions of the characteristics of mindfulness interventions that were effective in reducing their stress and feelings of burnout. Health care staff consisting of nurses, State Tested Nursing Aides, housekeeping staff, culinary staff, activities staff, social workers, and chaplain staff (N = 48) in a senior care and rehabilitation setting in a Midwestern city were invited to attend a semi-structured focus group, post-intervention. Thematic analysis was used to identify 3 main themes: ease of use promotes effective implementation, positive impact of mindfulness on self and others, and home- and work-related factors affect implementation. Overall, participants perceived benefit from various mindfulness practices for reducing their feelings of stress and burnout in the workplace. Guidance, ease of use of the mindfulness practice, and addressing barriers such as time and location can help with implementation.

Mindfulness-based Practices in Workers to Address Mental Health Conditions: A Systematic Review

The effectiveness of mindfulness techniques in addressing mental health conditions in workers is uncertain. However, it could represent a therapeutic tool for workers presenting with such conditions. Our objective was to assess the effects of mindfulness-based practices for workers diagnosed with mental health conditions. We conducted a systematic review of randomized controlled trials. Participants included were workers with a mental health condition. Interventions included any mindfulness technique, compared to any nonmindfulness interventions. Outcomes were scores on validated psychiatric rating scales. A total of 4,407 records were screened; 202 were included for full-text analysis; 2 studies were included. The first study (Finnes et al., 2017) used Acceptance and Commitment Therapy (ACT) associated or not with Workplace Dialogue Intervention (WDI), compared to treatment as usual. At 9 months follow-up, for the ACT group, depression scores improved marginally (standardized mean difference [SMD]: -0.06, p = 0.021), but anxiety scores were worse (SMD: 0.15, p = 0.036). Changes in mental health outcomes were not statistically significant for the ACT + WDI group. In the second study (Grensman et al., 2018), no statistically significant change in mental health scales has been observed after completion of mindfulness-based cognitive therapy compared to cognitive behavioral therapy. Substantial heterogeneity precluded meta-analysis. This systematic review did not find evidence that mindfulness-based practices provide a durable and substantial improvement of mental health outcomes in workers diagnosed with mental health conditions.

Family stress during the COVID-19 pandemic: a qualitative analysis

OBJECTIVE

This study aimed to understand experiences with stress and coping strategies used among families in the COVID-19 pandemic.

DESIGN/SETTING

This qualitative study took place in the paediatric outpatient clinics of a large academic medical centre in the USA between March and July of 2021.

PARTICIPANTS

Parents (over the age of 18 years) of children under the age of 18 years were invited to complete a 30-minute semistructured interview.

PRIMARY AND SECONDARY OUTCOME MEASURES

Participants were asked about types of stressors experienced during the COVID-19 pandemic and coping strategies used. All interviews were audio recorded and transcribed. In the grounded theory tradition, transcripts underwent thematic analysis.

RESULTS

A total of 26 participants completed interviews, including 88% (n=23) women, 85% (n=22) reported having children under the age of 10 years and 65% (n=17) were 30-50 years of age. Themes that emerged included the compounding effect of COVID-19 stressors, in which participants described multiple, intersecting sources of stress. One parent noted, "I worked two different jobs, since the other job I had counted on working, I lost because of COVID. And so, working from home, also with the kids, was stressful." The second theme reflected the challenges for children with virtual schooling due to decreased educational support. The third theme was the need for parental self-care. The fourth theme was finding the silver lining in which parents noted unforeseen opportunities for resilience by spending time in nature and activities promoting family bonding.

CONCLUSIONS

Parents indicated need for self-care, connecting with their child(ren) and spending time in nature. Future work should develop approaches to support families in these areas when facing complex stressors, especially during a pandemic or other times of crisis.

Yoga and pain: A mind-body complex system

Introduction

The human body's response to pain is indicative of a complex adaptive system. Therapeutic yoga potentially represents a similar complex adaptive system that could interact with the pain response system with unique benefits.

Objectives

To determine the viability of yoga as a therapy for pain and whether pain responses and/or yoga practice should be considered complex adaptive systems.

Methods

Examination through 3 different approaches, including a narrative overview of the evidence on pain responses, yoga, and complex system, followed by a network analysis of associated keywords, followed by a mapping of the functional components of complex systems, pain response, and yoga.

Results

The narrative overview provided extensive evidence of the unique efficacy of yoga as a pain therapy, as well as articulating the relevance of applying complex systems perspectives to pain and yoga interventions. The network analysis demonstrated patterns connecting pain and yoga, while complex systems topics were the most extensively connected to the studies as a whole.

Conclusion

All three approaches support considering yoga a complex adaptive system that exhibits unique benefits as a pain management system. These findings have implications for treating chronic, pervasive pain with behavioral medicine as a systemic intervention. Approaching yoga as complex system suggests the need for research of mind-body topics that focuses on long-term systemic changes rather than short-term isolated effects.

Stress Reduction by Yoga versus Mindfulness Training in Adults Suffering from Distress: A Three-Armed Randomized Controlled Trial including Qualitative Interviews (RELAX Study)

Distress is a growing public health concern. In this three-armed randomized controlled trial, n = 102 adults with elevated stress levels and stress-related symptoms were randomly assigned to (1) “integrative” yoga classes which combined physical exercises, mindfulness training, and ethical/philosophical aspects of traditional yoga; to (2) Iyengar yoga classes which entailed primarily physical exercises; or to (3) mindfulness training without physical training. We hypothesized the synergistic effects of physical yoga exercises, mindfulness, and ethical/philosophical aspects. The primary outcome was the group difference on Cohen’s Perceived Stress Scale (PSS) after 12 weeks. Secondary outcomes included burnout, quality of life, physical complaints, depression, anxiety, mindfulness, interoceptive awareness, self-regulation, spirituality, mysticism, and posttraumatic stress. All outcomes were evaluated at baseline (V0), after 12 weeks (V1), and after 24 weeks (V2). A subset of participants took part in qualitative interviews. A lasting and clinically relevant stress reduction was observed within all groups (PSS ΔV0−V1Integrative Yoga = −6.69 ± 6.19; ΔV0−V1Iyengar Yoga = −6.00 ± 7.37; ΔV0−V1Mindfulness = −9.74 ± 7.80; all p < 0.00). Effect sizes were also statistically large at the end of the follow-up period (Cohen’s d Integrative Yoga = 1.41; d Iyengar Yoga = 1.37; d Mindfulness = 1.23). There were no significant group differences or evidence of relevant synergistic effects from combining mindfulness and physical yoga exercises. All three interventions were found to be equally effective methods of stress reduction. Their use in practice should be based on availability and patient preference.

Breaking the Cycle of Overwork and Recuperation: Altering Somatic Engagement Across Boundaries

Past research often relegates the management of the ideal worker’s overworking body to the nonwork environment. Reflecting a segmentation approach to managing the boundary between work and nonwork, the nonwork setting is treated as a context for recuperation. Yet, segmentation may, ironically, support the ideal worker image and reinforce the persistence of overwork. Drawing on two-year-long ethnographic studies of yoga teacher training, this paper considers how individuals shift how they manage the boundaries around their bodies. In doing so, we challenge the notion that segmentation of nonwork from work is an ideal boundary management strategy for addressing the negative impacts of overwork. Rather, we suggest that an integration strategy developed in a nonwork community may be productive for breaking the cycle of overwork and recuperation promoted by the ideal worker image and creating a virtuous cycle of activation and release. We bring forward the bodily basis to overwork and conceptualize somatic engagement as a form of engagement through which actors come to connect reflexively with their bodily experience across domains. Relatedly, in revealing how individuals come to connect reflexively with their bodily experience, we elaborate our understanding of the relational phenomena that enhance individuals’ somatic experiences across boundaries.

Mindfulness Matters: Use and Perceptions of Mindfulness Practices Among Athletic Trainers

CONTEXT

Mindfulness practices are effective for injury or illness recovery, decreasing stress and anxiety, and strengthening emotional resilience. They are also beneficial for health care professionals' wellbeing and improving patient outcomes and safety. However, mindfulness has not been studied in athletic trainers.

OBJECTIVE

To investigate athletic trainers' use of mindfulness practices and their perceptions of its importance for self-care and patient or client care.

DESIGN

Cross-sectional study.

SETTING

All athletic training practice settings.

PATIENTS AND OTHER PARTICIPANTS

A total of 547 athletic trainers who were currently practicing completed the survey.

MAIN OUTCOME MEASURE(S)

We developed an 18-item survey that measured use (1 = never to 6 = very frequently) and perceptions (1 = strongly disagree to 7 = strongly agree) of mindfulness practices. Mann-Whitney U or Kruskal-Wallis tests with post hoc pairwise comparisons were performed to assess differences in use (P < .05). A related-samples Wilcoxon signed rank test was calculated to assess differences in participants' perceptions between self-care and patient or client care.

RESULTS

Overall, 86% (n = 471) of respondents reported involvement in some form of mindfulness practice, with females (median [interquartile range] = 4 [2-5] versus males: 3 [2-4]; P < .002), those not in a committed relationship (4 [2-5] versus those in such a relationship: 3 [2-4]; P = .048), and those without children in the home (4 [2-5] versus those with children in the home: 3 [2-4]; P = .040) describing the highest frequency of use for self-care. Females (4 [2-4] versus males: 3 [2-4]; P < .001), those without children in the home (3 [2-4] versus those with children in the home: 3 [2-4]; P = .036), and those in emerging (4 [2-4]; P = .003) or collegiate (3 [2-4]; P = .006) settings most frequently incorporated mindfulness into patient or client care. Overall frequency of use for self-care was higher than for patient or client care (4 = occasionally [2-4] versus 3 = rarely [2-4]; P < .001). Mindfulness practices were perceived as more important for self-care than for patient or client care (6 [5-7] versus 5 [5-6]; P < .001).

CONCLUSIONS

Athletic trainers perceived mindfulness practices as more important for personal wellbeing and used them, albeit occasionally, more for self-care than for patient or client care. Differences in gender, relationship status, children, and setting were observed. Mindfulness-based interventions for athletic trainer wellbeing and patient-centered care and implementation barriers should be explored.

How do people conceptualize mindfulness?

While the concept of mindfulness is ubiquitous, its meaning is ambiguous, with limited knowledge about how it is understood by the general public. Understanding how laypeople perceive mindfulness and mindful people is vital, as it will impact how people interpret and act upon information about mindfulness and mindfulness practices. Study 1 participants evaluated the term mindfulness positively, while Study 2 participants perceived a mindful target positively and as strongly endorsing self-transcendence values (e.g. equality). Study 3 participants learned about an unknown target who was mindful or not. The mindful target was evaluated more positively than the less-mindful target and seen as endorsing different values. Most effects in Studies 1-3 were stronger among more mindful participants. Study 4 assessed visual representations of mindful and less-mindful faces. Visual representations of a mindful face were judged by naive raters as more likeable, possessing higher self-transcendence values and performing more moral behaviours compared with a less-mindful face. The results suggest that how people interpret mindfulness has important consequences and can be used to guide how mindfulness is implemented in response to global challenges.

The Implementation of Mindfulness-Based Programs in the Swedish Healthcare System - A Survey Study of Service Providers

Background

The burden of depression and anxiety is on the rise globally. Mindfulness-Based Programs (MBPs) are a particular group of psychosocial programs targeting depression and anxiety. There is growing research and practice interest in MBPs internationally, and they are becoming more commonly implemented in a number of countries’ healthcare services.

Objective

To systematically map the existing provision of MBPs in the Swedish healthcare sector, in order to understand facilitators and barriers to uptake, and so inform future implementation efforts.

Methods

We assessed the experiences of MBP implementation among relevant stakeholders in Swedish healthcare settings through an online survey. The survey was designed to gather data on (1) the evidence-base of practice being implemented; (2) the context in which implementation was taking place and (3) the process of facilitation. Respondents were identified through snowball sampling of key stakeholders.

Results

In total, 129 individuals from 20 of the 21 healthcare regions in Sweden responded to the survey. Our findings showed that there is variation in the types of MBP models being implemented, and that the delivery structure of evidence-based programs were often being modified for implementation. We found some divergence from international guidance on good practice standards for the training of MBP teachers within Swedish implementation processes. The main service context for implementation is primary care; the most important facilitating factors for successful MBP implementation were the presence of a championing individual and support from leadership. The most influential hindering factors for implementation were lack of time, and lack of funding.

Conclusion

To support integrity and fidelity of MBP implementation in Sweden, a strategic plan and good practice guidelines seem necessary. Also, an evidence-based stepped care model for implementation may work to ensure intervention fidelity in cases where time and funding constraints permit.

A feasibility trial of a digital mindfulness-based intervention to improve asthma-related quality of life for primary care patients with asthma

Asthma outcomes remain suboptimal, despite effective pharmacotherapy. Psychological dysfunction (such as anxiety) is common, and associated with poorer outcomes. We evaluated a digital mindfulness programme as an intervention to improve asthma-related quality of life for primary care patients, in a prospectively registered randomized-controlled feasibility study. We offered ‘Headspace’, a widely-used digital mindfulness intervention, to adults with asthma through 16 UK GP practices. Participants were randomized on a 2:1 basis to the mindfulness intervention, or waitlist control. Participants completed questionnaires (including asthma symptom control, asthma-related quality of life, anxiety, depression) at baseline, 6-week and 3-month follow-up. 116 participants completed primary outcomes at 3-month follow-up: intervention 73 (79%), control 43 (84%). Compared to baseline, the intervention group but not the control group reported significantly improved asthma-related quality of life, with a between-group difference favoring the intervention group that was not significant (Mean difference = 0.15, 95%CI − 0.13 to 0.42). Intervention use varied (ranging from 0 to 192 times) but was generally high. Digital mindfulness interventions are feasible and acceptable adjunct treatments for mild and moderate asthma to target quality of life. Further research should adapt ‘generic’ mindfulness-based stress-reduction to maximize effectiveness for asthma, and validate our findings in a fully-powered randomized controlled trial.

Trial registration Prospectively registered: ISRCTN52212323.

Autonomic Rehabilitation: Adapting to Change

Adaption to changes of external environment or internal health, the body-mind connection, or autonomic nervous system must be flexible and healthy. Population health studies with wearable technology and remote monitoring will lead to paradigm shifts in how to approach the physiology of emotion. Heart rate variability as a whole health biomarker could emerge as a foundation for a process beginning with objective habits and skills of real-time modulation with focused breathing for healthier decision making and autonomic health trajectory change. Physical medicine and rehabilitation is uniquely poised to refine an autonomic rehabilitation process in an integrative manner to help individuals adapt.

Veterans' interests, perceptions, and use of mindfulness

Objective:

Mindfulness-based interventions are an evidence-based approach utilized in health care. There is developing evidence for effective use with military Veterans. However, little is known about Veterans’ view of mindfulness. This study aims to understand their interests, perceptions, and use of mindfulness to enhance educational outreach and treatment engagement.

Methods:

A cross-sectional study was conducted across the Veterans Health Administration in Salt Lake City, UT by administering a questionnaire to military Veterans. The questionnaire included the following themes: (1) demographics and respondents’ mindfulness practice; (2) respondents’ perceptions and beliefs about mindfulness; and (3) respondents’ knowledge and interest in learning about mindfulness.

Results:

In all, 185 military Veterans were surveyed; 30% practiced mindfulness in the past year, mainly for stress, posttraumatic stress disorder, sleep, and depression. Over 75% who practiced reported perceived benefit. Veterans rarely reported negative beliefs about mindfulness; 56% perceived an understanding of mindfulness and 46% were aware of Veterans Health Administration mindfulness offerings. In all, 55% were interested in learning about mindfulness, 58% were interested in learning how it could help, and 43% were interested in combining mindfulness with a pleasurable activity.

Conclusion:

Educational engagement approaches should be directed toward the benefits of mindfulness practice with minimal need to address negative beliefs. Outreach including education, with an experiential component, about mindfulness classes, availability of evening and weekend classes, individual sessions, and virtual offerings into Veteran’s homes, may enhance engagement in mindfulness-based interventions. Mindfulness-based interventions that combine mindfulness training with an experiential pleasurable activity may be one mechanism to enhance treatment engagement.

Contemplation by Design: Leveraging the "Power of the Pause" on a Large University Campus Through Built and Social Environments

College and university campuses have long been designed as embodied places of societal values and aspirations, reflecting both academic traditions and heritages alongside social and scientific change and innovation. More pragmatically, these spaces share some commonalities with other living and working environments, and must adapt to changing technological and social norms. Since the 1970's, workplace adaptations included employer-sponsored health promotion programs and facilities. While campus environments such as fitness centers and dining halls have been incorporated into health promotion initiatives, other aspects of human well-being have been neglected. In this paper, we describe an initiative, Contemplation By Design, to incorporate contemplation and mindfulness into the daily lives of all members of the Stanford University community, including students, faculty, staff, and their families, as well as alumni and retirees who live close by. This case study highlights ways that physical planning and programmatic initiatives for contemplative practices have been integrated to deliver generalizable, community-based well-being resources that can be emulated in diverse settings throughout the Stanford University campuses, including the main campus and local satellite campuses. Based on experience drawn from Contemplation By Design, practical recommendations for designing contemplative practice spaces and programs are offered.

Meditative Movements for Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis

OBJECTIVE

Physical activity plays a specific role in the fundamental aspect of diabetes care. It is necessary to develop exercise programs for these patients. The aim of this systematic review is to summarize current evidence regarding the effectiveness of meditative movement in patients with type 2 diabetes.

METHODS

The following databases were searched: PubMed, CENTRAL, Web of Science, Ovid LWW, and EMBASE. Two independent investigators searched and screened the studies by finding duplications, excluding irrelevant titles and abstracts, and then selecting eligible studies by reviewing full texts. 21 studies fulfilled the inclusion criteria. Meta-analyses were performed on glycated hemoglobin (HbA1c), fasting blood glucose (FBG) and postprandial blood glucose (PPBG), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and body mass index (BMI).

RESULTS

Meta-analyses showed that meditative movements significantly improved FBG, HbA1c, PPBG, TC, LDL-C, and HDL-C. No improvement was found in BMI.

CONCLUSIONS

The results demonstrated a favorable effect or tendency of meditative movements to improve blood glucose and blood lipid levels in patients with type 2 diabetes mellitus. The special effects of meditative movements in type 2 diabetes mellitus patients need further research.

Effect of Tai Chi on Quality of Life, Body Mass Index, and Waist-Hip Ratio in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a worldwide public health concern with high morbidity and various progressive diabetes complications that result in serious economic expenditure and social burden. This systematic review aims to evaluate the effect of Tai Chi on improving quality of life (QoL), body mass index (BMI) and waist-hip ratio (WHR) in patients with T2DM.

METHOD

A systematic review and meta-analysis was performed following PRISMA recommendation. Four English databases and three Chinese databases were searched. The PEDro scale was used to assess the methodological quality of including studies. Study inclusion criteria: randomized controlled trials (RCTs) and quasi-experimental studies were included, patients with T2DM that adopted Tai Chi as intervention and QoL, BMI and/or WHR as outcome measurements.

RESULTS

Eighteen trials were included. The aggregated results of seven trials showed that Tai Chi statistically significantly improved QoL measured by the SF-36 on every domains (physical function: MD = 7.73, 95% confidence interval (CI) = 1.76 to 13.71, p = 0.01; role-physical function: MD = 9.76, 95% CI = 6.05 to 13.47, p < 0.001; body pain: MD = 8.49, 95% CI = 1.18 to 15.8, p = 0.02; general health: MD = 9.80, 95% CI = 5.77 to 13.82, p < 0.001; vitality: MD = 6.70, 95% CI = 0.45 to 12.94, p = 0.04; social function: MD = 9.1, 95% CI = 4.75 to 13.45, p < 0.001; role-emotional function: MD = 7.88, 95% CI = 4.03 to 11.72, p < 0.001; mental health: MD = 5.62, 95% CI = 1.57 to 9.67, p = 0.006) and BMI (MD = -1.53, 95% CI = -2.71 to -0.36, p < 0.001) compared with control group (wait list; no intervention; usual care; sham exercise).

CONCLUSION

Tai Chi could improve QoL and decrease BMI for patients with T2DM, more studies are needed to be conducted in accordance with suggestions mentioned in this review.

Move-It: A Cluster-Randomised Digital Worksite Exercise Intervention in China: Outcome and Process Evaluation

We evaluate the outcomes and processes of a video and web-based worksite exercise intervention for sedentary office workers in China, in a 2-arm cluster-randomised wait-list control trial (n = 282: intervention (INT) n = 196 and wait-list control (WLC) n = 86). Eligible clusters were two sites of a major organisation in China randomly allocated to each group (INT: Guangzhou; WLC: Beijing); eligible participants were site employees (n = 690). A theoretically informed digital workplace intervention (Move-It) involving a 10 min Qigong exercise session (video demonstration via website) was delivered twice a day at set break times during the working day for 12 consecutive weeks. Individual-level outcomes were assessed. Participants' physical activity increased significantly from baseline to post-intervention similarly in both the intervention and the control group. There was a significantly smaller increase in weekday sitting hours in intervention than controls (by 4.66 h/week), and work performance increased only in the control group. Process evaluation (including six focus groups) was conducted using the RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework. The intervention had wide reach and was successfully marketed to all employees with good uptake. The participatory approach increased perceived organisational support and enhanced adoption. The intervention was implemented broadly as planned. Qigong worksite exercise intervention can be successfully delivered to sedentary office workers in China using video and web-based platforms. It may increase physical activity and does not adversely affect perceived work performance. The study highlights the complexity of conducting health promotion research in real-world organisational settings.

Effect of Tai Chi alone or as additional therapy on low back pain: Systematic review and meta-analysis of randomized controlled trials

BACKGROUND

This is the first systematic review evaluating and statistically synthesis the current studies regarding the effects of Tai Chi on pain and disability in patients with low back pain (LBP).

METHODS

Seven electronic databases including PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang and VIP information from inception to early March 2019 were searched. The Physiotherapy Evidence Database (PEDro) Scale was used to assess quality of all included randomized controlled trials (RCTs). The pooled effect size (weight mean difference, WMD) and 95% confidence interval (CI) were calculated to determine the effect of Tai Chi on pain and disability among LBP patients based on random effects model.

RESULTS

The aggregated results of the meta-analysis suggested that Tai Chi significantly decreased pain (WMD = -1.27, 95%CI -1.50 to -1.04, P < .00001, I = 74%) and improve function disability, Oswestry disability index (ODI) subitems: pain intensity (WMD = -1.70, 95% CI -2.63 to -0.76, P = .0004, I = 89%); personal care (WMD = -1.93, 95% CI -2.86 to -1.00, P < .0001, I = 90%); lifting (WMD = -1.69, 95% CI -2.22 to -1.15, P < .0001, I = 66%); walking (WMD = -2.05, 95% CI -3.05 to -1.06, P < .0001, I = 88%); standing (WMD = -1.70, 95% CI -2.51 to -0.89, P < .0001, I = 84%); sleeping (WMD = -2.98, 95% CI -3.73 to -2.22, P < .00001, I = 80%); social life (WMD = -2.06, 95% CI -2.77 to -1.35, P < 0.00001, I = 80%) and traveling (WMD = -2.20, 95% CI -3.21 to -1.19, P < .0001, I = 90%), Japanese Orthopedic Association (JOA) score (WMD = 7.22, 95% CI 5.59-8.86, P < .00001, I = 0%), Medical Outcomes Study Questionnaire Short Form 36 Health Survey (SF-36) physical functioning (WMD = 3.30, 95% CI 1.92-4.68, P < .00001), and Roland-Morris Disability Questionnaire (RMDQ) (WMD = -2.19, 95% CI -2.56 to -1.82, P < .00001).

CONCLUSION

We drew a cautious conclusion that Tai Chi alone or as additional therapy with routine physical therapy may decrease pain and improve function disability for patients with LBP. Further trials are needed to be conducted with our suggestions mentioned in the systematic review.

Digital Games and Mindfulness Apps: Comparison of Effects on Post Work Recovery

BACKGROUND

Engagement in activities that promote the dissipation of work stress is essential for post work recovery and consequently for well-being. Previous research suggests that activities that are immersive, active, and engaging are especially effective at promoting recovery. Therefore, digital games may be able to promote recovery, but little is known about how they compare with other popular mobile activities, such as mindfulness apps that are specifically designed to support well-being.

OBJECTIVE

The aim of this study was to investigate and compare the effectiveness of a digital game and mindfulness app in promoting post work recovery, first in a laboratory setting and then in a field study.

METHODS

Study 1 was a laboratory experiment (n=45) in which participants' need for recovery was induced by a work task, before undertaking 1 of 3 interventions: a digital game (Block! Hexa Puzzle), a mindfulness app (Headspace), or a nonmedia control with a fidget spinner (a physical toy). Recovery in the form of how energized participants felt (energetic arousal) was compared before and after the intervention and how recovered participants felt (recovery experience) was compared across the conditions. Study 2 was a field study with working professionals (n=20), for which participants either played the digital game or used the mindfulness app once they arrived home after work for a period of 5 working days. Measures of energetic arousal were taken before and after the intervention, and the recovery experience was measured after the intervention along with measures of enjoyment and job strain.

RESULTS

A 3×2 mixed analysis of variance identified that, in study 1, the digital game condition increased energetic arousal (indicative of improved recovery) whereas the other 2 conditions decreased energetic arousal (F_2,42=3.76; P=.03). However, there were no differences between the conditions in recovery experience (F_2,42=.01; P=.99). In study 2, multilevel model comparisons identified that neither the intervention nor day of the week had a significant main effect on how energized participants felt. However, for those in the digital game condition, daily recovery experience increased during the course of the study, whereas for those in the mindfulness condition, it decreased (F_1,18=9.97; P=.01). Follow-up interviews with participants identified 3 core themes: detachment and restoration, fluctuations and differences, and routine and scheduling.

CONCLUSIONS

This study suggests that digital games may be effective in promoting post work recovery in laboratory contexts (study 1) and in the real world, although the effect in this case may be cumulative rather than instant (study 2).

Awareness of Yoga for Supportive Care in Cancer: Implications for Dissemination

Objectives: Evidence indicates there are beneficial physical and psychosocial effects from practicing yoga in cancer patients and survivors. Despite yoga having been incorporated into National Comprehensive Cancer Network guidelines for symptoms ranging from fatigue to pain, patients' use of yoga for supportive care is low, ranging from 6% to 12%. This study aims to evaluate the awareness of yoga as therapy in an academic cancer center and the preferences for information delivery in this population. Design: We conducted a cross-sectional survey study at an urban academic cancer center. Responses regarding awareness and use of yoga were evaluated; those responding "not aware" were analyzed for preferences in information delivery. Univariate analysis was used to further characterize awareness of yoga for supportive care. Results: Of 303 respondents, 68% were female, 77% were white, and 75% were college educated. Despite access to yoga at the cancer center, 171 (56%) patients expressed they were not aware of the availability of yoga. Male patients were more likely to be unaware of yoga (72.4% vs. 48.8%, p = 0.045). Awareness did not vary by age, race, educational attainment, marital status, cancer type, or cancer stage. Of the 171 "not aware" patients, 87.6% expressed desire for information in the form of printed material, followed by 80.4% for e-mail, 37.6% for smartphone application, and 27.6% for social media. Non-white respondents were more likely to express interest in receiving information by smartphone. Conclusions: More than half of cancer patients were unaware of the yoga program despite advertising across the institution. Patients prefer varying methods for information receipt, with preferences differing by sociodemographic factors. Targeted education and outreach using appropriate engagement is needed to improve the awareness of yoga for symptom control in cancer patients.

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

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

Mindfulness Training Reduces Stress At Work: A Randomized Controlled Trial

Mindfulness-based interventions have been suggested as one way to improve employee well-being in the workplace. Despite these purported benefits, there have been few well-controlled randomized controlled trials (RCTs) evaluating mindfulness training in the workplace. Here we conducted a two-arm RCT at work among employees of a digital marketing firm comparing the efficacy of a high dose six-week mindfulness training to a low dose single-day mindfulness training for improving multiple measures of employee well-being assessed using ecological momentary assessment. High dose mindfulness training reduced both perceived and momentary stress, and buffered employees against worsened affect and decreased coping efficacy compared to low dose mindfulness training. These results provide well-controlled evidence that mindfulness training programs can reduce momentary stress at work, suggesting that more intensive mindfulness training doses (i.e., 6-weeks) may be necessary for improving workplace well-being outcomes. This RCT utilizes a novel experience sampling approach to measure the effects of a mindfulness intervention on employee well-being and considers potential dose-response effects of mindfulness training at work.

Effects of Meditative Movements on Major Depressive Disorder: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Tai Chi, Qigong, and Yoga are recognized as the most popular complementary approaches for alleviating musculoskeletal pain, improving sleep quality, and reducing blood pressure. The therapeutic effects of these meditative movements for treating major depressive disorder (MDD) is yet to be determined. Therefore, we examined whether meditative movements (Tai Chi, Qigong, and Yoga) are effective for treating MDD. Seven electronic databases (SPORTDiscus, PubMed, PsycINFO, Cochrane Library, Web of Science, CNKI, and Wanfang) were used to search relevant articles. Randomized controlled trials (RCT) using Tai Chi, Qigong or Yoga as intervention for MDD were considered for the meta-analysis (standardized mean difference: SMD).

RESULTS

Meta-analysis on 15 fair-to-high quality RCTs showed a significant benefit in favor of meditative movement on depression severity (SMD = -0.56, 95% CI -0.76 to -0.37, p < 0.001, I² = 35.76%) and on anxiety severity (SMD = -0.46, 95% CI -0.71 to -0.21, p < 0.001, I² = 1.17%). Meditative movement interventions showed significantly improved treatment remission rate (OR = 6.7, 95% CI 2.38 to 18.86, p < 0.001) and response rate (OR = 5.2, 95% CI 1.73 to 15.59, p < 0.001) over passive controls.

CONCLUSIONS

Emphasizing the therapeutic effects of meditative movements for treating MDD is critical because it may provide a useful alternative to existing mainstream treatments (drug therapy and psychotherapy) for MDD. Given the fact that meditative movements are safe and easily accessible, clinicians may consider recommending meditative movements for symptomatic management in this population.

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

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

Vertebral compression fractures associated with yoga: a case series

BACKGROUND

The importance of exercise in skeletal health is increasingly recognized by both patients and providers. However, the safety of prescribed or recreational exercise in at-risk populations remains under-reported and under-publicized. Yoga has gained widespread popularity due to its physical and psychological benefits. When practiced in a population at increased fracture risk, however, some yoga poses may increase fracture risk, particularly at the spine, rather than increasing BMD as noted in recent popular press reports.

CASE REPORT

Nine subjects (8 women) with a median age of 66 years (range 53-87), developed vertebral compression fracture (VCF) one month to six years after initiating yoga-associated spinal flexion exercises (SFE). VCF presented with back pain and occurred in the thoracicspine (N.=6), lumbar-spine (N.=4) and cervical-spine (N.=1). Four patients had osteoporosis by BMD criteria prior to VCF and 2 had osteopenia (median T-score -2.35; range -3.3 to +2.0). Interestingly, all patients had their lowest T-scores at the spine. Three patients had a history of fragility fracture prior to the index VCF. While one patient had primary hyperparathyroidism and another was treated with high dose prednisone, no other risk factors for bone loss including medications or secondary osteoporosis causes were identified in the other patients.

CLINICAL REHABILITATION IMPACT

This study identified patients in whom increased torsional and compressive mechanical loading pressures occurring during yoga SFE resulted in de novo VCF. Despite the need for selectivity in yoga poses in populations at increased fracture risk, both scientific and media reports continue to advertise yoga as a bone protective activity. Accordingly, yoga is misconceived as a 'onesize-fits-all' prescription. Instead, the appropriate selection of patients likely to benefit from yoga must be a cornerstone of fracture prevention.

Effects of Mind-Body Exercises for Mood and Functional Capabilities in Patients with Stroke: An Analytical Review of Randomized Controlled Trials

Objective: The effects of stroke are both physical and mental in nature and may have serious implications on the overall well-being of stroke survivors. This analytical review aims to critically evaluate and statistically synthesize the existing literature regarding the effects of mind-body (MB) exercises on mood and functional capabilities in patients with stroke. Methods: A structured literature review was performed in both English (PubMed, PEDro, and Cochrane Library) and Chinese (Wanfang and CNKI (Chinese National Knowledge Information Database)) databases. Sixteen randomized controlled trials were considered eligible for meta-analysis. Based on the random effects model, we used the pooled effect size to determine the magnitude of rehabilitative effect of MB exercise intervention on depression, anxiety, activities of daily living, and functional mobility among stroke survivors. The sum PEDro score ranged from five to nine points (fair-to-good methodological quality), but the absence of concealed allocation and blinded assessors were reported in most studies. Results: The aggregated results showed that MB exercise intervention is associated with significantly improved ADL (Hedges' g = 1.31, 95% CI 0.85 to 1.77, p < 0.001, I² = 79.82%) and mobility (Hedges' g = 0.67, 95% CI 0.25 to 1.09, p < 0.001, I² = 69.65%), and reduced depression (Hedges' g = -0.76, 95% CI -1.16 to -0.35, p < 0.001, I² = 74.84%). Conclusions: as add-on treatments, the MB exercises may potentially improve depression, activities of daily living, and mobility of these post-stroke patients. Future studies with more robust methodology will be needed to provide a more definitive conclusion.

Dispositional mindfulness, anticipation and abstinence symptoms related to hypnotic dependence among insomniac women who seek treatment: A cross-sectional study

Introduction

Dispositional mindfulness can be described as the mental ability to pay attention to the present moment, non-judgmentally. There is evidence of inverse relation between dispositional mindfulness and insomnia and substance use, but as of yet, no studies evaluating the specific association between dispositional mindfulness and the components of hypnotic use disorder.

Objective

To evaluate the association between dispositional mindfulness and the components of dependence among female chronic hypnotic users.

Design and method

Seventy-six women, chronic users of hypnotics, who resorted to Mindfulness-Based Relapse Prevention for the cessation of hypnotic use were included in the study. The Five Facet Mindfulness Questionnaire (FFMQ) evaluated the levels and facets of mindfulness, and the subscales of the Benzodiazepine Dependence Questionnaire (BENDEP) assessed dependence on hypnotics. We also evaluated sociodemographic variables and symptoms of insomnia and anxiety. The associations between the FFMQ facets and the BENDEP subscales were evaluated with binomial logistic regression, adjusted for income, schooling, anxiety, and insomnia.

Results

We observed associations between facets of the FFMQ and specific aspects of hypnotic dependence. The facet “observing” was inversely associated with the “concern about lack of availability of the hypnotic” [aOR = 0.87 95% CI (0.79–0.97)], and the facet “non-reacting to inner experience” with “noncompliance with the prescription recommendations” [aOR = 0.86 95% CI (0.75–0.99)]. The total score of the FFMQ was inversely associated to those two dependence subscales [aOR = 0.94 95% CI (0.89–0.99)]. “Observing” and “non-reactivity to inner experience” were also inversely associated with the “impairments related to the withdrawal symptoms” [aOR = 0.84 95% CI (0.73–0.97)] and [aOR = 0.78 95% CI (0.63–0.96)], respectively. The FFMQ was not associated with “awareness of problematic hypnotic use”.

Conclusion

Dispositional mindfulness, specifically the facets “observing” and “non-reactivity to inner experience, were inversely associated with the components of hypnotic dependence related to the anticipation of having the substance, its expected effect, and the impairments caused by the abstinence. We discuss the implications of those results for the clinical practice and future investigations.

Qigong and Tai-Chi for Mood Regulation

Qigong and Tai-Chi are traditional self-healing, self-cultivation exercises originating in ancient China. These exercises are characterized by coordinated body posture and movements, deep rhythmic breathing, meditation, and mental focus based on traditional Chinese medicine theories. Although the exact mechanisms of Qigong's and Tai-Chi's effects on physical and mental well-being are unknown, these practices may be viewed as meditative movements and share many of the healing elements observed in mindfulness meditation. Clinical studies including randomized controlled trials and meta-analyses have shown that both Qigong and Tai-Chi have beneficial effects on psychological well-being and reduce symptoms of anxiety and depression. Qigong and Tai-Chi frequently involve anchoring attention to interoceptive sensations related to breath or other parts of the body, which has been shown to enhance nonreactivity to aversive thoughts and impulses. Preliminary studies suggest that the slow movements in Qigong and Tai-Chi with slowing of breath frequency could alter the autonomic system and restore homeostasis, attenuating stress related to hypothalamus-pituitary-adrenal axis reactivity and modulating the balance of the autonomic nervous system toward parasympathetic dominance. Qigong's and Tai-Chi's effects on emotion regulation could occur through changes in multiple prefrontal regions, the limbic system, and the striatum or in the expression of genes linked to inflammatory responses and stress-related pathways.

The Effect of Taichi Practice on Attenuating Bone Mineral Density Loss: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective: The purpose of this study was to determine the effects of practicing Taichi on attenuating bone mineral density (BMD) loss. Methods: Both electronic and manual searches were performed for randomized controlled trials (RCTs) examining Taichi for bone health. Two review authors independently performed study selection and data extraction according to inclusion criteria. A third party (Lin Luo) emerged to discuss with the two review authors and resolve a disagreement. Results: Twenty RCTs were found to meet the inclusion criteria and used for meta-analysis with a total effective sample of 1604. The aggregated results from this systematic review have shown significant benefits in favour of Taichi on BMD at lumbar spine (Standard Mean Difference, SMD) = 0.29; 95% CI 0.15 to 0.43; p < 0.0001), femur neck (SMD = 0.56; 95% CI 0.38 to 0.75; p < 0.00001), femur trochanter (SMD = 0.04; 95% CI 0.01 to 0.07; p = 0.007), total hip BMD (SMD = 0.46; 95% CI 0.16 to 0.76; p = 0.003). Conclusions: The aggregated results from this systematic review suggests that Taichi is effective on attenuating BMD loss at the regions of lumbar spine and proximal femur neck in special populations (e.g., older adults, perimenopausal and postmenopausal women, people with osteoarthritis, and cancer survivors). Researchers should further examine the effect of Taichi on the proximal femur trochanter and total hip so that a more definitive claim can be made regarding the beneficial effects for attenuating BMD loss in these musculoskeletal regions.