Month: February 2020

Reduce Incontinence in Women with Yoga

psyjdc Leave a comment

Reduce Incontinence in Women with Yoga

 

By John M. de Castro, Ph.D.

 

“The pelvic floor is an instrumental player in the health and function of your bladder. Specifically, the perineum and the dynamic layers of muscle that compromise the inner pelvis, which are active in the passage of urine and control of the bladder. If you do experience leaks . . . strengthening your perineum with yoga will isolate the muscle, only furthering your ability to reduce leaks caused by incontinence.” – TENA

 

Urinary incontinence is common, particularly in women, and involves an involuntary loss of urine. This can range from slightly bothersome to debilitating. Possible public humiliation results in many women refraining from otherwise enjoyable public activities. This occurs due to problems with nerves and weakening of muscles that normally hold or discharge urine. Urinary incontinence occurs in about 10% of women and 2% of men under age 65 and 35% of women and 22% of men over age 65. Treatment can involve exercise, drugs, electrical stimulation, or even surgery.

 

Effective exercises for urinary incontinence strengthen the muscles of the pelvic floor and sphincter muscles. Yoga is a gentle exercise with a number of poses that strengthen the pelvic floor. In addition, yoga practice increases body awareness helping the individual to better sense and control the muscles involved. Also, yoga can reduce anxiety and stress which can contribute to urinary incontinence. So, it would seem reasonable to examine the application of yoga exercises for the treatment of urinary incontinence.

 

In today’s Research News article “A group-based yoga program for urinary incontinence in ambulatory women: feasibility, tolerability, and change in incontinence frequency over 3 months in a single-center randomized trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314206/?report=classic), Huang and colleagues recruited older women (> 50 years of age) who had urinary incontinence and provided them with a “written pamphlet providing basic patient-directed information about behavioral self-management of incontinence (such as pelvic floor exercises and timed urination) consistent with usual first-line care.” They were randomly assigned them to either receive additional 3 months, twice a week for 90 minutes, of yoga training or non-specific muscle stretching and strengthening. They were also asked to practice at home for an hour at least once a week. The yoga poses taught were selected to improve bladder control. They were measured before and after training for safety, feasibility, frequency of incontinence, and incontinence quality of life.

 

They found that over the 3-month program incontinence decreased by 76% in the yoga group and 56% in the exercise group, stress induced incontinence decreased by 61% in the yoga group and 35% in the exercise group. Group differences were not statistically significant. Participation rates were high and no serious adverse events were reported.

 

Yoga training produced on average superior results to the exercise program the lack of a statistically significant difference does not allow definitive conclusions. Yoga practice has been shown to reduce the effects of stress on the individual. So, the reduction in stress induced incontinence would be expected. Hence, the results make it clear that yoga training is a feasible, safe, and effective treatment for urinary incontinence in older women.

 

So, reduce incontinence in women with yoga.

 

“yoga can help women who suffer from urinary incontinence by improving pelvic health and help gain more control over their bladders.“ – Attends

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Huang, A. J., Chesney, M., Lisha, N., Vittinghoff, E., Schembri, M., Pawlowsky, S., … Subak, L. (2019). A group-based yoga program for urinary incontinence in ambulatory women: feasibility, tolerability, and change in incontinence frequency over 3 months in a single-center randomized trial. American journal of obstetrics and gynecology, 220(1), 87.e1–87.e13. doi:10.1016/j.ajog.2018.10.031

 

Structured Abstract

Background:

Due to the limitations of existing clinical treatments for urinary incontinence, many women with incontinence are interested in complementary strategies for managing their symptoms. Yoga has been recommended as a behavioral self-management strategy for incontinence, but evidence of its feasibility, tolerability, and efficacy is lacking.

Objectives:

To evaluate the feasibility and tolerability of a group-based therapeutic yoga program for ambulatory middle-aged and older women with incontinence and examine preliminary changes in incontinence frequency as the primary efficacy outcome after 3 months.

Study Design:

Ambulatory women aged 50 years or older who reported at least daily stress-, urgency-, or mixed-type incontinence, were not already engaged in yoga, and were temporarily willing to forgo clinical incontinence treatments were recruited into a randomized trial in the San Francisco Bay area. Women were randomly assigned to take part in a program of twice weekly group classes and once weekly home practice focused on Iyengar-based yoga techniques selected by an expert yoga panel (yoga group) or a non-specific muscle stretching and strengthening program designed to provide a rigorous time-and-attention control (control group) for 3 months. All participants also received written, evidence-based information about behavioral incontinence self-management techniques (pelvic floor exercises, bladder training) consistent with usual first-line care. Incontinence frequency and type were assessed by validated voiding diaries. Analysis of covariance models examined within- and between-group changes in incontinence frequency as the primary efficacy outcome over 3 months.

Results:

Of the 56 women randomized (28 to yoga, 28 to control), mean age was 65.4 (±8.1) years (range 55–83 years), mean baseline incontinence frequency was 3.5 (±2.0) episodes/day, and 37 (66%) had urgency-predominant incontinence. Fifty women completed their assigned 3-month intervention program (89%), including 27 in the yoga and 23 in the control group (P=0.19). Of those, 24 (89%) in the yoga and 20 (87%) in the control group attended at least 80% of group classes. Over 3 months, total incontinence frequency decreased by an average of 76% from baseline in the yoga and 56% in the control group (P=0.07 for between-group difference). Stress incontinence frequency also decreased by an average of 61% in the yoga group and 35% in controls (P=0.045 for between-group difference), but changes in urgency incontinence frequency did not differ significantly between groups. Forty-eight non-serious adverse events were reported, including 23 in the yoga and 25 in the control group, but none were directly attributable to yoga or control program practice.

Conclusions:

Findings demonstrate the feasibility of recruiting and retaining incontinent women across the aging spectrum into a therapeutic yoga program and provide preliminary evidence of reduction in total and stress-type incontinence frequency after 3 months of yoga practice. When taught with attention to women’s clinical needs, yoga may offer a potential community-based behavioral self-management strategy for incontinence to enhance clinical treatment, although future research should assess whether yoga offers unique benefits for incontinence above and beyond other physical activity-based interventions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314206/?report=classic

 

Effective Online Mindfulness Training Characteristics

psyjdc Leave a comment

Effective Online Mindfulness Training Characteristics

 

By John M. de Castro, Ph.D.

 

“Practicing mindfulness can help all sorts of people no matter what is going on in their lives. Learning mindfulness is very accessible, whether you have a center in your hometown or just an internet connection, whether you have enough money for a retreat or do not have any money at all, or if you want to learn how to teach mindfulness to others. No matter what your situation is, there is a mindfulness training option tailored to your needs.” – Joaquín Selva

 

Mindfulness training has been shown through extensive research to be effective in improving physical and psychological health and particularly with reducing the physical and psychological reactions to stress and increasing resilience in the face of stress. The vast majority of the mindfulness training techniques, however, require a trained therapist. This results in costs that many clients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules and at locations that may not be convenient. As an alternative, mindfulness training over the internet have been developed. These have tremendous advantages in decreasing costs, making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations.

 

The research has indicated that mindfulness training online can be effective for improving the health and well-being of the participants. But the question arises as to what is the best way to train mindfulness online for improving psychological health. In today’s Research News article “Relating Instructional Design Components to the Effectiveness of Internet-Based Mindfulness Interventions: A Critical Interpretive Synthesis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6906627/?report=classic), Lippmann and colleagues review the research studies employing online mindfulness training.

 

They focused on the instructional designs used in the online trainings. In particular they focused on formal learning tasks, supportive educational materials, timely support and reminders, and informal practices of targeted skills. There were 18 published research studies of online mindfulness training that fulfilled the criteria. There were a variety of outcome measures that varied with different studies but primarily they measured anxiety, depression, stress, distress, pain, physical fitness, and quality of life.

 

They classified 11 studies as having highly effective outcomes, 6 as less effective, and 1 as ineffective. They found that the studies that produced more and less effective outcomes all implemented formal practice at least twice a week. But the studies with more effective outcomes also had good supportive educational materials, timely support and reminders, and informal practices of targeted skills, while the studies with less effective outcomes had much less robust implementations of supportive educational materials, timely support and reminders, and informal practices of targeted skills. The study that had ineffective outcomes had formal practice only once a week and none of the other instructional design components were present.

 

The results suggest that online mindfulness trainings can be very effective in improving the physical and psychological health of the participants. But there needs to be several instructional components present and well implemented to maximize effectiveness. These components include clear formal mindfulness training occurring at least twice a week, instruction in the ideas underlying the practices, frequent reminders to practice, and an emphasis on practice outside of the formal online instruction. The better these components are implemented in the online instruction the better the improvements in the well-being of the participants.

 

So, online mindfulness training programs are very effective if they are well designed to implement four important instructional components.

 

“participants who completed the online mindfulness course reported significantly lower levels of perceived stress, depression and anxiety. The large effect sizes associated with completing the intervention were maintained for all of the outcome variables at 3- and 6-month follow-up.” – Dawn Querstret

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Lippmann, M., Laudel, H., Heinzle, M., & Narciss, S. (2019). Relating Instructional Design Components to the Effectiveness of Internet-Based Mindfulness Interventions: A Critical Interpretive Synthesis. Journal of medical Internet research, 21(11), e12497. doi:10.2196/12497

 

Abstract

Background

Internet-based mindfulness interventions are a promising approach to address challenges in the dissemination and implementation of mindfulness interventions, but it is unclear how the instructional design components of such interventions are associated with intervention effectiveness.

Objective

The objective of this study was to identify the instructional design components of the internet-based mindfulness interventions and provide a framework for the classification of those components relative to the intervention effectiveness.

Methods

The critical interpretive synthesis method was applied. In phase 1, a strategic literature review was conducted to generate hypotheses for the relationship between the effectiveness of internet-based mindfulness interventions and the instructional design components of those interventions. In phase 2, the literature review was extended to systematically explore and revise the hypotheses from phase 1.

Results

A total of 18 studies were identified in phase 1; 14 additional studies were identified in phase 2. Of the 32 internet-based mindfulness interventions, 18 were classified as more effective, 11 as less effective, and only 3 as ineffective. The effectiveness of the interventions increased with the level of support provided by the instructional design components. The main difference between effective and ineffective interventions was the presence of just-in-time information in the form of reminders. More effective interventions included more supportive information (scores: 1.91 in phases 1 and 2) than less effective interventions (scores: 1.00 in phase 1 and 1.80 in phase 2), more part-task practice (scores: 1.18 in phase 1 and 1.60 in phase 2) than less effective interventions (scores: 0.33 in phase 1 and 1.40 in phase 2), and provided more just-in-time information (scores: 1.35 in phase 1 and 1.67 in phase 2) than less effective interventions (scores: 0.83 in phase 1 and 1.60 in phase 2). The average duration of more effective, less effective, and ineffective interventions differed for the studies of phase 1, with more effective interventions taking up more time (7.45 weeks) than less effective (4.58 weeks) or ineffective interventions (3 weeks). However, this difference did not extend to the studies of phase 2, with comparable average durations of effective (5.86 weeks), less effective (5.6 weeks), and ineffective (7 weeks) interventions.

Conclusions

Our results suggest that to be effective, internet-based mindfulness interventions must contain 4 instructional design components: formal learning tasks, supportive information, part-task practice, and just-in-time information. The effectiveness of the interventions increases with the level of support provided by each of these instructional design components.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6906627/?report=classic

 

Moderate the Negative Psychological Effects of Racism with Mindfulness

psyjdc Leave a comment

Moderate the Negative Psychological Effects of Racism with Mindfulness

 

By John M. de Castro, Ph.D.

 

“mindfulness and related practices do assist in increasing focus and raising awareness, and have been shown to assist in minimizing bias.” – Rhonda Magee

 

Discrimination based upon race, religion, gender, national origin, sexual orientation, etc. has been going on since the beginning of recorded history. Even though quite common, it can have considerable negative impact for all who are involved but especially for the subject of the discrimination. General well-being, self-esteem, self-worth, and social relations can be severely impacted as a result of discrimination. This can, in turn, result in anxiety and depression.

 

It is important that we identify methods to deal with the consequences of discrimination. Mindfulness practices have been shown to reduce prejudice. It has also been shown to reduce depression and enhance positive emotions and reduce the negative effects of discrimination. So perhaps mindfulness can modulate the impact of discrimination on the individual.

 

In today’s Research News article “The Experience of Racism on Behavioral Health Outcomes: The Moderating Impact of Mindfulness.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402779/?report=classic), Zapolski and colleagues recruited African American college students aged 18 to 24 years. They completed an on-line questionnaire measuring demographics, frequency of experiencing racial discrimination, anxiety, depression, alcohol use, and mindfulness.

 

They found that 57% of the African American students had experienced racial discrimination over the last year. A correlational analysis revealed that the greater the frequency of racial discrimination reported, the greater the levels of anxiety, depression, and alcohol use. They also found that the higher the levels of mindfulness the lower the levels of anxiety, depression, and alcohol use. A mediation analysis of these data revealed that mindfulness moderated the effects of racial discrimination on anxiety, depression, and alcohol use such that the higher the levels of mindfulness the smaller the impact of racial discrimination on anxiety, depression, and alcohol use.

 

The study was correlational and as such causation cannot be concluded. Nevertheless, the results suggest that racial discrimination is associated with the individuals’ levels of psychological health and alcohol use but that these associations are weaker when mindfulness levels are high. This suggests that mindfulness may be helpful in mitigating the negative consequences of experience racism. It remains to be established if mindfulness training can immunize the individual from the impact of racism on their psychological health.

 

So, moderate the negative psychological effects of racism with mindfulness.

 

“Mindfulness can help us with a lot of the really subtle difficulties of doing the work that must be done to dismantle these patterns and habits that draw us to reinvest in segregation.” – Rhonda Magee

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Zapolski, T., Faidley, M. T., & Beutlich, M. (2019). The Experience of Racism on Behavioral Health Outcomes: The Moderating Impact of Mindfulness. Mindfulness, 10(1), 168–178. doi:10.1007/s12671-018-0963-7

 

Abstract

Research shows that racial discrimination results in adverse behavioral health outcomes for African American young adults, including risk for depression, anxiety, and substance use. Although high levels of mindfulness have been shown to reduce risk for such health outcomes, it is unknown whether mindfulness can reduce risk as a consequence of racial discrimination, particularly among African Americans. Three-hundred and eighty-eight African American young adults between the ages of 18–24 (M=20.6, 62% female) completed measures assessing past year experiences of racial discrimination, depressive symptoms, anxiety symptoms, alcohol use, and trait mindfulness. A positive correlation was found between racial discrimination and the behavioral health outcomes, as well as a negative correlation between mindfulness and the behavioral health outcomes. Moreover, mindfulness was found to significantly moderate the effect of racial discrimination on mood symptoms. Although mindfulness was found to lessen the effect of racial discrimination on alcohol use, this difference was not statistically significant. In line with previous literature, racial discrimination was shown to have a negative impact on behavioral health outcomes among African Americans. Moreover, our findings provide support for the buffering effect of mindfulness on mood symptoms as a consequence discrimination. This suggests that increasing mindfulness may be an effective strategy to include in interventions targeting improvement in mood symptoms for African American young adults. However, alternative strategies may be more appropriate to address outcomes, such as alcohol use, as a consequence of racial discrimination.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402779/?report=classic

 

Improve Well-Being with a Smartphone Mindfulness App

psyjdc Leave a comment

Improve Well-Being with a Smartphone Mindfulness App

 

By John M. de Castro, Ph.D.

 

“What do you do when you can’t afford therapy but are struggling to handle your mental illness alone? You could download an app. In recent years, there’s been a proliferation of mental health apps available to smartphone users. These reasonably-priced, or most often free, mental health apps offer a wealth of resources that make therapeutic techniques more accessible, portable, and cost-effective.” – Jessica Truchel

 

Mindfulness training has been shown through extensive research to be effective in improving physical and psychological health. The vast majority of the mindfulness training techniques, however, require a trained teacher. This results in costs that many college students can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy college schedules and at locations that may not be convenient. As an alternative, Apps for smartphones have been developed. These have tremendous advantages in decreasing costs, making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations. But the question arises as to the effectiveness of these Apps in inducing mindfulness and improving psychological health in college students.

 

In today’s Research News article “Intermittent mindfulness practice can be beneficial, and daily practice can be harmful. An in depth, mixed methods study of the “Calm” app’s (mostly positive) effects.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6928287/?report=classic), Clarke and Draper recruited healthy college students and had them complete a 7-day mindfulness training with the “Calm” smartphone app. The program consists of once a day 10-minute trainings. The students completed measures before and after training of mindfulness, well-being, and self-efficacy.

 

They found that after the 7-day training there were significant increases in mindfulness, well-being, and self-efficacy. They report that students who only completed 1 or 2 of the 7 “Calm” modules did not obtain the benefits. It appears that completing 3 or more of the modules is necessary to improve the students’ psychological health.

 

This is a brief study without a comparison condition and so the results must be interpreted cautiously. But, a number of prior studies have demonstrated that mindfulness trainings with smartphone apps are effective in improving well-being. In addition, the students who did not complete a significant number of the 7 training modules did not show improvements in psychological health. So, it would appear that the use of smartphone apps are a convenient method to teach mindfulness and this can have a significant impact on the psychological health of the users.

 

So, improve well-being with a smartphone mindfulness app.

 

“Mental health apps can be effective in making therapy more accessible, efficient, and portable.” – Mary Let

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Clarke, J., & Draper, S. (2019). Intermittent mindfulness practice can be beneficial, and daily practice can be harmful. An in depth, mixed methods study of the “Calm” app’s (mostly positive) effects. Internet interventions, 19, 100293. doi:10.1016/j.invent.2019.100293

 

Abstract

Objectives

Despite a weak evidence base, daily use of mindfulness-based self-help smartphone applications (apps) is said to promote wellbeing. However, many do not use these apps in the way that app developers and mindfulness proponents recommend. We sought to determine whether the “Calm” app works, and whether it does so even when it is used intermittently.

Methods

Employing a mixed-methods design, we recruited a self-selected sample of 269 students from a Scottish university (81% female, 84% white, mean age 23.89) to engage with a seven-day introductory mindfulness course, delivered using Calm, currently one of the most popular, yet under-researched, apps.

Results

Daily course engagement was associated with significant gains in wellbeing (p ≤.001, d = 0.42), trait mindfulness (p ≤.001, d = 0.50) and self-efficacy (p ≤.014, d = 0.21). Intermittent course engagement was also associated with significant gains in wellbeing (p ≤.028, d = 0.34), trait mindfulness (p ≤.010, d = 0.47) and self-efficacy (p ≤.028, d = 0.32). This study is therefore the first to demonstrate that the Calm app is associated with positive mental health outcomes. It also shows that regular use is not essential. A thematic analysis of qualitative data supported these quantitative findings. However it also revealed that some participants had negative experiences with the app.

Conclusions for practice

Mindfulness-based self-help apps such as Calm have the potential to both enhance and diminish users’ wellbeing. Intermittent mindfulness practice can lead to tangible benefits. Therefore, mindfulness proponents should not recommend daily practice, should increase awareness of the potential for negative outcomes, and resist the idea that mindfulness practice works for everyone. Developers of mindfulness apps ought to make specific features customisable in order to enhance their effectiveness.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6928287/?report=classic

 

Improve the Well-Being of Mothers of Children with Autism with Mindfulness

psyjdc Leave a comment

Improve the Well-Being of Mothers of Children with Autism with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Parents of children with autism spectrum disorder . . . who engage in a mindfulness-based practice see a decrease in their child’s aggression and challenging behaviors and an improvement in the child’s overall functioning.” – Katy Oberle

 

There is a tremendous demand for caregiving in the US. It is estimated that over 65 million (29% of the adult population) provides care to someone who is ill, disabled or aged, averaging 20 hours per week spent caring for their loved ones. This caregiving comes at a cost exacting a tremendous toll on caregivers’ health and well-being. Caregiving has been associated with increased levels of depression and anxiety as well as higher use of psychoactive medications, poorer self-reported physical health, compromised immune function, and increased mortality.

 

Providing care for a child with autism can be particularly challenging. About one out of every 68 children is considered autistic. These children’s behavior is characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors. These make it difficult to relate to the child and receive the kind of positive feelings that often help to support caregiving. The challenges of caring for a child with autism require that the parent be able to deal with stress, to regulate their own emotions, and to be sensitive and attentive to their child. These skills are exactly those that are developed in mindfulness training. It improves the psychological and physiological responses to stress. It improves emotion regulation. And it improves the ability to maintain attention and focus in the face of high levels of distraction.

 

Acceptance and Commitment Therapy (ACT) is a mindfulness-based psychotherapy technique that employs many of the techniques of Cognitive Behavioral Therapy (CBT). ACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes. The application of mindfulness skills to the parents of children with autism is relatively new. So, it would seem reasonable to investigate the ability of ACT to improve the psychological well-being of mothers of children with autism.

 

In today’s Research News article “The Effectiveness of Group Based Acceptance and Commitment Therapy (ACT) on Emotion Cognitive Regulation Strategies in Mothers of Children with Autism Spectrum.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6861729/?report=classic), Salimi and colleagues recruited mothers of children with autism and randomly assigned them to receive either a once a week for 2 hours for 8 weeks program of Acceptance and Commitment Therapy (ACT) or a health education control condition. They were measured before and after training for emotion regulation including self-blaming, blaming others and positive reevaluation, blaming, rumination, considering a situation as disastrous, reception, planning/positive refocuses.

 

They found that after treatment the mothers showed a significant increase in reception, planning/positive refocuses and significant decreases in self-blaming, blaming others and positive reevaluation, blaming, and considering a situation as disastrous. Hence, Acceptance and Commitment Therapy (ACT) significantly improved the ability of mothers of children with autism to regulate their emotions. This is very important as these mothers are extremely important for these children but under great stress and emotional turmoil. Being able to improve their psychological well-being is important for both the mother and child.

 

So, improve the well-being of mothers of children with autism with mindfulness.

 

“People who practice mindfulness learn to pay specific attention to what is happening in the moment — and that includes moments that are stressful or chaotic. It is easy to get overtaken by stress or negativity, but mindfulness teaches people to find distance from their negative thoughts by learning to acknowledge them and label them when they happen.” – Julianne Garey

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Salimi, M., Mahdavi, A., Yeghaneh, S. S., Abedin, M., & Hajhosseini, M. (2019). The Effectiveness of Group Based Acceptance and Commitment Therapy (ACT) on Emotion Cognitive Regulation Strategies in Mothers of Children with Autism Spectrum. Maedica, 14(3), 240–246. doi:10.26574/maedica.2019.14.3.240

 

Abstract

Background:Autism spectrum disorder has a big impact on family life. Mothers of children with autism face many challenges. This study was conducted to determine the effectiveness of group-based acceptance and commitment therapy on cognitive emotion regulation strategies in mothers of children with autism.

Method:This is a quasi-experimental study with a pretest-posttest control group design. The research population included mothers of children with autism spectrum disorder referring to exceptional schools, who were living in Tehran. After cluster random sampling, 30 mothers of children with autism spectrum disorder were selected and randomly assigned to two groups: an experimental group and a control group, each consisting of 15 women. Participants responded to the cognitive emotion regulation questionnaire vulbefore and after intervention. The experimental group received group-based acceptance and commitment therapy (eight two-hour sessions), while no intervention was given to the control group.

Results and conclusion:Covariance analysis of data showed that group-based acceptance and commitment therapy had a significant effect on positive/planning strategy refocusing (p=0.003), positive reappraisal (p=0.004), self-blaming (p=0.001), blaming others (p=0.007), considering a situation as disastrous (p=0.001), reception (p=0.008). However, there was not a significant difference in the dimensions of rumination (p=0.025). Therefore, it is recommended that welfare institutions and centers should provide a training plan based on acceptance and commitment therapy to improve the current cognitive emotion regulation strategies for mothers of children with autism spectrum.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6861729/?report=classic

 

Improve Borderline Personality Disorder with Dual Diagnosis with Mindfulness

psyjdc Leave a comment

Improve Borderline Personality Disorder with Dual Diagnosis with Mindfulness

 

By John M. de Castro, Ph.D.

 

“The pain, emotional instability and impulsive behavior of borderline personality disorder place these individuals at risk of drug or alcohol abuse.” – Foundation Recovery

 

Borderline Personality Disorder (BPD) is a very serious mental illness that is estimated to affect 1.6% of the U.S. population. It involves unstable moods, behavior, and relationships, problems with regulating emotions and thoughts, impulsive and reckless behavior, and unstable relationships. BPD is associated with high rates of co-occurring depression, anxiety disorders, substance abuse, eating disorders, self-harm, suicidal behaviors, and completed suicides. Needless to say, it is widespread and debilitating.

 

One of the few treatments that appears to be effective for Borderline Personality Disorder (BPD) is Dialectical Behavior Therapy (DBT). It is targeted at changing the problem behaviors characteristic of BPD through focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DBT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness.

 

Borderline Personality Disorder (BPD) frequently occurs with other problems, particularly drug and alcohol abuse. This dual diagnosis increases the issues presenting with the patient. It is therefore important to establish if Dialectical Behavior Therapy (DBT) is effective in the dual diagnosis patients. In today’s Research News article “Does an adapted Dialectical Behaviour Therapy skills training programme result in positive outcomes for participants with a dual diagnosis? A mixed methods study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694661/?report=classic), Flynn and colleagues examine the effectiveness of Dialectical Behavior Therapy (DBT) skills training for patients with dual diagnosis.

 

They recruited patients diagnosed with Borderline Personality Disorder (BPD) and substance abuse (primarily alcohol abuse). The patients were treated with a 48-week program of skills training adapted from Dialectical Behavior Therapy (DBT); mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness. They were measured before and after treatment and 6 months later for mindfulness, emotion regulation, coping behavior, and the frequency and severity of substance abuse. At the end of the program they were interviewed regarding their experiences with the program.

 

They found that compared with baseline, at the end of the program there were significant increases in mindfulness and Dialectical Behavior Therapy (DBT) skills use and significant reductions in dysfunctional coping behavior and emotional dysregulation that were maintained at the 6-month follow-up. Substance abuse was also significantly reduced after treatment. There was still a reduced use at the 6-month follow-up but it was no longer statistically significant. In the interviews the patients reported that the program improved their self-assurance and confidence, but there was a need for continued care after the end of the program.

 

These results are important as Borderline Personality Disorder (BPD) is extremely difficult to treat and when it is combined with substance abuse it is even more difficult to treat. It is very encouraging that training in Dialectical Behavior Therapy (DBT) skills of mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness is effective in improving emotion regulation and coping behavior and reducing substance abuse in BPD patients with dual diagnosis. This suggests that this skills training may be an acceptable and effective treatment for patients with both BPD and substance abuse.

 

So, improve borderline personality disorder with dual diagnosis with mindfulness.

 

“[Dialectical Behavior Therapy] DBT is reported to reduce suicidal behavior, non-suicidal self-injurious behavior, other impulsive behaviors strongly linked with borderline personality disorder, and significantly reduce psychiatric hospitalization (relapse), self-injury, and depression among adolescents and adults.” – Burning Tree

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Flynn, D., Joyce, M., Spillane, A., Wrigley, C., Corcoran, P., Hayes, A., … Mooney, B. (2019). Does an adapted Dialectical Behaviour Therapy skills training programme result in positive outcomes for participants with a dual diagnosis? A mixed methods study. Addiction science & clinical practice, 14(1), 28. doi:10.1186/s13722-019-0156-2

 

Abstract

Background

Treating severe emotional dysregulation and co-occurring substance misuse is challenging. Dialectical behaviour therapy (DBT) is a comprehensive and evidence-based treatment for borderline personality disorder (BPD). It has been hypothesised that the skills training, which is a facet of the full DBT programme, might be effective for people with severe emotional dysregulation and other co-occurring conditions, but who do not meet the criteria for BPD. However, there is limited research on standalone DBT skills training for people with substance misuse and emotional dysregulation.

Methods

A mixed methods study employing an explanatory sequential design was conducted where participants with a dual diagnosis (n = 64) were recruited from a community-based public addiction treatment service in Ireland between March 2015 and January 2018. DBT therapists screened potential participants against the study eligibility criteria. Quantitative self-report measures examining emotion regulation, mindfulness, adaptive and maladaptive coping responses including substance misuse, and qualitative feedback from participants were collected. Quantitative data were summarised by their mean and standard deviation and multilevel linear mixed effects models were used to estimate the mean change from baseline to post-intervention and the 6-month follow-up period. Thematic analysis was used to analyse the qualitative data.

Results

Quantitative results indicated reductions in binge drinking and use of Class A, B and C drug use from pre-intervention (T1) to the 6-month follow-up (T3). Additionally, significant improvements were noted for mindfulness practice and DBT skills use from T1 to T3 (p < 0.001). There were also significant reductions in dysfunctional coping and emotional dysregulation from T1 to T3 (p < 0.001). Significant differences were identified from pre to post intervention in reported substance use, p = 0.002. However, there were no significant differences between pre-intervention and 6-month follow up reports of substance use or at post-intervention to 6 month follow up. Qualitative findings indicated three superordinate themes in relation to participants’ experiences of a DBT skills training programme, adapted from standard DBT: (1) new lease of life; (2) need for continued formal aftercare and (3) programme improvements. Participants described reductions in substance misuse, while having increased confidence to use the DBT skills they had learned in the programme to deal with difficult emotions and life stressors.

Conclusions

This DBT skills training programme, adapted from standard DBT, showed positive results for participants and appears effective in treating people with co-occurring disorders. Qualitative results of this mixed methods study corroborate the quantitative results indicating that the experiences of participants have been positive. The study indicates that a DBT skills programme may provide a useful therapeutic approach to managing co-occurring symptoms.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694661/?report=classic

 

Improve Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms in Youth with Mind-Body Practices

psyjdc Leave a comment

Improve Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms in Youth with Mind-Body Practices

 

By John M. de Castro, Ph.D.

 

“mindfulness practice can help us pay attention better, resist distractions, be less impulsive, remember what we are doing in the moment, and regulate our own emotions, it is helpful whether we have ADHD or not. But it holds special interest for those with ADHD.” – Casey Dixon

 

Attention Deficit Hyperactivity Disorder (ADHD) is most commonly found in children, but for about half it persists into adulthood. It’s estimated that about 5% of the adult population has ADHD. Hence, this is a very large problem that can produce inattention, impulsivity, hyperactivity, and emotional issues, and reduce quality of life. The most common treatment is drugs, like methylphenidate, Ritalin, which helps reducing symptoms in about 30% of the people with ADHD. Unfortunately, the effectiveness of the drugs appears to be markedly reduced after the first year. In addition, the drugs often have troublesome side effects, can be addictive, and can readily be abused. So, drugs, at present, do not appear to be a good solution, only affecting some, only for a short time, and with unwanted side effects.

 

There are indications that mind-body practices training may be an effective treatment for ADHD. It makes sense that it should be, as the skills and abilities strengthened by mind-body practices training are identical to those that are defective in ADHD,  attention, impulse control, executive function, emotion control, and mood improvement. In addition, unlike drugs, they are relatively safe interventions that have minimal troublesome side effects. Since mind-body practices is so promising as treatments, it is important to step back and summarize what has been learned in the scientific research of the effectiveness of mindfulness training for ADHD.

 

In today’s Research News article “Interventions Based on Mind-Body Therapies for the Improvement of Attention-Deficit/Hyperactivity Disorder Symptoms in Youth: A Systematic Review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6680862/), Barranco-Ruiz and colleagues review and summarize the published research studies of the effectiveness pf mind-body practices in the treatment of Attention Deficit Hyperactivity Disorder (ADHD). They found 12 published randomized trials employing the mind-body practices of school based 8-week mindfulness trainings and yoga practices that were applied to children and adolescents of 5 to 18 years of age.

 

They found that 11 of the 12 reviewed studies reported significant improvements in Attention-Deficit/Hyperactivity Disorder (ADHD) following mind-body treatment in the youths. There were significant improvements in the symptoms of ADHD including significant increases in attention and planning, and significant decreases in inattention, hyperactivity, impulsivity, anxiety, shyness, social problems, perfectionism, inhibition, self-reported emotion dysregulation, and depressive symptoms.

 

These are impressive results. It has been previously shown with disparate healthy and ill populations that mindfulness training produces increases in attention and significant decreases in inattention, hyperactivity, impulsivity, anxiety, social problems, perfectionism, inhibition, emotion dysregulation, and depression. The present review extends these findings to children and adolescents. This is important as Attention-Deficit/Hyperactivity Disorder (ADHD) is highest among children and adolescents. These results suggest that mindfulness training and yoga practices are safe and effective in improving ADHD and its symptoms. Mind-body practices may be an excellent alternative to standard drug treatment.

 

So, improve Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms in youth with mind-body practices.

 

“Yoga has been shown to help improve ADHD symptoms. . . . Like mindfulness meditation, it ups dopamine levels and strengthens the prefrontal cortex. One study found that kids who practiced yoga moves for 20 minutes twice a week for 8 weeks improved on tests that measure attention and focus.” – WebMD

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Barranco-Ruiz, Y., Etxabe, B. E., Ramírez-Vélez, R., & Villa-González, E. (2019). Interventions Based on Mind-Body Therapies for the Improvement of Attention-Deficit/Hyperactivity Disorder Symptoms in Youth: A Systematic Review. Medicina (Kaunas, Lithuania), 55(7), 325. doi:10.3390/medicina55070325

 

Abstract

Background and objectives: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in children and adolescents. Mind–body therapies (MBTs) seem to be effective for improving health in different populations; however, whether a positive effect occurs in children and adolescents with ADHD is still controversial. The main aim of this systematic review was to analyse the interventions based on MBT aimed to improve the main ADHD symptoms in children and adolescents. Materials and Methods: A systematic review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to identify MBT studies on children and adolescents (4–18 years) with a clinical diagnosis of ADHD. Study quality was evaluated by the NIH quality tool (U.S. National Institute of Health). Results: There were positive results in eleven out of twelve included studies regarding the effect of the MBT interventions on ADHD symptoms. With respect to ADHD symptoms, we observed differences across studies. In relation to the studies’ quality, eleven studies were rated “poor” and one was rated as “fair”. Conclusions: MBTs, such as yoga or mindfulness, could be positive strategies to mitigate ADHD symptoms in children and adolescents. However, further research with high-quality designs, with randomization, greater sample sizes, and more intensive supervised practice programs are needed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6680862/

 

Improve Brain Function and Mild Cognitive Impairment in the Elderly with Tai Chi

psyjdc Leave a comment

Improve Brain Function and Mild Cognitive Impairment in the Elderly with Tai Chi

 

By John M. de Castro, Ph.D.

 

“in individuals age 60 or older with mild cognitive impairment . . . engaging in tai chi (a series of gentle, slow movements accompanied by deep breathing) reduces the risk of falling. What’s more, it may also improve cognitive abilities.” – Health and Wellness Alerts

 

The aging process involves a systematic progressive decline in every system in the body, the brain included. The elderly frequently have problems with attention, thinking, and memory, known as mild cognitive impairment. An encouraging new development is that mindfulness practices such as meditation training and mindful movement practices can significantly reduce these declines in cognitive ability. In addition, it has been found that mindfulness practices reduce the deterioration of the brain that occurs with aging restraining the loss of neural tissue. Indeed, the brains of practitioners of meditation,  yoga, and Tai Chi have been found to degenerate less with aging than non-practitioners.

 

Tai Chi has been practiced for thousands of years with benefits for health and longevity. Tai Chi training is designed to enhance function and regulate the activities of the body through regulated breathing, mindful concentration, and gentle movements. Tai Chi practice has been found to be effective for an array of physical and psychological issues. Tai Chi has been shown to help the elderly improve attention, balance, reducing falls, arthritis, cognitive function, memory, and reduce age related deterioration of the brain. So, it makes sense to further study the effectiveness of Tai Chi training on older adults with mild cognitive impairment to improve their cognitive performance.

 

In today’s Research News article “Mind-body exercise improves cognitive function and modulates the function and structure of the hippocampus and anterior cingulate cortex in patients with mild cognitive impairment.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6535682/), Tao and colleagues recruited sedentary patients over 60 years of age who were diagnosed with mild cognitive impairment. They were randomly assigned to receive 24 weeks, 3 times per week for 1 hour, of either Baduanjin Tai Chi or brisk walking, or 8 weeks, once a week for 30 minutes of health education. They were measured before and after the 24 weeks of training for cognitive function including naming, verbal memory registration, visuospatial/executive functions, and learning, attention, and abstraction. Their brains were also scanned with functional Magnetic Resonance Imaging (fMRI) before and after training.

 

They found that the group that practiced Baduanjin Tai Chi had significant improvements in cognitive functions that were about double those of the walking and health education groups. In the fMRI data they investigated the resting state amplitude of low-frequency fluctuations (ALFF), that is linked with cerebral blood flow. They found that Baduanjin Tai Chi group had significant decreases in ALFF in the right hippocampus and significant increases in the left medial prefrontal cortex and the anterior cingulate cortex. They also found that the Baduanjin Tai Chi group had significant increases in grey matter volume in the right hippocampus and the anterior cingulate cortex and increased functional connectivity between the hippocampus and right angular gyrus. Importantly, they found that the greater the change in the ALFF for the right hippocampus and also the anterior cingulate cortex the greater the improvement in cognitive function.

 

The hippocampus has been shown to be involved in information storage (memory). Since one of the biggest changes that accompany mild cognitive impairments are deficits in memory, it seems logical that interventions that improve cognitive function in these patients would affect the brain structure involved in the memory process.

 

These are very interesting results from a well-controlled study. They suggest that participation in Baduanjin Tai Chi changes the brain and increases cognitive function in patients with mild cognitive impairments. These results are in line with previous findings that Tai Chi improves cognitive function, memory, and reduces age related deterioration of the brain in the elderly. The results also suggest that the changes in the brain are associated with the changes in cognitive ability.

 

It’s important to note that Tai Chi is gentle and safe, appropriate for all ages, and for individuals with illnesses that limit their activities or range of motion. It is inexpensive to administer, can be performed in groups or alone, at home or in a facility, and can be quickly learned. In addition, it can be practiced in social groups. This can make it fun, improving the likelihood of long-term engagement in the practice. Overall, the results suggest that participation in Tai Chi should be recommended for patients with mild cognitive impairments.

 

So, improve brain function and mild cognitive impairment in the elderly with Tai Chi

 

 

“adults with mild cognitive impairment . . . found that a 12-week exercise program significantly improved performance on a semantic memory task, and also significantly improved brain efficiency.” – About Memory

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Tao, J., Liu, J., Chen, X., Xia, R., Li, M., Huang, M., … Kong, J. (2019). Mind-body exercise improves cognitive function and modulates the function and structure of the hippocampus and anterior cingulate cortex in patients with mild cognitive impairment. NeuroImage. Clinical, 23, 101834. doi:10.1016/j.nicl.2019.101834

 

Abstract

Mild cognitive impairment (MCI) is a common neurological disorder. This study aims to investigate the modulation effect of Baduanjin (a popular mind-body exercise) on MCI. 69 patients were randomized to Baduanjin, brisk walking, or an education control group for 24 weeks. The Montreal Cognitive Assessment (MoCA) and Magnetic Resonance Imaging scans were applied at baseline and at the end of the experiment. Compared to the brisk walking and control groups, the Baduanjin group experienced significantly increased MoCA scores. Amplitude of low-frequency fluctuations (ALFF) analysis showed significantly decreased ALFF values in the right hippocampus (classic low-freqency band, 0.01‐0.08 Hz) in the Baduanjin group compared to the brisk walking group and increased ALFF values in the bilateral anterior cingulate cortex (ACC, slow-5 band, 0.01-0.027 Hz) in the Baduanjin group compared to the control group. Further, ALFF value changes in the right hippocampus and bilateral ACC were significantly associated with corresponding MoCA score changes across all groups. We also found increased gray matter volume in the Baduanjin group in the right hippocampus compared to the brisk walking group and in the bilateral ACC compared to the control group. In addition, there was an increased resting state functional connectivity between the hippocampus and right angular gyrus in the Baduanjin group compared to the control group. Our results demonstrate the potential of Baduanjin for the treatment of MCI.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6535682/

 

Improve Gulf War Illness in Veterans with Tai Chi

psyjdc Leave a comment

Improve Gulf War Illness in Veterans with Tai Chi

 

By John M. de Castro, Ph.D.

 

“A prominent condition affecting Gulf War Veterans is a cluster of medically unexplained chronic symptoms that can include fatigue, headaches, joint pain, indigestion, insomnia, dizziness, respiratory disorders, and memory problems.” – US Department of Veterans Affairs

 

Engaging in warfare has many consequences to society and individuals, including the warriors themselves. Post-Traumatic Stress Disorder (PTSD) is a common problem among military veterans with between 11% to 20% of veterans who were involved in combat developing PTSD. There is a specific syndrome that has been identified in about 36% of veterans of the Persian Gulf war of 1991. The cluster of symptoms include fatigue, headaches, joint pain, indigestion, insomnia, dizziness, respiratory disorders, and memory problems.

 

It has been demonstrated that mindfulness training is effective for PTSD symptoms . In addition, Yoga practice is a mindfulness practice that has been shown to be helpful for PTSD. Mindful movement practices such as Tai Chi and Qigong have been found to be beneficial for individuals with a myriad of physical and psychological problems. This raises the possibility that Tai Chi practice may be beneficial for veterans suffering from Gulf War Illness.

 

In today’s Research News article “The Effects of Tai Chi Mind-Body Approach on the Mechanisms of Gulf War Illness: an Umbrella Review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6600798/), Reid and colleagues review and summarize the published research studies of the effectiveness of Tai Chi practice in relieving the symptoms of participants whose symptoms were similar to Gulf War Illness. They identified multiple randomized controlled trials and meta-analyses of Tai Chi practice for these symptoms.

 

They report that the published research indicates that Tai Chi practice significantly improves mood, sleep, global cognitive function, and respiratory function and significantly decreases insomnia, anxiety, depression, stress, and chronic pain. Hence Tai Chi practice has been shown to be effective in relieving symptoms that commonly occur in Gulf War Illness. This suggests that Tai Chi practice should be tried directly to treat veterans with Gulf War Syndrome. It remains for future research to test this hypothesis.

 

So, improve Gulf War Illness in veterans with Tai Chi.

 

“Mindfulness-based stress reduction may provide significant benefits to symptoms associated with Gulf War Illness in veterans.” – Laura Stiles

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Reid, K. F., Bannuru, R. R., Wang, C., Mori, D. L., & Niles, B. L. (2019). The Effects of Tai Chi Mind-Body Approach on the Mechanisms of Gulf War Illness: an Umbrella Review. Integrative medicine research, 8(3), 167–172. doi:10.1016/j.imr.2019.05.003

 

Abstract

Gulf War illness (GWI) is a chronic and multisymptom disorder affecting military veterans deployed to the 1991 Persian Gulf War. It is characterized by a range of acute and chronic symptoms, including but not limited to, fatigue, sleep disturbances, psychological problems, cognitive deficits, widespread pain, and respiratory and gastrointestinal difficulties. The prevalence of many of these chronic symptoms affecting Gulf War veterans occur at markedly elevated rates compared to nondeployed contemporary veterans. To date, no effective treatments for GWI have been identified. The overarching goal of this umbrella review was to critically evaluate the evidence for the potential of Tai Chi mind-body exercise to benefit and alleviate GWI symptomology. Based on the most prevalent GWI chronic symptoms and case definitions established by the Centers for Disease Control and Prevention and the Kansas Gulf War Veterans Health Initiative Program, we reviewed and summarized the evidence from 7 published systematic reviews and meta-analyses. Our findings suggest that Tai Chi may have the potential for distinct therapeutic benefits on the major prevalent symptoms of GWI. Future clinical trials are warranted to examine the feasibility, efficacy, durability and potential mechanisms of Tai Chi for improving health outcomes and relieving symptomology in GWI.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6600798/

 

Improve Knee and Hip Osteoarthritis with Exercise and Mind-Body Practices

psyjdc Leave a comment

Improve Knee and Hip Osteoarthritis with Exercise and Mind-Body Practices

 

By John M. de Castro, Ph.D.

 

“studies suggest that specific mind-body therapies may help reduce pain and improve physical function in persons with osteoarthritis of the knee.” – Terry Selfe

 

Osteoarthritis is a chronic degenerative joint disease that is the most common form of arthritis. It produces pain, swelling, and stiffness of the joints. It is the leading cause of disability in the U.S., with about 43% of arthritis sufferers limited in mobility and about a third having limitations that affect their ability to perform their work. Knee osteoarthritis effects 5% of adults over 25 years of age and 12% of those over 65. Hip osteoarthritis effects 9% of adults. It is painful and disabling. Its causes are varied including, hereditary, injury including sports injuries, repetitive stress injuries, infection, or from being overweight.

 

There are no cures for knee or hip osteoarthritis. Treatments are primarily symptomatic, including weight loss, exercise, braces, pain relievers and anti-inflammatory drugs, corticosteroids, arthroscopic knee surgery, or even knee or hip replacement. Gentle movements of the joints with exercise and physical therapy appear to be helpful in the treatment of knee or hip osteoarthritis. This suggests that alternative and mind-body practices that involve gentle knee movements may be useful in for treatment. Indeed, yoga practice has been shown to be effective in treating arthritis and Tai Chi and Qigong have also been shown to reduce the physical symptoms of knee osteoarthritis. So, it would seem reasonable to summarize the research into the effectiveness of mind-body practices relative to other exercises in treating knee or hip osteoarthritis.

 

In today’s Research News article “Relative Efficacy of Different Exercises for Pain, Function, Performance and Quality of Life in Knee and Hip Osteoarthritis: Systematic Review and Network Meta-Analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459784/), Goh and colleagues review, summarize, and perform a meta-analysis of the published research studies of the effectiveness of mind-body practices and exercise on knee or hip osteoarthritis. They found 103 controlled trials including a total of 9134 participants. Exercises were separated in strengthening, aerobic, and flexibility exercises and movements combined with mindfulness (e.g. yoga, Tai Chi, Qigong); mind-body practices. Most studies (76) compared these practices versus usual medical care.

 

They report that the published research studies found that in comparison to usual care, all exercises produced significant benefits including reduced pain, improved movement performance, self-reported motor abilities, and quality of life. These benefits were greater for knee osteoarthritis than for hip osteoarthritis. Of the various exercises they found that in general aerobic exercise produced the greatest benefits for pain and movement performance, while mind-body practices had equivalent benefit for pain and produced the greatest benefits for self-reported motor abilities.

 

These results confirm that exercise is good for patients with hip or knee osteoarthritis, improving movement and quality of life and reducing pain. It appears that aerobic exercises and mind-body exercises produce the greatest benefits. This suggests that these practices be recommended for patients with hip or knee osteoarthritis to reduce their difficulties with movement and reduce their suffering.

 

So, improve knee and hip osteoarthritis with exercise and mind-body practices.

 

“We don’t choose to have arthritis, but we can choose how to respond to and cope with it. By not allowing pain to define our lives, we can change how we view and relate to pain. That’s mindfulness – we are changing our feelings and thoughts around pain.” – Andrea Minick Rudolph

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Goh, S. L., Persson, M., Stocks, J., Hou, Y., Welton, N. J., Lin, J., … Zhang, W. (2019). Relative Efficacy of Different Exercises for Pain, Function, Performance and Quality of Life in Knee and Hip Osteoarthritis: Systematic Review and Network Meta-Analysis. Sports medicine (Auckland, N.Z.), 49(5), 743–761. doi:10.1007/s40279-019-01082-0

 

Abstract

Background

Guidelines recommend exercise as a core treatment for osteoarthritis (OA). However, it is unclear which type of exercise is most effective, leading to inconsistency between different recommendations.

Objectives

The aim of this systematic review and network meta-analysis was to investigate the relative efficacy of different exercises (aerobic, mind–body, strengthening, flexibility/skill, or mixed) for improving pain, function, performance and quality of life (QoL) for knee and hip OA at, or nearest to, 8 weeks.

Methods

We searched nine electronic databases up until December 2017 for randomised controlled trials that compared exercise with usual care or with another exercise type. Bayesian network meta-analysis was used to estimate the relative effect size (ES) and corresponding 95% credibility interval (CrI) (PROSPERO registration: CRD42016033865).

Findings

We identified and analysed 103 trials (9134 participants). Aerobic exercise was most beneficial for pain (ES 1.11; 95% CrI 0.69, 1.54) and performance (1.05; 0.63, 1.48). Mind–body exercise, which had pain benefit equivalent to that of aerobic exercise (1.11; 0.63, 1.59), was the best for function (0.81; 0.27, 1.36). Strengthening and flexibility/skill exercises improved multiple outcomes at a moderate level. Mixed exercise was the least effective for all outcomes and had significantly less pain relief than aerobic and mind–body exercises. The trend was significant for pain (p = 0.01), but not for function (p = 0.07), performance (p = 0.06) or QoL (p = 0.65).

Conclusion

The effect of exercise varies according to the type of exercise and target outcome. Aerobic or mind–body exercise may be the best for pain and function improvements. Strengthening and flexibility/skill exercises may be used for multiple outcomes. Mixed exercise is the least effective and the reason for this merits further investigation.

Electronic supplementary material

The online version of this article (10.1007/s40279-019-01082-0) contains supplementary material, which is available to authorized users.

Background

Guidelines recommend exercise as a core treatment for osteoarthritis (OA). However, it is unclear which type of exercise is most effective, leading to inconsistency between different recommendations.

Objectives

The aim of this systematic review and network meta-analysis was to investigate the relative efficacy of different exercises (aerobic, mind–body, strengthening, flexibility/skill, or mixed) for improving pain, function, performance and quality of life (QoL) for knee and hip OA at, or nearest to, 8 weeks.

Methods

We searched nine electronic databases up until December 2017 for randomised controlled trials that compared exercise with usual care or with another exercise type. Bayesian network meta-analysis was used to estimate the relative effect size (ES) and corresponding 95% credibility interval (CrI) (PROSPERO registration: CRD42016033865).

Findings

We identified and analysed 103 trials (9134 participants). Aerobic exercise was most beneficial for pain (ES 1.11; 95% CrI 0.69, 1.54) and performance (1.05; 0.63, 1.48). Mind–body exercise, which had pain benefit equivalent to that of aerobic exercise (1.11; 0.63, 1.59), was the best for function (0.81; 0.27, 1.36). Strengthening and flexibility/skill exercises improved multiple outcomes at a moderate level. Mixed exercise was the least effective for all outcomes and had significantly less pain relief than aerobic and mind–body exercises. The trend was significant for pain (p = 0.01), but not for function (p = 0.07), performance (p = 0.06) or QoL (p = 0.65).

Conclusion

The effect of exercise varies according to the type of exercise and target outcome. Aerobic or mind–body exercise may be the best for pain and function improvements. Strengthening and flexibility/skill exercises may be used for multiple outcomes. Mixed exercise is the least effective and the reason for this merits further investigation.

Key Points

The effect of exercise in knee and hip osteoarthritis depends on type of exercise and outcome of interest.
Aerobic and mind–body exercises appear to be the two most effective exercise therapies for pain and function, whereas strengthening and flexibility exercises appear to be good for moderate improvement of multiple outcomes.
Mixed exercise is the least effective exercise. However, it may be used for patients who do not respond to other types of exercise therapy because it is still better than no exercise control for all four patient-centred outcomes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459784/