Reduce Fear of Falling in the Elderly with Yoga

September 10, 2018January 17, 2023 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Yoga makes you have a strong core, so when moving around in your daily life, you are not just flapping around. You are stable, in control.” – Anne Bachner

The process of aging affects every aspect of the physical and cognitive domains. Every system in the body deteriorates including motor function with a decline in strength, flexibility, and balance. Impaired balance is a particular problem as it can lead to falls. In the U.S. one third of people over 65 fall each year and 2.5 million are treated in emergency rooms for injuries produced by falls. About 1% of falls result in deaths making it the leading cause of death due to injury among the elderly.

Falls, with or without injury, also carry a heavy quality of life impact. A growing number of older adults, fear falling and, as a result, limit their activities and social engagements. This can result in further physical decline, depression, social isolation, and feelings of helplessness. It is obviously important to discover methods to improve balance and decrease the number of falls in the elderly. Yoga practice helps to develop strength, flexibility, and balance. It would seem likely, then, that practicing yoga would reduce the likelihood of falling by the elderly.

In today’s Research News article “A mixed methods evaluation of yoga as a fall prevention strategy for older people in India.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928579/ ), Keay and colleagues recruited elderly participants (> 60 years of age) and provided them with 2 1-hour yoga classes per week for 3 months. The program emphasized standing poses that develop balance. The participants were measured before and after training for overall health, body size, fear of falling, history of falls, physical performance, and blood pressure. At the end of training the participants also attended focus groups with discussion focused on “perceptions of the yoga program, perceived benefits of yoga and understanding fall injury/reporting falls.”

They found that there were no adverse events and no falls reported during the program. After the 3-month yoga program the elderly participants were significantly faster in the sit-stand test, had increased stride length while walking, and significantly lower body weight and fear of falling. Hence, participation in a yoga program improved the physical abilities of the elderly. It should be noted that there wasn’t a control or comparison condition so conclusions should be reached cautiously.

The results suggest that practicing yoga is beneficial for elderly men and women. These results are sufficiently encouraging to support conducting a large randomized controlled trial. The participants in the present study were quite healthy at the beginning of the trail, so ceiling effects may have prevented the detection of further benefits. Indeed, the participants all successfully passed the most difficult balance test during the baseline test, leaving no room for improvement, In a future trial, it would be good to include participants whose health and physical abilities weren’t quite as good. Regardless, the results suggest that yoga practice is beneficial for the elderly.

So, reduce fear of falling in the elderly with yoga.

“the number of falls in older adults declined 48 percent in the six months after they began attending yoga classes compared to the six months prior.” – Breann Schossow

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

Keay, L., Praveen, D., Salam, A., Rajasekhar, K. V., Tiedemann, A., Thomas, V., … Ivers, R. Q. (2018). A mixed methods evaluation of yoga as a fall prevention strategy for older people in India. Pilot and Feasibility Studies, 4, 74. http://doi.org/10.1186/s40814-018-0264-x

Abstract

Background

Falls are an emerging public health issue in India, with the impact set to rise as the population ages. We sought to evaluate the acceptability, feasibility and likely impact of a yoga-based program aimed at improving balance and mobility for older residents in urban India.

Methods

Fifty local residents aged 60 years and older were recruited from urban Hyderabad, Andhra Pradesh. They were invited to attend a 1-h yoga class, twice weekly for 3 months. Mixed methods were used to evaluate the acceptability and feasibility (qualitative) and likely impact (quantitative). Two focus groups and eight interviews with participants were conducted to evaluate the acceptability and feasibility of a yoga program. Thematic analysis was conducted in context of perceptions, barriers and benefits of yoga participation and fall ascertainment. Physical performance using the Short Physical Performance Battery, fear of falling, blood pressure and weight loss were measured before and after the program.

Results

The interviews and focus groups provided insights into the preferred format for classes, including session times, level of supervision and location. Improvements were seen in the Short Falls Efficacy Scale-International (Short FES-I (15.9 ± 4.0 vs 13.8 ± 2.1 s, p = 0.002)), the number of steps taken in the timed 4-m walk (T4MW (9.0 ± 1.8 vs 8.6 ± 1.8, p = 0.04)), Short FES-I scores (9.4 ± 2.9 vs 8.6 ± 2.9, p = 0.02) and weight (63.8 ± 12.4 vs 62.1 ± 11.6, p = 0.004) were lower. No changes were seen in standing balance, blood pressure or T4MW time.

Conclusion

Yoga was well accepted and resulted in improved ability to rise from a chair, weight loss, increased step length and reduced fear of falling. These results provide impetus for further research evaluating yoga as a fall prevention strategy in India.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928579/

Improve Brain Metabolism and Muscle Energetics in Older Adults with Tai Chi

September 1, 2018 psyjdc 1 Comment

Improve Brain Metabolism and Muscle Energetics in Older Adults with Tai Chi

By John M. de Castro, Ph.D.

”A comparison of the effects of regular sessions of tai chi, walking, and social discussion, has found tai chi was associated with the biggest gains in brain volume and improved cognition.” – Fiona McPherson

The aging process involves a systematic progressive decline in every system in the body, the brain included. This includes our mental abilities which decline with age including impairments in memory, attention, and problem solving ability. It is inevitable and cannot be avoided. Using modern neuroimaging techniques, scientists have been able to view the changes that occur in the nervous system with aging. In addition, they have been able to investigate various techniques that might slow the process of neurodegeneration that accompanies normal aging. They’ve 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 and yoga have been found to degenerate less with aging than non-practitioners.

Tai Chi training is designed to enhance and regulate the functional activities of the body through regulated breathing, mindful concentration, and gentle movements. It includes balance training and has been shown to improve balance and coordination. Because it is not strenuous, involving slow gentle movements, and is safe, having no appreciable side effects, it is appropriate for an elderly population. Indeed, Tai Chi and Qigong have been shown to be beneficial in slowing or delaying physical and mental decline with aging and to increase brain matter in the elderly.

In today’s Research News article “Tai Chi Improves Brain Metabolism and Muscle Energetics in Older Adults.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055800/ ), Zhou and colleagues recruited healthy older people (>55 years of age) and trained them in Tai Chi practice with a one hour, twice a week, for 12 weeks instruction. They were measured before and after training for leg strength while having their brains scanned for metabolites with Magnetic Resonance Imaging (MRI). N‐acetylaspartate (NAA) is a neuronal marker of neuronal health. They also measured the rate of recovery of phosphocreatine (PCr) in the leg following exercise, a marker of muscular fitness.

They found that after training there was a significant increase in N‐acetylaspartate (NAA). NAA is a marker of the number of neurons present in the brain. Hence it’s increase in this study suggests that Tai Chi training increases the number of brain cells in the elderly. This further suggests that Tai Chi training is neuroprotective and may reduce the degeneration of the brain that occurs in normal aging.

They also found that after training there was a significant decrease in the rate of recovery of phosphocreatine (PCr) in the leg following exercise. A PCr decrease indicates that the capacity of muscles to use oxygen has increased. This, then, is a measure of muscular fitness. Hence it’s decrease in this study suggests that Tai Chi training improves exercise fitness in older adults helping to counter the age related decline in strength.

These results suggest the biochemical mechanisms that may underlie the ability of Tai Chi training to slow or delay physical and mental decline and to increase brain matter. These results not only further support the benefits of Tai Chi training for aging adults but also indicate how this training may change the chemistry of the brain and muscles to counter the effects of aging.

So, improve brain metabolism and muscle energetics in older adults with Tai Chi.

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

“Studies have shown that the incorporation of Tai Chi to an elders’ exercise program can be beneficial. Tai Chi practice was “beneficial to improve the balance control ability and flexibility of older adults, which may be the reason of preventing falls.” – Eric Edelman

In today’s Research News article “Tai Chi Improves Brain Metabolism and Muscle Energetics in

Study Summary

Zhou, M., Liao, H., Sreepada, L. P., Ladner, J. R., Balschi, J. A., & Lin, A. P. (2018). Tai Chi Improves Brain Metabolism and Muscle Energetics in Older Adults. Journal of Neuroimaging, 28(4), 359–364. http://doi.org/10.1111/jon.12515

ABSTRACT

BACKGROUND AND PURPOSE

Tai Chi is a mind‐body exercise that has been shown to improve both mental and physical health. As a result, recent literature suggests the use of Tai Chi to treat both physical and psychological disorders. However, the underlying physiological changes have not been characterized. The aim of this pilot study is to assess the changes in brain metabolites and muscle energetics after Tai Chi training in an aging population using a combined brain‐muscle magnetic resonance spectroscopy (MRS) examination.

METHODS

Six healthy older adults were prospectively recruited and enrolled into a 12‐week Tai Chi program. A brain 1H MRS and a muscle 31P MRS were scanned before and after the training, and postprocessed to measure N‐acetylaspartate to creatine (NAA/Cr) ratios and phosphocreatine (PCr) recovery time. Wilcoxon‐signed rank tests were utilized to assess the differences between pre‐ and post‐Tai Chi training.

RESULTS

A significant within‐subject increase in both the NAA/Cr ratios (P = .046) and the PCr recovery time (P =.046) was observed between the baseline and the posttraining scans. The median percentage changes were 5.38% and 16.51% for NAA/Cr and PCr recovery time, respectively.

CONCLUSIONS

Our pilot study demonstrates significant increase of NAA/Cr ratios in posterior cingulate gyrus and significantly improved PCr recovery time in leg muscles in older adults following short‐term Tai Chi training, and thus provides insight into the beneficial mechanisms.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055800/

Slow Aging with Meditation

August 8, 2018 psyjdc Leave a comment

Slow Aging with Meditation

By John M. de Castro, Ph.D.

“What we do know is that long-term engagement in mindfulness meditation may enhance cognitive performance in older adults, and that with persistent practice, these benefits may be sustained. That’s great news for the millions of aging adults working to combat the negative effects of aging on the brain.” – B. Grace Bullock

Human life is one of constant change. We revel in our increases in physical and mental capacities during development but regret their decreases during aging. The aging process, starting in the 20s involves a systematic progressive decline in every system in the body, the brain included. There is interest in finding ways to slow the aging process to improve longevity and health and mindfulness training has been found to do just that.

DNA methylation is an epigenetic mechanism used by cells to control gene expression. Epigenetic effects on the DNA arise from the environment and not the genes themselves. DNA methylation can fix genes in the “off” position, preventing them from carrying out their normal function. Indeed, the amount of methylation of DNA is associated with disease and aging. The greater the amount of methylation in the DNA the more disease. It can be thought of as a cellular marker of aging. It is sometimes considered as an epigenetic clock, the greater the age, the more methylation. It is possible that meditation practice slows the aging process by decreasing methylation in the DNA.

In today’s Research News article “Epigenetic clock analysis in long-term meditators.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5863232/ ), Chaix and colleagues obtained blood samples from meditation naïve individuals and long-term (> 3 years) meditators. The samples were assayed for methylation in the DNA and this was used to calculate the intrinsic epigenetic age of the individual (the age predicted by the degree of DNA methylation).

They found, as expected, that the greater the amount of methylation of the DNA the greater the actual calendar age of the participant for both groups. In the meditation naïve participants those over 52 years of age had significantly higher intrinsic epigenetic ages than those under 52. This is as expected. On the other hand, the long-term meditators over 52 years of age had equivalent intrinsic epigenetic ages to those under 52. The longer the meditators had been practicing the greater the reduction in their intrinsic epigenetic age. It was reduced by 0.24 years for each year of meditation practice.

These results suggest a possible mechanism by which meditation practice may slow the aging process. They suggest that meditation practice reduces the methylation in the DNA and perhaps, thereby, helps maintain the DNA’s functional integrity into higher ages. Stress is known to increase DNA methylation. So, it is possible that mindfulness practices reduce methylation in the DNA by reducing the physiological and psychological effects of stress. Regardless, the results suggest that meditation practice slows the changes in the individual’s genetic material that’s associated with aging.

So, slow aging with meditation.

“According to the National Institutes of Health, more than 20 million Americans practice some form of meditation to achieve greater peace of mind and enhanced sense of well-being. Now studies of the neurological differences between meditators and non-meditators, and studies of immune cell aging via telomere length in meditators and non-meditators, show that meditation can also affect the way we age.” – Seth Segall

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

Chaix, R., Alvarez-López, M. J., Fagny, M., Lemee, L., Regnault, B., Davidson, R. J., … Kaliman, P. (2017). Epigenetic clock analysis in long-term meditators. Psychoneuroendocrinology, 85, 210–214. http://doi.org/10.1016/j.psyneuen.2017.08.016

Abstract

In this paper, we examined whether meditation practice influences the epigenetic clock, a strong and reproducible biomarker of biological aging, which is accelerated by cumulative lifetime stress and with age-related chronic diseases. Using the Illumina 450 K array platform, we analyzed the DNA methylome from blood cells of long-term meditators and meditation-naïve controls to estimate their Intrinsic Epigenetic Age Acceleration (IEAA), using Horvath’s calculator. IEAA was similar in both groups. However, controls showed a different IEAA trajectory with aging than meditators: older controls (age ≥ 52) had significantly higher IEAAs compared with younger controls (age < 52), while meditators were protected from this epigenetic aging effect. Notably, in the meditation group, we found a significant negative correlation between IEAA and the number of years of regular meditation practice. From our results, we hypothesize that the cumulative effects of a regular meditation practice may, in the long-term, help to slow the epigenetic clock and could represent a useful preventive strategy for age-related chronic diseases. Longitudinal randomized controlled trials in larger cohorts are warranted to confirm and further characterize these findings.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5863232/

Improve Movement and Flexibility in Older Women with Tai Chi

August 4, 2018 psyjdc Leave a comment

Improve Movement and Flexibility in Older Women with Tai Chi

By John M. de Castro, Ph.D.

“Practising the ancient martial art of Tai Chi is so beneficial to elderly people’s health that it should be “the preferred mode of training” – The Telegraph

Tai Chi training is designed to enhance and regulate the functional activities of the body through regulated breathing, mindful concentration, and gentle movements. It includes balance training and has been shown to improve balance and coordination. Because it is not strenuous, involving slow gentle movements, and is safe, having no appreciable side effects, it is appropriate for an elderly population. So, it would seem that tai chi practice would be well suited to improving balance and coordination in seniors and thereby reduce the likelihood of falls.

In today’s Research News article “Effect of Yang-Style Tai Chi on Gait Parameters and Musculoskeletal Flexibility in Healthy Chinese Older Women.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968961/ ), Zou and colleagues recruited elderly women (> 65 years of age) and randomly assigned them to either a Tai Chi practice or no-treatment control conditions. Tai Chi was practiced under the supervision of a Tai Chi master for 90 minutes, 3 times per week for 8 weeks. They were measured before and after practice for physical activity and hip and foot flexibility. They also walked a short distance and their movements of the knee, hip, and ankle were analyzed through a kinematic analysis.

They found that the Tai Chi group and not the control group after the 8-week practice period had significant improvements in their walking including stride length, gait speed, stance phase, swing phase, and double support time. They also had significant improvements in their hip and foot flexibility and range of motion of the knee, hip, and ankle. No adverse events as a result of Tai Chi practice were reported by the participants.

These findings conclusively document the ability of Tai Chi practice to help maintain the flexibility and range of motion of elderly women. This is particularly important as it suggests that these women would be less likely to fall and maintain a high quality of life. In addition, as Tai Chi is gentle and safe, is appropriate for all ages including the elderly and for individuals with illnesses that limit their activities or range of motion, 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. So, Tai Chi practice would appear to be an almost ideal gentle exercise to maintain the health and well-being of the elderly.

So, improve movement and flexibility in older women with Tai Chi.

“Unlike other exercises, TCE may contribute to improving the quality of life and reducing depression in patients with chronic diseases.” – X. Wang

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

Zou, L., Wang, C., Tian, Z., Wang, H., & Shu, Y. (2017). Effect of Yang-Style Tai Chi on Gait Parameters and Musculoskeletal Flexibility in Healthy Chinese Older Women. Sports, 5(3), 52. http://doi.org/10.3390/sports5030052

Abstract

The purpose of the present study was to examine the effect of Yang-style Tai chi (TC) on gait parameters and musculoskeletal flexibility in healthy Chinese female adults. Sixty-six female adults aged >65 years were randomly assigned to either an experimental group (67.9 ± 3.2 years of age) receiving three 90-min simplified 24-form TC sessions for eight weeks, or a control group (67.4 ± 2.9 years of age) who maintained their daily lifestyles. All study participants were instructed to perform a selected pace walking for recording gait parameters (stride length, gait speed, swing cycle time, stance phase, and double support times) at both baseline and after the experiment. Low-limb flexibility and range of motion at specific musculoskeletal regions (hip flexion, hip extension, and plantar flexion, as well as anterior and lateral pelvic tilts, pelvic rotation, and joint range of motion (hip, knee, and ankle)) were also assessed in the present study. Multiple separate 2 × 2 Factorial Analysis of Variance (ANOVA) with repeated measures were used to examine the effects of TC on the abovementioned outcomes between baseline and posttest in the two groups. When compared to those in the control group, older female adults who experienced the 8-week Tai chi intervention demonstrated significant improvements in most of the outcome measures. More specifically, positive changes in the TC group were found, including gait parameter (p < 0.001 for all; stride length (1.12 to 1.24, +8.6%), gait speed (1.06 to 1.21, +13.9%), stance phase (66.3 to 61.8, −5.5%), swing phase (33.7 to 38.4, +10.1%), double support time (0.33 to 0.26, −21.1%)), flexibility-related outcomes (hip flexion (90.0 to 91.9, 22.6%, p < 0.0001), single hip flexor (6.0 to 2.0, −61.5%, p = 0.0386), and plantar flexion (41.6 to 49.7, +17.5%, p < 0.0001)), and range of motion (anterior pelvic tilt (9.5 to 6.2, −34.7%, p < 0.0001), lateral pelvic tilt (6.6 to 8.3, +23.8%, p = 0.0102), pelvic rotation (10.3 to 14.7, 28.2%, p < 0.0001), hip range of motion (29.8 to 32.9, +13.5%, p = 0.001), and ankle range of motion (28.0 to 32.6, +11.1%, p < 0.0001)). The present study supports the notion that the practice of TC has a positive effect on healthy older female adults in improving gait parameters and flexibility, counteracting the normal functional degeneration due to age.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968961/

Balance and Fitness in the Elderly and Tai Chi Training

July 21, 2018 psyjdc Leave a comment

Balance and Fitness in the Elderly and Tai Chi Training

By John M. de Castro, Ph.D.

“Tai chi is an ancient Chinese exercise that can help older adults improve their balance and lower their fall risk. And by reducing their risk of falls, seniors can lower their odds of suffering a debilitating fracture.” – Harvard Health Letter

Tai Chi training is designed to enhance and regulate the functional activities of the body through regulated breathing, mindful concentration, and gentle movements. It includes balance training and has been shown to improve balance and coordination. These studies, however, employ Tai Chi training over long time frames of 6 months to a year. It is not known if shorter term training would also be effective.

In today’s Research News article “Effects of 12 Weeks of Tai Chi Chuan Training on Balance and Functional Fitness in Older Japanese Adults.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968980/ ), Takeshima and colleagues recruited older adults averaging 73 years of age and assigned them to either receive 12 weeks of Tai Chi training for 2 days per week for 60 minutes or to a no-treatment control group. They were measured before and after training for static balance, dynamic balance, and functional fitness, including upper and lower body strength, balance and agility, upper and lower body flexibility, and cardiorespiratory fitness.

Contrary to longer-term studies, they did not find any significant differences between the Tai Chi training and no-treatment control groups in static balance, dynamic balance, or functional fitness. This lack of benefit of Tai Chi training may well be due to the relative shortness of the 12-week program relative to previous studies employing 6-month to one year trainings. Indeed, previous research by Holmes and colleagues also employing a 12 week program could not detect any overall improvement in balance, but could detect a subtle improvement in postural-respiratory coupling. This may be a precursor to improvements in overall balance. So, 12-weeks of training may produce subtle changes that, if continued over a longer period of time, will lead to improvements in balance.

Tai Chi movement patterns can be fairly complex and the elderly may have difficulty learning them over a few sessions. Indeed, it has been reported that it takes 8 to 16 sessions before the patterns are mastered. So, there may need for longer periods of training to master the technique and benefit from it. Hence, there is a need for further research on the amount of Tai Chi training needed to improve balance and reduce falls in the elderly.

“I’ve always been clumsy, so Tai Chi has offered me the opportunity to be able to think more about what I’m doing, pay attention to what I’m doing, and not fall. I’m able to catch myself if I trip over something because of Tai Chi,” – Velma Chapman

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

Takeshima, N., Islam, M. M., Kato, Y., Koizumi, D., Narita, M., Kitabayashi, Y., … Rogers, M. E. (2017). Effects of 12 Weeks of Tai Chi Chuan Training on Balance and Functional Fitness in Older Japanese Adults. Sports, 5(2), 32. http://doi.org/10.3390/sports5020032

Abstract

The purpose of this study was to determine the effects of Tai Chi Chuan on static and dynamic balance, and functional fitness in older adults. Forty-nine volunteers were divided into an exercise group (EX: 9 men and 16 women, average age 72 ± 5 years) and control group (13 men and 11 women, average age 73 ± 6 years). The EX participated in a 12-week supervised exercise program (60 min/day, 2 days/week) that consisted of 10-min warm-up and stretching, 40-min Tai Chi Chuan exercise (long-form Yang style with 108 movements), and 10-min cool-down/relaxation exercises. The control group was asked to not change their physical activity habits. Static (sway velocity standing on firm or foam surfaces with eyes open or closed) and dynamic balance (limits of stability (LOS)), as well as functional fitness measures of body mass; upper- and lower-body strength; and flexibility, mobility, and aerobic fitness were taken before and after the intervention. After the 12-week Tai Chi Chuan exercise program, there were no improvements in any functional fitness or balance variable although components of LOS tended to increase (13.1%, p = 0.052). These results indicate that 12 weeks of Tai Chi Chuan exercise has no significant effect on balance and functional fitness parameters in older Japanese adults.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968980/

Improve Brain Size and Function in Healthy Elderly with Tai Chi

July 20, 2018 psyjdc Leave a comment

Improve Brain Size and Function in Healthy Elderly with Tai Chi

By John M. de Castro, Ph.D.

“Epidemiologic studies have shown repeatedly that individuals who engage in more physical exercise or are more socially active have a lower risk of Alzheimer’s disease. The current findings suggest that this may be a result of growth and preservation of critical regions of the brain affected by this illness.” – James Mortimer

Tai Chi and Qigong have also been shown to be beneficial in slowing or delaying physical and mental decline with aging and to increase brain matter in the elderly. In today’s Research News article “The Effects of Tai Chi Intervention on Healthy Elderly by Means of Neuroimaging and EEG: A Systematic Review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915963/ ), Pan and colleagues review, summarize, and perform a meta-analysis of the 11 published research articles that examine the effects of Tai Chi practice on the brain of the elderly.

They find that there was 1 published study reporting that long-term Tai Chi practitioners have a thicker cortex in the brain. This is interesting but it cannot be determined if people who practice Tai Chi are simply people who have thicker cortexes. Other studies using functional Magnetic Imaging (fMRI) indicate that Tai Chi results in increased connectivity between brain structures and increased functional activity in the brain, so there is greater activity and signals are better sent from one area to another. Still other studies employing electroencephalographic (EEG) recordings indicate that Tai Chi produces greater electrical activity in the frontal areas of the cortex that are known to be involved in high level cognitive function (executive function)

One weakness in the studies is that the comparison groups are most often sedentary, not engaging in any exercise. As a result, it cannot be determined if the changes in the brain are due to Tai Chi per se or whether any form of exercise might have a similar effect. Future research should employ comparisons to groups performing other exercises.

Nevertheless, the results are encouraging; suggesting that Tai Chi can alter the brain in ways that may improve memory and cognitive performance. Significantly, Tai Chi practice is gentle and completely safe, can be used with the elderly and sickly, is inexpensive to administer, can be performed in groups or alone, at home or in a facility or even public park, and can be quickly learned. Also, it can be practiced in social groups without professional supervision. This can make it fun, improving the likelihood of long-term engagement in the practice. So, Tai Chi practice may be ideal for slowing or reversing age-related deterioration of the brain and the related cognitive decline.

So, improve brain size and function in healthy elderly with Tai Chi.

“The ability to reverse this trend with physical exercise and increased mental activity implies that it may be possible to delay the onset of dementia in older persons through interventions that have many physical and mental health benefits.” – James Mortimer

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

Pan, Z., Su, X., Fang, Q., Hou, L., Lee, Y., Chen, C. C., … Kim, M.-L. (2018). The Effects of Tai Chi Intervention on Healthy Elderly by Means of Neuroimaging and EEG: A Systematic Review. Frontiers in Aging Neuroscience, 10, 110. http://doi.org/10.3389/fnagi.2018.00110

Abstract

Aging is a process associated with a decline in cognitive and motor functions, which can be attributed to neurological changes in the brain. Tai Chi, a multimodal mind-body exercise, can be practiced by people across all ages. Previous research identified effects of Tai Chi practice on delaying cognitive and motor degeneration. Benefits in behavioral performance included improved fine and gross motor skills, postural control, muscle strength, and so forth. Neural plasticity remained in the aging brain implies that Tai Chi-associated benefits may not be limited to the behavioral level. Instead, neurological changes in the human brain play a significant role in corresponding to the behavioral improvement. However, previous studies mainly focused on the effects of behavioral performance, leaving neurological changes largely unknown. This systematic review summarized extant studies that used brain imaging techniques and EEG to examine the effects of Tai Chi on older adults. Eleven articles were eligible for the final review. Three neuroimaging techniques including fMRI (N = 6), EEG (N = 4), and MRI (N = 1), were employed for different study interests. Significant changes were reported on subjects’ cortical thickness, functional connectivity and homogeneity of the brain, and executive network neural function after Tai Chi intervention. The findings suggested that Tai Chi intervention give rise to beneficial neurological changes in the human brain. Future research should develop valid and convincing study design by applying neuroimaging techniques to detect effects of Tai Chi intervention on the central nervous system of older adults. By integrating neuroimaging techniques into randomized controlled trials involved with Tai Chi intervention, researchers can extend the current research focus from behavioral domain to neurological level.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915963/

Improve Psychological Health in the Elderly with Mindfulness

July 17, 2018 psyjdc Leave a comment

Improve Psychological Health in the Elderly with Mindfulness

By John M. de Castro, Ph.D.

“In nursing homes and other long-term care facilities, loneliness, depression, and anxiety are considerable risk factors for residents. Mindfulness may help elders to find peace within themselves with daily practice.” – GoldenCares

Human life is one of constant change. We revel in our increases in physical and mental capacities during development but regret their decline during aging. As we age, there are systematic progressive declines in every system in the body, the brain included. This includes our mental abilities and results in impairments in memory, attention, and problem solving ability. It is inevitable and cannot be avoided. Aging also results in changes in mental health. Depression is very common in the elderly. The elderly cope with increasing loss of friends and family, deteriorating health, as well as concerns regarding finances on fixed incomes. All of these are legitimate sources of worry. In addition, many elderly experience withdrawal and isolation from social interactions. But, no matter how reasonable, the increased loneliness, worry and anxiety add extra stress that can impact on the elderly’s already deteriorating physical and psychological health.

Mindfulness appears to be effective for an array of physical and psychological issues that occur with aging. It appears to strengthen the immune system and reduce inflammation. It has also been shown to be beneficial in slowing or delaying physical and mental decline with aging. and improve cognitive processes. It has also been shown to reduce anxiety, worry, and depression and improve overall mental health. Since the global population of the elderly is increasing at unprecedented rates, it is imperative to investigate safe and effective methods to improve mental health in the elderly. In addition, more and more elderly individuals are residing in continuing care retirement communities. Hence it is important to find treatment methods amenable to implementation in these facilities.

In today’s Research News article “An Adapted Mindfulness-Based Stress Reduction Program for Elders in a Continuing Care Retirement Community: Quantitative & Qualitative Results from a Pilot Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5973835/ ), Moss and colleagues recruited elderly residents, predominantly female (82%), of a continuing care retirement community. They were 62 to 92 years of age. They were randomly assigned to either receive an adapted Mindfulness-Based Stress Reduction (MBSR) program or to a wait-list control condition. The MBSR program was presented for 2 hours, once a week, for 8 weeks with 30-minute daily home practice. It consisted of the standard meditation, body scan, and yoga practices. But, yoga practice was changed to chair yoga to be better practiced by the elderly. The participants were measured before and after the treatment for acceptability of the program including attendance and rate of home practice, health, psychological flexibility, mindfulness, self-compassion, anxiety, depression, and somatization.

They found a high degree of acceptability of the program with only 20% dropping out and the participants averaged 5 days a week of home practice. In comparison to the baseline and wait-list control group, the participants who received the Mindfulness-Based Stress Reduction (MBSR) had significantly improved psychological flexibility and reduced physical limitations. In comparison to baseline the MBSR participants had significantly greater observing mindfulness, mental health, and vitality, and significantly less emotional limitations. The participants reflected that after the training they were better able to attend to the present moment, had greater well-being, self-compassion and kindness, and reduced self-judgement and stress.

These are wonderful results that demonstrate that Mindfulness-Based Stress Reduction (MBSR) is an acceptable, safe, and effective program to enhance the psychological health of elderly residents of a continuing care retirement community. The adaptations to the program to recognize the physical limitations of the elderly did not appear to blunt its’ effectiveness and perhaps made it more acceptable. Future research should employ an active control condition, such as aerobic exercise to better control for confounding variables. Regardless, the MBSR program would appear to have great benefits for the aging population.

So, improve psychological health in the elderly with mindfulness.

“Often elderly people can live uncomfortable, lonely, quiet lives. Teaching them to pay attention moment by moment, on purpose but without judgement, to each of their experiences, can improve of the quality of their lives, based on the demonstrated effectiveness of mindfulness techniques in many forms of therapy. Mindfulness practice has a definite positive impact on issues such as recurrent depression, stress, anxiety, chronic physical pain and loneliness. For the elderly, chronic health conditions, the loss of self-determination in their daily lives, isolation, and a lack of interaction with the outside world can understandably take much of the joy out of life.” – MyHomecare

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

Moss, A. S., Reibel, D. K., Greeson, J. M., Thapar, A., Bubb, R., Salmon, J., & Newberg, A. B. (2015). An Adapted Mindfulness-Based Stress Reduction Program for Elders in a Continuing Care Retirement Community: Quantitative & Qualitative Results from a Pilot Randomized Controlled Trial. Journal of Applied Gerontology : The Official Journal of the Southern Gerontological Society, 34(4), 518–538. http://doi.org/10.1177/0733464814559411

Abstract

The purpose of this study was to test the feasibility and effectiveness of an adapted 8-week mindfulness-based stress reduction (MBSR) program for elders in a continuing care community. This mixed-methods study used both quantitative and qualitative measures. A randomized wait-list control design was used for the quantitative aspect of the study. Thirty-nine elderly were randomized to MBSR (n=20) or a wait-list control group (n=19); mean age 82 years. Both groups completed pre-post measures of health related quality of life, acceptance and psychological flexibility, facets of mindfulness, self-compassion, and psychological distress. A subset of MBSR participants completed qualitative interviews. MBSR participants showed significantly greater improvement in acceptance and psychological flexibility and in role limitations due to physical health. In the qualitative interviews, MBSR participants reported increased awareness, less judgment and greater self-compassion. Study results demonstrate the feasibility and potential effectiveness of an adapted MBSR program in promoting mind-body health for elders.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5973835/

Reduce Menopausal Symptoms, Anxiety, and Depression during Menopause with Mindfulness

June 16, 2018 psyjdc Leave a comment

Reduce Menopausal Symptoms, Anxiety, and Depression during Menopause with Mindfulness

By John M. de Castro, Ph.D.

“Mindfulness cannot entirely remove the symptoms of menopause, but it can help you deal with them in a calmer and more compassionate way – and self compassion boosts mental health.” – Karita Cullen

Menopause occurs in the 40s and 50s in most women, on average at 51 years of age. It is a natural physical process that marks the end of the menstrual cycle. The symptoms that occur over the years preceding menopause include irregular periods, vaginal dryness, hot flashes, chills

night sweats, sleep problems, mood changes, weight gain and slowed metabolism, thinning hair and dry skin, and loss of breast fullness. This is a natural process that is healthy and needs to occur. So, treatments are designed for symptomatic relief and include drugs and hormone treatments.

Mindfulness training may be a more natural treatment for the symptoms of menopause. Indeed, the mindful practice of yoga has been shown to improve the cardiac symptoms of menopause. It is important to study the effectiveness of other mindfulness practices in relieving these symptoms. In today’s Research News article “Mindfulness-Based Stress Reduction (MBSR) or Psychoeducation for the Reduction of Menopausal Symptoms: A Randomized, Controlled Clinical Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5919973/ ), Wong and colleagues examine the effectiveness for the treatment of menopausal symptoms of a Mindfulness-Based Stress Reduction (MBSR) program, which includes meditation, yoga, and body scan practices.

They recruited women 40-60 years of age who were experiencing menopausal symptoms. They were randomly assigned to receive either Mindfulness-Based Stress Reduction (MBSR) training of once-a-week 2.5-hour sessions for 8 weeks or Menopausal education on a similar schedule. Both groups were encouraged to practice at home for 40 minutes daily. They were measured before and after training and 3 and 6 months later for menopausal symptoms, perceived stress, health related quality of life, and mindfulness.

They found that both groups had significant reductions in menopausal symptoms at all follow-up measurements including the 6-month follow-up, but the MBSR group had significantly greater improvement than the menopausal education group. In addition, the MBSR group had significantly greater reductions in anxiety and depression at the follow-up measurements. Hence, MBSR appears to produce greater improvements in menopausal symptoms than an active control condition.

Mindfulness-Based Stress Reduction (MBSR) is a complex program including, meditation, yoga, and body scan practices. In the present study, it cannot be determined which of these components or combinations of components are effective and which are not. It has been previously shown, however, that yoga practice improves the cardiac symptoms of menopause. So, it would seem likely that at least the yoga component is effective. It remains for future research to determine whether meditation and body scan are necessary or sufficient to relieve the symptoms of menopause. Regardless, it is clear that the complex of practices of MBSR has beneficial effects for women undergoing menopause.

So, reduce menopausal symptoms, anxiety, and depression during menopause with mindfulness.

“The degree of bother reported from hot flashes and night sweats in the mindfulness group decreased over time, indicating time and persistence using mindfulness techniques may be key to obtaining beneficial results.” – Lena Suhaila

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

Carmen Wong, Benjamin Hon-Kei Yip, Ting Gao, Kitty Yu Yuk Lam, Doris Mei Sum Woo, Annie Lai King Yip, Chloe Yu Chin, Winnie Pui Yin Tang, Mandy Mun Tse Choy, Katrina Wai Key Tsang, Suzanne C. Ho, Helen Shuk Wah Ma, Samuel Yeung Shan Wong. Mindfulness-Based Stress Reduction (MBSR) or Psychoeducation for the Reduction of Menopausal Symptoms: A Randomized, Controlled Clinical Trial. Sci Rep. 2018; 8: 6609. Published online 2018 Apr 26. doi: 10.1038/s41598-018-24945-4

Abstract

Psychological and behavioural interventions may be effective in reducing menopause-related symptoms. This randomized controlled trial aimed to evaluate the effectiveness of Mindfulness-based Stress Reduction (MBSR) in reducing menopause-related symptoms by comparing with an active control group, the menopause education control (MEC). Symptomatic peri-menopausal and post-menopausal women with mild to moderate symptoms were recruited. The primary outcome was overall menopausal symptoms measured by modified Greene Climacteric Scale (GCS). Secondary outcomes include subscales of the GCS perceived stress, mindfulness and health related Quality of Life. All outcome measures were collected at baseline, 2 months (immediately post intervention), 5 and 8 months (3 and 6 months post intervention respectively). Both MBSR (n = 98) and MEC (n = 99) groups reported a reduction in total GCS score at 8 months. Between group analysis show significant symptom score reduction in MBSR group on Anxiety and Depression subscales of GCS. No differences were found between groups on other GCS subscales and majority of the secondary outcome measures. The findings show that menopausal symptoms in both MBSR and MEC significantly reduced over the study period. MBSR show a greater reduction of psychological symptoms of depression and anxiety above active controls but do not reduce other somatic, urogenital and vasomotor symptoms.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5919973/

Improve Sleep Quality in Older Adults with Mindfulness

May 25, 2018 psyjdc Leave a comment

Improve Sleep Quality in Older Adults with Mindfulness

By John M. de Castro, Ph.D.

“Studies have shown that sleeping habits improve dramatically when participants where taught to respond to sleep disturbance with mindfulness skills- rather than reacting automatically by increasing effort to rest. After meditating regularly, the average time it took participants to fall asleep dropped from an hour and a half to only 15 minutes.” – IPNOS

It is estimated that over half of Americans sleep too little due to stress. As a result, people today sleep 20% less than they did 100 years ago. Not having a good night’s sleep has adverse effects upon the individual’s health, well-being, and happiness. Yet over 70 million Americans suffer from disorders of sleep and about half of these have a chronic disorder. It has been estimated that about 4% of Americans revert to sleeping pills. But, these do not always produce high quality sleep and can have problematic side effects.

Unfortunately. as we age it becomes more and more difficult to get that good night’s sleep. Although the need for sleep doesn’t change with age sleep patterns change. Older people have a more difficult time falling asleep and staying asleep, waking up several times during the night, and waking early in the morning. In addition, there is less deep sleep, so we don’t feel as rested. Insomnia is much higher in older adults affecting as many as 44%. A safe and effective means for improving sleep in the elderly is important for the health and wellbeing of this vulnerable population. Mindfulness-based practices have been reported to improve sleep amount and quality. There is a need, however, to further study the impact of mindfulness training on sleep in older individuals.

In today’s Research News article “A Secondary Analysis of Sleep Quality Changes in Older Adults From a Randomized Trial of an MBSR Program.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5874181/ ), Gallegos and colleagues recruited older adults over 65 years of age and randomly assigned them to receive either an 8-week, once a week, 2 hour session of Mindfulness-Based Stress Reduction (MBSR) or be assigned to a wait-list control condition. MBSR consists of a combination of meditation, yoga, and body scan practice in combination with discussion and home practice. The participants were measured before and after training and 6-months later for sleep quality.

They found that compared to baseline and the wait-list controls, the MBSR participants had significantly improved sleep quality that was maintained for 6 months following completion of training. The effectiveness of MBSR was amplified in participants who had sleep disturbance and was even greater in participants who had insomnia. Hence, the MBSR program improved sleep in the elderly, with the greater the sleep problem the greater the improvement. These are interesting and important results. Sleep disturbance in the elderly is common and is associated with health problems. So, improving sleep quality in this group may well lead to improvements in overall health and longevity.

So, improve sleep quality in older adults with mindfulness.

“When I first started using mindfulness to get sleep, I believed I needed to be meditating at bedtime if I wanted to cure my insomnia. I was completely wrong! I learned that my worries about sleep were happening all day long. I started using mindfulness during the day to notice those worries and learn to accept that I may not get as much sleep as I hope for each night.” – Mary Sauer

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

Gallegos, A. M., Moynihan, J., & Pigeon, W. R. (2016). A Secondary Analysis of Sleep Quality Changes in Older Adults From a Randomized Trial of an MBSR Program. Journal of Applied Gerontology : The Official Journal of the Southern Gerontological Society, 733464816663553. Advance online publication. http://doi.org/10.1177/0733464816663553

Abstract

This secondary analysis examined changes in sleep quality associated with participation in a Mindfulness-Based Stress Reduction (MBSR) program among healthy older adults. Data were collected at baseline, 8-weeks post-treatment, and a 6-month follow-up from adults aged ≥ 65 (N = 200), randomly assigned to MBSR or a waitlist control. Group differences were examined using mixed analysis of covariance with repeated measures on the total Pittsburgh Sleep Quality Index (PSQI) score. A small-sized, significant effect was found on overall sleep among MBSR participants with baseline PSQI scores > 5, indicative of a sleep disturbance, F(2, 80) = 4.32, p = .02, η2P=.05. A medium-sized, significant effect was found for MBSR participants with baseline PSQI scores ≥ 10, F(2, 28) = 3.13, p = .04, η2P=.10. These findings indicate that improved sleep quality for older adults who have higher levels of sleep disturbance may be associated with participation in MBSR.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5874181/

Improve Functional Fitness with Yoga

May 5, 2018 psyjdc Leave a comment

Improve Functional Fitness with Yoga

By John M. de Castro, Ph.D.

“All forms of exercise are important for the body. The right amount of it keeps us in shape, improves longevity, and certainly keeps me sane if nobody else. Yoga is so much more than simple stretches, and it’s certainly not just for flexible people who can already wrap their legs around their heads. Yoga is about creating balance, strength, flexibility and relaxation in the body through a series of postures, movements and breathing patterns.” – Victoria Adams

We celebrate the increasing longevity of the population. But, aging is a mixed blessing. The aging process involves a systematic progressive decline of the body and the brain. Every system in the body deteriorates including motor function with a decline in strength, flexibility, and balance. It is inevitable. In addition, many elderly experience withdrawal and isolation from social interactions. There is some hope as there is evidence that these declines can be slowed. For example, a healthy diet and a regular program of exercise can slow the physical decline of the body with aging. Also, contemplative practices such as meditation, yoga, and tai chi or qigong have all been shown to be beneficial in slowing or delaying physical and mental decline.

Yoga practice has been shown to have a myriad of benefits for psychological and physical health. It is both an exercise and a mind-body practice that stresses both mental attention to present moment movements, breath control, and flexibility, range of motion, and balance. It has been shown to improve balance and flexibility in older individuals. It is safe and can be practiced by anyone from children to seniors. Recently, there have been a number of high profile athletes who have adopted a yoga practice to improve their athletic performance. But, the lack of exercise that is often associated with aging is a major problem. It is not known whether yoga practice is as good as traditional exercise programs in improving the overall functional fitness of sedentary older adults and slow the age related physical decline.

In today’s Research News article “Yoga Is as Good as Stretching–Strengthening Exercises in Improving Functional Fitness Outcomes: Results From a Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5864160/ ), Gothe and McAuley recruited older sedentary adults over 55 years of age and randomly assigned them to engage in either 8 weeks, 3 times per week, Hatha yoga practice or stretching–strengthening exercises. The Senior Fitness test was administered before and after training. It measured strength, agility, balance, endurance, flexibility, and gait speed.

They found that both the yoga and stretching–strengthening exercise practices produced significant improvements in the older participants’ functional fitness for all measured parameters. So, yoga practice produced as good improvements in fitness as more traditional exercise. In, addition, yoga practice was found to produce significantly better leg balance than stretching–strengthening exercise. This is important as problems with balance contributes to falls in the elderly which is a major contributor to poor health and mortality.

These are important and interesting results that suggest that older individuals can choose between yoga and more traditional exercise to improve their fitness and slow their physical decline. In general, yoga practice has been found to be safe and effective and if practiced with groups it can also be more fun and tend to offset the social isolation experienced by the elderly. Hence, yoga practice may be an excellent choice to maintain fitness during aging.

So, improve functional fitness with yoga.

“Yoga promotes physical health in multiple different ways. Some of them derive from better stress management. Others come more directly from the physical movements and postures in yoga, which help promote flexibility and reduce joint pain.” – Harvard Health

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

Gothe, N. P., & McAuley, E. (2016). Yoga Is as Good as Stretching–Strengthening Exercises in Improving Functional Fitness Outcomes: Results From a Randomized Controlled Trial. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 71(3), 406–411. http://doi.org/10.1093/gerona/glv127

Abstract

Background.

Despite yoga’s popularity, few clinical trials have employed rigorous methodology to systematically explore its functional benefits compared with more established forms of exercise. The objective of this study was to compare the functional benefits of yoga with the conventional stretching–strengthening exercises recommended for adults.

Methods.

Sedentary healthy adults ( N = 118; Mage = 62.0) participated in an 8-week (three times a week for 1 hour) randomized controlled trial, which consisted of a Hatha yoga group ( n = 61) and a stretching–strengthening exercise group ( n = 57). Standardized functional fitness tests assessing balance, strength, flexibility, and mobility were administered at baseline and postintervention.

Results.

A repeated measures multivariate analysis of variance showed a significant time effect for measures of balance [ F (3,18) = 4.88, p < .01, partial η 2 = .45], strength [ F (2,19) = 15.37, p < .001, partial η 2 = .62], flexibility [ F (4,17) = 8.86, p < .001, partial η 2 = .68], and mobility [ F (2,19) = 8.54, p < .002, partial η 2= .47]. Both groups showed significant improvements on measures of balance (left–right leg and four square step); strength (chair stands and arm curls); flexibility (back scratch and sit-and-reach); and mobility (gait speed and 8-feet up and go), with partial η 2 ranging from .05 to .47.

Conclusions.

These data suggest that regular yoga practice is just as effective as stretching–strengthening exercises in improving functional fitness. To our knowledge, this is the first study to examine functional benefits of yoga in comparison with stretching–strengthening exercises in sedentary, healthy, community-dwelling older adults. These findings have clinical implications as yoga is a more amenable form of exercise than strengthening exercises as it requires minimal equipment and can be adapted for individuals with lower levels of functioning or disabilities.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5864160/