Cardiovascular

Improve the Physical and Psychological Symptoms of Covid-19 with Yoga

psyjdc Leave a comment

Improve the Physical and Psychological Symptoms of Covid-19 with Yoga

 

By John M. de Castro, Ph.D.

 

“If there are threats to humanity, yoga often gives us a way of holistic health. Yoga also gives us a happier way of life. I am sure, Yoga will continue playing its preventive, as well as promotive role in healthcare of masses,” – Narendra Modi

 

Mindfulness training and yoga practices have been shown to improve health and well-being in healthy individuals. They have also been found to be effective for a large array of medical and psychiatric conditions, either stand-alone or in combination with more traditional therapies. The COVID-19 pandemic has challenged the mental and physical health of the population. It has created intense stress both for frontline workers but also for people simply isolating at home. Mindfulness is known to decrease the psychological and physical responses to stress and yoga practice also produces similar improvements. So, yoga practice may be helpful in coping with the mental and physical challenges resulting from the lockdown during the COVID-19 pandemic. The evidence has been accumulating. So, it makes sense to summarize what has been learned.

 

In today’s Research News article “A narrative review on yoga: a potential intervention for augmenting immunomodulation and mental health in COVID-19.” (See summary below or view the full text of the study at:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9289356/ ) Basu-Ray and colleagues review and summarize the published research on the effectiveness of yoga practice for the treatment of the psychological and physical symptoms of Covid-19.

 

They note that the published research suggests that yoga practice improves the immune response and decreases inflammation. The research also found that yoga decreases responses physical and psychological responses to stress and decreases anxiety and depression. They found that yoga practice improves the cardiovascular and respiratory systems. It has been shown to improve cardiac arrhythmia, congestive cardiac failure, ischemic heart disease, and hypertension, reducing blood pressure.

 

All these benefits of yoga practice should improve the individual’s ability to combat Covid-19.

 

“Meditation can turn fools into sages but unfortunately, fools never meditate.” – Ramakrishna Paramhansa, Vivekananda

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Twitter @MindfulResearch

 

Study Summary

 

Indranill Basu-Ray, Kashinath Metri, Dibbendhu Khanra, Rishab Revankar, Kavitha M. Chinnaiyan, Nagaratna Raghuram, Mahesh Chandra Mishra, Bhushan Patwardhan, Manjunath Sharma, Ishwar V. Basavaraddi, Akshay Anand, Shrinath Reddy, K. K. Deepak, Marian Levy, Sue Theus, Glenn N. Levine, Holger Cramer, Gregory L. Fricchione, Nagendra R. Hongasandra. A narrative review on yoga: a potential intervention for augmenting immunomodulation and mental health in COVID-19, BMC Complement Med Ther. 2022; 22: 191. Published online 2022 Jul 18. doi: 10.1186/s12906-022-03666-2

 

Abstract

Background

The ongoing novel coronavirus disease 2019 (COVID-19) pandemic has a significant mortality rate of 3–5%. The principal causes of multiorgan failure and death are cytokine release syndrome and immune dysfunction. Stress, anxiety, and depression has been aggravated by the pandemic and its resultant restrictions in day-to-day life which may contribute to immune dysregulation. Thus, immunity strengthening and the prevention of cytokine release syndrome are important for preventing and minimizing mortality in COVID-19 patients. However, despite a few specific remedies that now exist for the SARS-CoV-2virus, the principal modes of prevention include vaccination, masking, and holistic healing methods, such as yoga. Currently, extensive research is being conducted to better understand the neuroendocrinoimmunological mechanisms by which yoga alleviates stress and inflammation. This review article explores the anti-inflammatory and immune-modulating potentials of yoga, along with its role in reducing risk for immune dysfunction and impaired mental health.

Methods

We conducted this narrative review from published literature in MEDLINE, EMBASE, COCHRANE databases. Screening was performed for titles and abstracts by two independent review authors; potentially eligible citations were retrieved for full-text review. References of included articles and articles of major non-indexed peer reviewed journals were searched for relevance by two independent review authors. A third review author checked the excluded records. All disagreements were resolved through discussion amongst review authors or through adjudication by a fourth review author. Abstracts, editorials, conference proceedings and clinical trial registrations were excluded.

Observations

Yoga is a nonpharmacological, cost-effective, and safe intervention associated with several health benefits. Originating in ancient India, this vast discipline consists of postures (asanas), breathing techniques (pranayama), meditation (dhyana/dharana), and relaxation. Studies have demonstrated yoga’s ability to bolster innate immunity and to inhibit cytokine release syndrome. As an intervention, yoga has been shown to improve mental health, as it alleviates anxiety, depression, and stress and enhances mindfulness, self-control, and self-regulation. Yoga has been correlated with numerous cardioprotective effects, which also may play a role in COVID-19 by preventing lung and cardiac injury.

Conclusion and relevance

This review paves the path for further research on yoga as a potential intervention for enhancing innate immunity and mental health and thus its role in prevention and adjunctive treatment in COVID-19.

Conclusions

The aggregation of pathophysiological aberrations, both psychological and somatic, secondary to COVID-19 pandemic and its resultant restrictions, may increase the severity of the infection. Accumulated evidence leads us to hypothesize that, for many, yoga practice may attenuate the ill effects of COVID-19–induced immune dysfunction at different stages.

From a public health perspective, yoga represents a low-cost, noninvasive strategy for alleviating the physical and emotional toll of the COVID-19 pandemic. The aforementioned yoga practices can be performed at home, in adherence to social distancing guidelines. Outcomes from an 8-week yoga intervention (asanas, pranayama, and meditation) indicated that medical treatment plus yoga is more effective than medical treatment alone in reducing anxiety [90]. Relaxation techniques like yoga and meditation helps in managing chronic or long term stress by regulating the cytokines, thus assisting people to overcome co-morbidities associated with diseases and improving the quality of life; which is important in COVID-19 and post-COVID illness [2, 21]. Notwithstanding, appropriate clinical trials are required to document the efficacy of this strategy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9289356/

Improve Glycemic Control in Patients with Type 2 Diabetes with Tai Chi

psyjdc Leave a comment

Improve Glycemic Control in Patients with Type 2 Diabetes with Tai Chi

 

By John M. de Castro, Ph.D.

 

“Tai chi does not mean oriental wisdom or something exotic. It is the wisdom of your own senses, your own mind and body together as one process.” – Chungliang Al Huang

 

Diabetes is a major health issue. It is estimated that 30 million people in the United States have diabetes and the numbers are growing. Type 2 Diabetes results from a resistance of tissues, especially fat tissues, to the ability of insulin to promote the uptake of glucose from the blood. As a result, blood sugar levels rise producing hyperglycemia. Diabetes is the 7th leading cause of death in the United States. In addition, diabetes is heavily associated with other diseases such as cardiovascular disease, heart attacks, stroke, blindness, kidney disease, and circulatory problems leading to amputations. As a result, diabetes doubles the risk of death of any cause compared to individuals of the same age without diabetes.

 

Type 2 diabetes is largely preventable. One of the reasons for the increasing incidence of Type 2 Diabetes is its association with overweight and obesity which is becoming epidemic in the industrialized world. A leading cause of this is a sedentary lifestyle. Current treatments for Type 2 Diabetes focus on diet, exercise, and weight control. Recently, mindfulness practices have been shown to be helpful in managing diabetes. Tai Chi is mindfulness practice and a gentle exercise that has been found to improve the symptoms of Type 2 Diabetes. The research is accumulating. So, it is reasonable to examine what has been learned

 

In today’s Research News article “Effect of tai chi on glycaemic control, lipid metabolism and body composition in adults with type 2 diabetes: A meta-analysis and systematic review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8814847/ ) Guo and colleagues review, summarize, and perform a meta-analysis of the published research studies of the effectiveness of Tai Chi practice in the treatment of Type 2 Diabetes. They identified 23 published randomized clinical trials.

 

They report that the published research found that in comparison to usual clinical care, patients who were given Tai Chi practice had significantly lower levels of body mass index, systolic and diastolic blood pressure, insulin levels, fasting blood glucose, blood glucose levels after meals, HbA1c, total cholesterol, and low density lipoproteins (LDL), and higher levels of high density lipoproteins (HDL). Tai Chi produced similar results in comparison to aerobic exercise with body mass index, fasting blood glucose levels, total cholesterol, triglycerides, and low-density lipoproteins (LDL). Tai Chi produced superior results to aerobic exercise in reducing HbA1c and increasing high density lipoproteins (HDL).

 

Hence, the research published to date indicates that Tai Chi practice is superior to usual clinical care in improving obesity, glycemic control, and plasma fats and is superior to  aerobic exercise in improving glycemic control and blood fats. This suggests that Tai Chi practice should be recommended for patients with Type 2 Diabetes.

 

“Tai Chi Chuan, the great ultimate, strengthens the weak, raises the sick, invigorates the debilitated, and encourages the timid.” – Cheng Man-ch’ing

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Twitter @MindfulResearch

 

Study Summary

 

Guo S, Xu Y, Qin J, Chen Y, You Y, Tao J, Liu Z, Huang J. Effect of tai chi on glycaemic control, lipid metabolism and body composition in adults with type 2 diabetes: A meta-analysis and systematic review. J Rehabil Med. 2021 Mar 22;53(3):jrm00165. doi: 10.2340/16501977-2799. PMID: 33594445; PMCID: PMC8814847.

 

Abstract

Objective

The aim of this systematic review was to evaluate the effects of tai chi on metabolic control and body composition indicators in patients with type 2 diabetes mellitus.

Design

Systematic review and meta-analysis of existing literature.

Methods

Electronic resource databases were searched to collect eligible studies. Two reviewers selected studies and independently evaluated methodological quality.

Results

Twenty-three studies were included in this meta-analysis. The pooled results showed that tai chi had significant effects in improving metabolic indices, such as fasting blood glucose (mean difference (MD) = –1.04; 95% confidence interval (95% CI) –1.42 to 0.66; p < 0.01) and total cholesterol (MD = –0.50; 95% CI –0.86 to –0.13; p < 0.01) compared with conventional clinical therapy. Most indices did not support the use of tai chi over aerobic exercise, except for glycated haemoglobin (HbA1c) (MD = –0.24; 95% CI –0.49 to 0.00; p < 0.01) and high-density lipoprotein (MD = 0.07; 95% CI 0.01 to 0.12; p < 0.01).

Conclusion

Tai chi had better effects on metabolic control and body composition indicators than clinical conventional therapy, but only on HbA1c and HDL were superior than that of aerobic exercise. The best time-window for tai chi intervention may differ with different metabolic indices.

LAY ABSTRACT

Exercise therapy is a possible alternative and effective strategy for blood glucose control in patients with type 2 diabetes, since drug therapy is associated with side-effects, long-term loss of efficacy, and poor adherence to lifelong treatment. A review of evidence was performed regarding the effects of tai chi on glycaemic control and other indicators in patients with type 2 diabetes mellitus. The results indicate that tai chi not only improves metabolic control, e.g. fasting blood glucose and total cholesterol, but also improves body composition indicators, e.g. body mass index. However, benefits of tai chi over aerobic exercise were seen in only a few outcome measures. The type and methodology of studies varied widely, with discrepancies in intensity, frequency, and duration of tai chi; therefore, further high-quality research is needed in order to draw specific and accurate conclusions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8814847/

 

Improve the Health of the Elderly with Depression with Tai Chi

psyjdc Leave a comment

Improve the Health of the Elderly with Depression with Tai Chi

 

By John M. de Castro, Ph.D.

 

“adding a mind-body exercise like tai chi that is widely available in the community can improve the outcomes of treating depression in older adults.” – UCLA Health

 

The aging process involves a systematic progressive decline in every system in the body, the cardiovascular system and respiratory system included. The elderly frequently also have problems with attention, thinking, and memory abilities, 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.

 

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. The elderly are often depressed. So, it makes sense to study the effectiveness of Tai Chi practice on the health of  the elderly with depression.

 

In today’s Research News article “Comparison of the effects of Tai Chi and general aerobic exercise on weight, blood pressure and glycemic control among older persons with depressive symptoms: a randomized trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9077840/ ) Wang and colleagues recruited older adults (> 60 years of age) who had depressive symptoms and randomly assigned the to receive 3 times per week for 60 minutes for 12 weeks of either Tai Chi practice or 20 movement low impact aerobic exercise. They were measured before and after training and 3 month later for body size, blood pressure and blood HbA1c levels.

 

They found that in comparison to baseline and the aerobic exercise group, the group that practiced Tai Chi lost a significantly greater amount of weight and Body Mass Index (BMI), had significantly lower systolic and diastolic blood pressure, and had significantly lower HbA1c levels. Hence, in older adults with depressive symptoms Tai Chi practice is more effective than aerobic exercise in reducing body weight, blood pressure, and improving long-term glucose control.

 

So, Tai Chi improves the physical well-being of older adults.

 

“tai chi is an exercise form you can practice all your life.  Good for the mind and the body, it’s a physical activity that will help keep you feeling healthy for years to come. “ – NHSNetworks

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Twitter @MindfulResearch

 

Study Summary

 

Wang, Y., Luo, B., Wu, X., Li, X., & Liao, S. (2022). Comparison of the effects of Tai Chi and general aerobic exercise on weight, blood pressure and glycemic control among older persons with depressive symptoms: a randomized trial. BMC geriatrics, 22(1), 401. https://doi.org/10.1186/s12877-022-03084-6

 

Abstract

Background

Blood pressure and glycemic control are associated with the management of depressive symptoms in patients with depression. Previous studies have demonstrated that both Tai Chi and aerobic exercise have positive effects on blood pressure and glycemic control. Few studies have compared the physiological effects of Tai Chi versus aerobic exercise in older adults with depressive symptoms. The objective of this study was to compare the effects of Tai Chi and aerobic exercise on weight, body mass index, blood pressure and glycosylated hemoglobin (HbA1c) level in older persons with mild to moderate-severe depressive symptoms.

Methods

A randomized controlled trial was performed. The older persons (age ≥ 60 years old) with depressive symptoms were recruited. Then, participants were randomly allocated to the Tai Chi group and the aerobic exercise group received a 12-week 24-movement Yang’s Tai Chi intervention and aerobic exercise, respectively. Data collection occurred at baseline and after completion of the interventions (week 12).

Results

A total of 238 participants with mild to moderate-to-severe depressive symptoms were included in the final analysis, including 120 in the Tai Chi group and 118 in the aerobic exercise group. The difference in weight and body mass index in the Tai Chi group was 2.0 kg (Z = -4.930, P < 0.001) and 0.77 kg/m2 (Z = -5.046, P < 0.001) higher than that in the aerobic exercise group, respectively. After the 12-week intervention, the systolic pressure and diastolic pressure in the Tai Chi group were 5.50 mmHg (Z = -2.282, P = 0.022) and 8.0 mmHg (Z = -3.360, P = 0.001) lower than that in the aerobic exercise group, respectively. The difference in HbA1c level in the Tai Chi group was 0.50% higher than that in the aerobic exercise group (Z = -4.446, P < 0.001).

Conclusion

This study showed that Tai Chi exercise was more effective in improving blood pressure and HbA1c level than general aerobic exercise. It suggested that Tai Chi might be an effective approach for the management of blood pressure and long-term glucose control in older persons with depressive symptoms.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9077840/

Improve Physiological Relaxation in Breast Cancer Patients with Mindfulness

psyjdc Leave a comment

Improve Physiological Relaxation in Breast Cancer Patients with Mindfulness

 

By John M. de Castro, Ph.D.

 

“mindfulness-based meditation can help ease the stress, anxiety, fear, and depression that often come along with a breast cancer diagnosis and treatment.” –  Breastcancer.org

 

Mindfulness training has been shown to help with general cancer recovery. Mindfulness practices have been shown to improve the residual symptoms in cancer survivors. The Mindfulness-Based Stress Reduction (MBSR) program is a mindfulness training program that includes meditation practice, body scan, yoga, and discussion along with daily home practice. MBSR has been shown to be beneficial for cancer patients in general and also specifically for the symptoms of breast cancer survivors. So, it makes sense to further explore the mechanisms of the effectiveness of MBSR for the treatment of breast cancer survivors.

 

In today’s Research News article “.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9180838/ ) and colleagues recruited breast cancer survivors who had received a diagnosis and treatment at least 2 years ago. They either participated in a 6 week, 2 hour once a week session of Mindfulness-Based Stress Reduction (MBSR) or usual care. Before and after treatment they were measured for heart rate, heart rate variability with an electrocardiogram.

 

They found that in comparison to baseline and the usual care group after Mindfulness-Based Stress Reduction (MBSR) the survivors had significantly lower resting heart rate and higher heart rate variability. Increases in heart rate variability indicates a reduction in physiological activation, an increase in parasympathetic relaxation, providing a physiological indicator of physiological relaxation. This suggests that MBSR resulted in greater relaxation in the breast cancer survivors and this is an indicator of improved physical and psychological well-being in these cancer survivors.

 

So, mindfulness training increases physiological relaxation in breast cancer survivors.

 

“practice mindfulness meditation to help you better handle the stressors that life is throwing your way. Being more mindful can also help you remain physically active and stick to a healthy diet – all key ingredients for successfully navigating cancer survivorship!” – Jessica Pieczynski

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Twitter @MindfulResearch

 

Study Summary

 

Wang, S. J., Chang, Y. C., Hu, W. Y., Chang, Y. M., & Lo, C. (2022). The Comparative Effect of Reduced Mindfulness-Based Stress on Heart Rate Variability among Patients with Breast Cancer. International journal of environmental research and public health, 19(11), 6537. https://doi.org/10.3390/ijerph19116537

 

Abstract

Heart rate variability (HRV) is a powerful tool for observing interactions between the sympathetic and parasympathetic nervous systems. This study evaluated HRV during a mindfulness-based stress reduction (MBSR) program among women with breast cancer after receiving treatment. A quasi-experimental, nonrandomized design was used. Patients were allocated to usual care (n = 25) and MBSR (n = 25) groups. HRV was measured using recognized methods to assess the autonomic nervous system. Two-way ANOVA and t-tests were used to examine HRV changes between and within groups, respectively. A significant interaction effect of time with group was observed on heart rate (F (1, 96) = 4.92, p = 0.029, η2 = 0.049). A significant difference was also observed within the MBSR group preintervention and postintervention with regard to heart rate (t (24) = −3.80, p = 0.001), standard deviation of the RR interval (t (24) = 5.40, p < 0.001), root-mean-square difference in the RR interval (t (24) = 2.23, p = 0.035), and high-frequency power (t (24) = 7.73, p < 0.001). Large effect sizes for heart rate and SDNN of 0.94 and 0.85, respectively, were observed between the MBSR and usual care groups. This study provides preliminary evidence that an MBSR program may be clinically useful for facilitating parasympathetic activity associated with feelings of relaxation in treated breast cancer survivors.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9180838/

Manage Hypertension with Yoga

psyjdc Leave a comment

Manage Hypertension with Yoga

 

By John M. de Castro, Ph.D.

 

“brisk walking, reducing salt intake, and practicing yoga can each benefit people with high blood pressure.” – Markus MacGill

 

High Blood Pressure (Hypertension) is an insidious disease because there are no overt symptoms. The individual feels fine. But it can be deadly as more than 360,000 American deaths, roughly 1,000 deaths each day, had high blood pressure as a primary or contributing cause. In addition, hypertension markedly increases the risk heart attack, stroke, heart failure, and kidney disease.  It is also a very common disorder with about 70 million American adults (29%) having high blood pressure and only about half (52%) of people with high blood pressure have their condition under control. Treatment frequently includes antihypertensive drugs. But these medications often have adverse side effects. So, patients feel lousy when taking the drugs, but fine when they’re not. So, compliance is a major issue with many patients not taking the drugs regularly or stopping entirely.

 

Obviously, there is a need for alternative to drug treatments for hypertension. Exercise has been shown to effectively reduce blood pressure. Also, mindfulness practices have been shown to aid in controlling hypertension. Yoga practice is both an exercise and a mindfulness practice that has been shown to reduce blood pressure. The research has been accumulating. So, it makes sense to summarize what has been learned regarding the conditions under which yoga practice is effective in reducing hypertension.

.

In today’s Research News article “Content, Structure, and Delivery Characteristics of Yoga Interventions for Managing Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8995771/ ) Nalbant and colleagues review, summarize, and perform a meta-analysis of the published randomized controlled studies of the conditions under which yoga practice is effective in reducing hypertension. They identified 34 published randomized controlled trials.

 

They report that the published studies found that yoga practice was overall effective in lowering diastolic and systolic blood pressure in patients with hypertension. In comparing trials that produced significant improvement in hypertension to those that didn’t they report that the successful trials incorporated balance of postures, breathing practices, meditation and relaxation practices, occurring over 2 sessions per week, and were delivered in a formal setting under supervision.

 

This summary of published research supports the use of yoga practice in the treatment of hypertension and defines the components that need to be present to produce significant benefits.

 

“Yoga leaves a positive impact on your mind and body. It is an effective way to lower blood pressure. Here are some effective yoga asanas for hypertension.” – Varsha Vats

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Twitter @MindfulResearch

 

Study Summary

 

Nalbant, G., Hassanein, Z. M., Lewis, S., & Chattopadhyay, K. (2022). Content, Structure, and Delivery Characteristics of Yoga Interventions for Managing Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in public health, 10, 846231. https://doi.org/10.3389/fpubh.2022.846231

 

Abstract

Objectives

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

Design and Method

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

Results

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

Conclusion

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

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8995771/

 

Improve Cardiorespiratory Function in the Elderly with Tai Chi

psyjdc Leave a comment

Improve Cardiorespiratory Function in the Elderly with Tai Chi

 

By John M. de Castro, Ph.D.

 

“Long term regular [Tai Chi] exercise has favourable effects on the promotion of balance control, flexibility, and cardiovascular fitness in older adults.” – Youlian Hong

 

The aging process involves a systematic progressive decline in every system in the body, the cardiovascular system and respiratory system included. The elderly frequently also have problems with attention, thinking, and memory abilities, 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.

 

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. The research on the effects of Tai Chi training on the cardiorespiratory system of older adults has been accumulating. So, it makes sense to summarize what has been learned.

 

In today’s Research News article “A Systematic Review and Meta-Analysis of Tai Chi Training in Cardiorespiratory Fitness of Elderly People.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8942636/ ) Tan and colleagues review and summarize the published research randomized controlled trials on the effects of Tai Chi training on the cardiorespiratory system of older adults (> 50 years of age). They identified 24 published research studies.

 

They report that the published randomized controlled trials found that Tai Chi training produced significant increases in heart rate, VO2 max (the maximum amount of oxygen your body can utilize during exercise) and O2 pulse (oxygen consumed per heart beat, a measure of stroke volume), and vital capacity (the greatest volume of air that can be expelled from the lungs after taking the deepest possible breath). The increase in vital capacity was significantly larger in participants who practiced for 48 weeks and over.

 

The results are clear. Tai Chi training produces improves cardiorespiratory function in older adults. Thus suggests that Tai Chi training can help overcome or delay age-related physical decline.

 

“tai chi is an effective way in improving cardiovascular responses and stress in prehypertensive individuals.” – Touraj Hashemi Nosrat-abad

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Twitter @MindfulResearch

 

Study Summary

 

Tan, T., Meng, Y., Lyu, J. L., Zhang, C., Wang, C., Liu, M., Zhao, X., Lyu, T., & Wei, Y. (2022). A Systematic Review and Meta-Analysis of Tai Chi Training in Cardiorespiratory Fitness of Elderly People. Evidence-based complementary and alternative medicine : eCAM, 2022, 4041612. https://doi.org/10.1155/2022/4041612

 

Abstract

Objectives

The purpose of this study was to investigate the influence of Tai Chi on cardiorespiratory fitness (CRF) in elderly people using meta-analysis.

Methods

This study used seven electronic databases and data retrieved from randomized controlled trials (RCTs) investigating the role of Tai Chi on CRF in the elderly. All these 24 RCTs were screened and selected from 7 literature databases. The Stata 11.2 software (StataCorp, USA) was used for the meta-analysis, subgroup analysis, and bias test, while the Cochrane Collaboration’s tool was used for the assessment of the risk of bias (RoB). 4 researchers independently participated in sample selection, data extraction, and RoB assessment.

Results

Following the inclusion criteria, 24 eligible studies were included in our analysis. The meta-analysis indicated that Tai Chi practice significantly increased the maximum rate of oxygen consumption (VO2 max) (weighted mean difference (WMD)  = 3.76, 95% CI: 1.25 to 6.26, P < 0.1), leading to an overall reduction in the heart rate (HR) (WMD  = −1.84, 95% CI: −2.04 to −1.63, P  ≤ 0.001) and an increase in the O2 pulse (WMD = 0.94, 95% CI: 0.60 to 1.28, P ≤ 0.001) in individuals who practiced Tai Chi regularly compared with those who did not. The subgroup analysis suggested that overall in those who practiced Tai Chi, males (WMD = 1.48, 95% CI: 0.85 to 2.12, P ≤ 0.001) had higher O2 pulse than females (WMD = 0.73, 95% CI: 0.33 to 1.12, P ≤ 0.001). The subgroup analysis also showed an increase in the vital capacity (VC) (WMD = 316.05, 95% CI: 239.74 to 392.35, P ≤ 0.001) in individuals practicing Tai Chi. When the samples were further stratified by Tai Chi practicing time, the subgroup analysis suggested that individuals practicing Tai Chi over a period of 24 weeks showed no significant difference in VC (WMD = 82.95, 95% CI: -98.34 to 264.23, P=0.370), while those practicing Tai Chi over a period of 48 weeks showed a significant increase (WMD = 416.62, 95% CI: 280.68 to 552.56, P ≤ 0.001). Furthermore, the subgroup analysis demonstrated that the increase in VC is significantly correlated with the Tai Chi practicing time (WMD = 344.97, 95% CI: 227.88 to 442.06, P ≤ 0.001).

Conclusion

Regular Tai Chi practice could improve the CRF in the elderly, as indicated by significant improvement in indicators including VO2max, O2pulse, VC, and HR. However, gender and practice time might influence the overall beneficial outcomes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8942636/

 

Improve the Psychological Well-Being of Patients with Cardiovascular Disease with Tai Chi

psyjdc Leave a comment

Improve the Psychological Well-Being of Patients with Cardiovascular Disease with Tai Chi

 

By John M. de Castro, Ph.D.

 

“Tai Chi involves a series of graceful, gentle movements that can get your heart rate up while also relaxing your mind. It’s been called meditation in motion.” – Cleveland Heart Lab

 

Cardiovascular disease is the number one killer. A myriad of treatments has been developed including a variety of surgical procedures and medications. In addition, lifestyle changes have proved to be effective including quitting smoking, weight reduction, improved diet, physical activity, and reducing stresses. Unfortunately, for a variety of reasons, 60% of cardiovascular disease patients decline engaging in these lifestyle changes, making these patients at high risk for another attack.

 

Contemplative practices have been shown to be safe and effective alternative treatments for cardiovascular disease. Practices such as meditation, tai chi, and yoga, have been shown to be helpful for heart health and to reduce the physiological and psychological responses to stress. They have also been shown to be effective in maintaining cardiovascular health and the treatment of cardiovascular disease. The research has been accumulating. So, it makes sense to pause and take a look at what has been learned.

 

In today’s Research News article “Does tai chi improve psychological well-being and quality of life in patients with cardiovascular disease and/or cardiovascular risk factors? A systematic review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8725570/ ) Yang and colleagues review, summarize, and perform a meta-analysis of the published randomized controlled trials of the effectiveness of Tai Chi practice for patients with cardiovascular disease. They identified 37 published trials.

 

They report that the published research found that Tai Chi practiced improved the psychological well-being of the patients including decreases in perceived stress, anxiety, depression, bodily pain and increases in mental health, self-efficacy, and mood.

 

Hence practicing Tai Chi improves the mental health and quality of life of patients with cardiovascular disease.

 

“practicing tai chi may help to modestly lower blood pressure. It’s also proved helpful for people with heart failure, who tend to be tired and weak as a result of the heart’s diminished pumping ability. The slow movements involve both the upper and lower body, which safely strengthens the heart and major muscle groups without undue strain.” – Harvard Health

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Twitter @MindfulResearch

 

Study Summary

 

Yang, G., Li, W., Klupp, N., Cao, H., Liu, J., Bensoussan, A., Kiat, H., Karamacoska, D., & Chang, D. (2022). Does tai chi improve psychological well-being and quality of life in patients with cardiovascular disease and/or cardiovascular risk factors? A systematic review. BMC complementary medicine and therapies, 22(1), 3. https://doi.org/10.1186/s12906-021-03482-0

 

Abstract

Background

Psychological risk factors have been recognised as potential, modifiable risk factors in the development and progression of cardiovascular disease (CVD). Tai Chi, a mind-body exercise, has the potential to improve psychological well-being and quality of life. We aim to assess the effects and safety of Tai Chi on psychological well-being and quality of life in people with CVD and/or cardiovascular risk factors.

Methods

We searched for randomised controlled trials evaluating Tai Chi for psychological well-being and quality of life in people with CVD and cardiovascular risk factors, from major English and Chinese databases until 30 July 2021. Two authors independently conducted study selection and data extraction. Methodological quality was evaluated using the Cochrane Risk of Bias tool. Review Manager software was used for meta-analysis.

Results

We included 37 studies (38 reports) involving 3525 participants in this review. The methodological quality of the included studies was generally poor. Positive effects of Tai Chi on stress, self-efficacy, and mood were found in several individual studies. Meta-analyses demonstrated favourable effects of Tai Chi plus usual care in reducing anxiety (SMD − 2.13, 95% confidence interval (CI): − 2.55, − 1.70, 3 studies, I2 = 60%) and depression (SMD -0.86, 95% CI: − 1.35, − 0.37, 6 studies, I2 = 88%), and improving mental health (MD 7.86, 95% CI: 5.20, 10.52, 11 studies, I2 = 71%) and bodily pain (MD 6.76, 95% CI: 4.13, 9.39, 11 studies, I2 = 75%) domains of the 36-Item Short Form Survey (scale from 0 to 100), compared with usual care alone. Tai Chi did not increase adverse events (RR 0.50, 95% CI: 0.21, 1.20, 5 RCTs, I2 = 0%), compared with control group. However, less than 30% of included studies reported safety information.

Conclusions

Tai Chi seems to be beneficial in the management of anxiety, depression, and quality of life, and safe to practice in people with CVD and/or cardiovascular risk factors. Monitoring and reporting of safety information are highly recommended for future research. More well-designed studies are warranted to determine the effects and safety of Tai Chi on psychological well-being and quality of life in this population.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8725570/

Meditation is an Effective Treatment for a Variety of Medical Conditions

psyjdc Leave a comment

Meditation is an Effective Treatment for a Variety of Medical Conditions

 

By John M. de Castro, Ph.D.

 

“Mindfulness is not a cure-all. . . . There have been thousands of studies showing that there are psychological and physical benefits to mindfulness meditation, but the intention . . . is not to cure the disease or fully treat the symptoms, but to treat the whole person — and that includes their mental and emotional well-being — so they can live in greater health and joy.” – Men’s Health

 

Over the last several decades, research and anecdotal experiences have accumulated an impressive evidential case that meditation has positive benefits for the individual’s mental, physical, and spiritual life. Meditation appears to be beneficial both for healthy people and for people suffering from a myriad of mental and physical illnesses. It appears to be beneficial across ages, from children to the elderly. And it appears to be beneficial across genders, personalities, race, and ethnicity. The breadth and depth of benefits is unprecedented. There is no other treatment or practice that has been shown to come anyway near the range of mindfulness’ positive benefits.

 

Over the last few decades, a vast amount of research has been published on the benefits of meditation on the mental and physical health of the practitioners. So, it makes sense to step back and summarize what has been learned.

 

In today’s Research News article “Systematic Review for the Medical Applications of Meditation in Randomized Controlled Trials.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8834867/ ) Kim and colleagues review and summarize the 104 published randomized controlled trials on the benefits of meditation practices on mental and physical well-being.

 

They report that the published research found that different studies report varying results but the most common significant benefits of meditation practice were improvements in fatigue, sleep quality, quality of life, stress, PTSD symptoms, blood pressure, intraocular pressure, and depression. In general yoga-based practices produced slightly better results than mindfulness based techniques,

 

Hence, meditation practices have been found to help improve mental and physical well-being.

 

“meditation can improve mental health and reduce symptoms associated with chronic conditions.” – Ashley Welch

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Twitter @MindfulResearch

 

Study Summary

 

Kim, D. Y., Hong, S. H., Jang, S. H., Park, S. H., Noh, J. H., Seok, J. M., Jo, H. J., Son, C. G., & Lee, E. J. (2022). Systematic Review for the Medical Applications of Meditation in Randomized Controlled Trials. International journal of environmental research and public health, 19(3), 1244. https://doi.org/10.3390/ijerph19031244

 

Abstract

Background: Meditation has been increasingly adapted for healthy populations and participants with diseases. Its beneficial effects are still challenging to determine due to the heterogeneity and methodological obstacles regarding medical applications. This study aimed to integrate the features of therapeutic meditation in randomized controlled trials (RCTs). Methods: We conducted a systematic review of RCTs with meditation for populations with diseases using the PubMed database through June 2021. We analyzed the characteristics of the diseases/disorders, participants, measurements, and their overall benefits. Results: Among a total of 4855 references, 104 RCTs were determined and mainly applied mindfulness-based (51 RCTs), yoga-based (32 RCTs), and transcendental meditation (14 RCTs) to 10,139 patient-participants. These RCTs were conducted for participants with a total of 45 kinds of disorders; the most frequent being cancer, followed by musculoskeletal and connective tissue diseases and affective mood disorder. Seven symptoms or signs were frequently assessed: depressive mood, feeling anxious, quality of life, stress, sleep, pain, and fatigue. The RCTs showed a higher ratio of positive outcomes for sleep (73.9%) and fatigue (68.4%). Conclusions: This systematic review produced the comprehensive features of RCTs for therapeutic meditation. These results will help physicians and researchers further study clinical adaptations in the future as reference data.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8834867/

 

Improve Physical and Mental Health during Aging with Mindfulness

psyjdc Leave a comment

 

Improve Physical and Mental Health during Aging with Mindfulness

 

By John M. de Castro, Ph.D.

 

“The healthier and more active one’s lifestyle, the more likely he or she will maintain cognitive performance over time. And meditation may be a key ingredient for ensuring brain health and maintaining good mental performance.“ – Grace Bullock

 

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 abilities, 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 have been found to degenerate less with aging than non-practitioners.

 

In today’s Research News article “Long-Term Physical Exercise and Mindfulness Practice in an Aging Population.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2020.00358/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1832518_a0P58000000G0YfEAK_Psycho_20220317_arts_A&utm_source=sfmc&utm_medium=email&utm_campaign=Article+Alerts+V4.1-Frontiers&utm_term=%%%3d+++++++REDIRECTTO(+++++CONCAT(%27http%3a%2f%2fjournal.frontiersin.org%2farticle%2f%27%2c+TreatAsContent(field(%40article%2c+%27DOI__c%27))%2c+%27%2ffull%3futm_source%3dF-AAE%26utm_medium%3dEMLF%26utm_campaign%3dMRK_%27%2c+TreatAsContent(JobID)%2c+%27_%27%2c+TreatAsContent(%40FieldId)%2c+%27_%27%2c+TreatAsContent(Substring(Replace(Field(%40field%2c+%27Name%27)%2c+%27+%27%2c+%27%27)%2c+0%2c+6))% ) Tang and colleagues compared older adults (average age of 64 years) who were either experienced (> 10 years) meditators or exercisers on physical, mental, immune, stress, and brain plasticity measures.

 

They report that the older adults who exercised had superior cardiovascular and respiratory fitness. But the older adults who meditated had superior physiological relaxation, quality of life, immune response, stress response, and brain plasticity. They conclude that the optimum results for older adults would be produced by combining meditation and exercise. Regardless, it is clear that meditation restrains the physical and mental deterioration with aging.

 

“it’s heartening to know that age may not only bring wisdom or sore knees, but also more mindfulness.” – Jenn Director Knudsen 

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Twitter @MindfulResearch

 

Study Summary

 

Tang Y-Y, Fan Y, Lu Q, Tan L-H, Tang R, Kaplan RM, Pinho MC, Thomas BP, Chen K, Friston KJ and Reiman EM (2020) Long-Term Physical Exercise and Mindfulness Practice in an Aging Population. Front. Psychol. 11:358. doi: 10.3389/fpsyg.2020.00358

 

Previous studies have shown that physical exercise and mindfulness meditation can both lead to improvement in physical and mental health. However, it is unclear whether these two forms of training share the same underlying mechanisms. We compared two groups of older adults with 10 years of mindfulness meditation (integrative body-mind training, IBMT) or physical exercise (PE) experience to demonstrate their effects on brain, physiology and behavior. Healthy older adults were randomly selected from a large community health project and the groups were compared on measures of quality of life, autonomic activity (heart rate, heart rate variability, skin conductance response, respiratory amplitude/rate), immune function (secretory Immunoglobulin A, sIgA), stress hormone (cortisol) and brain imaging (resting state functional connectivity, structural differences). In comparison with PE, we found significantly higher ratings for the IBMT group on dimensions of life quality. Parasympathetic activity indexed by skin conductance response and high-frequency heart rate variability also showed more favorable outcomes in the IBMT group. However, the PE group showed lower basal heart rate and greater chest respiratory amplitude. Basal sIgA level was significantly higher and cortisol concentration was lower in the IBMT group. Lastly, the IBMT group had stronger brain connectivity between the dorsal anterior cingulate cortex (dACC) and the striatum at resting state, as well as greater volume of gray matter in the striatum. Our results indicate that mindfulness meditation and physical exercise function in part by different mechanisms, with PE increasing physical fitness and IBMT inducing plasticity in the central nervous systems. These findings suggest combining physical and mental training may achieve better health and quality of life results for an aging population.

https://www.frontiersin.org/articles/10.3389/fpsyg.2020.00358/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1832518_a0P58000000G0YfEAK_Psycho_20220317_arts_A&utm_source=sfmc&utm_medium=email&utm_campaign=Article+Alerts+V4.1-Frontiers&utm_term=%%%3d+++++++REDIRECTTO(+++++CONCAT(%27http%3a%2f%2fjournal.frontiersin.org%2farticle%2f%27%2c+TreatAsContent(field(%40article%2c+%27DOI__c%27))%2c+%27%2ffull%3futm_source%3dF-AAE%26utm_medium%3dEMLF%26utm_campaign%3dMRK_%27%2c+TreatAsContent(JobID)%2c+%27_%27%2c+TreatAsContent(%40FieldId)%2c+%27_%27%2c+TreatAsContent(Substring(Replace(Field(%40field%2c+%27Name%27)%2c+%27+%27%2c+%27%27)%2c+0%2c+6))%

 

Reduce the Psychological and Physical Responses Before a Major Dental Procedure with Yogic Relaxation

psyjdc Leave a comment

Reduce the Psychological and Physical Responses Before a Major Dental Procedure with Yogic Relaxation

 

By John M. de Castro, Ph.D.

 

“Practicing yoga has been effectively proven to reduce stress levels and induce the sense of calmness in individuals, which could help in the management of several stress-induced oral conditions.” – Roquaiya Nishat

 

If you asked most people what’s one of the most common health problems that people have, probably the last thing that they would come up with is oral health. But more than 26% of adults in the United States have untreated tooth decay and 65% of adults had a dental visit every year. A common dental procedure is a root canal that is performed around 15 million times annually. But this procedure is accompanied by great anxiety and stress in the patients. This often results in patients avoiding or delaying needed procedures. There is considerable evidence that yoga practice reduces anxiety and stress. But it is not known if a brief yogic relaxation practice can reduce anxiety and stress prior to a dental root canal procedure.

 

In today’s Research News article “Effect of Pranayama Techniques with Marmanasthanam Kriya as Yogic Relaxation on Biopsychosocial Parameters Prior to Endodontic Therapy: A Cross Sectional Study Design.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8191219/ ) Thiruvalluvan and colleagues recruited adults between the ages of 25-50 years who were scheduled to undergo a dental root canal procedure and randomly assigned them to receive either guided Yogic relaxation for 15 minutes before the root canal treatment or to simply relax for 15 minutes. Yoga relaxation included breathing practices, mudras, and body scan exercises. The participants were measured before and after the intervention for anxiety, heart rate, and blood pressure.

 

They found that in comparison to baseline and the relaxation control group, the patients who practiced yogic relaxation had a significant decrease in anxiety, heart rate, and diastolic and systolic blood pressure. Hence, yogic relaxation prior to a dental root canal procedure reduced anxiety and physiological arousal in the patients. It is important to note that yogic relaxation produced superior results to simply asking the patient to relax. This suggests that yogic relaxation produces does more than simply relax the patients.

 

Yoga has been repeatedly shown to reduce anxiety, blood pressure, and heart rate in a variety of conditions. The present results demonstrate that a brief yogic relaxation can produce similar effects in patients before a major dental procedure. Anxiety and fear have been found to be major barriers to dental treatment. This leads to patients avoiding or delaying treatment allowing the damage to progress, So, a treatment that can reduce the anxiety before the treatment may be helpful in promoting dental health.

 

So, reduce the psychological and physical responses before a major dental procedure with yogic relaxation.

 

“Yoga is versatile, enjoyable and highly beneficial and a great way for dentists and their patients to battle stress and anxiety. ‘– Saurabh Bhargava

 

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

 

Thiruvalluvan, A., Sekizhar, V., Ramanathan, M., Bhavanani, A. B., Chakravathy, D., & Reddy, J. (2021). Effect of Pranayama Techniques with Marmanasthanam Kriya as Yogic Relaxation on Biopsychosocial Parameters Prior to Endodontic Therapy: A Cross Sectional Study Design. International journal of yoga, 14(2), 146–151. https://doi.org/10.4103/ijoy.IJOY_133_20

 

Abstract

Background:

The root canal treatment is one of the common dental or endodontic therapies associated with high levels of patient anxiety. Yoga therapy (YT) is reported in medical literature as an effective modality in bringing down anxiety in clinical scenarios; however, the reports of the same for dental settings are fewer. The current study aimed to evaluate the effect of YT on biopsychosocial parameters in patients undergoing root canal therapy.

Materials and Methods:

A cross sectional study was conducted on 50 participants who underwent dental root canal therapy. The sample was divided into two groups: Yoga group (Group A; n = 25) who received YT and control group (Group B; n = 25) who were subjected to self-relaxation during dental procedure. The state of anxiety was measured by a 5-point single-item Likert scale and the cardiovascular (CV) parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR]) and CV indices (pulse pressure [PP], mean arterial pressure [MAP], rate-pressure product [RPP], and double product [DoP]) were derived and compared between both the groups.

Results:

The intergroup comparison showed statistically significant differences in anxiety score (P < 0.001), SBP (P < 0.001), MAP (P < 0.001), RPP (P < 0.001), DoP (P < 0.001), HR (P < 0.029), DBP (P < 0.003), and PP (P < 0.116).

Conclusion:

A significant reduction was recorded in terms of anxiety and primary and derived CV parameters in the yoga group. The YT can be adopted as an interventional tool for anxiety management in patients indicated for dental root canal therapy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8191219/