Bikram Yoga Does Not Affect Cardiovascular Risk Factors with Healthy Participants

April 29, 2017 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“those with a regular yoga practice are likely to adopt a healthy lifestyle, and to experience lower levels of perceived stress and depression than runners or inactive adults.” – B. Grace Bullock

Cardiovascular disease is the number one killer, claiming more lives than all forms of cancer combined. “Heart disease is the leading cause of death for both men and women. About 610,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths. Every year about 735,000 Americans have a heart attack.” (Centers for Disease Control). A myriad of treatments has been developed for heart disease including a variety of surgical procedures and medications. But the safest effective treatments are lifestyle changes. These include quitting smoking, weight reduction, improved diet, physical activity, and reducing stresses. Other safe and effective treatments are contemplative practices, such as meditation, tai chi, and yoga, have also been shown to be helpful for heart health. These practices have also been shown to be helpful for producing the kinds of lifestyle changes needed such as smoking cessation, weight reduction, and stress reduction.

Yoga is a mindfulness practice that has been shown to improve physical well-being and cardiovascular health. Bikram Yoga is somewhat unique yoga practice as it employs a set sequence of 26 poses (asanas) and two breathing exercises. It is practiced in a heated environment (105°F, 40.6°C, 40% humidity) and there is a unique programmed instructional dialogue. The hot environment is thought to soften the muscles making them more pliable and loosen the joints making them more flexible allowing the practitioner to go deeper into poses. The sweating that occurs is thought to help remove toxins and impurities.

In today’s Research News article “Effect of a 16-week Bikram yoga program on heart rate variability and associated cardiovascular disease risk factors in stressed and sedentary adults: A randomized controlled trial.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5399826/

Hewett and colleagues examined the effectiveness of Bikram yoga to alter cardiovascular risk factors. They recruited sedentary, stressed, adults and randomly assigned them to receive either a 16-week, 90 minute, 3 times per week, Bikram Yoga program or a no-treatment control condition. They were measured before and after training for heart rate variability, resting systolic and diastolic blood pressure, and heart rate, c-reactive protein, triglycerides, total cholesterol, low-density- and high-density lipoprotein cholesterol, total cholesterol to HDL ratio, and fasting blood glucose, height, weight, waist circumference, body composition, health status, and attendance at yoga sessions.

Surprisingly, they did not find any significant group differences in any of the measures before or after training. But, when they looked at attendance ay the Bikram Yoga sessions they found that the more sessions attended the greater the decrease in diastolic blood pressure, body fat percentage, fat mass, and body mass index. So, there appeared to be some modest benefits of high levels of attendance to Bikram Yoga sessions.

These are disappointing results. But, the lack of change produced in cardiovascular risk factors by participation in a Bikram Yoga program may have resulted from the fact that the participants were healthy, although sedentary, to begin with. It is possible that significant effects would have been evident if unhealthy participants were examined. On the other hand, it is possible that this form of yoga is simply not an effective means of reducing cardiovascular disease risk in healthy, sedentary individuals.

“Yoga has a powerful effect on stress and hypertension and can help people reduce the amount of medication they need. . . researchers reported significant reductions in blood pressure for interventions incorporating three basic elements of yoga practice: postures, meditation, and breathing. “ – Amy Wheeler

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

Hewett, Z. L., Pumpa, K. L., Smith, C. A., Fahey, P. P., & Cheema, B. S. (2017). Effect of a 16-week Bikram yoga program on heart rate variability and associated cardiovascular disease risk factors in stressed and sedentary adults: A randomized controlled trial. BMC Complementary and Alternative Medicine, 17, 226. http://doi.org/10.1186/s12906-017-1740-1

Abstract

Background

Chronic activation of the stress-response can contribute to cardiovascular disease risk, particularly in sedentary individuals. This study investigated the effect of a Bikram yoga intervention on the high frequency power component of heart rate variability (HRV) and associated cardiovascular disease (CVD) risk factors (i.e. additional domains of HRV, hemodynamic, hematologic, anthropometric and body composition outcome measures) in stressed and sedentary adults.

Methods

Eligible adults were randomized to an experimental group (n = 29) or a no treatment control group (n = 34). Experimental group participants were instructed to attend three to five supervised Bikram yoga classes per week for 16 weeks at local studios. Outcome measures were assessed at baseline (week 0) and completion (week 17).

Results

Sixty-three adults (37.2 ± 10.8 years, 79% women) were included in the intention-to-treat analysis. The experimental group attended 27 ± 18 classes. Analyses of covariance revealed no significant change in the high-frequency component of HRV (p = 0.912, partial η 2 = 0.000) or in any secondary outcome measure between groups over time. However, regression analyses revealed that higher attendance in the experimental group was associated with significant reductions in diastolic blood pressure (p = 0.039; partial η 2 = 0.154), body fat percentage (p = 0.001, partial η 2 = 0.379), fat mass (p = 0.003, partial η 2 = 0.294) and body mass index (p = 0.05, partial η 2 = 0.139).

Conclusions

A 16-week Bikram yoga program did not increase the high frequency power component of HRV or any other CVD risk factors investigated. As revealed by post hoc analyses, low adherence likely contributed to the null effects. Future studies are required to address barriers to adherence to better elucidate the dose-response effects of Bikram yoga practice as a medium to lower stress-related CVD risk.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5399826/

Improve Elderly Blood Pressure and Waist Circumference with Tai Chi

March 28, 2017March 28, 2017 psyjdc Leave a comment

Improve Elderly Blood Pressure and Waist Circumference with Tai Chi

By John M. de Castro, Ph.D.

“For those with limited space, tai chi may be an easier and more convenient than brisk walking as an anti-aging choice. Previous studies have shown tai chi also improves balance and may help boost brain functioning.” – Shinn-Zong Lin

Metabolic Syndrome is a major risk factor for cardiovascular disease and diabetes. It generally results from overweight and abdominal obesity and includes high blood pressure, insulin resistance and elevation of plasma cholesterol and triglycerides. It is an important risk factor as it increases the risk of developing type-2 diabetes five-fold and heart attack or stroke three-fold. Metabolic Syndrome incidence has been rising rapidly and it currently affects 34% of U.S. adults. Needless to say, this is a major health problem. The good news is that timely treatment can prevent or reverse the risk. The simplest treatment is simply exercise and weight loss.

The incidence of metabolic syndrome is much higher in the elderly with 50% of people over 60 years of age suffering from metabolic syndrome. Exercise that is appropriate for younger individuals is often not appropriate for the elderly. Tai Chi is a mindfulness practice and gentle exercise that has been found to be safe and effective for the elderly. Hence, it would seem reasonable to test the effectiveness of Tai Chi for metabolic syndrome in the elderly.

In today’s Research News article “The effects of Tai Chi on waist circumference and blood pressure in the elderly.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300833/

Lee tested the effect of Tai Chi on the blood pressure and waist circumference of the elderly. She recruited sedentary individuals over 65 years of age and randomly assigned them to groups that practiced Tai Chi or a control group that practiced solely the warm up and cool down portions of the program. Tai Chi was practiced for 60 minutes, 5 times per week for 6 weeks. The participants were measured for blood pressure and waist circumference before and after the 6-week practice period.

Lee found that practicing Tai Chi produced a significant reduction in both systolic and diastolic blood pressure and waist circumference in the elderly participants. There were no recorded injuries or adverse effects from the practice. Since metabolic syndrome is associated with excess body fat and high blood pressure, these results suggest that Tai Chi practice may be a safe and effective treatment to reduce the risk of metabolic syndrome in the elderly. Tai Chi has also been shown to improve the elderly mentally and physically including the risk of falls. So, it would seem reasonable to encourage the participation of the elderly in Tai Chi practice for their health and wellbeing.

So, improve elderly blood pressure and waist circumference with Tai Chi.

“Tai chi is often described as “meditation in motion,” but it might well be called “medication in motion.” There is growing evidence that this mind-body practice, which originated in China as a martial art, has value in treating or preventing many health problems. And you can get started even if you aren’t in top shape or the best of health.” – Harvard Women’s Health Watch

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

Lee, Y. M. (2017). The effects of Tai Chi on waist circumference and blood pressure in the elderly. Journal of Physical Therapy Science, 29(1), 172–175. http://doi.org/10.1589/jpts.29.172

Abstract

[Purpose] The purpose of this study was to investigate the effects of Tai Chi on waist circumference and blood pressure in the elderly. The present study used a nonequivalent control group pretest-posttest design. [Subjects and Methods] Sixty-eight elderly individuals residing in J city were divided into 2 groups: 34 in the experimental group, who received Tai Chi training for 6 weeks, and 34 in the control group, who did not receive Tai Chi training. Simplified Yang style 24-form Tai Chi was used as the intervention, which was conducted for 60 minutes per session, 5 sessions per week, for a total of 6 weeks. In each session, subjects in the experimental group conducted 10 minutes of warm-up exercises, 45 minutes of Tai Chi, and 5 minutes of cool-down exercises. Waist circumference and blood pressure were measured before and after the 6-week intervention. [Results] Waist circumference and blood pressure decreased significantly after the 6-week intervention in the experimental group compared with the control group. [Conclusion] Tai Chi can be used as an effective intervention to improve waist circumference and blood pressure in the elderly.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300833/

Improve Heart Failure Patient Longevity with Spirituality

January 22, 2017 psyjdc Leave a comment

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Improve Heart Failure Patient Longevity with Spirituality

By John M. de Castro, Ph.D.

“Although difficult to study, spirituality has been evaluated and deemed to have a beneficial effect on multiple measures including global quality of life, depression and medical compliance in the treatment of patients with heart failure.” – J Naqhi

Cardiovascular disease is the number one killer, claiming more lives than all forms of cancer combined. “Heart disease is the leading cause of death for both men and women. About 610,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths. Every year about 735,000 Americans have a heart attack.” – Centers for Disease Control. Congestive heart failure (CHF) is a major type of cardiovascular disease. “CHF is a chronic progressive condition that affects the pumping power of your heart muscles. While often referred to simply as “heart failure,” CHF specifically refers to the stage in which fluid builds up around the heart and causes it to pump inefficiently” (Healthline).

Congestive heart failure (CHF) is a very serious life-threatening condition. About 5.7 million adults in the United States have congestive heart failure. One in 9 deaths include heart failure as a contributing cause. The seriousness of CHF is underscored by the fact that about half of people who develop CHF die within 5 years of diagnosis. Hence, effective treatment is very important. There is a myriad of treatments that have been developed to treat CHF including a variety of surgical procedures and medications. Importantly, lifestyle changes have proved to be quite effective. These include quitting smoking, weight reduction, improved diet, physical activity, and reducing stresses.

Spirituality, a sense of inner peace and harmony, and religiosity are known to help with a wide range of physical and psychological problems. So, it would make sense to investigate the relationship of spirituality and religiosity to the treatment of congestive heart failure. In today’s Research News article “Spiritual Peace Predicts 5-Year Mortality in Congestive Heart Failure Patient.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1458465060844082/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4760860/.

Park and colleagues recruited a large sample of patients who had experienced congestive heart failure (CHF) of at least moderate severity. They were 64% male and averaged 69 years of age. The researchers measured severity of CHF, other health conditions, smoking, alcohol consumption, engagement in health behaviors, depression, social support, attendance at religious services, and spiritual peace. The patients were followed over a five year period to establish mortality rates.

At the five-year follow-up, almost a third (32%) of the patients had died. They found that age, other health conditions, and depression contributed to mortality. Controlling for these variables they found that smoking nearly tripled the risk of death, while alcohol consumption mildly reduced the risk. Adhering to a healthy lifestyle cut the risk in half and spirituality and engagement in religious practice was associated with greater engagement in healthy lifestyles. Controlling for all of these variables they found that spirituality was associated with a 20% reduction in mortality.

These results suggest that controlling lifestyle is critical for survival after CHF. This includes reducing smoking and increasing healthy lifestyle behaviors. But, in addition to these important factors, spirituality, but not engagement in religious practices, improves longevity. Although spirituality is associated with lifestyle, the analysis suggests that spirituality’s association with improved longevity occurs independently of lifestyle factors. These results have to be interpreted with caution since they are correlative and cannot prove causation. But, the fact that spirituality predicts longevity over a 5-year period after measurement, is compatible with an interpretation that spirituality causally contributes to longevity.

These results suggest that just being religious is not enough. One must be spiritual in order to obtain the longevity benefits. So, it is not enough to just believe in a greater power or attend religious services. Rather, a sense of spiritual peace and harmony is required. To some extent, this makes sense as this would reduce stress which is known to exacerbate disease processes. In addition, spirituality has been shown to improve adherence to treatment regimens for heart failure and this by itself could account for improved longevity. Regardless, the results make it clear that being spiritual can help extend the lives of patients with congestive heart failure (CHF).

So, improve heart failure patient longevity with spirituality.

“We found that more gratitude in these patients was associated with better mood, better sleep, less fatigue and lower levels of inflammatory biomarkers related to cardiac health,” – Paul J. Mills

CMCS – Center for Mindfulness and Contemplative Studies

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

Study Summary

Park, C. L., George, L., Aldwin, C. M., Choun, S., Suresh, D. P., & Bliss, D. (2016). Spiritual Peace Predicts 5-Year Mortality in Congestive Heart Failure Patients. Health Psychology : Official Journal of the Division of Health Psychology, American Psychological Association, 35(3), 203–210. http://doi.org/10.1037/hea0000271

Abstract

Objective: Spirituality is favorably related to depression, quality of life, hospitalizations, and other important outcomes in congestive heart failure (CHF) patients but has not been examined as a predictor of mortality risk in this population. Given the well-known difficulties in managing CHF, we hypothesized that spirituality would be associated with lower mortality risk, controlling for baseline demographics, functional status, health behaviors, and religiousness.

Method: Participants were 191 CHF patients (64% male; Mage = 68.6 years, SD = 10.1) who completed a baseline survey and were then followed for five years.

Results: Nearly one third of the sample (32%) died during the study period. Controlling for demographics and health status, smoking more than doubled the risk of mortality, while alcohol consumption was associated with slightly lower risk of mortality. Importantly, adherence to healthy lifestyle recommendations was associated with halved mortality risk. While both religion and spirituality were associated with better health behaviors at baseline in bivariate analyses, a proportional hazard model showed that only spirituality was significantly associated with reduced mortality risk (by 20%), controlling for demographics, health status, and health behaviors.

Conclusions: Experiencing spiritual peace, along with adherence to a healthy lifestyle, were better predictors of mortality risk in this sample of CHF patients than were physical health indicators such as functional status and comorbidity. Future research might profitably examine the efficacy of attending to spiritual issues along with standard lifestyle interventions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4760860/

Improve Circulation with Tai Chi

January 2, 2017 psyjdc Leave a comment

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By John M. de Castro, Ph.D.

“Tai chi is often described as “meditation in motion,” but it might well be called “medication in motion.” There is growing evidence that this mind-body practice, which originated in China as a martial art, has value in treating or preventing many health problems. And you can get started even if you aren’t in top shape or the best of health.” – Harvard Women’s Health Watch

Arthritis is a chronic disease that most commonly affects the joints. Depending on the type of arthritis, symptoms may include pain, stiffness, swelling, redness, and decreased range of motion. It affects an estimated 52.5 million adults in the United States. It is associated with aging as arthritis occurs in only 7% of adults ages 18–44, while 30% adults ages 45–64 are affected, and 50% of adults ages 65 or older. Due to complications associated with rheumatoid arthritis (RA), the lifespan for people with RA may be shortened by 10 years. This is due to a higher incidence of cardiovascular disease in rheumatoid arthritis (RA) patients, with the risk more than double that of non-RA individuals.

Cardiovascular disease is the number one killer, claiming more lives than all forms of cancer combined. “Heart disease is the leading cause of death for both men and women. About 610,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths. Every year about 735,000 Americans have a heart attack” (Centers for Disease Control). Rheumatoid arthritis is associated with high levels of inflammation and inflammation damages blood vessels. It can lead to hardening of the arteries (arteriosclerosis) which in turn leads to cardiovascular disease. So, there is a need for treatments to reduce inflammation and hardening of the arteries in rheumatoid arthritis (RA) patients.

Contemplative practices have been shown to be helpful for heart health particularly those that are also exercises such as tai chi and yoga. Tai chi is an ancient contemplative practice involving slow motion smooth mindful movement. The reason that it has continued to be practiced by millions for centuries is that it has major mental and physical benefits including a reduction in the inflammatory response. Modern research is verifying these benefits. Mindful movement practice has been shown to improve balance, self-concept, and attention span, reduce falls, boost the immune system and helps to relieve symptoms of arthritis, asthma, Parkinson’s disease, insomnia, even improve cancer recovery, and improve recovery from heart failure. So, it makes sense to further explore the effectiveness of Tai Chi practice for hardening of the arteries in rheumatoid arthritis (RA) patients.

In today’s Research News article “The beneficial effects of Tai Chi exercise on endothelial function and arterial stiffness in elderly women with rheumatoid arthritis.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1440063292684259/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4718020/

Shin and colleagues recruited female rheumatoid arthritis patients (average 64 years old) and randomly assigned them to either receive 3 months of Tai Chi training or education about rheumatoid arthritis, its effects and methods of control. At the end of training they found that, in comparison to the education group, the Tai Chi group had a significant (32%) improvements in the ability of the blood vessels to dilatate in response to blood flows, (6%) reduction in arterial stiffness, and a significant decrease in total cholesterol. They found that the effectiveness of Tai Chi to improve the blood vessels was independent of its effects on cholesterol.

These results are impressive and important. Tai Chi exercise was effective in reducing the hardening of the arteries and blood cholesterol levels that normally are problematic with rheumatoid arthritis. This suggests that Tai Chi practice may reduce the cardiovascular disease which is a potentially fatal consequence of rheumatoid arthritis. Importantly, since rheumatoid arthritis impairs movement, Tai Chi is a very gentle practice, it is safe for a wide range of individuals, including the elderly and patients compromised by other illnesses including rheumatoid arthritis. So, tai chi is an excellent light exercise program that can improve hardening of the arteries and cholesterol levels and potentially reduce the risk of cardiovascular disease and death in rheumatoid arthritis patients.

So, improve circulation with Tai Chi.

CMCS – Center for Mindfulness and Contemplative Studies

“Qi gong and tai chi are relaxing ways to improve your flexibility and balance. Both are great ways to stay active and vital. The gentle, flowing movements are easy on the joints.” – Melinda Ratini

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

Study Summary

Shin, J.-H., Lee, Y., Kim, S. G., Choi, B. Y., Lee, H.-S., & Bang, S.-Y. (2015). The beneficial effects of Tai Chi exercise on endothelial function and arterial stiffness in elderly women with rheumatoid arthritis. Arthritis Research & Therapy, 17, 380. http://doi.org/10.1186/s13075-015-0893-x

Abstract

Background: Rheumatoid arthritis (RA) has been known to be associated with increased risk of cardiovascular disease (CVD). The aim of this study was to investigate the effects of Tai Chi exercise on CVD risk in elderly women with RA.

Method: In total, 56 female patients with RA were assigned to either a Tai Chi exercise group (29 patients) receiving a 3-month exercise intervention once a week or a control group (27 patients) receiving general information about the benefits of exercise. All participants were assessed at baseline and at 3 months for RA disease activity (Disease Activity Score 28 and Routine Assessment of Patient Index Data 3), functional disability (Health Assessment Questionnaire), CVD risk factors (blood pressure, lipids profile, body composition, and smoking), and three atherosclerotic measurements: carotid intima-media thickness, flow-mediated dilatation (FMD), and brachial-ankle pulse wave velocity (baPWV).

Results: FMD, representative of endothelial function, significantly increased in the Tai Chi exercise group (initial 5.85 ± 2.05 versus 3 months 7.75 ± 2.53 %) compared with the control group (initial 6.31 ± 2.12 versus 3 months 5.78 ± 2.13 %) (P = 1.76 × 10−3). Moreover, baPWV, representative of arterial stiffness, significantly decreased in the Tai Chi exercise group (initial 1693.7 ± 348.3 versus 3 months 1600.1 ± 291.0 cm/s) compared with the control group (initial 1740.3 ± 185.3 versus 3 months 1792.8 ± 326.1 cm/s) (P = 1.57 × 10−2). In addition, total cholesterol decreased significantly in the Tai Chi exercise group compared with the control group (−7.8 ± 15.5 versus 2.9 ± 12.2 mg/dl, P = 2.72 × 10−2); other changes in RA-related characteristics were not significantly different between the two groups. Tai Chi exercise remained significantly associated with improved endothelial function (FMD; P = 4.32 × 10−3) and arterial stiffness (baPWV; P = 2.22 × 10−2) after adjustment for improvement in total cholesterol level.

Conclusion: Tai Chi exercise improved endothelial dysfunction and arterial stiffness in elderly women with RA, suggesting that it can be a useful behavioral strategy for CVD prevention in patients with RA.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4718020/

Lower Blood Fat with Tai Chi

December 29, 2016 psyjdc Leave a comment

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By John M. de Castro, Ph.D.

“Tai Chi is a gentle, graceful, inspiring exercise that has been found to reduce blood pressure, improve balance and reduce falls. It also increases overall toning, improves posture and circulation, increases flexibility and strength.” – Nabi Su

Contemplative practices have also been shown to be helpful for heart health particularly those that are also exercises such as tai chi and yoga. Tai chi is an ancient contemplative practice involving slow motion smooth mindful movement. The reason that it has continued to be practiced by millions for centuries is that it has major mental and physical benefits. Modern research is verifying these benefits. Mindful movement practice has been shown to improve balance, self-concept, and attention span, reduce falls, boost the immune system and helps to relieve symptoms of arthritis, asthma, Parkinson’s disease, insomnia, even improve cancer recovery, and improve recovery from heart failure. So, it makes sense to further explore the effectiveness of Tai Chi practice for the control of blood fat levels.

In today’s Research News article “Effect of Tai Chi exercise on blood lipid profiles: a meta-analysis of randomized controlled trials.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1436358716388050/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4980442/

Pan and colleagues summarized the published research literature on the effects of tai chi practice on the levels of fats in the blood of Chinese adults. They found six randomized controlled trials, containing a control condition. Tai chi training ranged from 12 weeks to 12 months, with most between 12-14 weeks of practice. They reported that the literature found that tai chi practice produced a statistically significant decrease in blood fat levels overall and a trend toward a significant reduction in total blood cholesterol levels. But, there were no significant differences for either low-density or high-density lipoproteins.

These are promising results. It should be noted, however, that the majority of studies employed a wait-list control condition that did not contain a systematic exercise program. So, it cannot be determined if the effects on blood fat levels were due to tai chi practice specifically or would have been produced by any exercise program. But, since tai chi is a very gentle practice, it is safe for a wide range of individuals, including the elderly and patients compromised by other illnesses. So, tai chi is an excellent light exercise program that can improve blood fat levels and potentially reduce the risk of cardiovascular disease.

So, lower blood fat with tai chi.

“So, it’s unclear what mechanism of action is responsible for the reduction in blood pressure, cholesterol and depressive symptoms among these folks, but it’s unlikely to be from Chinese exercise alone. A more probable explanation is that these patients adopted other health enhancing behaviors in addition to Chinese exercise such as improving their diet and/or engaging in physical exercises with a comparatively higher cardiac demand.” – American Council on Science and 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

Study Summary

Pan, X., Mahemuti, A., Zhang, X., Wang, Y., Hu, P., Jiang, J., … Wang, J. (2016). Effect of Tai Chi exercise on blood lipid profiles: a meta-analysis of randomized controlled trials. Journal of Zhejiang University. Science. B, 17(8), 640–648. http://doi.org/10.1631/jzus.B1600052

ABSTRACT

Objective: Studies have demonstrated that Tai Chi exercise improves blood lipid level with inconsistent results. A meta-analysis was conducted to quantify the effects of Tai Chi on blood lipid profiles in humans. Methods: We screened the databases of PubMed, EMBASE, Cochrane Library (Central), Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang data, and Clinicaltrials.gov for randomized controlled trials with Physiotherapy Evidence Database (PEDro) score more than 3 points up to June 2015. Six studies involving 445 subjects were included. Most trials applied 12-week Tai Chi intervention courses. Results: In comparison with the control group, blood triglyceride (TG) level difference between follow-up and baseline was statistically significantly lower in the Tai Chi practicing group (weighted mean difference (WMD) −16.81 mg/dl; 95% confidence intervals (CI) −31.27 to −2.35 mg/dl; P=0.02). A trend to improving total cholesterol (TC) reduction was found with Tai Chi (WMD −7.96 mg/dl; 95% CI −17.30 to 1.39 mg/dl; P=0.10). However, no difference was found in blood low-density lipoprotein cholesterol (LDL-C) or high-density lipoprotein cholesterol (HDL-C). Conclusions: Tai Chi exercise lowered blood TG level with a trend to decrease blood TC level. Our data suggest that Tai Chi has the potential to implement meaningful blood lipid modification and serve as an adjunctive exercise modality. The relationship between Tai Chi exercise regimen and lipid profile change might have a scientific priority for future investigation.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4980442/

Chill Cardiac Patients with Mindfulness

November 23, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“For people with cardiovascular disease, meditation provides a technique for reducing stress and focusing on things they can do to be healthier. Meditation is a way of allowing you to come to balance in your life. It can also help you to sleep better, which is a very important restorative part of physical health.” – Richard Stein

Cardiovascular disease is the number one killer, claiming more lives than all forms of cancer combined. “Heart disease is the leading cause of death for both men and women. About 610,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths. Every year about 735,000 Americans have a heart attack.” (Centers for Disease Control). A myriad of treatments has been developed for heart disease 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. Stress reduction is a key lifestyle change in treating heart conditions as stress can lead to increased physiological arousal including increased blood pressure that can exacerbate the patient’s condition

Contemplative practices, such as meditation, tai chi, and yoga, have also been shown to be helpful for heart health. In addition, mindfulness practices have also been shown to be helpful for producing the kinds of other lifestyle changes needed such as smoking cessation and weight reduction. They are particularly helpful for stress reduction, decreasing the psychological and physiological responses to stress. So, it would make sense to investigate the effectiveness of mindfulness practices in the treatment of cardiac patients.

In today’s Research News article “The effects of mindfulness-based stress reduction on cardiac patients’ blood pressure, perceived stress, and anger: a single-blind randomized controlled trial.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1389925544364701/?type=3&theater

or see summary below. Momeni and colleagues recruited cardiac patients who were also hypertensive and randomly assigned them to either receive an 8-week Mindfulness-Based Stress Reduction (MBSR) program or to a wait list control condition. The MBSR program included mindful body scan, sitting meditation, walking meditation, and yoga. All of the patients were also receiving antihypertensive medications. They were measured both before and after treatment for blood pressure, perceived stress, and state and trait anxiety.

They found that MBSR training resulted in a significant decrease (12%) in systolic blood pressure, but not diastolic blood pressure, a 45% decrease in perceived stress, a 47% decrease in state anxiety, and a 31% decrease in trait anxiety. Thus, MBSR training was highly effective in reducing blood pressure, stress, and anxiety levels in cardiac patients. The magnitude of the effects large and clinically significant. Hence, they found that MBSR training was a safe and effective treatment for improving the physical and psychological conditions of cardiac patients. This is very important as it may be life saving.

So, chill cardiac patients with mindfulness.

“People who are more mindful tend to have more awareness of where their mind and bodies are at. By increasing our awareness, we might become more aware of the impact of what we are doing on ourselves.” – Eric Loucks

CMCS – Center for Mindfulness and Contemplative Studies

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

Study Summary

Momeni J, Omidi A, Raygan F, Akbari H. The effects of mindfulness-based stress reduction on cardiac patients’ blood pressure, perceived stress, and anger: a single-blind randomized controlled trial. J Am Soc Hypertens. 2016 Aug 4. pii: S1933-1711(16)30448-X. doi: 10.1016/j.jash.2016.07.007.

Abstract

This study aimed at assessing the effects of mindfulness-based stress reduction (MBSR) on cardiac patients’ blood pressure (BP), perceived stress, and anger. In total, 60 cardiac patients were recruited between April and June 2015 from a specialized private cardiac clinic located in Kashan, Iran. Patients were allocated to the intervention and control groups. Patients in the experimental group received MBSR in eight 2.5-hour sessions, while patients in the control group received no psychological therapy. The main outcomes were BP, perceived stress, and anger. Analysis of covariance revealed a significant difference between the study groups regarding the posttest values of systolic BP, perceived stress, and anger (P < .001). However, the study groups did not differ significantly in terms of diastolic BP (P = .061; P = .17). This study reveals that MBSR is effective in reducing cardiac patients’ systolic BP, perceived stress, and anger.

Tai Chi for Physical and Psychological Health after Heart Failure

October 21, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“A growing body of carefully conducted research is building a compelling case for tai chi as an adjunct to standard medical treatment for the prevention and rehabilitation of many conditions commonly associated with age.” – Peter M. Wayne

Contemplative practices, such as tai chi and yoga, have also been shown to be helpful for heart health. In addition, mindfulness practices have also been shown to be helpful for producing the kinds of other lifestyle changes needed such as smoking cessation, weight reduction, and stress reduction. Tai Chi is an ancient practice involving slow motion smooth mindful movement. The reason that it has continued to be practiced by millions for centuries is that it has major mental and physical benefits. Modern research is verifying these benefits. Mindful movement practice has been shown to improve balance, self-concept, and attention span, reduce falls, boost the immune system and helps to relieve symptoms of arthritis, asthma, Parkinson’s disease, insomnia, even improve cancer recovery, and improve recovery from heart failure.

In today’s Research News article “The Impact of Tai Chi Exercise on Self-Efficacy, Social Support, and Empowerment in Heart Failure: Insights from a Qualitative Sub-Study from a Randomized Controlled Trial.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1356134834410439/?type=3&theater

or see summary below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866692/

Yeh and colleagues randomly selected and interviewed a sample of participants from a previous successful trial of tai chi for heart failure. This trial demonstrated that tai chi produced significant improvements in quality of life, exercise self-efficacy, and mood in the patients. In the prior trial patients were randomly assigned to receive either a 12-week tai chi intervention consisting of one-hour group classes held twice weekly, or an attention control group which attended education sessions twice weekly. At the end of treatment, a sub-sample of the participants were audio recorded answering a semi-structured interview on their heart condition and its impact on their lives, how the program helped them, and any negative effects. Themes were then classified using grounded-theory methods.

They found that both groups described improved self-efficacy to perform specific health behaviors and improved social support. In addition, the tai chi group described more global empowerment and perceived control of their health, a heightened or new sense of mindful awareness, greater calmness and less stress, greater reengagement in social activities, and improved strength, energy, flexibility, balance, decreased pain and stiffness, and overall endurance.

These qualitative findings support and extend the positive quantitative findings from the prior study and suggest that tai chi practice has many important benefits beyond the crucial health benefits. The tai chi participants felt more empowered, aware, and socially connected. These are important benefits that help the patient to feel in greater control of their lives and health and improve their quality of life. Since tai chi is a safe and gentle exercise with so many positive effects on heart failure patients, it should be strongly considered as part of the treatment for heart failure.

So, use tai chi for physical and psychological health after heart failure.

“patients with heart disease can benefit from traditional Chinese exercises. Not only may these exercises boost outcomes, they promote a better quality of life in patients with heart disease. As experts highlight, they’re generally safe for all ages and fitness levels. Exercises like tai chi require no special equipment and can be performed anywhere, including outside or indoors. So for patients who are unable to do more vigorous forms of exercise, traditional Chinese exercises may be a good option to promote better health.” – CardioSmart

CMCS – Center for Mindfulness and Contemplative Studies

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

Study Summary

Yeh, G. Y., Chan, C. W., Wayne, P. M., & Conboy, L. (2016). The Impact of Tai Chi Exercise on Self-Efficacy, Social Support, and Empowerment in Heart Failure: Insights from a Qualitative Sub-Study from a Randomized Controlled Trial. PLoS ONE, 11(5), e0154678. http://doi.org/10.1371/journal.pone.0154678

bstract

Objective: To qualitatively explore perceived physical and psychosocial effects and overall patient experience associated with a 12-week tai chi (TC) intervention and an education group in a clinical trial of patients with chronic heart failure (HF).

Subjects and Methods: We randomized 100 patients with chronic systolic HF (NYHA Class 1–3, ejection fraction≤40%) to a 12-week group TC program or an education control. At 12-weeks, semi-structured interviews were conducted on a random subset (n = 32; n = 17 in TC, n = 15 in control), audiorecorded and transcribed verbatim. Two independent reviewers extracted information using grounded-theory methods for emergent themes. We explored similarities and differences in themes/sub-themes between the groups, and examined qualitative association with changes from baseline to post-intervention in previously reported quantitative measures (e.g., Minnesota Living with HF, Cardiac Exercise Self Efficacy and Profile of Mood States).

Results: The mean age (±SD) of participants was 68±9 years, baseline ejection fraction 29±7%, and median New York Heart Association class 2 HF. We idenitifed themes related to the patient’s experience of illness, perceptions of self, and relationship to others. Specific psychosocial and physical benefits were described. Common themes emerged from both groups including: social support and self-efficacy related to activity/exercise and diet. The tai chi group, however, also exhibited a more global empowerment and perceived control. Additional themes in TC included mindfulness/self-awareness, decreased stress reactivity, and renewed social role. These themes mirrored improvements in previously reported quantitative measures (quality-of-life, self-efficacy, and mood) in TC compared to control. Patients in TC also reported physical benefits (e.g., decreased pain, improved energy, endurance, flexibility).

Conclusion: Positive themes emerged from both groups, although there were qualitative differences in concepts of self-efficacy and perceived control between groups. Those in tai chi reported not only self efficacy and social support, but overall empowerment with additional gains such as internal locus of control, self-awareness and stress management. Future studies of mind-body exercise might further examine perceived control, self-efficacy, and locus-of-control as potential mediators of effect.

Improve Heart Failure Treatment Adherence with Spirituality

September 25, 2016 psyjdc 1 Comment

By John M. de Castro, Ph.D.

“Given the mechanism by which we think religion/spirituality influences physical health, i.e., through psychosocial and behavioral pathways, and the strong influence that psychosocial and behavioral factors have on risk of developing cardiovascular disease, there is no medical condition that R/S is more likely to influence than CVD.” – Fernando A. Lucchese

A myriad of treatments has been developed for heart disease 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. Contemplative practices, such as meditation, tai chi, and yoga, have also been shown to be helpful for heart health. In addition, mindfulness practices have also been shown to be helpful for producing the kinds of other lifestyle changes needed such as smoking cessation, weight reduction, and stress reduction. Mindfulness has also been shown to be linked to spirituality and

Spirituality and religiosity are known to help with a wide range of physical and psychological problems. So, it would make sense to investigate the relationship of spirituality and religiosity to recovery from heart failure.

In today’s Research News article “Association between Spirituality and Adherence to Management in Outpatients with Heart Failure.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1332516243438965/?type=3&theater

or see summary below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940148/

Alvarez and colleagues measured adherence to therapy, quality of life, depression, religiosity and spirituality in adult patients with heart failure. They found that there were significant relationships between spirituality and adherence to pharmacologic and non-pharmacologic therapy, such that the higher the spirituality of the patient the greater the adherence. This was true for all of the spirituality subscales including spiritual connection, meaning of life, awe and wonder, wholeness & integration, spiritual strength, inner peace, hope & optimism and faith and was also true for intrinsic religiosity but not overall religiosity. They also found that the higher the levels of spirituality the higher the quality of life, both overall and disease specific, and the lower the depression.

It should be pointed out that these results are correlational and as such causation cannot be concluded. It could be that the kinds of people who tend to adhere to medical recommendations are also the kinds of people who pursue spirituality. It will take a study where spirituality is manipulated to establish a causal connection.

These findings indicate that spirituality has very positive relationships with adherence and quality of life and negative relationship to depression in heart failure patients. Adherence is particularly significant. One of the biggest challenges in all of medicine is to get patients to actually take the prescribed medications, perform the recommended life style changes, and participate in the prescribed therapy sessions. So, increasing adherence is very important for increasing the likelihood of patients getting the full benefit of their medical recommendations. For heart failure patients this could literally be the difference between life and death. These findings, like many others, point to the importance of spirituality and intrinsic religiosity, but not simple participation in religion, in the health and well-being of the individual.

So, improve heart failure treatment adherence with spirituality.

“the link between improved health and spiritual wellbeing was at least partially explained by the role gratitude plays in spirituality. It seems that a more grateful heart is indeed a more healthy heart. Gratitude journaling is an easy way to support cardiac health.” – Paul Mills

CMCS – Center for Mindfulness and Contemplative Studies

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

Study Summary

Alvarez, J. S., Goldraich, L. A., Nunes, A. H., Zandavalli, M. C. B., Zandavalli, R. B., Belli, K. C., … Clausell, N. (2016). Association between Spirituality and Adherence to Management in Outpatients with Heart Failure. Arquivos Brasileiros de Cardiologia, 106(6), 491–501. http://doi.org/10.5935/abc.20160076

Abstract

Background: Spirituality may influence how patients cope with their illness.

Objectives: We assessed whether spirituality may influence adherence to management of outpatients with heart failure.

Methods: Cross sectional study enrolling consecutive ambulatory heart failure patients in whom adherence to multidisciplinary treatment was evaluated. Patients were assessed for quality of life, depression, religiosity and spirituality utilizing validated questionnaires. Correlations between adherence and psychosocial variables of interest were obtained. Logistic regression models explored independent predictors of adherence.

Results: One hundred and thirty patients (age 60 ± 13 years; 67% male) were interviewed. Adequate adherence score was observed in 38.5% of the patients. Neither depression nor religiosity was correlated to adherence, when assessed separately. Interestingly, spirituality, when assessed by both total score sum (r = 0.26; p = 0.003) and by all specific domains, was positively correlated to adherence. Finally, the combination of spirituality, religiosity and personal beliefs was an independent predictor of adherence when adjusted for demographics, clinical characteristics and psychosocial instruments.

Conclusion: Spirituality, religiosity and personal beliefs were the only variables consistently associated with compliance to medication in a cohort of outpatients with heart failure. Our data suggest that adequately addressing these aspects on patient’s care may lead to an improvement in adherence patterns in the complex heart failure management.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940148/

Improve Arthritis with Tai Chi

August 18, 2016 psyjdc 2 Comments

By John M. de Castro, Ph.D.

“With its integrative approach that strengthens the body while focusing the mind, tai chi addresses a range of physical and mental health issues—including bone strength, joint stability, cardiovascular health, immunity, and emotional well-being.” – Stephanie Watson

Arthritis is a chronic disease that most commonly affects the joints. Depending on the type of arthritis symptoms may include pain, stiffness, swelling, redness, and decreased range of motion. It affects an estimated 52.5 million adults in the United States. It is associated with aging as arthritis occurs in only 7% of adults ages 18–44, while 30% adults ages 45–64 are affected, and 50% of adults ages 65 or older. The pain, stiffness, and lack of mobility associate with arthritis produce fatigue and markedly reduce the quality of life of the sufferers. Arthritis can have very negative psychological effects diminishing the individual’s self-image and may lead to depression, isolation, and withdrawal from friends and social activities Arthritis reduces the individual’s ability to function at work and may require modifications of work activities which can lead to financial difficulties. It even affects the individual’s physical appearance. In addition, due to complications associated with rheumatoid arthritis, particularly cardiovascular disease, the lifespan for people with rheumatoid arthritis may be shortened by 10 years.

It is obvious that there is a need for a safe and effective treatment to help rheumatoid arthritis sufferers cope with the disease and its consequences. Increasing exercise has been shown to increase flexibility and mobility but many form of exercise are difficult for the arthritis sufferer to engage in and many drop out. But all that may be needed is gentle movements of the joints. Tai Chi training is designed to enhance and regulate the functional activities of the body through regulated breathing, mindful concentration, and gentle movements. It has been shown to have many physical and psychological benefits, especially for the elderly. 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 treat arthritis in seniors.

In today’s Research News article “The beneficial effects of Tai Chi exercise on endothelial function and arterial stiffness in elderly women with rheumatoid arthritis.” See

summary below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4718020/

Shin and colleagues examine the effectiveness of tai chi practice to help alleviate some of the cardiovascular symptoms of rheumatoid arthritis. They recruited elderly (over 50 years of age) women with rheumatoid arthritis and assigned them to two groups, a tai chi and an exercise information group. The tai chi participants engaged in a group tai chi exercise once a week for 60 min for 3 months at the hospital gymnasium. Measurements were taken before and after the 3-month practice period of rheumatoid arthritis symptoms and cardiovascular function. They found that the tai chi group had a significant decrease in plasma cholesterol and measures of atherosclerosis including significant decreases in arterial stiffness and flow mediated dilatation. Both of these measures are associated with the beginnings of cardiovascular disease.

These findings suggest that tai chi practice is beneficial in reducing cardiovascular risk factors associated with rheumatoid arthritis. These risk factors are likely due to the sedentary lifestyle of most rheumatoid arthritis sufferers and the gentle exercise of tai chi appears to be sufficient to begin to reverse some of these risk factors. This is very significant as cardiovascular disease associated with rheumatoid arthritis is serious and can lead to premature death. Since tai chi is safe and appropriate for seniors, it would appear to be an excellent treatment to reduce the cardiovascular disease risks associated with rheumatoid arthritis in the elderly.

So, improve arthritis 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

Study Summary

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4718020/

Improve Mind-Body Connection with Mindfulness

March 17, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“It is fascinating to see the brain’s plasticity and that, by practicing meditation, we can play an active role in changing the brain and can increase our well-being and quality of life.” – Sarah Lazar

The mind and body are intrinsically intertwined. The old distinction between mind and body has been shown to be a false distinction. The brain, the organ of the mind, also controls the physiology, while the activity of the physiology affects the brain. So, mind and body are interconnected. Hence, mind practices should also affect the physiology just as physiological changes affect the mind.

Contemplative practices have been shown to influence both the mind, brain, and the physiology. Among the many physiological effects of contemplative practices are alterations of the cardiovascular system, producing reductions in heart rate, heart rate variability, and blood pressure. Contemplative practices have also been shown to alter the nervous system changing the size, activity, and connectivity of brain structures. These changes can be measured in many ways, but a convenient and inexpensive non-invasive method to document changes in brain activity is by recording the electrical activity of the nervous system from the scalp, known as the electroencephalograph or EEG. Indeed, the changes in brain activity produced by contemplative practices can be seen in the EEG.

Mindfulness Based Stress Reduction (MBSR) was one of the first contemplative practices to be applied to improving human well-being. It is an amalgam of practices, including meditation, yoga, and body scan. It has been shown to be beneficial for cardiovascular function and to change neural activity. One way to look at the integration of mind-body activity is to measure the relationship between brain activity and cardiovascular activity over time. In today’s Research News article “Entrainment of chaotic activities in brain and heart during MBSR meditation”

Harvard neuroscientist: Meditation not only reduces stress, here’s how it changes your brain

https://www.washingtonpost.com/news/inspired-life/wp/2015/05/26/harvard-neuroscientist-meditation-not-only-reduces-stress-it-literally-changes-your-brain/

Gao and colleagues investigated the effects of an 8-week Mindfulness Based Stress Reduction (MBSR) training program on the coordination of electrical activity from the nervous system (EEG) with the electrical activity from the heart (Electrocardiogram, ECG). The EEG and ECG were recorded during 10-minutes of mindful breathing both before and after MBSR training.

They measured the chaotic nature of the activity in both the EEG and ECG employing a measure of wavelet entropy. This measure documents the unpredictability and random nature of the signals. They found that after MBSR training there was a reduction in the entropy of both the brain waves, EEG, and the heart electrical activity, ECG. This demonstrates that MBSR training results in reduced variability and randomness of the electrical activities of both the heart and brain. Significantly, they found that the entropy of the EEG and EKG were highly correlated as a result of MBSR training. That is, the lower the entropy of the EEG, the lower the entropy of that ECG. In other words, as the brain activity became less chaotic, so did the activity of the heart. They were coordinated.

One way that Mindfulness Based Stress Reduction (MBSR) training might produce these effects on the level of entropy and its coordination of the heart and brain activities is by its effects on the autonomic nervous system. This system has two roughly opposing systems, the sympathetic and parasympathetic nervous systems. Sympathetic activation tends in activate the heart and brain while parasympathetic activity tends to reduce activation of both. If these two systems oppose one another instead of acting in a coordinated fashion, then greater variability of the EEG and ECG would be expected. MBSR has been shown to reduce the activity of the sympathetic nervous system both centrally and peripherally and increase parasympathetic activity. The current results, then, could well have occurred by MBSR producing better coordination of the balance of sympathetic and parasympathetic activity.

Mindfulness Based Stress Reduction (MBSR) appears to improve the coordination between the mind and body. This is emphasized in the body scan and yoga components of MBSR where attention to sensations from the body is emphasized. It is also emphasized during meditation as a result of learning to attend to the sensations associated with breathing. So, MBSR would seem well suited to increasing the coordination of mind and body. Today’s Research News results support this idea.

So, improve mind-body connection with mindfulness.

“We can intentionally shape the direction of plasticity changes in our brain. By focusing on wholesome thoughts, for example, and directing our intentions in those ways, we can potentially influence the plasticity of our brains and shape them in ways that can be beneficial.” – Richie Davidson

CMCS – Center for Mindfulness and Contemplative Studies