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

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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

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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 Weight Loss with Yoga Practice

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Improve Weight Loss with Yoga Practice

 

By John M. de Castro, Ph.D.

 

“Yoga may be a promising way to help with behavioral change, weight loss, and maintenance by burning calories, heightening mindfulness, and reducing stress.” – Emily Cronkleton

 

Overweight and obesity is epidemic in the modern world. Despite copious research and a myriad of dietary and exercise programs, there still is no safe and effective weight loss method. Mindfulness is known to be associated with lower risk for obesity, alter eating behavior and improve health in obesity. This suggests that mindfulness training may be an effective treatment for overweight alone or in combination with other therapies. Yoga is both an exercise and a mindfulness practice that has been shown to have a myriad of physical and psychological benefits. These include significant loss in weight and body mass index (BMI), resting metabolism, and body fat.

 

In today’s Research News article “A preliminary investigation of yoga as an intervention approach for improving long-term weight loss: A randomized trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8815874/ ) Unick and colleagues recruited overweight and obese adult women and had them complete a 12-week behavioral weight loss program including reduced caloric intake and increased exercise and weekly 1-hour group eating behavior therapy meetings. They then randomly assigned them to receive 12 weeks of twice weekly 1-hour classes of either yoga or culinary and nutrition classes. The women were measured before treatment, after the weight loss treatment (3 months), and after yoga or control treatment (6 months) for body size, physical activity, mindfulness perceived stress, distress tolerance, positive and negative emotions, and self-compassion.

 

The women lost on average 6.4 kg of weight over the behavioral weight loss treatment. They found that among the women with high weight loss (>5% body weight) after the 3-month yoga or control period those that practiced yoga had a significantly greater average weight loss, 9.0 kg, compared to controls, 6.7 kg and had significantly greater increases in mindfulness, distress tolerance, and self-compassion and significantly greater decreases in negative emotions and perceived stress.

 

The findings show that for overweight and obese women who had significant weight losses, as a result of a behavioral weight reduction program, those that practiced yoga during the succeeding 3 months lost more weight than controls. This suggests that practicing yoga after weight loss treatment produces greater further reductions in weight and improved psychological well-being.

 

So, yoga assists in long-term weight loss after a dietary program and improves psychological well-being.

 

“Yoga, if done right, becomes a lifestyle change, which in turn can help increase physical activity and decrease emotional eating. And it can help you manage stress, which can also help with weight maintenance.” – Judi Barr

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Unick, J. L., Dunsiger, S. I., Bock, B. C., Sherman, S. A., Braun, T. D., & Wing, R. R. (2022). A preliminary investigation of yoga as an intervention approach for improving long-term weight loss: A randomized trial. PloS one, 17(2), e0263405. https://doi.org/10.1371/journal.pone.0263405

 

Abstract

Objective

Yoga targets psychological processes which may be important for long-term weight loss (WL). This study is the first to examine the feasibility, acceptability, and preliminary efficacy of yoga within a weight management program following WL treatment.

Methods

60 women with overweight or obesity (34.3±3.9 kg/m2, 48.1±10.1 years) were randomized to receive a 12-week yoga intervention (2x/week; YOGA) or a structurally equivalent control (cooking/nutrition classes; CON), following a 3-month behavioral WL program. Feasibility (attendance, adherence, retention) and acceptability (program satisfaction ratings) were assessed. Treatment groups were compared on weight change, mindfulness, distress tolerance, stress, affect, and self-compassion at 6 months. Initial WL (3-mo WL) was evaluated as a potential moderator.

Results

Attendance, retention, and program satisfaction ratings of yoga were high. Treatment groups did not differ on WL or psychological constructs (with exception of one mindfulness subscale) at 6 months. However, among those with high initial WL (≥5%), YOGA lost significantly more weight (-9.0kg vs. -6.7kg) at 6 months and resulted in greater distress tolerance, mindfulness, and self-compassion and lower negative affect, compared to CON.

Conclusions

Study findings provide preliminary support for yoga as a potential strategy for improving long-term WL among those losing ≥5% in standard behavioral treatment.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8815874/

 

Improve Health in Unhealthy People with Yoga

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Improve Health in Unhealthy People with Yoga

 

By John M. de Castro, Ph.D.

 

“Incorporating [yoga] into your routine can help enhance your health, increase strength and flexibility and reduce symptoms of stress, depression and anxiety. Finding the time to practice yoga just a few times per week may be enough to make a noticeable difference when it comes to your health.” – Rachel Link

 

Yoga practice has been shown to have a myriad of benefits for psychological and physical health, social, and spiritual well-being. It is both an exercise and a mind-body practice which stresses both mental attention to present moment movements, breath control, and flexibility, range of motion, and balance. But beginning yoga practice has risks and adverse events are known to occur. These can be particularly problematic for people who are not in the best of health. So, it is important to examine the risks and benefits of beginning yoga practice for people in a variety of health conditions.

 

In today’s Research News article “Health-related benefits and adverse events associated with yoga classes among participants that are healthy, in poor health, or with chronic diseases.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8499562/ ) Oka and colleagues recruited first time participants in 3-month, once a week for 60-90 minutes yoga classes. They were separated into 3 groups: healthy, poor health (some somatic or psychological complaints but no medication), and chronic disease (on medication). Before and after the class they completed measures of mood, perceived stress, quality of life, subjective symptoms, satisfaction with the yoga class, and adverse events defined as “undesirable symptoms or responses that occurred during a yoga class”.

 

They found that from the beginning to the end of both the first and last yoga class there was a significant reduction in fatigue and tension-anxiety and increase in vigor in all groups. Over the 3-months of practice there was a significant reduction in perceived stress, subjective symptoms, and increase in health-related quality of life in the poor health and chronic disease groups. Perceived stress in the unhealthy groups reached the level of the healthy group at the end of training. Relatively mild adverse events were reported in all groups but more so in the unhealthy groups. But the symptoms were mild and did not stop participation inn the class in which they occurred.

 

Previous research with varied groups has shown that yoga training results in reduced fatigue and tension-anxiety and increased vigor. So, these findings were not surprising in the present study. The interesting findings here was that participants in ill health benefited more than healthy participants in reduced perceived stress and subjective symptoms and increased health-related quality of life. This suggests that yoga practice is particularly beneficial for individuals who have current somatic symptoms or who have chronic diseases.

 

Yoga practice appears to be beneficial for the psychological and physical well-being of everyone but is particularly beneficial for those who have current or chronic health issues. Although adverse symptoms produced by participation in yoga classes are common and occur more frequently in people with health problems. they tend to be mild, not stopping participation in the classes in which they occurred. So, for everyone the benefits of yoga practice appear to outweigh the costs.

 

So, improve health in unhealthy people with yoga.

 

“there’s also a growing body of science showing that a regular yoga practice may benefit people with a host of chronic health conditions, including asthma, heart disease, and MS.” – Wyatt Meyers

 

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

 

Oka, T., & Lkhagvasuren, B. (2021). Health-related benefits and adverse events associated with yoga classes among participants that are healthy, in poor health, or with chronic diseases.

BioPsychoSocial medicine, 15(1), 17. https://doi.org/10.1186/s13030-021-00216-z

 

Abstract

Background

Our previous study demonstrated that 42% of yoga class participants in Japan had chronic diseases requiring medication. This raises the question as to whether those with chronic diseases would benefit from practicing yoga or if they are at higher risk for specific adverse events compared to healthy individuals receiving the same instruction.

Methods

To address these questions, 328 adults who started practicing yoga for the first time were asked to complete the Profile of Mood States (POMS), Perceived Stress Scale (PSS), and Medical Outcomes Study Short Form 8, standard version (SF-8™) and to record any adverse events on the first day of the yoga class and again three months later. The participants consisted of three groups: a healthy (H) group (n = 70), a poor health (PH) group (n = 117), and a chronic disease (CD) group (n = 141). The degree of subjective symptoms was also compared between the pre- and post-intervention period in the PH and CD groups.

Results

Typically, yoga classes were held once a week for 60–90 min. The programs included asanas, pranayamas, meditation, isometric yoga, and sukshma vyayama. In the PH and CD groups, the POMS tension-anxiety and fatigue scores decreased and the vigor score increased significantly after the first class. Furthermore, PSS scores decreased and the SF-8™ scores increased significantly three months later. The degree of subjective symptoms such as easy fatigability, shoulder stiffness, and insomnia also decreased over three months. Individuals in these groups experienced more frequent adverse events than those in the H group. The PH and CD groups also experienced a greater variety of symptoms, including psychological ones, not reported by the H group. Adverse events were not so serious that participants stopped practicing yoga during the class. About 60% of all participants were highly satisfied with participating in yoga classes.

Conclusions

If yoga classes are conducted with attention to possible adverse events, yoga practice in a yoga studio may have beneficial effects for people with functional somatic symptoms and chronic diseases, as well as healthy participants. These benefits include reductions in perceived stress and uncomfortable symptoms as well as improved mood and quality of life.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8499562/

 

Improve Eating Disorders with Dialectical Behavior Therapy

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Improve Eating Disorders with Dialectical Behavior Therapy

 

By John M. de Castro, Ph.D.

 

“Dialectical behavioral therapy encourages change but also promotes acceptance. The term dialectic means that two opposite ideas can be correct at the same time. This is helpful for individuals in eating disorder treatment as most of these clients adopt an “all or nothing view”. The dialectical view appeals to many as they navigate recovery; they can accept their difficulties and work towards changing them.” – Discovery

 

Around 30 million people in the United States of all ages and genders suffer from an eating disorder: either anorexia nervosa, bulimia, or binge eating disorder. 95% of those who have eating disorders are between the ages of 12 and 26. Eating disorders are not just troubling psychological problems, they can be deadly, having the highest mortality rate of any mental illness. Binge eating disorder involves eating a large amount of food within a short time-period while experiencing a sense of loss of control over eating.

 

Eating disorders can be difficult to treat because eating is necessary and cannot be simply stopped as in smoking cessation or abstaining from drugs or alcohol. One must learn to eat appropriately not stop. So, it is important to find methods that can help prevent and treat eating disorders. Contemplative practices, mindfulness, and mindful eating have shown promise for treating eating disorders. Dialectical Behavior Therapy (DBT) produces behavior change by focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings, and behaviors. In DBT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness. It is likely, then that DBT is effective in treating eating sidorders.

 

There is accumulating evidence of the effectiveness of Dialectical Behavior Therapy (DBT) for the treatment of eating disorders. So, it makes sense to review what has been learned. 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/PMC8470932/ ) Rozakou-Soumalia and colleagues review, summarize, and perform a meta-analysis of the published controlled research studies of the effectiveness of DBT in the treatment of eating disorders.

 

They identified 11 published studies, 10 of which were randomized controlled trials. They report that the published research found that Dialectical Behavior Therapy (DBT) produced a significant increase in emotion regulation and a significant decrease in depression, body mass index, and the severity of eating disorders symptoms, including binge eating episodes.

 

These findings of the published research suggest that Dialectical Behavior Therapy (DBT) is an effective treatment for eating disorders, reducing the severity of the symptoms. A core issue for patients with eating disorders is an inability to effectively deal with their emotions. The findings suggest that one way that DBT improves eating disorders is by increasing the patient’s ability to effectively regulate their emotions. Mindfulness training, which is contained in DBT has been shown in a wide range of research studies to improve emotion regulation and this may be the mechanism by which DBT improves eating disorders.

 

So, improve eating disorders with Dialectical Behavior Therapy.

 

“DBT techniques equip eating disorder sufferers with methods for identifying triggers and improving responses to stress, (such as engaging in breathing and relaxation exercises), and applying mindful eating.” – Eating Disorders Hope

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Rozakou-Soumalia, N., Dârvariu, Ş., & Sjögren, J. M. (2021). Dialectical Behaviour Therapy Improves Emotion Dysregulation Mainly in Binge Eating Disorder and Bulimia Nervosa: A Systematic Review and Meta-Analysis. Journal of Personalized Medicine, 11(9), 931. https://doi.org/10.3390/jpm11090931

 

Abstract

Emotion dysregulation is a transdiagnostic phenomenon in Eating Disorders (ED), and Dialectical Behaviour Therapy (DBT) (which was developed for reducing dysregulated emotions in personality disorders) has been employed in patients with ED. This systematic review and meta-analysis investigated whether the effect of DBT was stronger on emotion dysregulation, general psychopathology, and Body Mass Index (BMI) in participants with ED, when compared to a control group (active therapy and waitlist). Eleven studies were identified in a systematic search in accordance with PRISMA guidelines. Most studies included participants with Binge Eating Disorder (BED) (n = 8), some with Bulimia Nervosa (BN) (n = 3), and only one with Anorexia Nervosa (AN). The pooled effect of DBT indicated a greater improvement in Emotion Regulation (ER) (g = −0.69, p = 0.01), depressive symptoms (g = −0.33, p < 0.00001), ED psychopathology (MD = −0.90, p = 0.005), Objective Binge Episodes (OBE) (MD = −0.27, p = 0.003), and BMI (MD = −1.93, p = 0.01) compared to the control group. No improvement was detected in eating ER following DBT (p = 0.41). DBT demonstrated greater efficacy compared with the control group in improving emotion dysregulation, ED psychopathology, and BMI in ED. The limitations included the small number of studies and high variability.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470932/

 

Reduce Body Mass and Improve Body Composition in the Overweight Young Women with Yoga

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Reduce Body Mass and Improve Body Composition in the Overweight Young Women with Yoga

 

By John M. de Castro, Ph.D.

 

“The purpose of exercise interventions should be to help youth with obesity find alternatives that increase their engagement with activity, and thus lead to more sustainable changes in lifestyle. Yoga practice is an excellent example of how to use more nontraditional approaches to engage students with exercise.” – Sarah Shultz

 

Obesity has become an epidemic in the industrialized world. In the U.S. the incidence of obesity, defined as a Body Mass Index (BMI) of 30 or above has more than doubled over the last 35 years to currently around 35% of the population, while two thirds of the population are considered overweight or obese (BMI > 25). Sadly, children and adolescents have not been spared with 1 in 5 school age children and young people (6 to 19 years) classified as obese.

 

Obviously, there is a need for effective treatments to prevent or treat obesity. But, despite copious research and a myriad of dietary and exercise programs, there still is no safe and effective treatment. Mindfulness is known to be associated with lower risk for obesity, alter eating behavior and improve health in obesity. This suggests that mindfulness training may be an effective treatment for overeating and overweight alone or in combination with other therapies. Yoga practice has been shown to have a myriad of physical and psychological benefits. These include significant loss in weight and body mass index (BMI), resting metabolism, and body fat and improve health in the obese.

 

In today’s Research News article “Effects of Continuous Yoga on Body Composition in Obese Adolescents.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8410386/ ) Nongkhai and colleagues recruited overweight (BMI 23-29.5) young women (age 19-22 years) and randomly assigned them to either engage in continuous yoga practice 3 times per week for 50 minutes for 12 weeks or to a no treatment control condition. The yoga practice was designed to increase and maintain aerobic exercise levels (65% – 75% of maximum heart rate). Before, at the midpoint, and after training they were measured for body size and composition.

 

They found that in comparison to baseline and the control group the yoga group had significant decreases in their Body Mass Index (BMI) and body fat mass. While the control group had a significant decrease in muscle mass, the yoga group maintained their muscle mass. Hence, participation in yoga had positive body size and composition benefits for overweight young women.

 

In the present study, the intervention was a yoga practice that elevated and maintained aerobic levels. This makes it impossible to discern if the benefits were due to yoga per se or to the exercise. Nevertheless, these results to some extent replicate previous findings that yoga practice improves weight and body composition. Future research should contain a non-yoga aerobic exercise group. Regardless, it is clear that engaging in continuous yoga is improves the body size and composition of young women.

 

So, reduce body mass and improve body composition in the overweight young women with yoga.

 

“Yoga practice works to expand consciousness of overall health and well being.  . . . many children and teens dealing with obesity who find a safe place in yoga to cultivate a positive sense of self that contributes to confidence.” – Abby Wills

 

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

 

Na Nongkhai, M. P., Yamprasert, R., & Punsawad, C. (2021). Effects of Continuous Yoga on Body Composition in Obese Adolescents. Evidence-based complementary and alternative medicine : eCAM, 2021, 6702767. https://doi.org/10.1155/2021/6702767

 

Abstract

Overweight/obesity is a pressing international health concern, and conventional treatments demonstrate poor long-term efficacy. Several studies have shown that yoga can control risk factors for cardiovascular disease, obesity, and psychosocial stress. The present study aimed to assess the effect of continuous yoga (asanas, pranayama, and Surya Namaskar yoga) on body composition in overweight participants. Forty adolescents with obesity were enrolled in this study. The study was conceived as a prospective, single-center, single-blinded randomized controlled trial. The participants were divided into 2 groups: the intervention group (n = 20), which undertook a continuous yoga practice, and the control group (n = 20). Body composition, including body weight (BW), body mass index (BMI), body fat mass (BFM), and muscle mass, was evaluated using tetrapolar bioelectrical impedance (BIA). Our results showed that the mean BMI and BFM of the yoga intervention group were significantly decreased at week 8 and week 12. The muscle mass of the yoga group continued to improve at a rate of 0.515 per week, which was statistically significant. In conclusion, a continuous yoga practice had a tendency to decrease BMI and BFM and increase muscle mass. These findings demonstrate intervention effectiveness similar to that observed in other clinical research and indicate that continuous yoga practice may be used as an alternative therapy for obesity prevention and health promotion in adolescents with obesity.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8410386/

 

Improve Reaction Time and Memory and Lose Weight with Yoga

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Improve Reaction Time and Memory and Lose Weight with Yoga

 

By John M. de Castro, Ph.D.

 

“Yoga practice seems to be associated with moderate improvements in cognitive function.” – Neha Gothe

 

Mindfulness training has been shown to be effective in improving physical and psychological health and also improves cognitive flexibility. Yoga practice has been shown to have a large number of beneficial effects on the psychological, emotional, and physical health of the individual and is helpful in the treatment of mental and physical illness. Yoga practice has been shown to improve both social–emotional and cognitive skills.

 

In today’s Research News article “Effect of 12 Weeks of Yogic Training on Neurocognitive Variables: A Quasi-Experimental Study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8117916/ ) Chatterjee and colleagues recruited healthy adults and assigned them to receive either 6-days per week for 12 weeks of yoga practice or to a wait-list control group. Yoga practice started at 45 minutes per day at the start of training increasing systematically to 105 minutes by the 12th week. They were measured before during and after training for body size, visual and auditory reaction time, and for short-term memory.

 

They found that in comparison to baseline and the wait-list control group, the group that practiced yoga had a significant weight loss, increase in short-term memory, and decrease in visual and auditory reaction times.

 

In interpreting these findings, it should be recognized that the comparison, control, condition was passive and as such there is a possibility that the observed changes were due to participant expectancies, experimenter bias, attention effects, etc. In addition, the control condition did not involve any physical activity. So, it is possible that the benefits seen were due to the exercise provided by the yoga practice rather than anything specific to yoga. But clearly the two groups had different response over the course of treatment. In addition, yoga practice has been shown in controlled research to improve cognitive performance and memory. So, the results probably result from the effects of the practice.

 

So, improve reaction time and memory and lose weight with yoga.

 

“taking up yoga may be a good way to maintain your brain health by increasing physical activity and possibly also alleviating stress.” – Yuko Hara

 

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

 

Chatterjee, S., Mondal, S., & Singh, D. (2021). Effect of 12 Weeks of Yogic Training on Neurocognitive Variables: A Quasi-Experimental Study. Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine, 46(1), 112–116. https://doi.org/10.4103/ijcm.IJCM_325_20

 

Abstract

Background:

Neurocognitive abilities are the brain-mind skills needed to initiate any task from the simplest to the most complex, decreases with advancing age. Attention, alertness, and memory are the basic neurocognitive functions most affected by age. There are potential benefits of yoga on neurocognitive functions because this ancient Indian technique positively nurtures the mind-body systems.

Aim of the Study:

The present study was aimed to evaluate the effect of 12 weeks of yogic training on neurocognitive abilities in a middle-aged group.

Methods:

A total of 86 volunteers (46 male and 40 females, age group of 35–55 years), with no prior experience of yoga were participated in this study. Five male and 4 female participants were excluded from the study. All participants divided into yoga training group (male = 21 and female = 18) and control group (male = 20 and female = 18). The yoga training group underwent yoga practices, including kriya, surya namaskar, asana, pranayama, and dhyana daily in the morning, for 6 days/week, for 12 weeks. Standing height, body weight, body mass index, visual reaction time (RT), auditory RT (attention and alertness), and short-term memory were assessed day 1 (pre), 6th week (mid), and 12th weeks (post) of intervention.

Results:

Repeated-measures analysis of variance showed that a statistically significant increased (P < 0.05) in attention-alertness and short-term memory after 12 weeks of yogic practices.

Conclusion:

Integrated approach of yogic intervention may have promising effect on neurocognitive abilities that concomitantly promote successful aging.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8117916/

 

Improve Physical and Mental Health with an Isha Yoga Retreat

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Improve Physical and Mental Health with an Isha Yoga Retreat

 

By John M. de Castro, Ph.D.

 

“As we have physical science to create external wellbeing there is a whole inner dimension of science to create inner wellbeing. I call it Inner Engineering.” – Sadhguru

 

Retreat can be a powerful experience. But it can be quite difficult and challenging. It can be very tiring and physically challenging as engaging in sitting meditation repeatedly over the day is guaranteed to produce many aches and pains in the legs, back, and neck. But the real challenges are psychological, emotional, and spiritual. Retreat can be a real test. The darkness can descend. Deep emotional issues can emerge and may even overwhelm the individual. With all these difficulties, why would anyone want to put themselves through such an ordeal and go on a meditation retreat? People go because they find that retreat produces many profound and sometimes life altering benefits.

 

In today’s Research News article “Isha Yoga Practices and Participation in Samyama Program are Associated with Reduced HbA1C and Systemic Inflammation, Improved Lipid Profile, and Short-Term and Sustained Improvement in Mental Health: A Prospective Observational Study of Meditators.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2021.659667/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1645362_69_Psycho_20210525_arts_A )   Sadhasivam and colleagues recruited adult participants in a scheduled 8-day Isha yoga retreat and their spouses as controls. Retreat participants had to engage in 2 months of preparatory practices including a vegan diet daily practice of hata yoga, kriya yoga, and Shoonya meditation. In the retreat there was intensive practice. They were measured before, after, and 3-4 months later for depression, anxiety, mindfulness, joy, vitality, and resilience, diet, yoga practice, dietary restrictions, and overall health/well-being. They also had blood drawn and assayed for hemoglobin A1c (HbA1c), hemoglobin (Hb), lipid profile [cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), and triglycerides (TG)], and C-reactive protein (CRP).

 

They found that after the retreat and sustained 3-4 months later were significant decreased in anxiety and depression and significant increases in mindfulness, joy, vitality, resilience, blood triglycerides, and body weight. These changes did not occur in the control group. Previous research has similarly demonstrated that yoga and meditation decreases anxiety, depression, blood triglycerides and increases joy, vitality, resilience, and body weight.

 

The study did not have a comparable control group and as a result there are a number of possible alternative explanations for the results including participant expectancy effects. To sign up for and engage in an intensive retreat, there was likely a strong belief that the retreat would be beneficial producing a strong expectancy (placebo) effect. Future research should include a comparison to a different kind of retreat or, as has been used in other studies, a comparison to the effects of a comparable duration vacation.

 

The results are interesting in that the participants had considerable practice during the 2-month preparatory phase. So, the effects of the practices would be expected to be present before the retreat began. So, the improvements observed were due to participation in a 4-day intensive retreat rather than the practices themselves. The retreat involves residential living in a group and withdrawal from daily life. This has social effects and vacation-like effects of removal of life stressors. These could be responsible for the observed benefits. This supports the need for future better controlled research.

 

So, improve physical and mental health with an Isha yoga retreat.

 

“An intense 4-day guided Isha meditation retreat significantly decreased depression and anxiety while improving happiness, mindfulness, and psychological well-being.” – Senthilkumar Sadhasivam

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

 

Sadhasivam S, Alankar S, Maturi R, Williams A, Vishnubhotla RV, Hariri S, Mudigonda M, Pawale D, Dubbireddi S, Packiasabapathy S, Castelluccio P, Ram C, Renschler J, Chang T and Subramaniam B (2021) Isha Yoga Practices and Participation in Samyama Program are Associated with Reduced HbA1C and Systemic Inflammation, Improved Lipid Profile, and Short-Term and Sustained Improvement in Mental Health: A Prospective Observational Study of Meditators. Front. Psychol. 12:659667. doi: 10.3389/fpsyg.2021.659667

 

Background: Meditation is gaining recognition as a tool to impact health and well-being. Samyama is an 8-day intensive residential meditation experience conducted by Isha Foundation requiring several months of extensive preparation and vegan diet. The health effects of Samyama have not been previously studied. The objective was to assess physical and emotional well-being before and after Samyama participation by evaluating psychological surveys and objective health biomarkers.

Methods: This was an observational study of 632 adults before and after the Isha Samyama retreat. All participants were invited to complete surveys. Controls included household significant others. Surveys were completed at baseline (T1), just before Samyama (T2), immediately after Samyama (T3), and 3 months later (T4) to assess anxiety, depression, mindfulness, joy, vitality, and resilience through validated psychometric scales. Voluntary blood sampling for biomarker analysis was done to assess hemoglobin (Hb), HbA1c, lipid profile, and C-reactive protein (CRP). Primary outcomes were changes in psychometric scores, body weight, and blood biomarkers.

Results: Depression and anxiety scores decreased from T1 to T3, with the effect most pronounced in participants with baseline depression or anxiety. Scores at T4 remained below baseline for those with pre-existing depression or anxiety. Vitality, resilience, joy, and mindfulness increased from T1 to T3 (sustained at T4). Body weight decreased by 3% from T1 to T3. Triglycerides (TG) were lower from T2 to T3. Participants had lower HbA1c and HDL at T2, and lower CRP at all timepoints compared with controls.

Conclusions: Participation in the Isha Samyama program led to multiple benefits. The 2-month preparation reduced anxiety, and participants maintained lower anxiety levels at 3 months post-retreat. Physical health improved over the course of the program as evidenced by weight loss and improved HbA1C and lipid profile. Practices associated with the Samyama preparation phase and the retreat may serve as an effective way to improve physical and mental health. Future studies may examine their use as an alternative therapy in patients with depression and/or anxiety.

https://www.frontiersin.org/articles/10.3389/fpsyg.2021.659667/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1645362_69_Psycho_20210525_arts_A

 

Yoga and Other Exercises Improve Body Image and Psychological Well-Being

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Yoga and Other Exercises Improve Body Image and Psychological Well-Being

 

By John M. de Castro, Ph.D.

 

“Overall, practicing yoga can have a profound impact on improving body image, but it depends how it is approached by the individual. When you treat yoga as a tool for body appreciation, healthy movement, and inner reflection, it helps improve body image and mental health.” – Tara Caguait

 

The media is constantly presenting idealized images of what we should look like. These are unrealistic and unattainable for the vast majority of people. But it results in most everyone being unhappy with their body.  This can lead to problematic consequences. In a number of eating disorders there’s a distorted body image. This can and does drive unhealthy behaviors. As a treatment mindfulness has been shown to improve eating disorders.

 

In the media, yoga is portrayed as practiced by lithe beautiful people. This is, of course, unrealistic and potentially harmful. But yoga is also an exercise that tends to improve the body and it has been shown to improve body image and psychological health. It is unclear whether it is the exercise provided by yoga practice that promotes psychological health and a healthy body image or to components specific to yoga practice.

 

In today’s Research News article “Yoga, Dance, Team Sports, or Individual Sports: Does the Type of Exercise Matter? An Online Study Investigating the Relationships Between Different Types of Exercise, Body Image, and Well-Being in Regular Exercise Practitioners.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2021.621272/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1616048_69_Psycho_20210504_arts_A )  Marshin and colleagues recruited adults online and had them complete measures of amount and type of exercise, body size, body image, body dissatisfaction, eating disorders, physical efficacy, physical activity, positive and negative emotions, and depression.

 

They found that the participants who engaged in regular exercise had significantly lower body dissatisfaction, perceived body weight, and depression and significantly higher positive emotions than sedentary individuals. They also found that there were no significant differences in any of the outcome variables for regular exercise practitioners of yoga, ballroom dance, team sports, or individual sports.

 

These findings are correlational, so no conclusions can be reached regarding causation. But it is clear that people who exercise have a better image of their bodies and better mental health than sedentary individuals. The fact that there were no significant differences between practitioners of different types of exercise including yoga suggests that exercise of any type is associated with greater satisfaction with the body and better mood. Yoga practice has been shown to improve body image and positive emotions and lower depression. The present findings suggest that these benefits of yoga practice are due to the exercise and not to the other components of yoga practice.

 

So, yoga and other exercises improve body image and psychological well-being.

 

“Individuals who are dissatisfied with their body image are at a higher risk for eating disorders, depression, and low self-esteem. When diversity and inclusivity are encouraged, yoga may have an important role to play in supporting healthy feelings toward body image.” – Lacey Gibson

 

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

 

Marschin V and Herbert C (2021) Yoga, Dance, Team Sports, or Individual Sports: Does the Type of Exercise Matter? An Online Study Investigating the Relationships Between Different Types of Exercise, Body Image, and Well-Being in Regular Exercise Practitioners. Front. Psychol. 12:621272. doi: 10.3389/fpsyg.2021.621272

 

Physical activity, specifically exercising, has been suggested to improve body image, mental health, and well-being. With respect to body image, previous findings highlight a general benefit of exercise. This study investigates whether the relationship between exercising and body image varies with the type of exercise that individuals preferentially and regularly engage in. In addition, physical efficacy was explored as a potential psychological mediator between type of exercise and body image. Using a cross-sectional design, healthy regular exercise practitioners of yoga, ballroom dance, team sports, or individual sports as well as healthy adults reporting no regular exercising were surveyed. Body image and its different facets were assessed by a set of standardized self-report questionnaires, covering perceptual, cognitive, and affective body image dimensions particularly related to negative body image. In addition, participants were questioned with regard to mental health. Participants were 270 healthy adults. Descriptive statistics, measures of variance (ANOVA), and multiple linear regression analysis with orthogonal contrasts were performed to investigate differences between the different exercise and non-exercise groups in the variables of interest. In line with the hypotheses and previous findings, the statistic comparisons revealed that body dissatisfaction (as one important factor of negative body image) was most pronounced in the non-exercise group compared to all exercise groups [contrast: no exercise versus exercise (all groups taken together)]. Physical efficacy, as assessed with a standardized questionnaire, mediated the difference between type of exercise (using contrasts) and body image including perceptual, cognitive, and affective body image dimensions. The findings shed light on so far less systematically investigated questions regarding the relationship between types of exercise, like yoga and ballroom dance, and body image. The results underscore the relevance of considering possible influencing factors in exercise research, such as the perception of one’s physical efficacy as a mediator of this relationship.

https://www.frontiersin.org/articles/10.3389/fpsyg.2021.621272/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1616048_69_Psycho_20210504_arts_A

 

Improve Physical and Mental Well-Being with Mindfulness Meditation-Based Interventions

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Improve Physical and Mental Well-Being with Mindfulness Meditation-Based Interventions

 

By John M. de Castro, Ph.D.

 

“mindfulness meditation is related to improved mental health across a variety of disorders, including different anxiety disorders, depression, eating disorders, substance abuse, and chronic pain symptom reduction.” – Jennifer Wolkin

 

Over the last several decades, research and anecdotal experiences have accumulated an impressive evidential case that the development of mindfulness has positive benefits for the individual’s mental, physical, and spiritual life. Mindfulness 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 mindfulness practices on the mental and physical health of the practitioners. Many reviews, summarizations, and meta-analyses have been performed of these studies. So, it makes sense to step back and summarize what these meta-analyses have found.

 

In today’s Research News article “The empirical status of mindfulness-based interventions: A systematic review of 44 meta-analyses of randomized controlled trials.” (See summary below or view the full text of the study at: https://centerhealthyminds.org/assets/files-publications/Goldberg-the-empirical-status.pdf ) Goldberg and colleagues review, summarize, and perform a meta-analysis of previous meta-analyses of published randomized controlled studies on benefits of sustained meditation practices on mental and physical well-being. They identified 44 published meta-analyses, representing 336 randomized controlled trials, which included a total of 30,483 participants.

 

They report that the meta-analyses of published randomized controlled trials found that sustained mindfulness meditation practices in comparison to passive, no treatment, controls had a very wide range of beneficial effects across a wide range of participants from children to the elderly, over a variety of programs from Mindfulness-Based Stress Reduction (MBSR) to mobile health, over a variety of psychological issues from anxiety to psychoses, and over a wide range of diseases from chronic pain to cancer. These effects were present immediately post treatment and at later follow-ups (an average of 7 months after treatment).

 

Comparison of these mindfulness meditation practices to active control conditions such as attentional controls to evidence-based treatments, resulted in reduced effect sizes and many were non-significant. Mindfulness meditation practices had significantly superior effects than active controls for adults, children, employees, and health care professionals/trainees but not for students. They were superior for psychiatric disorders, substance use, smoking, and depression but not for physical health conditions, pain, weight/eating-related conditions, cancer, or anxiety. They were superior for stress, and psychiatric symptoms but not for sleep, physical health symptoms, objective measures, or physiological measures.

 

These findings are essentially summaries of summaries and are based upon a wide variety of different researchers, methodologies, cultures, and time frames. Yet, the results are fairly consistent. In comparison to doing nothing, passive controls, mindfulness meditation practices are very beneficial for a wide range of physical and psychological issues over a wide range of ages. But these practices when compared to other types of treatments, are less effective and at times not superior. Nevertheless, this meta-analysis of meta-analyses paints a clear picture of the wide-ranging efficacy of mindfulness meditation practices for the relief of physical and psychological issues. These results verify the unprecedented depth and breadth of benefits of mindfulness meditation practices.

 

So, improve physical and mental well-being with mindfulness meditation-based interventions.

 

“Practicing mindfulness exercises can have many possible benefits, including: reduced stress, anxiety and depression, less negative thinking and distraction, and improved mood,” -Mayo Clinic

 

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

 

Goldberg, S. B., Riordan, K., Sun, S., & Davidson, R. J. (2021). The empirical status of mindfulness-based interventions: A systematic review of 44 meta-analyses of randomized controlled trials. Perspectives on Psychological Science 1–23, DOI: 10.1177/1745691620968771

 

Abstract

In response to questions regarding the scientific basis for mindfulness-based interventions (MBIs), we evaluated their empirical status by systematically reviewing meta-analyses of randomized controlled trials (RCTs). We searched six databases for effect sizes based on ≥4 trials that did not combine passive and active controls. Heterogeneity, moderators, tests of publication bias, risk of bias, and adverse effects were also extracted. Representative effect sizes based on the largest number of studies were identified across a wide range of populations, problems, interventions, comparisons, and outcomes (PICOS). A total of 160 effect sizes were reported in 44 meta-analyses (k=336 RCTs, N=30,483 participants). MBIs showed superiority to passive controls across most PICOS (ds=0.10-0.89). Effects were typically smaller and less often statistically significant when compared to active controls. MBIs were similar or superior to specific active controls and evidence-based treatments. Heterogeneity was typically moderate. Few consistent moderators were found. Results were generally robust to publication bias, although other important sources of bias were identified. Reporting of adverse effects was inconsistent. Statistical power may be lacking in meta-analyses, particularly for comparisons with active controls. As MBIs show promise across some PICOS, future RCTs and meta-analyses should build upon identified strengths and limitations of this literature.

https://centerhealthyminds.org/assets/files-publications/Goldberg-the-empirical-status.pdf