Mind-body interventions (Yoga/Tai Chi) Flashcards
Yoga history
Yoga is from Sanskrit root “Yuj”, which means to bind, join, attach
Refers to the binding of the individual soul to the universal soul
2,000 years ago, the Indian sage Pantajali codified the various philosophies and methodologies of yoga into the “Yoga Sutras”, which define 8 limbs of yoga
In the US, the term “yoga” typically refers to two of these limbs: asanas (poses), and pranayama (breathing)
Yoga styles
There are many styles of yoga currently practiced in the US (e.g., Iyengar, Ashtanga, Vini, Kundalini)
Each of these approaches represents a distinct intervention, emphasizing different components and with different standards for teacher training
Empirical research on yoga
Yoga is traditionally believed to have beneficial effects on mental and physical health
There is a growing body of empirical research on yoga interventions
-Yoga has been studied among patients with asthma, cardiac conditions, arthritis, kyphosis, multiple sclerosis, epilepsy, headache, depression, diabetes, pain, GI disorders, and addictions, also among healthy individuals
-In some trials, see beneficial effects on cardiopulmonary function, perceptual and motor skills, and functional abilities, as well as mood and pain (Bussing et al., 2012)
Yoga effects on physiology?
A handful of studies have examined effects on “Y” mediators
- Cortisol
- Immune
Yoga and cortisol
Some evidence that yoga interventions are associated with reductions in cortisol, especially morning cortisol levels
- Acute effects: Undergraduates randomized to a single yoga session showed decreases in cortisol relative to African dance or biology lecture (West et al., 2004)
- suggests that yoga may have some affects on the HPA axis
Yoga and inflammation
Observational study compared expert and naïve yoga practitioners before, during, and after a standard yoga session and two control conditions Outcomes: -Inflammatory markers (IL-6) -Cortisol -NE and E
both groups show increases of IL-6 : showing that exercise increases activity not that yoga is stressful
Experts have lower levels of IL-6 across sessions compared to novices
-the experts are always lower - suggesting that yoga has turned down the inflammatory system in these people - they still show an inflammatory response but it is lowered
-this could just be their lifestyle in general is different from novices (healthier foods etc.)
No consistent associations with other outcomes
Intervention trial: Two arm RCT comparing yoga to standard therapy for patients with chronic heart failure -try to lower inflammation Outcomes: Inflammatory markers (IL-6, CRP) Exercise capacity Quality of life
Yoga group showed significant reductions in inflammatory markers (IL-6 and CRP)
Remember that inflammation plays an important role in the development and progression of CVD!
Reducing inflammation could have beneficial health effects for patients with heart disease
Yoga for cancer-related fatigue : Bower yoga study
Intervention designed for specific patient group: breast cancer survivors with persistent fatigue
Why target fatigue?
-Most common and distressing side effect of cancer treatment
-May persist for years after successful treatment completion
(30% of breast cancer survivors report persistent fatigue)
-Causes serious disruption in quality of life
Why yoga?
- Yoga and other CAM interventions are very popular in cancer populations
- Yoga is adaptable for fatigued patients who cannot participate in standard exercise interventions
- Shown to be effective in reducing fatigue in other patient populations
Two arm RCT for breast cancer survivors with persistent fatigue
Iyengar yoga intervention:
Strong therapeutic tradition
-Specific sequences designed for specific medical problems
-Use of props enables all individuals to achieve benefits of poses
Iyengar yoga condition:
12 weeks, two 90-minute classes per week
Led by Intermediate Iyengar yoga instructor and assistant
Focus on poses thought to be effective for reducing fatigue
-Passive backbends
-Passive inversions
-Restorative poses
Specific sequencing of poses, moving from easier to more challenging
control group:
health education
-designed to control for non-specific components of yoga: group setting, leader, provision of material designed to address fatigue
-12 weeks, one 120 min class per week
-led by PhD level psychologist
-focus on topic relevant breast cancer survivors: fatigue, sleep, nutrition, weight management, etc.
Primary outcomes: -Fatigue (Fatigue Symptom Inventory) -Vigor (MFSI) Secondary outcomes: -Depressive symptoms (BDI-II) -Inflammatory markers
Assessed at baseline, post-treatment, and 3 month post-treatment follow-up
Results:
Decrease in fatigue in yoga group
-these women are at a 5 at baseline and drop quite a bit on the scale
-didn’t bounce back to their baseline a the followup
-they’ve been fatigued for 2-20 years and yoga helps to reduce their fatigue
Increase in energy in yoga group
-no change in control group
Decrease in depression in yoga group
-both groups actually showed decrease in depression
Slight decrease in inflammatory markers in yoga group
-control group goes up
-yoga is buffering against increases in inflammatory markers
Decreases in NF-kB in yoga group
-less inflammation than controls
Conclusions:
Targeted yoga intervention feasible for fatigued breast cancer survivors
-Excellent adherence during trial
-At 3 month follow-up, 64% of women who attended yoga classes were continuing to practice
Intervention led to large, clinically-significant improvements in fatigue
Evidence of decreased inflammation in yoga group, no effect on cortisol
Key poses: passive backbends
Setubandha Sarvangasana, Full bridge Posture, on crossed bolsters and blankets
Key poses: passive inversions
Salamba Sarvangasana, Supported Shoulderstand, with a chair, bolster, mat, and blanket
Salamba Sirsasana, Supported Headstand, with ropes
Key poses: restorative
Supta Baddhakonasana, Reclining bound angle posture, with bolster, strap, and blankets
Yoga for breast cancer survivors
Two arm RCT comparing yoga to wait-list control group for breast cancer survivors
Larger trial, did not target fatigued survivors
Outcomes:
-Fatigue
-Vitality
-Depression
-Inflammation
Yoga reduces fatigue and inflammation
Tai Chi
Traditional form of Chinese martial art
Incorporates aerobic activity, relaxation, and meditation
-“Meditation through movement”
Tai Chi effects on physiology
Growing number of studies have examined effects of Tai Chi on physiological “Y” variables, including immune function and inflammation
Irwin et al. Tai Chi trials: Shingles
Two group RCT comparing TC to health education for older adults
Used Tai Chi Chih (TCC)
-Standardized, western form of Tai Chi with 20 poses
Outcomes:
-Immune response to shingles virus
Results:
Increases in cell mediated immunity to VZV (shingles virus)
-TC boosts the immune response
-if you JUST give them the vaccine then they won’t boost above the target level (the line)
What is shingles virus?
Varicella zoster virus (VZV)
- Virus responsible for chicken pox in childhood, or herpes zoster (“shingles”) in adulthood
- Herpes zoster causes a painful rash on skin that can lead to significant impairment in QOL
Irwin et al. Tai Chi trials: Insomnia
Three group RCT comparing TCC to CBT and health education for older adults with insomnia
CBT focused on maladaptive thoughts and behaviors related to insomnia (address dysfunctional thoughts about their sleep patterns)
Outcomes:
-Sleep quality
-Inflammation
Both CBT and TCC lead to improvements in sleep quality
-CBT does the best
Both treatments also lead to reductions in inflammation
comparing two active conditions in this trial
Tai Chi for diabetes
Two group RCT comparing TCC to conventional exercise for individuals with type 2 diabetes who were also obese
Interventions were conducted 3x/week for 12 weeks
TCC led to greater reduction in CRP than exercise
-tai chi was more effective than exercise in reducing CRP - something about the meditative quality of TC
Other mind-body interventions: Biofield therapies
What are they?
Therapies that are intended to affect energy fields that purportedly surround and penetrate the human body for the purposes of healing
Reiki, Therapeutic Touch, Healing Touch, etc.
Biofield therapy for cancer-related fatigue
Three group RCT comparing biofield therapy to “mock healing” and waitlist control for breast cancer survivors with persistent fatigue
Outcomes:
-Fatigue
-Diurnal cortisol (steeper slope = healthier)
Description of interventions
- Biofield therapy: Hands-on healing using standard hand positions on different parts of body, done by experienced practitioners
- Mock healing: Used identical hand positions, done by skeptical scientists who were told to think about grants and research
Results:
Both healing groups showed reduction in fatigue compared to controls
Biofield group also showed increased waking cortisol levels
Biofield therapy for cancer-related fatigue: What Coyne says…
We believe that publication of this trial encourages more pseudoscientific studies of energy fields or auras and gives the wrong message to clinicians and patients
Shamini responds to Coyne
Should the data from our well conducted, rigorous, randomized controlled trial be dismissed because the mechanisms are unknown or because some scientists do not believe in the specific therapy?
Healing touch and ovarian cancer
compared to relaxation
Healing touch maintained killing ability of natural killer cells during chemoradiation therapy
usual care group just goes down
relaxation goes down but not as drastically
healing touch is buffering the effects of that (stays constant)
