Yoga Medical News Daily

Newly announced Tai chi clinical trial for osteopenia offers flexibility

Can Tai Chi be considered a weight bearing mind-body exercise that effectively addresses bone-loss issues in post-menopausal osteopenic women? This study will address that unknown. A total of 86 post-menopausal women, aged 45-70, have been recruited from primary care clinics of a large healthcare system based in Boston. 

"They have been randomized to a group-based 9-month Tai Chi program plus standard care or to standard care only. A unique aspect of this trial is its pragmatic design, which allows participants randomized to Tai Chi to choose from a pre-screened list of community-based Tai Chi programs." 

" . . .  Primary outcomes are serum markers of bone resorption (C-terminal cross linking telopeptide of type I collagen, bone formation (osteocalcin), and BMD of the lumbar spine and proximal femur (dual-energy X-ray absorptiometry). Secondary outcomes include health-related quality-of-life, exercise behavior, and psychological well-being." . . .  Results of this study will provide preliminary evidence regarding the value of Tai Chi as an intervention for decreasing fracture risk in osteopenic women. They will also inform the feasibility, value and potential limitations related to the use of pragmatic designs for the study of Tai Chi and related mind-body exercise. If the results are positive, this will help focus future, more in-depth, research on the most promising potential mechanisms of action identified by this study."  Abstract: PubMed. "Tai Chi for osteopenic women: design and rationale of a pragmatic randomized controlled trial," in BMC Musculoskeletal Disorders [2010 Mar 1;11(1):40]

Study finds Tai Chi practitioners have better stability and overall body awareness

Conducted by researchers in the Department of Health Sciences, Lund University, Lund, Sweden, this study investigated stability limits, single-leg jumping, and body awareness in older Tai Chi practitioners. Set at the University-based rehabilitation center, participants included 24 Tai Chi practitioners and 20 healthy control subjects.

"Measures included the following: (1) subjects' intentional weight shifting to 8 different spatial positions within their base of support using the limits of stability test, (2) the ability to leave the floor in single-leg jumping and to maintain balance on landing using force platform measurements, and (3) body awareness and movement behaviors using the Body Awareness Scale-Health (BAS-H)."  

The findings showed that Tai Chi practitioners had a significantly better ability to lean further without losing stability and better directional control. They were also better able to jump off the floor; better able to maintain a longer single-leg stance after landing; and had better overall body awareness. Abstract: PubMed. Article by Gyllensten AL, Hui-Chan CW, Tsang WW,"Stability Limits, Single-Leg Jump, and Body Awareness in Older Tai Chi Practitioners," Archives of Physical Medicine and Rehabilitation [2010 Feb;91(2):215-220]   Photo by Diana bella.

Exercise programs for the institutionalized elderly do make a difference

This randomized controlled trial conducted in France assessed the effects of targeted exercise programs versus usual care based on the ability to perform activities of daily living and on the Neuropsychiatric Inventory scores of geriatric institutionalized persons. Two exercise programs versus usual care were conducted on 160 institutionalized persons 65 years or older who were able to understand basic motor commands and to move from one position to another.

Interventions performed over 6 months included either an adapted tai chi program (4 times 30 min/wk) or a cognition-action program (2 times 30-45 min/wk) that focused primarily on an adapted guidance of patient-centered communication skills.  

The control group, which received no exercise and the usual care, experienced a decline in activities of daily living over the 12-month period compared with the adapted tai chi and cognition-action groups. Also, the components such as ability to walk, continence, and nutrition, were maintained better in the intervention groups than in the control group. The total Neuropsychiatric Inventory score also worsened significantly in the control group, but was unchanged or improved in the intervention groups.

Conclusion: "Adapted exercise programs can slow down the decline in health-related quality of life among heterogeneous, institutionalized elderly persons."  

Abstract: PubMed. Trial Registration clinicaltrials.gov Identifier: NCT00623532. "Effects of exercise programs to prevent decline in health-related quality of life in highly deconditioned institutionalized elderly persons: a randomized controlled trial," Archives of Internal Medicine [2010 Jan 25;170(2):162-9]  Photo by Let Ideas Compete

Resistance training for seniors benefits cognitive function

While this study did not focus on an intervention directly related to yoga, the resistance part of the intervention could very well be duplicated using yoga exercises; and the balance and tone training part of the article mentions using "tai chi–based forms."   

The study compared the effect of once-weekly and twice-weekly resistance training with that of twice-weekly balance and tone exercise training on the performance of executive cognitive functions in 155 community-dwelling women aged 65 to 75 years living in Vancouver. The women were "allocated to once-weekly (n = 54) or twice-weekly (n = 52) resistance training or twice-weekly balance and tone training (control group) (n = 49). . . .  Both resistance training groups significantly improved their performance on the Stroop test compared with those in the balance and tone group (P < or = .03). Task performance improved by 12.6% and 10.9% in the once-weekly and twice-weekly resistance training groups, respectively; it deteriorated by 0.5% in the balance and tone group. Enhanced selective attention and conflict resolution was significantly associated with increased gait speed.. . .  

CONCLUSION: Twelve months of once-weekly or twice-weekly resistance training benefited the executive cognitive function of selective attention and conflict resolution among senior women. clinicaltrials.gov Identifier: NCT00426881. Abstract: PubMed. Published as: "Resistance training and executive functions: a 12-month randomized controlled trial," Archives of Internal Medicine [2010 Jan 25;170(2):170-8]

Challenges in carrying out a tai chi study involving older adults with cognitive impairments

This report details the recruitment experiences based on older adults' comments and on staff observations and reports in a pilot randomized controlled trial (RCT) using tai chi as an intervention to reduce osteoarthritis knee pain in a population of older adults with cognitive impairment. Recruitment challenges, staffing, provision of incentives/motivation, and other issues are discussed. Abstract: PubMed. Published as "Enrolling older adults with cognitive impairments in research: lessons from a study of Tai chi for osteoarthritis knee pain," in Research in Gerontological Nursing [2009 Oct;2(4):228-34]. 

Insomnia: Behavioral Treatments

Clinical Trial currently seeking participants.  Location: Cousins Center for Psychoneuroimmunology, UCLA Neuropsychiatric Institute Recruiting Los Angeles, California,  Inclusion criteria: Older than 55 years of age at time of entry, difficulties with sleep for a minimum of 3 nights per week, and sleep-onset delay, maintenance insomnia, or terminal insomnia. 

"Preliminary studies found that Tai Chi Chih (TCC), a slow moving meditation, contributes to improvements in subjective sleep quality, sleep amounts and sleep efficiency, alterations in sympathetic activity, decreases in proinflammatory cytokines, and improvements in health functioning in community-dwelling older adults. Additionally, cognitive behavior therapy (CBT) confers benefits on sleep outcomes.

"In this randomized, controlled trial, 150 older adults will be randomly assigned to CBT, TCC, or sleep hygiene/education control (EC) over 16 weeks and followed for one year. The aims of this project are to: 1) evaluate the effects of CBT vs TCC vs. EC on objective and subjective measures of sleep and on fatigue, mood, and health functioning in older adults with insomnia; 2) determine the effects of CBT vs.TCC vs. EC on measures of proinflammatory cytokine activity and sympathovagal balance, and whether these two biological mechanisms are related to changes of disordered sleep over the course of the treatment trial; and 3) evaluate whether circulating levels of proinflammatory cytokines are associated with measures of sleep continuity in older adults with insomnia over the treatment trial. This study will advance psychobiological models of disordered sleep and the potential benefits of two readily exportable behavioral interventions for promoting improvements in sleep outcomes in the elderly."  Additional details: ClinicalTrials.gov.

Evidence from the Cochrane Collaboration for Traditional Chinese Medicine therapies

This study reviewed "the evidence base according to Cochrane systematic reviews" by extracting "data on the number of trials included and the total number of participants. We provided an indication of the strength of the review findings by assessing the reviewers' abstract conclusions statement. We supplemented our assessment of the abstract conclusions statements with a listing of the comparisons and outcomes showing statistically significant meta-analyses results."

"RESULTS: We identified 70 Cochrane systematic reviews of TCM, primarily acupuncture (n = 26) and Chinese herbal medicine (n = 42), and 1 each of moxibustion and t'ai chi. Nineteen (19) of 26 acupuncture reviews and 22/42 herbal medicine reviews concluded that there was not enough good quality trial evidence to make any conclusion about the efficacy of the evaluated treatment, while the remaining 7 acupuncture and 20 herbal medicine reviews and each of the moxibustion and t'ai chi reviews indicated a suggestion of benefit, which was qualified by a caveat about the poor quality and quantity of studies. . . . 

"CONCLUSIONS: Most Cochrane systematic reviews of TCM are inconclusive, due specifically to the poor methodology and heterogeneity of the studies reviewed. Some systematic reviews provide preliminary evidence of Chinese medicine's benefits to certain patient populations, underscoring the importance and appropriateness of further research. These preliminary findings should be considered tentative and need to be confirmed with rigorous randomized controlled trials."  Abstract: PubMed. Published in the Journal of Alternative and Complementary Medicine [2009 Sep;15(9):1001-14].

Clinical Trial now underway in Taipei: Tai Chi Exercise in Older People

Clinical study currently recruiting participants. Location: Taipei Medical University Recruiting Taipei, Taiwan. Interventions will include Yang-style tai chi with 13 movements every week over the 6-month intervention period at a subject's residence by tai chi instructors. Participants must be 60 years or older.  More details at: ClinicalTrials,gov. 

Complementary and Alternative Medicine Practices Among U.S. Cancer Survivors

The objective of this study was "to identify relationships among gender, physical and psychological symptoms (pain, insomnia, fatigue, and depression), and use of specific complementary and alternative medicine (CAM) practices among survivors in the U.S. cancer population. . . . Methods: NHIS interview data on use of CAM practices (diet, yoga, tai chi, qigong, meditation, guided imagery, relaxation, and deep breathing) were examined in relationship to gender and symptoms. . . . "

"Conclusions: CAM practices are widely used in the U.S. cancer population, especially among women. Symptom experience influences likelihood of use, with increased odds when men report symptoms. Implications for Nursing: Study findings inform oncology nurses on the benefits of integrating self-care CAM practices in relationship to gender into the symptom management care plan for cancer survivors. Findings reported in this study will help guide future CAM practice intervention studies." Abstract: PubMed. Article appearing in: Oncology Nursing Forum [2010 Jan 1;37(1):E7-E15].

Physical activity in the prevention of osteoporosis – what's needed are high impact exercise programs

This update review article published in Maturitas [2009 May 20;63(1):34-8] points out that in "Europe and North America about 6% of men and 21% of women aged 50-84 years are classified to have osteoporosis. Although it is well accepted that exercise is essential for the management of osteoporosis, the exact role of physical activity in the primary and secondary prevention of osteoporotic fractures is still controversial. . . . Two prospective cohort studies indicate the clinical relevance of this association by showing an inverse relationship between physical activity and the risk of hip fracture. There is convincing evidence that physical activity effectively slows bone loss in postmenopausal women in a dose-dependent manner. Exercise programs may increase bone mineral density. CONCLUSION: In order to maximize the goals of public health most effective, individually adapted, intense, high impact exercise programs are needed. However, they may be complicated to communicate and adherence on the population level may be hard to achieve. These programs must be weighed against popular and applicable existing programs (e.g. aerobic classes, Tai Chi, and walking) which appear to be easier to adhere to but appear to be less effective in the prevention of osteoporotic fractures in the individual postmenopausal women."  Abstract: PubMed.