Yoga Medical News Daily

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.

The Effect of Exercise and Alagebrium on the Diastolic Function of the Heart (AGE)

Clinical trial currently seeking participants. Location: The Institute for Exercise and Environmental Medicine Recruiting Dallas, Texas. The purpose of this study is to determine whether an investigational drug (Alagebrium (generic: ALT-711), a type of medication referred to as an advanced glycaton end-product clever) can be combined with exercise training to reverse the stiffening of the heart that takes place naturally with aging. Tai Chi and/or Yoga Training will be used. Ages Eligible for Study: 65 Years to 80 Years. Hypothesis: We hypothesize that AGE cross-links must be broken before a meaningful improvement in cardiac compliance can occur with exercise training in previously sedentary seniors; the combination of the AGE cross-link breaker, ALT-711, with exercise training will be superior to either intervention alone in improving cardiac compliance in these subjects.

Specific Aim: To test this hypothesis, we will study four groups of previously sedentary senior subjects for one year with the following interventions: A) sedentary controls taking placebo; B) sedentary subjects taking ALT-711; C) subjects undergoing moderate intensity exercise training while taking placebo and D) subjects undergoing moderate intensity exercise training while taking ALT-711.  Details: ClinicalTrials.gov.

Tai chi exercise for patients with cardiovascular conditions and risk factors

This systematic review published in the Journal of Cardiopulmonary Rehabilitation and Prevention [2009 May-Jun;29(3):152-60], looked at the "literature evaluating tai chi exercise as an intervention for patients with cardiovascular disease (CVD) or with CVD risk factors (CVDRF). . . . RESULTS: Twenty-nine studies met inclusion criteria: 9 RCTs, 14 nonrandomized studies, and 6 observational trials. Three studies examined subjects with coronary heart disease, 5 in subjects with heart failure, and 10 in heterogeneous populations that included those with CVD. Eleven studies examined subjects with CVDRF (hypertension, dyslipidemia, impaired glucose metabolism). Study duration ranged from 8 weeks to 3 years. Most studies included fewer than 100 subjects (range, 5-207). Six of 9 RCTs were of adequate quality (Jadad >or= 3). Most studies reported improvements with tai chi, including blood pressure reductions and increases in exercise capacity. . . . CONCLUSION: Preliminary evidence suggests that tai chi exercise may be a beneficial adjunctive therapy for some patients with CVD and CVDRF. Further research is needed."  Abstract: PubMed.

Delaying mobility disability in people with Parkinson disease . . .

Published in Physical Therapy [2009 Apr;89(4):384-93], "this article introduces a new framework for therapists to develop an exercise program to delay mobility disability in people with Parkinson disease (PD). Mobility, or the ability to efficiently navigate and function in a variety of environments, requires balance, agility, and flexibility, all of which are affected by PD. This article summarizes recent research identifying how constraints . . .  limit mobility in people with PD. Based on these constraints, a conceptual framework for exercises to maintain and improve mobility is presented. An example of a constraint-focused agility exercise program, incorporating movement principles from tai chi, kayaking, boxing, lunges, agility training, and Pilates exercises, is presented. This new constraint-focused agility exercise program is based on a strong scientific framework and includes progressive levels of sensorimotor, resistance, and coordination challenges that can be customized for each patient while maintaining fidelity. . . ."  Abstract: PubMed with open-access link to full text of article on same page.

Green tea and Tai Chi for bone health

Discussion of the design of a randomized trial. "BACKGROUND: Osteoporosis is a major health problem in postmenopausal women. Evidence suggests the importance of oxidative stress in bone metabolism and bone loss. Tea consumption may be beneficial to osteoporosis due to its antioxidant capability. However, lack of objective data characterizing tea consumption has hindered the precise evaluation of the association between tea ingestion and bone mineral density in previous questionnaire-based epidemiological studies. On the other hand, although published studies suggest that Tai Chi (TC) exercise can benefit bone health and may reduce oxidative stress, all studies were conducted using a relatively healthy older population, instead of a high-risk one such as osteopenic postmenopausal women. Therefore, this study was designed to test an intervention including green tea polyphenol (GTP) and TC exercise for feasibility, and to quantitatively assess their individual and interactive effects on postmenopausal women with osteopenia. . . . DISCUSSION: We present the rationale, design, and methodology of a placebo-controlled randomized trial to investigate a new complementary and alternative medicine strategy featuring a dietary supplement and a mind-body exercise for alleviating bone loss in osteopenic postmenopausal women." Abstract: PubMed. Full-text: BMC Musculoskeletal Disorders (2009 Sept 4;10;110). 

T'ai chi and qigong for health: patterns of use in the United States

Appearing in the Journal of Alternative and Complementary Medicine [2009 Sep;15(9):969-73]; by Birdee GS, Wayne PM, Davis RB, Phillips RS, Yeh GY, Osher Research Center, Harvard Medical School, this summary "analyzed associations of t'ai chi and qigong use for health using cross-sectional data from the 2002 National Health Interview Survey (NHIS) Alternative Medicine Supplement (n = 31,044). The 2002 NHIS estimated the number of t'ai chi and qigong users for health to be 2.5 and 0.5 million persons, respectively."  Half of the t'ai chi and qigong users reported also using "yoga for health in the last 12 months."  Abstract: PubMed.