The mind-body connection: Clear new evidence

Posted on November 3, 2014 by Stone Hearth News

For the first time, researchers have shown that practising mindfulness meditation or being involved in a support group has a positive physical impact at the cellular level in breast cancer survivors.

A group working out of Alberta Health Services’ Tom Baker Cancer Centre and the University of Calgary Department of Oncology has demonstrated that telomeres – protein complexes at the end of chromosomes – maintain their length in breast cancer survivors who practise meditation or are involved in support groups, while they shorten in a comparison group without any intervention.

Although the disease-regulating properties of telomeres aren’t fully understood, shortened telomeres are associated with several disease states, as well as cell aging, while longer telomeres are thought to be protective against disease.

“We already know that psychosocial interventions like mindfulness meditation will help you feel better mentally, but now for the first time we have evidence that they can also influence key aspects of your biology,” says Dr. Linda E. Carlson, PhD, principal investigator and director of research in the Psychosocial Resources Department at the Tom Baker Cancer Centre.

“It was surprising that we could see any difference in telomere length at all over the three-month period studied,” says Dr. Carlson, who is also a U of C professor in the Faculty of Arts and the Cumming School of Medicine, and a member of the Southern Alberta Cancer Institute. “Further research is needed to better quantify these potential health benefits, but this is an exciting discovery that provides encouraging news.”

 The study was published online today in the journal Cancer. It can be found at: http://onlinelibrary.wiley.com/doi/10.1002/cncr.29063/full

A total of 88 breast cancer survivors who had completed their treatments for at least three months were involved for the duration of the study. The average age was 55 and most participants had ended treatment two years prior. To be eligible, they also had to be experiencing significant levels of emotional distress.

In the Mindfulness-Based Cancer Recovery group, participants attended eight weekly, 90-minute group sessions that provided instruction on mindfulness meditation and gentle Hatha yoga, with the goal of cultivating non-judgmental awareness of the present moment. Participants were also asked to practise meditation and yoga at home for 45 minutes daily.

In the Supportive Expressive Therapy group, participants met for 90 minutes weekly for 12 weeks and were encouraged to talk openly about their concerns and their feelings. The objectives were to build mutual support and to guide women in expressing a wide range of both difficult and positive emotions, rather than suppressing or repressing them.

The participants randomly placed in the control group attended one, six-hour stress management seminar.

All study participants had their blood analysed and telomere length measured before and after the interventions.

Scientists have shown a short-term effect of these interventions on telomere length compared to a control group, but it’s not known if the effects are lasting. Dr. Carlson says another avenue for further research is to see if the psychosocial interventions have a positive impact beyond the three months of the study period.

Allison McPherson was first diagnosed with breast cancer in 2008. When she joined the study, she was placed in the mindfulness-based cancer recovery group. Today, she says that experience has been life-changing.

“I was skeptical at first and thought it was a bunch of hocus-pocus,” says McPherson, who underwent a full year of chemotherapy and numerous surgeries. “But I now practise mindfulness throughout the day and it’s reminded me to become less reactive and kinder toward myself and others.”

Study participant Deanne David was also placed in the mindfulness group. “Being part of this made a huge difference to me,” she says. “I think people involved in their own cancer journey would benefit from learning more about mindfulness and connecting with others who are going through the same things.”

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Fibromyalgia patients may benefit from aquatic exercise

Posted on November 3, 2014 by Stone Hearth News

Cochrane Database Syst Rev. 2014 Oct 28;10:CD011336. doi: 10.1002/14651858.CD011336. Aquatic exercise training for fibromyalgia. Bidonde J1, Busch AJ, Webber SC, Schachter CL, Danyliw A, Overend TJ, Richards RS, Rader T. Author information 1Community Health & Epidemiology, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, Canada, S7N 5E5.

Abstract

BACKGROUND:
Exercise training is commonly recommended for individuals with fibromyalgia. This review examined the effects of supervised group aquatic training programs (led by an instructor). We defined aquatic training as exercising in a pool while standing at waist, chest, or shoulder depth. This review is part of the update of the ‘Exercise for treating fibromyalgia syndrome’ review first published in 2002, and previously updated in 2007.

OBJECTIVES:
The objective of this systematic review was to evaluate the benefits and harms of aquatic exercise training in adults with fibromyalgia.

SEARCH METHODS: We searched The Cochrane Library 2013, Issue 2 (Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, NHS Economic Evaluation Database), MEDLINE, EMBASE, CINAHL, PEDro, Dissertation Abstracts, WHO international Clinical Trials Registry Platform, and AMED, as well as other sources (i.e., reference lists from key journals, identified articles, meta-analyses, and reviews of all types of treatment for fibromyalgia) from inception to October 2013. Using Cochrane methods, we screened citations, abstracts, and full-text articles. Subsequently, we identified aquatic exercise training studies.

SELECTION CRITERIA:
Selection criteria were: a) full-text publication of a randomized controlled trial (RCT) in adults diagnosed with fibromyalgia based on published criteria, and b) between-group data for an aquatic intervention and a control or other intervention. We excluded studies if exercise in water was less than 50% of the full intervention.

DATA COLLECTION AND ANALYSIS:
We independently assessed risk of bias and extracted data (24 outcomes), of which we designated seven as major outcomes: multidimensional function, self reported physical function, pain, stiffness, muscle strength, submaximal cardiorespiratory function, withdrawal rates and adverse effects. We resolved discordance through discussion. We evaluated interventions using mean differences (MD) or standardized mean differences (SMD) and 95% confidence intervals (95% CI). Where two or more studies provided data for an outcome, we carried out meta-analysis. In addition, we set and used a 15% threshold for calculation of clinically relevant differences.

MAIN RESULTS:

We included 16 aquatic exercise training studies (N = 881; 866 women and 15 men). Nine studies compared aquatic exercise to control, five studies compared aquatic to land-based exercise, and two compared aquatic exercise to a different aquatic exercise program.We rated the risk of bias related to random sequence generation (selection bias), incomplete outcome data (attrition bias), selective reporting (reporting bias), blinding of outcome assessors (detection bias), and other bias as low. We rated blinding of participants and personnel (selection and performance bias) and allocation concealment (selection bias) as low risk and unclear. The assessment of the evidence showed limitations related to imprecision, high statistical heterogeneity, and wide confidence intervals.

Aquatic versus control.

We found statistically significant improvements (P value < 0.05) in all of the major outcomes. Based on a 100-point scale, multidimensional function improved by six units (MD -5.97, 95% CI -9.06 to -2.88; number needed to treat (NNT) 5, 95% CI 3 to 9), self reported physical function by four units (MD -4.35, 95% CI -7.77 to -0.94; NNT 6, 95% CI 3 to 22), pain by seven units (MD -6.59, 95% CI -10.71 to -2.48; NNT 5, 95% CI 3 to 8), and stiffness by 18 units (MD -18.34, 95% CI -35.75 to -0.93; NNT 3, 95% CI 2 to 24) more in the aquatic than the control groups. The SMD for muscle strength as measured by knee extension and hand grip was 0.63 standard deviations higher compared to the control group (SMD 0.63, 95% CI 0.20 to 1.05; NNT 4, 95% CI 3 to 12) and cardiovascular submaximal function improved by 37 meters on six-minute walk test (95% CI 4.14 to 69.92). Only two major outcomes, stiffness and muscle strength, met the 15% threshold for clinical relevance (improved by 27% and 37% respectively). Withdrawals were similar in the aquatic and control groups and adverse effects were poorly reported, with no serious adverse effects reported.

Aquatic versus land-based

There were no statistically significant differences between interventions for multidimensional function, self reported physical function, pain or stiffness: 0.91 units (95% CI -4.01 to 5.83), -5.85 units (95% CI -12.33 to 0.63), -0.75 units (95% CI -10.72 to 9.23), and two units (95% CI -8.88 to 1.28) respectively (all based on a 100-point scale), or in submaximal cardiorespiratory function (three seconds on a 100-meter walk test, 95% CI -1.77 to 7.77). We found a statistically significant difference between interventions for strength, favoring land-based training (2.40 kilo pascals grip strength, 95% CI 4.52 to 0.28). None of the outcomes in the aquatic versus land comparison reached clinically relevant differences of 15%. Withdrawals were similar in the aquatic and land groups and adverse effects were poorly reported, with no serious adverse effects in either group. Aquatic versus aquatic (Ai Chi versus stretching in the water, exercise in pool water versus exercise in sea water)Among the major outcomes the only statistically significant difference between interventions was for stiffness, favoring Ai Chi (1.00 on a 100-point scale, 95% CI 0.31 to 1.69).

AUTHORS’ CONCLUSIONS:

Low to moderate quality evidence relative to control suggests that aquatic training is beneficial for improving wellness, symptoms, and fitness in adults with fibromyalgia. Very low to low quality evidence suggests that there are benefits of aquatic and land-based exercise, except in muscle strength (very low quality evidence favoring land). No serious adverse effects were reported.

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