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Impact of Transcendental Meditation(R) on cardiovascular function at rest and during acute stress in adolescents with high normal blood pressure


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This study examined the impact of the Transcendental Meditation (TM) program on cardiovascular (CV) reactivity in adolescents with high normal BP. Thirty-five adolescents [34 African Americans (AAs), 1 Caucasian American (CA); ages 15-18 years] with resting systolic blood pressure (SBP) between the 85th and 95th percentile for their age and gender on three consecutive occasions, were randomly assigned to either TM (n=17) or health education control (CTL, n=18) groups. The TM group engaged in 15-min meditation twice each day for 2 months including sessions during school lunch break. Primary CV outcome measures were changes in blood pressure (BP), heart rate (HR), and cardiac output (CO) at rest and in response to two laboratory stressors, a simulated car driving stressor and an interpersonal social stressor interview. The TM group exhibited greater decreases in resting SBP (P<.03) from pre- to postintervention, compared to the CTL group. The TM group exhibited greater decreases from pre- to postintervention in SBP, HR, and CO reactivity (P's<.03) to the simulated car driving stressor, and in SBP reactivity (P<.03) to the social stressor interview. The TM program appears to have a beneficial impact upon CV functioning at rest and during acute laboratory stress in adolescents at-risk for hypertension.
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Impact of Transcendental Meditation
on cardiovascular function at rest
and during acute stress in adolescents with high normal blood pressure
Vernon A. Barnes
*, Frank A. Treiber
, Harry Davis
Department of Pediatrics, Georgia Institute for Prevention of Human Diseases and Accidents, Building HS1640,
Medical College of Georgia, Augusta, GA 30912, USA
Department of Psychiatry, Medical College of Georgia, Augusta, GA 30912, USA
Office of Biostatistics, Medical College of Georgia, Augusta, GA 30912, USA
Received 22 November 2000; accepted 22 June 2001
Objective: This study examined the impact of the Tran-
scendental Meditation (TM) program on cardiovascular (CV)
reactivity in adolescents with high normal blood pressure (BP).
Method: Thirty-five adolescents [34 African Americans (AAs),
1 Caucasian American (CA); ages 15 –18 years] with resting
systolic blood pressure (SBP) between the 85th and 95th
percentile for their age and gender on three consecutive
occasions, were randomly assigned to either TM (n= 17) or
health education control (CTL, n= 18) groups. The TM group
engaged in 15-min meditation twice each day for 2 months
including sessions during school lunch break. Primary CV
outcome measures were changes in BP, heart rate (HR), and
cardiac output (CO) at rest and in response to two laboratory
stressors, a simulated car driving stressor and an interpersonal
social stressor interview. Results: The TM group exhibited
greater decreases in resting SBP ( P< .03) from pre- to post-
intervention, compared to the CTL group. The TM group
exhibited greater decreases from pre- to postintervention in
SBP, HR, and CO reactivity ( Ps < .03) to the simulated car
driving stressor, and in SBP reactivity ( P< .03) to the social
stressor interview. Conclusion: The TM program appears to have
a beneficial impact upon CV functioning at rest and during acute
laboratory stress in adolescents at-risk for hypertension. D2001
Elsevier Science Inc. All rights reserved.
Keywords: Transcendental Meditation; Blood pressure; Stress response; Adolescents; Cardiovascular reactivity
Essential hypertension (EH) remains a significant health
problem in the US with approximately 40 to 50 million
persons affected [1]. Epidemiological studies have shown
that blood pressure (BP) percentile ranking relative to age
mates tends to track from late childhood through adoles-
cence into adulthood [2,3]. Teenagers with high normal BP
are at increased risk for development of EH as young adults
[4 7]. From late childhood onward, African Americans
(AAs) exhibit higher casual BP than Caucasian Americans
(CAs) [8]. Thus, AA youth with high normal BP are at
particular risk for EH [8,9].
Although the relationship between cardiovascular react-
ivity (CVR) and EH has been controversial, exaggerated
CVR to stress has been hypothesized as contributing to the
early etiology of EH [10 12]. Exaggerated CVR to labor-
atory stressors has been shown to predict future EH in adults
[13 15], and change in BP levels and left ventricular mass
1 to 6 years later in youth [16 21]. It has been hypothesized
that the high prevalence of EH among AAs is in part due to
their greater exposure to chronic environmental stress
related to sociostructural barriers (e.g., racism, inadequate
economic resources) [11,2224]. Similar to adult findings
[22,25 27], AA youth often exhibit greater BP reactivity to
stress than CA youth, and the underlying hemodynamic
mechanism frequently responsible is increased total peri-
pheral resistance (TPR) [17,28 30].
Few studies have examined whether stress reduction
methods reduce casual BP in youth with high normal BP,
and the results of those studies are mixed. Ewart et al. [31]
0022-3999/01/$ – see front matter D2001 Elsevier Science Inc. All rights reserved.
PII: S0022-3999(01)00261-6
* Corresponding author. Tel.: +1-706-721-2195; fax: +1-706-721-
E-mail address: (V.A. Barnes).
Journal of Psychosomatic Research 51 (2001) 597 – 605
examined the efficacy of progressive muscle relaxation
(PMR) training in teenagers with BP above the 85th percent-
ile. PMR instruction provided in class for 3 months reduced
the systolic blood pressure (SBP) compared to a waiting-
list control condition, but group BP differences 4 months
later were not significant [31]. In another study, relaxation
training combined with increased physical activity did not
decrease BP compared to a control group in community-
home boys [32].
Recent research suggests that behavioral stress reduc-
tion via Transcendental Meditation (TM) may hold prom-
ise in the reduction of casual BP and/or CVR in at-risk
youth. Recent clinical trials found that TM lowered clinic
BP, and reduced the risk of heart disease, carotid athero-
sclerosis, and mortality in hypertensive AA adults
[3337]. Further, a recent finding with long-term TM
practitioners indicated that acute declines in BP during
TM are due to decreases in TPR [38]. Goleman and
Schwartz [39] found that TM reduced heart rate (HR)
reactivity to a stressful film in normotensive CA adults,
but another study of normotensive CA adults found no
decreases in HR or BP reactivity to three laboratory stres-
sors [40]. TM has also been shown to effect beneficial
stress-related physiological changes, including decreased
sympathetic nervous system arousal [41,42], hypothala-
micpituitary adrenocortical axis dysregulation [43,44],
cortisol levels [44], and sympathetic b-adrenergic receptor
sensitivity [45]. These findings suggest that examination of
the effects of TM on reducing BP and CVR in at-risk youth
is warranted.
In the present study, youth with high normal BP, prim-
arily AAs, were randomly assigned to either a 2-month
TM program or a health education control (CTL) group.
Based on previous findings, it was predicted that youth
who practiced TM would exhibit greater decreases in
resting BP and TPR, and greater decreases in CVR to
laboratory stressors from pretest to 2-month posttest
than controls.
Permission to conduct the study was granted by the
Superintendent of Richmond County Public Schools and
the Medical College of Georgia Human Assurance Com-
mittee. A BP screening was conducted on a random sample
of youth at an inner-city high school (200 students,
97% AAs). Thirty-five adolescents (34 AAs, 1 CA; ages
1518 years) exhibited resting SBP in the sitting position in
the 85th and 95th percentile for their age and gender
on three consecutive occasions [46]. Exclusion criteria
included: current involvement in a health promotion pro-
gram; unwillingness to accept randomization into either
study group; self-reported pregnancy or parental report of
subject’s history of congenital heart defect, diabetes, asthma,
or any chronic illness that requires regular pharmacological
intervention. None were affected and all consented to
participate in the study.
Subjects were given the preintervention as described
below and randomly assigned to either a TM group
(n= 17; 7 AA and 1 CA female, 9 AA males) or a
CTL group (n= 18; 8 AA females, 10 AA males). The
TM group engaged in 15-min sessions each day at school
at 10:30 a.m. Additional 15-min individual sessions were
prescribed at home, each school day, as well as 15 min
twice daily individual home practice on weekends for
2 months. The CTL group was presented with seven
weekly one-hour lifestyle education sessions based in part
on the National Institutes of Health guidelines on low-
ering BP through weight loss, diet (reducing fat and
sodium intake), and increasing physical activity [47].
These sessions were intended to provide comparable time
and attention to the CTL subjects. Two subjects dropped
out of the TM group and did not complete the post-
intervention. Attendance was taken for all sessions at
school and weekly ‘‘participation cards’’ were completed
by the subjects to document meditations at home. Two
months after receiving the intervention, both groups were
posttested as described below. A 2-month intervention
period resulted due to constraint imposed by the school
semester period. Several studies using TM have reported
BP reductions at 1 3 months [34,48,49]. Subjects were
paid US$150 for their participation.
The TM technique has been described as a simple mental
procedure practiced for 15 min twice a day while sitting
comfortably with eyes closed [50]. The TM technique has
its origin in the ancient Vedic approach to health [51], and
does not require changes in personal belief, lifestyle, or
philosophy [52]. No mental effort is required toward inten-
tionally altering physiological processes (e.g., respiration
rate, muscle relaxation, etc.). The ordinary thinking process
becomes quiescent and a distinctive state of psychophysio-
logical ‘‘restful alertness,’’ a wakeful but deeply restful
state, is gained [53,54].
All testing was conducted at the Georgia Prevention
Institute of the Medical College of Georgia. After a consent
form was signed, anthropometric and hemodynamic param-
eters were measured, at both the pre- and posttest. At
pretest, subjects completed an expectation-of-benefits ques-
tionnaire, and parents completed a demographic informa-
tion form [which includes measures of socioeconomic
status, and a family health history of cardiovascular (CV)
disease form].
V.A. Barnes et al. / Journal of Psychosomatic Research 51 (2001) 597–605598
Height (via stadiometer), weight (via Detecto scale),
waist and hip circumference measurements were recorded
using established protocols [55,56].
Outcome measures were changes in BP, HR, cardiac
output (CO), and TPR at rest and in response to a virtual
reality car driving simulation task and social stressor inter-
view. All CV measurements were conducted with the subject
in the supine position. BP was monitored with a Dinamap
Vital Signs Monitor 1846SX [57]. CO and HR measurements
were obtained using a noninvasive thoracic electrical bio-
impedance system (NCCOM-3 Model 6, Bo-Med Medical
Manufacturing, Irvine, CA). The bioimpedance-measuring
procedure has been validated via significant correlations
between the NCCOM-3 readings and simultaneous thermo-
dilution-derived estimates of CO [58,59]. CO and HR were
calculated every successive 12 QRS complexes with the
bioimpedance monitor while the Dinamap was inflating and
calculating BP. These values were averaged to provide one
measurement for each BP evaluation. BP and CO values
measured simultaneously were used to calculate TPR as
{TPR=(SBP + 2DBP)/3/CO} expressed as mmHg/(l/min)
where DBP stands for diastolic blood pressure.
A calibration protocol was used, which adjusted imped-
ance-derived values of stroke volume (SV), and thus CO to
Doppler-derived measures [16]. During each visit, each sub-
ject’s bioimpedance system-derived SV measures at rest were
calibrated based upon M-mode echocardiography-derived SV
measurements, which have been shown to provide absolute
measurements of SV and CO [60,61]. An M-mode echocar-
diographic examination using a Hewlett-Packard 5500 echo-
cardiograph was conducted to measure aortic flow velocity.
Utilizing computer analysis and the area under the velocity
curve (flow velocity integral), SV and CO were calculated.
The average Doppler-derived SV values during rest for each
subject in conjunction with their HR values were compared to
the subject’s average impedance-derived resting SVs at the
same HRs. The percentage differences in SV were used as a
(b) Preintervention cardiovascular responsivity to stressors by intervention
Prestressor level Mean stressor level Prestressor level Mean stressor level
Car driving
SBP (mmHg) 125.9 ± 8.2 139.5 ± 8.3 119.3 ± 7.8 127.2 ± 13.2
DBP (mmHg) 61.7 ± 7.8 75.2 ± 10.2 63.5 ± 8.1 70.0 ± 8.3
HR (bpm) 64.6 ± 9.6 79.1 ± 9.7 65.7 ± 7.3 72.8 ± 11.2
CO (l/min) 4.9 ± 1.3 5.4 ± 1.3 5.2 ± 1.4 5.2 ± 1.5
TPR (mmHg/(l/min)) 17.9 ± 4.7 19.1 ± 5.1 17.4 ± 7.2 18.7 ± 6.1
Social stressor interview
SBP (mmHg) 123.7 ± 8.5 140.0 ± 10.2 118.1 ± 6.1 133.8 ± 7.2
DBP (mmHg) 62.0 ± 8.1 73.0 ± 9.9 62.6 ± 8.3 72.9 ± 9.4
HR (bpm) 66.0 ± 9.3 73.0 ± 10.4 66.4 ± 13.6 70.9 ± 9.5
CO (l/min) 5.0 ± 1.3 4.9 ± 1.3 5.1 ± 1.4 5.1 ± 1.3
TPR (mmHg/(l/min)) 17.3 ± 4.4 20.8 ± 5.7 17.2 ± 6.6 20.0 ± 6.8
Values are means ± standard deviation. SBP = systolic blood pressure; DBP= diastolic blood pressure; HR= heart rate; CO = cardiac output; TPR = total
peripheral resistance. All TM vs. CTL effects = not significant.
Table 1
Preintervention descriptive characteristics and cardiovascular responsivity to stressors by intervention
(a) Preintervention descriptive characteristics by intervention
TM (n= 15) CTL ( n= 18)
Age (years) 16.5 ± 1.1 16.6 ± 1.1
Weight (kg) 87.1 ± 21.8 91.2 ± 25.7
Height (cm) 170.6 ± 6.8 171.0 ± 8.2
Body surface area (m
) 1.98 ± 0.25 2.02 ± 0.27
Body mass index (kg/m
) 29.7 ± 6.2 31.2 ± 8.6
Ponderal index (kg/m
) 17.4 ± 3.4 18.3 ± 5.2
Waist-to-hip ratio 0.81 ± 0.07 0.81 ± 0.09
Baseline resting CV function
SBP (mmHg) 124.7 ± 9.1 118.8 ± 8.2
DBP (mmHg) 61.6 ± 7.1 59.7 ± 5.8
HR (bpm) 65.3 ± 9.5 66.0 ± 12.8
CO (l/min) 4.9 ± 1.2 5.1 ± 1.3
TPR (mmHg/(l/min)) 17.7 ± 4.5 16.4 ± 5.3
V.A. Barnes et al. / Journal of Psychosomatic Research 51 (2001) 597–605 599
calibration for impedance-derived SV measures during the
formal evaluation. This approach resulted in standardization
of all CO and TPR readings providing a more accurate means
of measuring absolute responses to the stressors.
Following instrumentation with the CV monitoring
equipment, all subjects were placed in a supine position
and instructed to relax as completely as possible by closing
the eyes, freeing the mind of distracting thoughts, and
concentrating on breathing in a slow regular manner for
15 min. CV responses were simultaneously measured during
minutes 10, 12, and 14. Following baseline evaluation,
during both the preintervention and 2-month postinterven-
tion evaluations, the virtual reality car driving simulation and
social stressor interview were presented, with the order of
presentation counterbalanced among subjects but maintained
within-subject for both evaluations. The car driving simu-
lation stressor was chosen as an individual behavioral
challenge and the social stressor interview was chosen as
an interpersonal relationship challenge. Both stressors have
been shown to increase sympathetic arousal and CVR to
each has been predictive of CV risk factors in youth such as
increased BP levels and left ventricular mass [20,62]. Full
details of the stressor protocols have been presented in earlier
reports [63,64]. The car driving stressor and social stressor
interview were presented in the supine position. During each
10-min behavioral stressor, and each 15-min recovery
period, CV readings were obtained every other minute.
Car driving simulation stressor
The virtual reality car driving protocol was developed in
our lab [64]. The subject was fitted with a Kaiser-Optic
Virtual Immersion monitor (VIM-500, Kaiser Aerospace
and Electronics, Carlsbad, CA) fitted on his/her head. The
VIM 500 was interfaced with a Panasonic Real 3DO
(b) Postintervention cardiovascular responsivity to stressors by intervention and time
Prestressor level Mean stressor level Prestressor level Mean stressor level Significant effects
Car driving
SBP (mmHg) 121.1 ± 9.5 130.2 ± 10.9 119.8 ± 12.3 131.2 ± 13.9
DBP (mmHg) 59.1 ± 10.0 69.5 ± 11.2 60.7 ± 7.6 71.8 ± 10.1
HR (bpm) 66.2± 11.1 76.9 ± 12.7 64.8 ± 8.9 75.3 ± 14.9
CO (l/min) 4.8 ± 1.4 4.9 ± 1.5 5.4 ± 1.3 5.7 ± 1.3
TPR (mmHg/(l/min)) 17.8 ± 5.2 20.1 ± 6.0 15.4 ± 3.5 19.1 ± 9.4
Social stressor interview
SBP (mmHg) 126.0 ± 10.8 133.1 ± 10.9 121.0 ± 10.9 133.1 ± 12.2
DBP (mmHg) 64.5 ± 7.1 70.2 ± 9.5 61.5 ± 6.3 69.7 ± 6.8
HR (bpm) 70.0± 10.5 74.7 ± 9.7 66.0 ± 9.9 71.7 ± 12.4
CO (l/min) 4.7 ± 1.6 4.6 ± 1.4 5.3 ± 1.4 5.7 ± 1.6
TPR (mmHg/(l/min)) 21.3 ± 11.4 22.9 ± 11.8 16.3 ± 4.8 17.2 ± 5.0
Values are means ± standard deviation.
Intervention effect (TM vs. CTL).
Time effect (pre- vs. postintervention).
Phase effect (prestressor vs. task level).
*P< .05
** P< .10
Table 2
Postintervention descriptive characteristics and cardiovascular responsivity to stressors by intervention and time
(a) Postintervention descriptive characteristics by intervention
TM (n= 15) CTL ( n=18) Significant effect
Age (years) 16.7 ± 1.1 16.8 ± 1.1
Weight (kg) 88.1 ± 20.8 92.0 ± 26.1
Height (cm) 170.5 ± 6.7 171.0 ± 8.2
Body surface area (m
) 1.99 ± 0.24 2.03 ± 0.27
Body mass index (kg/m
) 30.1 ± 6.1 31.4 ± 8.8
Ponderal index (kg/m
) 17.6 ± 3.4 18.4 ± 5.3
Waist-to-hip ratio 0.83 ± 0.08 0.83 ± 0.08
Baseline rest CV function
SBP (mmHg) 119.9 ± 9.1 121.4± 11.2
DBP (mmHg) 58.1 ± 8.5 60.9 ± 7.9
HR (bpm) 66.2 ± 11.2 64.5 ± 8.5 ns
CO (l/min) 5.0 ± 1.3 5.3 ± 1.3 ns
TPR (mmHg/(l/min)) 16.4 ± 5.3 16.3 ± 4.6 ns
V.A. Barnes et al. / Journal of Psychosomatic Research 51 (2001) 597–605600
Interactive Multiplayer System (Model FZ-1, Matsushita
Electric of America, Secaucus, NJ) for the CD ROM ‘‘Need
for Speed’’ (Pioneer Productions and Electronic Arts, Bur-
naby, Canada). The Panasonic 3DO system incorporates a
handheld control pad. Standardized instructions and a
demonstration were given by a trained research assistant.
The subject engaged in the stressor under a condition of
challenge was prompted every minute to drive as fast as
possible. The research assistant recorded the average and
peak driving speed. Subjects then completed nine Likert
scale questions which assessed perception of task involve-
ment, skill level, and experience with the game, and
affective state changes during the stressor.
Social stressor interview
The social stressor interview was previously validated for
use with adolescents [63]. During the interview, the subject
discussed a recent socially stressful event. The interviewer
presented the subject with a list of problems concerning
school, family, friends, work, and money, which recently
resulted in anger and/or frustration. Through guided
imagery and reflective listening, the interviewer attempted
to promote accurate reexperiencing of the event, including
the subject’s affective and behavioral responses. This was
followed by a summary of the outcome of the event and the
subject’s perception of satisfaction with his/her responses to
the event. Subjects then completed six Likert scale questions
which assessed perception of task involvement and affective
state changes during the stressor.
Statistical analyses
To ensure comparability between the two groups at pre-
and postintervention on all sociodemographic (e.g., socio-
economic status, family history of CVD) and anthropomet-
ric variables (e.g., skinfolds, weight, height), a series of 2
(Intervention: TM vs. CTL) 2 (Time: pre- vs. postinter-
vention) repeated-measures analyses of variance (ANOVA)
with time as the repeated measure was conducted.
Supine resting CV data (i.e., SBP, DBP, HR, CO, TPR)
were analyzed as dependent variables using 2 (Intervention:
TM vs. CTL) 2 (Time: pre- vs. postintervention) repeated-
measures ANOVAs with time as the repeated measure.
Multivariate repeated-measures analyses of covariance
(MANCOVAs) were conducted separately for each stressor
using the mean CV responses (i.e., SBP, DBP, HR, CO, TPR)
as the dependent variables with phase (prestressor vs. stress
response) and time (pre- vs. postintervention) as repeated-
measures factors, intervention (TM vs. CTL) as the grouping
factor, and supine resting CV values as covariates. Follow-up
comparisons were not needed because there were only two
levels for each of the independent variables.
Descriptive characteristics
The average attendance of the TM and CTL groups at the
school sessions was 67.8% and 68.2%, respectively. The
average self-reported compliance with TM practice at home
was 76.6%. The percentage of students attending at least 60%
of the total possible sessions was 80% for the TM groups and
58% for the CTL group. Descriptive characteristics of the TM
and CTL groups are presented in Tables 1a and 2a. There
were no significant main (i.e., intervention, time) or inter-
action effects for any parameter (all Ps > .36) indicating that
the groups did not differ significantly at preintervention in
expectation of benefits nor at pre- or postintervention in any
anthropometric or demographic parameters.
Resting CV evaluations
The unadjusted means and standard deviations for the
resting CV parameters as a function of intervention status
Fig. 1. Change in supine resting SBP (pre- minus postintervention) after a
2-month intervention.
Fig. 2. Change in SBP reactivity (mean stressor minus prestressor level) to
the car driving simulation stressor (pre- minus postintervention) comparing
TM vs. CTL groups after a 2-month intervention.
V.A. Barnes et al. / Journal of Psychosomatic Research 51 (2001) 597–605 601
and time are presented in Tables 1b and 2b. Analyses
revealed no main effects for intervention on any CV
parameter ( Ps >.42). A Group Time interaction (Fig. 1,
P< .03) for SBP indicated that at postintervention, the TM
group exhibited lower while the CTL group exhibited
slightly higher resting SBP than at preintervention. An
Intervention Time interaction indicated a trend such that
the TM group exhibited lower while the CTL group exhib-
ited higher resting DBP at postintervention ( P< .06).
CV responsivity evaluations
Car driving simulation stressor
For the MANCOVA analyses, the most important term to
be tested was the three-way interaction of Intervention
Phase Time. The MANCOVAs revealed significant phase
effects for all CV parameters ( Ps < .04), indicating that
subjects exhibited significant CV arousal to the stressors.
For the car driving stressor, Intervention Phase Time
interactions were observed for SBP (Fig. 2, P< .03), CO
(P< .01), and HR ( P< .03) and for a trend was noted for DBP
(P< .07). The nature of these interactions was such that
differences between the prestressor and stress responses
(reactivity) were smaller at postintervention for the TM
compared to the CTL group which showed a slight increase.
There were no significant differences between the groups
in self-reported task involvement, and affective responses to
the stressors at pre- or postintervention ( Ps >.14). At pre-
intervention, there were no significant differences between
the groups on maximum (TM: 113.8 ± 14.1; CTL: 114.6 ±
7.9 mph) and average (TM: 70.8 ± 6.0; CTL: 66.5 ± 11.3 mph)
driving speeds ( Ps >.24) during the car driving stressor. At
postintervention during the car driving simulation task, the
TM group exhibited higher maximum (TM: 119.3 ± 10.1;
CTL: 114.8 ± 8.7 mph, P< .04), but similar average (TM:
74.4 ± 7.8; CTL: 72.9 ± 13.3 mph) driving speeds.
Social stressor interview
A less consistent pattern of findings was noted for the
social stressor interview. The MANCOVAs revealed sig-
nificant phase effects for all CV parameters ( Ps < 0.04),
except for CO ( P>.10), indicating that subjects exhibited
significant CV arousal to the stressors. For SBP, there was
a significant Group Phase Time interaction (Fig. 3,
P< .03). The interaction was such that the differences
between the prestressor and stress response were mark-
edly smaller at post- compared with preintervention
for the TM compared to the CTL group for which
the differences were slightly smaller at post- compared
with preintervention.
This study examined the impact of a 2-month participa-
tion in the TM technique on CV function at rest and during
acute stress in adolescents with high normal BP. With
respect to resting CV function, the TM group exhibited
greater decreases in resting SBP and a trend for greater
decreases in DBP compared to the control group. These
findings were not attributable to differences in anthropo-
metrics or demographics since the TM and control groups
were similar on these parameters at pre- and postinterven-
tion, and both groups were similar in their expectations of
health benefits at preintervention. Eisenberg et al. [65] were
unable to document the efficacy of various types of stress
reduction approaches upon EH (e.g., biofeedback, relaxa-
tion, stress management, and/or non-TM meditation) under
controlled conditions. However, the present findings are
consistent with adult studies which have shown that TM
reduced BP significantly in older hypertensive AAs [34] at
3 months, CAs [49] at 3 months, normotensive Asian
medical students at 1.5 and 3 months [48], and in normo-
tensive CA college students over 4 months [40].
Few BP-related stress reduction studies have been con-
ducted in youth and findings have been mixed. Relaxation
training combined with increased physical activity for
4 months failed to yield any BP differences in commun-
ity-home boys compared to a control group [32]. A daily
PMR program conducted for 4 months at school in teen-
agers with high normal BP showed a 5.3 mmHg greater
decrease in their SBP compared to a waiting-list control
condition [31]. The present findings compare favorably with
the results of that study [31] in that the TM group exhibited
a 4.8-mmHg greater decrease in SBP compared to a
2.6-mmHg increase in the CTL group.
Only a few studies have examined the impact of TM
upon CVR and all have involved adults. TM was shown
to decrease HR reactivity to viewing a stressful film in
normotensive adults [39]. No significant changes were
Fig. 3. Change in SBP reactivity (mean stressor minus prestressor level) to
the social stressor interview (pre- minus postintervention) comparing TM
vs. CTL groups after a 2-month intervention.
V.A. Barnes et al. / Journal of Psychosomatic Research 51 (2001) 597–605602
reported in either BP or HR reactivity to mental arith-
metic, mirror star tracing, public speaking, or an isometric
handgrip task in a 4-month study comparing TM to a
stress education control group in normotensive CA college
students [40]. The present findings in youth extend these
reports. Greater decreases in SBP, HR, and CO reactivity
and a trend for a greater decrease in DBP reactivity were
observed in the TM group compared to increases in the
control group during the car driving simulation task. With
respect to the social stressor interview, both groups
exhibited decreases in SBP reactivity but a greater
decrease was observed in the TM group compared to
the control group.
Why TM had a more consistent impact on CVR to car
driving simulation is unknown. Perhaps TM subjects exhib-
ited decreased sympathetic arousal to the car driving simu-
lation on the postevaluation due in part to improved
perceptual motor coordination and/or faster reaction time
previously observed to be a result of TM [66,67]. Partial
support for this hypothesis is provided by the higher peak
driving speed for the TM group on the second visit. No
other measures of driving-related performance (e.g., number
of wrecks, time off of road, etc.) were recorded. Future
stress reduction studies evaluating possible CVR reduction
to perceptual motor or cognitive skills stressors may bene-
fit from inclusion of relevant performance measures. Rea-
sons for the increased CVR to car driving simulation in the
CTL group are also unknown. Although many studies have
reported a decrease in CVR to the same stressor over time,
findings have been mixed and a number have reported
increases in CVR. For example Mills et al. [68] reported
increases in SBP (6 mmHg), DBP (4 mmHg), and HR
(3 bpm) reactivity to standing and math stressors given
10 days apart.
Although intriguing and supported by the adult literature,
the present findings should be interpreted cautiously since
impact of health education on change in lifestyle-related
moderators, such as diet (e.g. sodium intake), physical
activity, and environmental stress were not evaluated. How-
ever, all subjects resided in the same geographical locale
(i.e., lower socioeconomic status neighborhoods), and none
participated in any formal sports or lifestyle programs
during the intervention period, besides physical education.
Further, there were no significant differences between the
groups in changes in weight or adiposity, which would
provide some indication of significant diet and/or physical
activity lifestyle changes. The study did not provide the
groups with knowledge regarding the impact of stress on BP
and other CV variables. Although efforts were made to
provide comparable instruction time and attention at school
to both groups, the TM group did receive greater direct
contact. While TM is not conventionally practiced during
lunch breaks, this facilitated fitting a daily session into the
school schedule without taking time from the academic
schedule. In other studies, neither lifestyle modification
education matched for direct attention, nor waiting-list
control groups showed significant decreases in resting BP
[31,32,34]. Further, one of these studies found the CTL
group to exhibit slight increases in clinic BP at follow-up
compared to the decrease exhibited by the TM group [34].
To our knowledge, no studies have shown whether
relaxation-reduced CVR in youth prevents the development
of EH. The health-damaging effects of CVR are thought to
be due to the accumulation of repeated occurrences that
eventually produce detrimental alterations in CV structure
and function [69]. Since it is frequently many years before
children display overt clinical symptoms of CV disease,
longitudinal studies are needed to examine the impact of
reduced CVR or the development of preclinical manifesta-
tion of increased EH risk (e.g., left ventricular hypertrophy,
endothelial dysfunction, increased resting BP). Future stud-
ies would benefit from inclusion of follow-up evaluation to
determine whether impact of TM is lasting. Also, evaluation
of possible moderators such as diet, physical activity, and
social support would be beneficial.
To our knowledge, this is the first controlled randomized
study of reduction of resting BP and CVR to acute stress in
at-risk youth using behavioral stress reduction via TM. The
successful implementation of the intervention points to the
potential of school-based stress reduction programs to
prevent early onset of EH in high-risk youth, particularly
AAs. The results of this study contribute to the currently
limited knowledge of the efficacy of stress reduction pro-
grams in reducing resting BP and CVR to acute stress.
We would like to thank Dr. Charles Larke, Super-
intendent; Dr. Rush Utley and Mr. Quentin Motley,
Principals, Richmond County Public Schools in Augusta,
GA for their cooperation in providing the facilities for this
study. This study was supported in part by National
Institutes of Health Grant #HL62976 to Dr. Treiber and an
American Heart Association Scientist Development Grant
#9930073N to Dr. Barnes.
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... A reduction in EE would mirror the effectiveness of the TM practice in relieving burnout, which was demonstrated by previous studies showing significant reductions of the psychological and physiological impact of stress (including lower sympathetic nervous system tone and cortisol levels). 34,35 Reductions in burnout after 4 months of TM practice were also reported in randomized controlled trials of secondary school teachers and staff, another highly stressful profession. 19,36 PA, a second key MBI dimension, significantly increased after 1 month of TM practice and remained significant at 4 months. ...
Introduction: Burnout is pervasive among physicians and has widespread implications for individuals and institutions. This research study examines, for the first time, the effects of the Transcendental Meditation (TM) technique on academic physician burnout and depression. Methods: A mixed methods randomized controlled trial was conducted with 40 academic physicians representing 15 specialties at a medical school and affiliated VA hospital using the TM technique as the active intervention. Physicians were measured at baseline, 1 month, and 4 months using the Maslach Burnout Inventory, Beck Depression Inventory, Insomnia Severity Index, Perceived Stress Scale, and Brief Resilience Scale. Repeated measures analysis of covariance was used to assess adjusted mean change scores for the 1- and 4-months posttests. Qualitative interviews were conducted at baseline and 4 months and compared with the quantitative measurements. Results: Significant improvements were found for the TM group compared with controls at 4 months in total burnout (p = .020) including the Maslach Burnout Inventory dimensions of emotional exhaustion (p = .042) and personal accomplishment (p = .018) and depression (p = .016). Qualitative interviews supported quantitative outcomes. Physicians reported classic burnout and depression symptoms in baseline interviews. Those regularly practicing the TM technique reported relief from those symptoms. The control group did not state similar changes. Discussion: Mixed methods findings suggest the TM technique is a viable and effective intervention to decrease burnout and depression for academic physicians. Larger longitudinal studies with a wider range of health care providers are needed to validate these findings for extrapolation to the greater medical community.
... [8][9][10] It has been shown to facilitate a reduction of distress and anxiety, 8,[11][12][13] benefit autonomic nervous system function and heart rate variability, 14 and decrease in resting systolic blood pressure, cardiac output and heart rate. [15][16][17] When used in conjunction with existing treatment protocol, patients with osteosarcoma and breast cancer who receive training in MM are reported to experience more positive treatment outcomes than patients not practicing MM. 18,19 Across clinical populations, 20 MM has been shown to facilitate a decrease in both acute [21][22][23] and chronic pain, 24,25 distress tolerance, 26 reduce perceived stress, 27 improve quality-of-life scores, 24 and reduce depression. 28 Effects have been seen across a wide variety of populations 29 including patients with cancer, 18,19,30,31 fibromyalgia, 32 and tinnitus, 33 adults who stutter, 34,35 patients experiencing long-term effects of COVID-19, 36 and those recovering postseptorhinoplasty. 23 Of interest to the voice and upper-airway disordered population, mindfulness training has been observed to reduce dyspneic symptoms in patients with COPD, and improve quality of life in patients suffering with GERD. ...
Objectives The benefits of mindfulness meditation are well documented. This study evaluated the immediate effects of mindfulness meditation (MM) on the voice and voice user. Study design Prospective experimental study. Methods Participants: 19 vocally healthy (VH) individuals, and 26 individuals with common voice disorders (CVD; benign lesions and hyperfunctional muscle tension) deemed stimulable for voice therapy. Exclusionary criteria: prior training or regular meditation practice. Participants recorded speech samples before and after a 11.5-minute prerecorded session of MM. Primary outcomes: phonatory aerodynamics and participants’ self-reported experience of voice. Secondary outcomes: self-reported anxiety, vocal acoustics, speech breathing patterns, and auditory-perceptual outcomes. Baseline self-reported measures of voice (Voice Handicap Index-10 - VHI-10), breathing (Dyspnea Index – DI), stress (Perceived Stress Scale - PSS), and trait mindfulness (Cognitive and Mindfulness Scale – Revised, CAMS-R, Five Facet Mindfulness Questionnaire – FFMQ) were compared between groups. Results At baseline, CVD had significantly higher VHI-10 (P< 0.001) and DI (P= 0.0014), and lower trait mindfulness (CAMS-R, P= 0.02). No difference between groups for PSS or FFMQ. Changes postMM: decreased CPP for all-voiced sentences for VH (P= 0.003), decreased mean SPL (P= 0.012) on sustained vowel for VH, increased mean phonatory airflow during sustained vowel for CVD (P = 0.012). VH demonstrated a decrease in CPP on the all-voice sentence, and CVD demonstrated an increase, resulting in a significant between group difference (P= 0.013). Participants reported improvements in voice, emotional and physical states. State anxiety decreased for both groups (= < 0.001). No other objective outcomes reached significance. Conclusions After a brief MM, participants experienced improvement in physical, emotional, and cognitive states, and in their perceptions of their voice. Results indicate that a brief, single session of MM may be beneficial for some, but not sufficient to override habitual voice and speech patterns. Given the benefits of MM, future work should evaluate MM in a standard voice therapy protocol.
... However, Dillbeck et al. (2020) have surveyed the studies on changes to hormone levels and physiological stress responses, cardiovascular functioning, EEG patterns, evoked potentials and cortical plasticity, as well as reductions to ambulatory blood pressure and hypertension, which collectively result in improved health and well-being and a reduction in medical care utilisation. While many of these findings do not draw directly from the experiences of school children, earlier research on adolescent health by Barnes, Treiber and Davis (2001) does suggest Transcendental Meditation has a salutary effect on childhood health, energy, and stress. ...
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Over three decades of research on the role of meditation in hypertension have shown beneficial effects. The authors glue together the effects of different forms of meditation on hypertension from the earliest to the latest.KeywordsMeditationCardiovascular diseaseRisk factorsPsychological stressStress reductionMBSRTMYoga
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Daily behaviors influence an individual’s health and, in turn, all the domains of their quality of life (QoL). Accurately quantifying these behaviors may allow individuals to improve their overall awareness of these behaviors, make necessary habit changes, and receive more individualized treatment approaches. Currently, self-reported patient-reported outcomes (PROs) are the most common means of assessing daily behaviors. However, this method has multiple limitations, including the infrequency of collection, its subjective nature, its reliance on memory recall, and the influence of social norms. In comparison with PROs, using personalized and miniaturized technological innovations, including smartphones, mobile applications, and wearables, can enable the continuous assessment of daily life behaviors that contribute to or result from an individual’s QoL in a more accurate and timely manner. These technologies have the potential to transform the current state of quantifying QoL, allowing for improved research and the implementation of more individualized approaches to prevention and treatment. This chapter thus presents potential areas of future research and development opened by the use of these technologies in the field of QoL.
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Objective—Increased peripheral vasoconstriction (ie, total peripheral resistance, or TPR) has been implicated as playing an important role in the early development of essential hypertension. Some studies have demonstrated that Transcendental Meditation (TM) reduces high blood pressure, but the hemodynamic adjustments behind these blood pressure reductions have not been elucidated. The aim of this study was to provide a preliminary investigation of the acute effects of TM on TPR. Methods—Subjects were 32 healthy adults (16 women and 16 men; 30 white and two African American; mean age, 46.4 ± 3.9 years). Subjects were divided into a TM group of long-term TM practitioners (eight white women, nine white men, and one African American man; mean years of twice-daily TM practice, 22.4 ± 6.7) and a control group (eight white women, five white men, and one African American man). Hemodynamic functioning was assessed immediately before and during three conditions: 20 minutes of rest with eyes open (all subjects), 20 minutes of TM (TM group), and 20 minutes of eyes-closed relaxation (control group). Results—During eyes-open rest, the TM group had decreases in systolic blood pressure (SBP) and TPR, compared with increases in the control group (SBP: −2.5 vs. +2.4 mm Hg, p < .01; TPR: −0.7 vs. +0.5 mm Hg/liter per minute, p < .004). During TM, there was a greater decrease in SBP due to a concomitantly greater decrease in TPR compared with the control group during eyes-closed relaxation (SBP: −3.0 vs. +2.1 mm Hg, p < .04; TPR: −1.0 vs. +0.3 mm Hg/liter per minute, p < .03). Conclusions—TPR decreased significantly during TM. Decreases in vasoconstrictive tone during TM may be the hemodynamic mechanism responsible for reduction of high blood pressure over time. The results of this study provide a preliminary contribution to the understanding of the underlying hemodynamic mechanisms responsible for the beneficial influence of TM on cardiovascular risk factors.
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Background. The "Report of the Second Task Force on Blood Pressure Control in Children - 1987" developed normative blood pressure (BP) data for children and adolescents. These normative data are used to classify BP levels. Since 1987, additional BP data in children and adolescents, the use of newer classes of drugs, and the role of primary prevention of hypertension have expanded the body of knowledge regarding the classification and treatment of hypertension in the young. Objective. To report new normative BP data in children and adolescents and to provide additional information regarding the diagnosis, treatment, and prevention of hypertension in children. Methods. A working group was appointed by the director of the National Heart, Lung, and Blood Institute as chair of the National High Blood Pressure Education Program (NHBPEP) Coordinating Committee. Data on children from the 1988 through 1991 National Health and Nutrition Examination Survey III and nine additional national data sets were combined to develop normative BP tables. The working group members produced initial draft documents that were reviewed by NHBPEP Coordinating Committee representatives as well as experts in pediatrics, cardiology, and hypertension. This reiterative process occurred for 12 draft documents. The NHBPEP Coordinating Committee discussed the report, and additional comments were received. Differences of opinion were adjudicated by the chair of the working group. The final report was sent to representatives of the 44 organizations on the NHBPEP Coordinating Committee for vote. It was approved unanimously by the NHBPEP Co-ordinating Committee on October 2, 1995. Conclusions. This report provides new normative BP tables for children and adolescents, which now include height percentiles, age, and gender. The fifth Korotkoff sound is now used to define diastolic BP in children and adolescents. New charts have been developed to guide practicing clinicians in antihypertensive drug therapy selection. The primary prevention of hypertension in these age groups is discussed. A statement on public health considerations in the treatment of children and adolescents is provided.
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Conducted a meta-analysis of studies about blood pressure (BP) and heart rate (HR) responses to behavioral stress in essential hypertensives (HTNs), borderline HTNs, and offspring of HTNs. Essential HTNs had large BP responses during all stressors, but especially during passive stressors not requiring a behavioral response. Borderline HTNs had moderately large and more reliable BP and HR responses primarily during active stressors (ASTs). Normotensive offspring of HTNs had moderately large and more reliable BP and HR responses to ASTs. Excessive sympathetic nervous system activity during behavioral stress seems to have a pathophysiologic role in the development of hypertension. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Resting cardiovascular parameters were predicted from anthropometric data, resting baseline cardiovascular data, and cardiovascular responses to three laboratory stressors completed 1 year earlier. Subjects were 106 male and female children (72 Whites, 34 Blacks) aged 6–7 years at the initial evaluation. During initial testing, blood pressure, heart rate, cardiac output, and total peripheral resistance were assessed at rest and also during a forehead cold pressor task, postural change, and treadmill exercise. The same cardiovascular parameters were then assessed at rest 1 year later. After controlling for significant anthropometric measures and the pertinent previous year's resting data, systolic and diastolic responses to the cold pressor were predictive of respective follow-up resting levels. Postural change heart rate responses were predictive of follow-up resting heart rate after controlling for initial resting levels. Exercise cardiac index reactivity predicted follow-up cardiac index after controlling for earlier resting levels and adiposity. Follow-up total peripheral resistance index was predicted by earlier resting levels.© 1997 Elsevier Science B.V.
Cardiovascular reactivity is the change in blood pressure, pulse, and other parameters of cardiovascular function in response to a challenging task. During the conduct of cardiovascular reactivity protocols, researchers frequently use automated blood pressure devices to measure blood pressure reactivity. However, the accuracy of automated devices in measuring blood pressure reactivity is unknown. To investigate the accuracy and precision of the Dinamap 1846 SXP and the VitaStat 2600B in the measurement of blood pressure reactivity, we compared blood pressure reactivity recorded by the VitaStat and Dinamap with that obtained by observers using a conventional mercury sphygmomanometer. At three sites, 159 normotensive subjects performed the same task twice, once with blood pressure reactivity measured by the manual observers and once by the VitaStat (n = 79) or Dinamap (n = 80), with the order determined at random. Ratios (VitaStat/Dinamap) of aggregate within-person variance for baseline and task, systolic and diastolic blood pressures ranged from 1.53 to 4.93 (all P < 0.01), suggesting that the Dinamap has better precision than the VitaStat. For both diastolic and systolic blood pressure reactivity and for both types of automated devices, the mean differences in blood pressure reactivity between manual and automated measurements were small (range, −1.8 to 0.8 mm Hg). However, the VitaStat versus manual scatter plot of diastolic blood pressure reactivity showed greater dispersion (correlation coefficient r = 0.16, P = 0.15) than the Dinamap versus manual scatter plot (r = 0.36, P = 0.001). For systolic blood pressure reactivity, the VitaStat versus manual and Dinamap versus manual scatter plots were similar. Our data indicate that the Dinamap is superior to the VitaStat in the measurement of blood pressure reactivity. The substantial performance differences between the VitaStat and Dinamap suggest that other automated blood pressure monitors must be evaluated prior to use in cardiovascular reactivity studies.
This new reference book on the pathophysiology, diagnosis, and treatment of hypertension is the most comprehensive text to date on this multidisciplinary disease process. The two-volume book has eight large sections that include 150 chapters by more than 250 contributing national and international experts in the basic and clinical disciplines associated with hypertensive diseases.The scope is massive, and the editors have done an excellent job in recruiting a "Who's Who" of hypertension contributors in their various disciplines. As the editors state in their preface, "There is something in it for everybody" as the field of hypertension brings together the most basic of scientists with the most practical of clinicians. This is certainly true, as the mainstream journals in the field of hypertension tend to devote about 60% of their pages to basic research and the remainder to clinical science. Fortunately, this textbook does not follow these proportions, as most