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Yoga reduces inflammatory signaling in fatigued breast cancer survivors: A randomized controlled trial
... Refs. [2][3][4][5][6][7][8][9] and any session and duration; (3) C (Comparator): Studies involving control type (such as active control, waitlist, and treatment as usual). However, studies that compared the effects of different MBIs were excluded; (4) O (Outcome): The measurement of biomarker levels and statistics (mean, standard deviation [SD], and effect size). ...
... After excluding 831 duplicated articles, 189 articles were assessed for eligibility. Finally, 89 articles [3][4][5][6][7][8][9][12][13][14][15][16] were assessed for suitability according to the inclusion criteria for this meta-analysis. The PRISMA flow diagram for studies retrieved through electronic searches and the selection process for study inclusion are shown in Figure 1. ...
... This finding may be attributed to the relatively large number of participants. In the analysis of IL-1ra levels, the 2022 Li study [86], which was excluded from [6,8,9,38,42,44,47,49,56,91,94,96,100], (B) BDNF [3,15,41,51,53,61,63,66,68,78,105], (C) IFN-γ [5,8,30,57,83,86,92], (D) IL-10 [3,6,40,45,53,54,68,82,83,86,99]. Control: pre-MBI effect. ...
Objective: Chronic stress affects the immune system via the hypothalamic–pituitary–adrenal (HPA) axis and autonomic system. Chronic inflammation is a risk factor for cardiovascular diseases, cancer onset and progression, susceptibility to infection, and cognitive impairment. Mind–body interventions (MBIs) could affect the immune and neuroendocrine systems, and we aimed to assess the correlations among these systems through a meta-analysis. Methods: RCTs were identified by searching three databases: PubMed, Embase, and Scopus. Of the 1697 studies identified, 89 were included in this study. Risk of bias was examined using the Cochrane risk-of-bias assessment tool. Data were pooled using a random-effects model, and SMDs were calculated. I² statistics and Egger’s test were used to assess the significance of the asymmetry. Influence diagnostics were used to assess whether pooled effects were disproportionately dependent on any single study. The trim-and-fill method was applied to all identified asymmetric instances. Meta-regression was used to examine the moderating effect of MBI efficacy on biomarkers. Results: MBIs generally decreased the levels of inflammatory factors, such as the CRP, IL-6, TNF-α, IL-1, IL-8, IL-17, ESR, and cortisol, and increased IL-10, IFN-γ, IL-1ra, BDNF, and secretory IgA. In a subgroup analysis of the CNS and cancer, qigong and yoga showed increased BDNF and IL-6, respectively. Notably, IL-10 was increased in inflammatory diseases, and IFN-γ was increased in viral infections. Conclusions: This study revealed MBIs decrease inflammatory cytokine and increase anti-inflammatory, antiviral, and immune-activating factors. These results suggest the MBIs including gentle physical exercise may be beneficial for neuropsychiatric disorders or tumors. Prospero registration number: CRD42024507646.
... In this review, we make an effort to create a theoretical notion of gut microbial diversity that can be enhanced by mind-body medicine. On the other hand, mind-body medicine has been shown to boost immunity and lower cytokines like TNF-alpha, IL-1, IL-6, and IL-8 that reduce inflammation (Bower et al., 2014;Kiecolt-Glaser et al., 2014;Kant et al., 2014;Chen et al., 2017;Naoroibam et al., 2016). Additionally, we hypothesize that mind-body medicine can control neuronal and endocrine activities to create the proper balance between the immune system and the human gut flora. ...
... However, another study found that after performing yoga for six months, asthmatics' levels of hemoglobin and the antioxidant (Superoxide Dismutases) SOD significantly improved. Additionally, their total and differential leukocyte counts (neutrophils, eosinophils, monocytes, and lymphocytes) significantly decreases (Bower et al., 2014;Kiecolt-Glaser et al., 2014). Studies claim that Yoga interventions given to fatigued breast cancer survivors reduced the activity of pro-inflammatory transcription factors such as nuclear factor kappa B (Bower et al., 2014). ...
... Additionally, their total and differential leukocyte counts (neutrophils, eosinophils, monocytes, and lymphocytes) significantly decreases (Bower et al., 2014;Kiecolt-Glaser et al., 2014). Studies claim that Yoga interventions given to fatigued breast cancer survivors reduced the activity of pro-inflammatory transcription factors such as nuclear factor kappa B (Bower et al., 2014). According to Chen et al. (2017), yoga can also boost levels of IL-12, CD4 + cells, and IgA concentration. ...
... Tumour necrosis factor receptor II (TNF-RII) was significant (P = 0.03) at 12 weeks of Iyengar yoga but was not significant for IL-6 (P = 0.87). [25] Post 3 months of Hatha yoga, TNF-α, IL-6 and IL-1β have significantly reduced (P < 0.05) in BC survivors. [26] A study on the effect of therapeutic yoga and meditation for 04 months among the cancer survivors where the majority (65%) of the study population were BC showed significant reduction in IL-1β (P < 0.05). ...
... [30] Bower et al. reported that Iyengar yoga in BC survivors was found to maintain the stability of soluble TNF-RII when compared to the health education group. [25] A study by Rao et al. on the effects of yoga on post-operative outcomes and wound healing in BC patients found that serum TNF-α was downregulated in the integrated yoga group, whereas in the control group, it was upregulated, though statistically, it was not significant. [31] These study results corroborated our research finding where TNF-α was attenuated in the yoga intervention group, and in the control group, it was up-regulated. ...
Objectives
Yoga, renowned for its ability to maintain physical, mental and spiritual well-being, has recently gained prominence as a supportive therapy during conventional breast cancer (BC) treatment. This paradigm shift reflects a growing trend of people embracing yoga to enhance their overall health and aid in managing BC. The objective of this study was to determine the yoga intervention and inflammatory homoeostasis in newly diagnosed BC patients.
Materials and Method
This study recruited 44 newly diagnosed BC patients at stages II, III and IV (without distant metastasis or other inflammatory diseases), all admitted for neoadjuvant chemotherapy followed by surgery. A prospective non-randomised control design was employed. Baseline assessments were conducted before the first chemotherapy cycle, with follow-ups before the 2 nd and 3 rd chemotherapy cycles, before surgery, and 2 months post-surgery. The outcome was compared with the control group.
Results
The study showed significant within-subject effects in the yoga intervention group on serum tumour necrosis factor-alpha, interleukin (IL)-1-beta and IL-6 levels, while no significant changes were observed in the control group. Although between groups did not show statistically significant, the mean values indicated a consistent downregulation of proinflammatory markers over time in the yoga group.
Conclusion
Incorporating yoga as a complementary therapy alongside conventional BC treatment significantly improved the health outcomes of BC patients by modulating proinflammatory markers.
... Yoga can regulate the dysregulation of the HPA axis, decrease plasma cortisol levels, and increase the release of endogenous dopamine and g-aminobutyric acid levels (37)(38)(39). Some studies have been conducted to investigate the potential mechanisms underlying the improvement effect of yoga on CRF (40,41), which may involve the modulation of the inflammatory processes, such as regulating the levels of inflammatory cytokines (e.g., IL-1b, IL-10), or the NF-kB pathway. Moreover, yoga may enhance glucocorticoid signal transduction and reduce sympathetic nervous system signaling through b-adrenergic receptors to influence inflammatory processes. ...
... In addition, some of these biomarkers have been assessed as independent risk factors for CRF (17,(75)(76)(77)(78). Moreover, some studies have confirmed that improvements in the levels of certain inflammatory markers can ameliorate CRF (40,(79)(80)(81). ...
Objective
Cancer seriously endangers human health and represents a global public health issue. Cancer-related fatigue (CRF) is a distressing and persistent sense of exhaustion caused by cancer or cancer treatment, widely prevalent among cancer patients. This study aims to summarize emerging trends and provide directions for future research of CRF through bibliometric and visualization analyses.
Methods
A systematic search in the Web of Science Core Collection database from 2001-01-01 to 2023-05-18 were conducted. Only reviews and articles written in English were considered. CiteSpace and the R were used for bibliometric and visualization analyses.
Results
The analysis revealed that 2,566 studies on CRF have been published by 1,041 institutions in 70 countries so far. The number of articles published and cited annually have been steadily increasing. Eduardo Bruera published the most articles, and Julienne E Bower is the most co-cited author. The University of Texas System is the leading institution in cancer-related fatigue research. The United States and China have the largest number of publications. Supportive Care in Cancer published the most articles, and Journal of Clinical Oncology is the most co-cited journal. “Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue: A Meta-analysis”, authored by Mustian KM et al. and published in JAMA Oncology was the most co-cited document. Keyword analysis indicated that research focus had shifted from “epoetin alpha” and “anemia” to “risk factors”, “systematic review”, “acupuncture”, “anxiety”, “traditional Chinese medicine” and “guidelines”.
Conclusion
In conclusion, this analysis provides comprehensive research trends and knowledge network maps of CRF. Clinical physicians should concurrently focus on the anemia, insomnia, anxiety, and depression status of patients when assessing or managing CRF. Improvements in related risk factors also contribute to alleviating fatigue. Furthermore, it is essential to pay attention to authoritative CRF guidelines. Acupuncture and traditional Chinese medicine also have therapeutic potential, which merits further investigation. Researchers should draw attention to the crucial roles of inflammation, hypoxia, and mitochondrial dysfunction, which could be the frontiers.
... Bower et al. showed the positive effects of yoga on reducing resistant fatigue in cancer survivors in three studies. [20] The result of Bower's study indicated that yoga has a greater effect on reducing fatigue than other behavioral interventions in previous studies. [20] Sadja et al. [21] in a review, the study reviewed 10 articles regarding the effect of yoga on fatigue in cancer patients. ...
... [20] The result of Bower's study indicated that yoga has a greater effect on reducing fatigue than other behavioral interventions in previous studies. [20] Sadja et al. [21] in a review, the study reviewed 10 articles regarding the effect of yoga on fatigue in cancer patients. There were 8 articles on breast cancer patients. ...
... In their randomized controlled trial, Bower et al. investigated whether a 12-week Iyengar yoga intervention could decrease inflammationrelated gene expression and circulating markers of pro-inflammatory cytokine activity in breast cancer survivors with persistent cancerrelated fatigue, which is a common and debilitating long-term effect of cancer and its treatment. [52] Participants were randomized into two groups: an Iyengar yoga intervention group (16 participants) and a health education control group (15 participants). The yoga intervention emphasized passive inversions and backbends, which are characteristic of the Iyengar system. ...
... Bower et al. 2014 [52] 31 ...
Background: Cancer is a growing problem worldwide, and new strategies for its management and treatment are required. The immune system plays a crucial role in cancer progression and the response to treatment. Recent studies have demonstrated that practicing yoga can positively affect the immune system. This review aimed to examine the impact of yoga on immune parameters in patients with cancer. Methods: We conducted literature searches across several scientific databases for trials published from 2014 to 2023. Studies were selected based on specific criteria, including randomized controlled trials involving yoga interventions with quantitative outcome assessments. Results: Eight studies met our inclusion criteria. These findings suggest that practicing yoga can significantly improve immune function in patients with cancer. Key findings include reductions in inflammatory cytokines, improvements in natural killer cell counts, and modulated gene expression related to immune cell survival. Specific studies have demonstrated benefits in reducing stress and fatigue, enhancing overall quality of life (QoL), and immunological benefits. Conclusion: This review indicates that yoga interventions hold substantial promise in enhancing immune function and overall QoL in patients with cancer. Evidence supports the incorporation of yoga into cancer treatment protocols as a non-invasive, holistic approach to improving immune function. However, further research is needed to standardize yoga interventions and to explore their long-term effects.
... [15][16][17] Some studies suggested that yoga practice could modulate inflammation by regulating the level of expression of a wide range of proinflammatory and anti-inflammatory cytokines. [18][19][20] For example, Kiecolt-Glaser et al reported a yoga programme in breast cancer survivors, consisting of one 90 min session twice per week, for 12 weeks, and showed benefits on inflammation and fatigue. 19 However, these studies mainly used supervised yoga programmes, and few of them associate it with at-home practice. ...
... 21 46-48 Moreover, stress and anxiety are known to impact inflammation, and recent studies have shown the effect of yoga on inflammation. [18][19][20] The originality of our programme is the introduction of the PE approach. Indeed, our theory-based multifaceted intervention foresees, anticipates and optimises at-home yoga practice. ...
Introduction
Osteoarticular pain is experienced by approximately 50% of patients with breast cancer under hormone therapy and can increase the risk of therapy discontinuation. Among complementary therapies, yoga has shown efficacy regarding reduction of fatigue, anxiety, pain due to hormone therapy and inflammation. Personalised patient education programmes increase engagement and motivation, and induce effective behavioural changes. The SKYPE programme, an integrated intervention combining physiotherapy, yoga and patient education, showed promising efficacy on hormone therapy-induced pain in a previous pilot study. In this study, we hypothesised that using theory-based patient education favour learning and practising 15 min of at-home yoga every day to decrease hormone therapy-induced pain.
Methods and analysis
This multicentre randomised study will assess the efficacy of the SKYPE programme on pain reduction compared with standard care in patients with breast cancer reporting osteoarticular pain due to hormone therapy. Main secondary objectives will describe pain evolution and characteristics, patient adhesion to yoga sessions and home practice, forward flexibility, quality of life, fatigue, anxiety and compliance to hormone therapy. Patients in the intervention group will participate in 1 weekly educational yoga session of 90 min for 6 weeks, supervised by physiotherapists (period 1). They will also perform daily at-home 15 min yoga sessions for 12 weeks, the total duration of the intervention (periods 1 and 2). Pain will be evaluated during physiotherapy check-ups at baseline (T0), at 6 weeks (T1) and at 12 weeks (T2).
Ethics and dissemination
This study was approved by the ethics committee (CPP Ile de France 8 on 22 June 2020). The results will be disseminated to patients and healthcare professionals, and published in a peer-reviewed journal.
Trial registration number
NCT04457895.
... Some studies reported an association with leukocytes or some subtype (neutrophils, basophils, or lymphocytes) [31,43,71,72,90]. CRP was found to be associated with CRF in some studies [29,31,32,34,39,47,90] but not in others [37,56,64,65,76,81]. Results concerning other cytokines, such as IL-6 and IL-1, were even more inconsistent (see Table 5). ...
... Interestingly, most research was performed by a few laboratories. An astonishing number of 12 studies (19% of the total) were published under the leadership or participation of the University of California Los Angeles (UCLA) [37,55,61,68,74,81,83,89,[92][93][94]. In this regard, Bower's group has developed considerable evidence about neuroimmune interactions and immune mechanisms for CRF. ...
Purpose
Cancer-related fatigue (CRF) is the most common symptom experienced by cancer survivors. It is a multidimensional symptom affecting physical, emotional, and/or cognitive spheres, different from other types of fatigue. Characteristically is not alleviated by sleep or rest. CRF could have specific features in breast cancer survivors (BCS), because of sex, hormones, and distinct treatments. On the other hand, more than 25% of BCS report persistent CRF for 10 years or more after the diagnosis. The present study aims to recapitulate the knowledge about the biological mechanisms that potentially drive CRF in BCS after treatment.
Methods
To answer a broad question, a scoping review methodology was used. Data were collated from three bibliographic databases: PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Studies were selected if they had included more than 20 BCS, after finishing their treatment, fatigue was measured with a quantitative scale and biomarkers were analyzed.
Results
The final database was composed of 1896 records. Sixty-four studies finally met the eligibility criteria. Inflammation (61%), hypothalamic–pituitary–adrenal (HPA) axis dysregulation (14%), autonomic nervous system (ANS) dysfunction (11%), and diet (9%) were the biological pathways most frequently studied. Unfortunately, results from studies about inflammation and HPA axis show many inconsistencies.
Conclusion
More research about the role of ANS dysfunction and diet on the pathogenesis of CRF would be warranted according to the results of the review. There are some fields such as endocannabinoid systems, mitochondrial dysfunction, gut microbiota, and oxidative stress that have been insufficiently explored.
Implications for Cancer Survivors
To widen the scope of future research in the physiopathology of CRF, it is necessary to identify mechanisms that would be potentially involved and have been insufficiently explored. Because of the high prevalence of CRF in BCS and the tremendous impact that fatigue has in their quality of life, it is essential to improve the efficacy of the treatments through a good knowledge of the biological basis of CRF.
... A qualitative study at Ulin regional public hospital Banjarmasin showed that pain and fatigue symptoms result in patients not being able to continue working or having to reduce how much time they spend at work (Kolin et al., 2016). These correlate with the symptom scale scores shown in Neuropathic cancer pain due to cancer per se and/or treatment is reported to be as prevalent as 90% (Evenepoel et al., 2022), and fatigue related to cancer treatment is as prevalent as 25% to 99% (Bower, 2014). Both symptoms might persist for months. ...
... Educating patients that cancer pain management is a trial-and-error process is important; pain control is challenging, adverse effects can be serious, and it may take several weeks to months to achieve control (Yoon & Oh, 2018). Supervised aerobic exercise regimens combined with resistance exercise with or without stretching are beneficial in reducing the chemotherapy-related increase in fatigue (Meneses-Echávez et al., 2015), as well as a targeted yoga program (Bower et al., 2014). ...
Adult cancer patients who received chemotherapy with JKN coverage were enrolled on this observational cross-sectional study to evaluate their quality of life (QOL) and to identify the associated variables that affected QOL. Eligible patients who received outpatient chemotherapy at Keluarga Sehat Hospital were asked to complete an EORTC QLQ-C30 questionnaire, as well as a socio-demographic inquiry. We collected answers from 53 patients and converted them into EORTC dimensions and symptoms. One-way analysis of variance was used in addition to descriptive statistics and independent t-tests. The QOL average score was 78.93 ± 20.89, with a 95% CI (73.31-84.55). The highest performance was on the cognitive scale (94.03 ± 16.85), while the poorest was on the role scale (73.27 ± 27.91). Pain (95% CI [24.05, 36.95]) and fatigue (95% CI [23.14, 35.98]) were the most troubling symptoms reported. The marital status (p < 0.05) and cancer treatment history (p < 0.01) were factors affecting our population’s QOL. Through the understanding of the relationship between QOL and socio-demographic and medical variables, oncologists, chemotherapy providers, and health insurers can improve the quality of life of vulnerable populations.
... [15] Literature suggests that yoga is effective in the management of musculoskeletal disorders as it improves the range of motion and physical functioning and reduces inflammation by downregulating the nuclear factor-kappa β (F-Kβ). [13] Yoga that is commonly employed in rheumatological diseases includes yogic Sukshmavyama, Asanas (Tadasana, Katichakrasana [7,16] ...
... In addition to this, there is also downregulation of genes involved in Type I IFN response and reductions in IFN-related transcription factors. [7] Some studies also show significant improvement in decreased % of body fat but not in the cardiorespiratory capacity or in inflammatory serum markers − IL-6, IL-8, TNF-α, and CRP. [30] Yoga and cardIovascular dIseases Yoga practice has exhibited many cardio and vascular protective effects. ...
... An exploratory study found that integrating a low-carbohydrate diet (with controlled amounts of healthy proteins and fats) and mindful yoga sessions reduced chronic fatigue in Hodgkin's lymphoma patients and created a more favorable setting for radiotherapy response [83][84][85][86]. ...
... It modulates the autonomic nervous system by enhancing parasympathetic activity and reducing sympathetic overdrive, thereby improving heart rate variability and reducing stress-related responses [10]. Regular practice of yoga has also been shown to regulate the hypothalamic-pituitary-adrenal (HPA) axis, reducing cortisol levels and inflammatory markers such as interleukin-6 (IL-6) and C-reactive protein (CRP), which are often elevated in cancer patients undergoing distress [11]. ...
... The study also found a statistically significant reduction in the activity of CREB protein family transcription factors as compared to the control group. Together, these results suggest a reduction in inflammation in cancer survivors, indicating an improvement in recovery with the yoga intervention (Bower et al., 2014). ...
Yoga and meditation were integral to Ayurveda and were prevalent from 1500 BC to 400 AD. The psychoneuroimmunology of yoga and meditation has been of interest in recent times, and much research is focused on the influence of meditation and yoga on cell telomerase activity, neuroendocrine system, cells of the immune system, oxidative stress, cell aging, and cancer recovery. Yoga and meditation reduce stress and depression and improve sleep quality. Stress-immune relationship influences all age groups, especially individuals with clinical diagnoses, and is a factor in lifestyle diseases and cancer. Elevated levels of oxytocin, serotonin, and dopamine were associated with bliss and positivity, which contribute to the reduction in inflammation and pain perception among practitioners. The present chapter focuses on the psychoneuroimmunology of the effects of yoga and meditation on improving immunity and fast and efficient recovery.
... The upregulation of CTRA gene expression was reported to be associated with decreased expression of antiviral and antibody-related genes, which, in addition to contributing to neurodegenerative diseases, may also leave the patient vulnerable to a myriad of infectious diseases [18,19]. An interesting finding within some randomized controlled trials is that positive psychological interventions such as group therapy, gratitude journaling, positive affirmation, and mindfulness meditation can lead to down-regulation of CTRA gene expression [20][21][22]. ...
This narrative review focused on research investigating the impact of loneliness on the prevalence of dementia and its relationship with other risk factors. A comprehensive and rigorous search was conducted using a variety of scientific databases with specific keywords to identify all prior studies that examined the correlation between dementia and loneliness. The inquiry was confined to articles published in English from January 2017 to March 2024. The narrative review identified a consensus regarding the role of loneliness in enhancing the risk of all‐cause dementia, with a particular emphasis on the subjective perception of loneliness. This phenomenon may be caused by the sensations of exclusion, discrimination, and alienation that are typically associated with low self‐esteem and low life satisfaction, which may contribute to cognitive impairment and depressive symptoms. This finding was obtained despite the absence of robust evidence regarding the involvement of loneliness in the pathogenesis of dementia. Existing research has not yet identified a correlation between hereditary factors that influence the development of dementia and feelings of loneliness. However, loneliness is strongly associated with depression, which is a potential risk factor for dementia. Previous studies have reported a moderate correlation between depression and loneliness, as individuals who are isolated and lack a sense of community exhibit higher levels of depression. Meditation, social cognitive training, and social support are three strategies that have been implemented to address loneliness and are reported to be the most effective interventions. A strong correlation exists between dementia and loneliness. Although such strategies are unlikely to impede the progression of the disease if cognitive deterioration is already underway, understanding these associations can assist in the development of strategies to alleviate the effects of loneliness on vulnerable individuals.
... More studies have followed, focusing on different meditation styles, in the light of the encouraging results of the first pioneering works described above. For example, longitudinal studies have shown that Yoga can be associated with differential gene expression of genes responding to type I interferon and inflammation both in healthy subjects (Qu et al. 2013) and breast cancer survivors (Bower et al. 2014(Bower et al. , 2015. In addition, using bioinformatic approaches, immunological modulation emerged as the dominant target of differential transcription in Yoga practitioners (Khokhar et al. 2022). ...
Epigenetic mechanisms are key processes that constantly reshape genome activity carrying out physiological responses to environmental stimuli. Such mechanisms regulate gene activity without modifying the DNA sequence, providing real-time adaptation to changing environmental conditions. Both favorable and unfavorable lifestyles have been shown to influence body and brain by means of epigenetics, leaving marks on the genome that can either be rapidly reversed or persist in time and even be transmitted trans-generationally. Among virtuous habits, meditation seemingly represents a valuable way of activating inner resources to cope with adverse experiences. While unhealthy habits, stress, and traumatic early-life events may favor the onset of diseases linked to inflammation, neuroinflammation, and neuroendocrine dysregulation, the practice of mindfulness-based techniques was associated with the alleviation of many of the above symptoms, underlying the importance of lifestyles for health and well-being. Meditation influences brain and body systemwide, eliciting structural/morphological changes as well as modulating the levels of circulating factors and the expression of genes linked to the HPA axis and the immune and neuroimmune systems. The current chapter intends to give an overview of pioneering research showing how meditation can promote health through epigenetics, by reshaping the profiles of the three main epigenetic markers, namely DNA methylation, histone modifications, and non-coding RNAs.
... There is convincing evidence from systematic reviews and meta-analyses that yoga enhances physical, psychological, and cognitive outcomes, and, when practiced in a group-setting, feelings of social connection and support in adults diagnosed with cancer (>18 years of age). [7][8][9][10] There is also evidence suggesting yoga may improve body composition, decrease leptin, and attenuate systemic inflammation associated with increased risk of cancer onset, recurrence, and early mortality, [11][12][13][14][15][16] and that as little as a single yoga session can augment heart rate variability, 17 another factor associated with disability, morbidity, and early mortality. 18 Among young adults diagnosed with cancer, many of whom are overweight or obese, 19 insufficiently active, 20 and face numerous barriers to engaging in protective health behaviours, 21 yoga may be an ideal supportive care strategy. ...
Background
Cancer among young adults (18-39 years) is relatively rare, but remains a leading cause of disability, morbidity, and mortality. Identifying strategies to support young adults’ health following a diagnosis of cancer is important. Yoga may enhance health and could be delivered by videoconference. However, little research exploring yoga, and no research exploring videoconference delivery of yoga has been conducted with this cohort. We worked with young adults affected by cancer and developed, piloted, and refined a yoga intervention delivered by videoconference.
Objective
To evaluate our yoga intervention in a full-scale, mixed methods, single-arm, hybrid effectiveness-implementation trial.
Methods
Young adults 18 years or older, diagnosed with cancer between the ages of 18-39 years of age, and at any stage along the cancer trajectory are eligible. Participants receive 2 yoga classes/week over 12-weeks by videoconference and complete assessments at baseline, post-intervention, and 6- and 12-month follow-ups. Assessments include self-reported questionnaires (ie, stress, yoga barriers, physical activity behaviour, fatigue, cognition, cancer-related symptoms, general health, health-related quality of life, self-compassion, mindfulness, group identification), physical assessments (ie, aerobic endurance, flexibility, range of motion, balance, functional mobility), and a semi-structured interview (post-intervention only; exploring perceptions of acceptability, feasibility, and experiences). Quality improvement cycles occur every 6 months. Repeated measures analysis of variance will be conducted to explore effectiveness, descriptive statistics and responder/non-responder analyses will be used to explore implementation, and qualitative interview data, analyzed using content analysis and reflexive thematic analysis, will bolster effectiveness and implementation findings.
Discussion
As the first full-scale trial to evaluate yoga delivered by videoconference for this cohort, findings will make substantial contributions to young adults' supportive cancer care.
Conclusion
This protocol, reporting on yoga delivered by videoconference for young adults diagnosed with cancer, will enhance transparency and reproducibility and provide a reference for forthcoming trial results.
Trial registration
NCT05314803 at clinicaltrials.gov .
... Meditation is one of the component or branch of yoga practice which is primarily acting on the mind by improving the attention and awareness of the inner self and outer world, thereby reducing the psychological condition causing immune suppression, (2) The practice of yoga and meditation has been found to reduce IL-6, TNF-alpha, NF-kappa B and IL-1beta levels in breast cancer patients with increase in antiinflammatory receptors. (3,4) Yoga and meditation have been shown to increase IgA in pregnant women, providing a protection against the invading pathogens (5) and CD4 cells in HIV-infected individuals (6). Similarly, in healthy individuals, yoga and meditation technique significantly increases the IL-12, INF-gamma and serotonin with significant decrease in the adrenalin (7). ...
Background: Yoga and Meditation is a mind body technique which has various positive effects on immune system and helps in bring down the inflammatory markers. Therefore, therapies based on Yoga and Meditation showed promising effects on immuno-compromised condition like HIV, Aim: To examine the effects of Yoga and Meditation on immune system functioning in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for conducting systematic reviews.Methods: Four electronic databases (MEDLINE/PubMed, Scopus, the Cochrane Central Register of Controlled Trials, and IndMED) were searched and the extraction of the applicable variables and assessing the risk of bias from the gathered studies was noted. The data analysis was done using, Review Manager software (RevMan; version 5.3.5) and R statistical software (version 3.6.1). Mean differences (MD), and standardize mean difference (SMD) were measured for continuous outcomes. Heterogeneity with the help of I2 statistic was used for the assessment of inconsistency across studies with the level of significance at P< 0.10. Publication bias was assessed using funnel plots, Egger’s test for the selected studies.Results:From a total of 141 papers, duplicates and other filtrations like languages other than English, non- clinical trials and non-RCT papers were excluded and finally 91 papers were selected for the present study. After the complete review of the selected papers, articles were grouped based on each immune parameters like Nuclear factor-kB , Interleukin-1b, Interleukin-6 , Tumor necrosis factor , CD4 T-cells, CD8-cells and NK cells. According to the inclusion and exclusion criteria, a total of nineteen RCTs were included in the meta-analysis. Conclusion: Yoga may have potential for the supplemental treatment and prevention of inflammation-related disorders, according to current studies. Yoga practice may be beneficial as it combines the positive effects of physical activity with those of mindfulness; consequently, more research into the advantages of yoga-based therapies is especially important.Systematic review registration: PROSPERO registration number- CRD42020187532
... Indeed, we observe reduced oxidative stress and improved DNA integrity in sperm following YBLI. Additionally, yoga leads to the upregulation of anti-inflammatory genes and downregulation of proinflammatory genes (31). ...
Infertility is defined as the failure to conceive after one year of unprotected intercourse. Male infertility, affecting up to 50% of infertility cases, can arise from factors like age, medical history, genetics, and environmental exposures. Evaluating male infertility aims to identify reversible causes, guide treatments, and address potential underlying health issues.
Causes of male infertility include endocrine disorders (2-5%), sperm transport issues (5%), primary testicular defects (65-80%), and idiopathic cases (10-20%). Accurate prevalence data are lacking, but declining sperm quality in Indian men has been observed, potentially due to environmental and lifestyle factors. COVID-19 has also been linked to reduced male fertility, necessitating further research.
Sperm quality declines with age, starting around 35, leading to infertility and genetic issues in offspring. Oxidative stress (OS) is a major factor, exacerbated by smoking and environmental toxins, damaging sperm DNA. Yoga has emerged as a beneficial therapy for male infertility, reducing anxiety, enhancing semen parameters, and promoting overall well-being. Yoga's stress-reducing effects involve downregulating the HPA axis and balancing autonomic functions. It also elevates melatonin, improving mitochondrial integrity and reducing OS.
Yoga-based lifestyle interventions (YBLI) have shown epigenetic changes in sperm DNA, enhancing sperm quality. Practices like moola bandha improve circulation and testosterone regulation, benefiting sexual health. Age-specific yoga modules can maintain hormonal balance and reproductive health.
In conclusion, while lifestyle and environmental impacts on spermatogenesis need more research, yoga offers promising benefits for male reproductive health, potentially alleviating stress and enhancing sperm quality.
... Yoga seems to modulate various aspects ranging from intracerebral neurotransmitters, inflammation, gene expression, autonomous nervous system, heart rate variability and emotional, psychological factors [17]. Reduction of inflammation markers as IL-6 [18] and TNF-a [19] could be shown, as well as a reduction of the expression of pro-inflammatory transcription factors as NF-κB [20]. The sirtuin-1 pathway [17] also seems to be modulated. ...
Introduction
There is growing evidence of the benefit of physical activity and mindfulness in breast cancer patients (HC et al. in BMC Complement Altern Med, 2017). Yoga offers a combination of both. The aim of this study was to establish an online yoga program for breast cancer patients and survivors. As the project was launched during the (COVID) pandemic restrictions, we intended to prove effective online yoga as a way to access supportive therapy independently of sanitary issues and geographic locations in rural regions.
Methods
The two main outcomes were quality of life and sleep quality, and both were evaluated by standardized questionnaires (EORTC-QLQ 30 BR 23 and PSQI). Participants (n = 173) had breast cancer or a history of breast cancer and were randomized to either 6 weeks online yoga, twice a week for 45 min or a waiting control group.
Results
Our results show improved sleep quality in the PSQI score and improved subitems (dyspnea and physical activity) in the EORTC quality of life score.
Discussion
Online yoga seems to be a valid option in supportive therapy for breast cancer patients, as it improves physical fitness, dyspnea and overall sleep quality. It is also safe and cost effective as a remote intervention.
Trial registration
Trial registration number and date of registration for prospectively registered trials: DRKS00029548, 07.07.2022.WHO International clinical trials registry platform number: DRKS00029548. The registration number of the ethical committee CAU in Kiel: D 589/20.
... This diversity in scale indicates the potential for varying data collection and analysis levels. Breast cancer trials dominate the portfolio [17,18,[22][23][24]27,29,[30][31][32]34,38,39,41,43,45,47,50,51,56,58,59,[60][61][62][63][64][65][68][69][70][71][72], possibly due to the high prevalence of breast cancer and the active survivor communities often engaged in complementary therapies. However, there is a notable disparity in research focus toward cancer types such as colon [26], glioma [52,53], hematological malignancies [25,37], head and neck [16,19], and lung cancer [35], with each category having only one or two studies. ...
This literature review presents a bibliometric analysis of the randomized controlled trials conducted between 2014 and 2023 on the potential benefits of yoga as a complementary therapy for cancer patients. To conduct this analysis, we searched medical and scientific databases, such as Scopus, Cochrane, and PubMed, using relevant keywords. Our search yielded 58 clinical trials involving 4,762 patients, which indicates a growing trend in this field of research. The studies we reviewed mainly focused on breast cancer patients and demonstrated the adaptability and versatility of yoga, offering a ray of hope and optimism. Among the various styles of yoga, Hatha yoga was the most frequently practiced style in these clinical trials. The analysis we conducted reveals that yoga interventions have a promising role in cancer care and can be a valuable complementary therapy for cancer patients. However, significant gaps and limitations still need to be addressed in this area of research. For instance, more rigorous and diverse investigations are needed to further establish the potential benefits of yoga interventions for cancer patients. Additionally, the standardization of yoga interventions is crucial to optimize therapeutic benefits. By addressing these gaps and limitations, we can further enhance the potential of yoga as a complementary therapy for cancer patients.
... [28] Antoni et al. be-lieve that stress management interventions can be physiologically protective against tumor progression by enhancing protective immunity (e.g., immune surveillance), reducing chronic inflammatory processes, and suppressing immunosuppressive mechanisms. [123] In breast cancer survivors, yoga and tai chi reduced pro-inflammatory processes, [124] and mindfulness-based www.advancedsciencenews.com www.advancedscience.com stress reduction increased the ratio of Th1/ Th2 cells, [125] decreased NF-B activity, and increased anti-inflammatory signaling and gene expression of type 1 interferons. ...
The incidence rate of cancer is increasing year by year due to the aging of the population, unhealthy living, and eating habits. At present, surgery and medication are still the main treatments for cancer, without paying attention to the impact of individual differences in health management on cancer. However, increasing evidence suggests that individual psychological status, dietary habits, and exercise frequency are closely related to the risk and prognosis of cancer. The reminder to humanity is that the medical concept of the unified treatment plan is insufficient in cancer treatment, and a personalized treatment plan may become a breakthrough point. On this basis, the concept of “Humanistic Health Management” (HHM) is proposed. This concept is a healthcare plan that focuses on self‐health management, providing an accurate and comprehensive evaluation of individual lifestyle habits, psychology, and health status, and developing personalized and targeted comprehensive cancer prevention and treatment plans. This review will provide a detailed explanation of the relationship between psychological status, dietary, and exercise habits, and the regulatory mechanisms of cancer. Intended to emphasize the importance of HHM concept in cancer prevention and better prognostic efficacy, providing new ideas for the new generation of cancer treatment.
... 48,49 On the one hand, YT may reduce cancer-related fatigue and state anxiety via physiological mechanisms. Indeed, based on evidence suggesting that yoga and other mind-body practices including meditation, Qigong, and mindfulness directly impact physiological parameters, [50][51][52][53][54] and evidence of associations between physiological parameters and cancer-related fatigue and anxiety, these mechanisms may include autonomic nervous system activation and homeostasis maintenance, improvements in heart rate variability measures, anti-inflammatory effects, neural pathways, neurogenesis, neuroplasticity, and/or improved pulmonary function. As well, YT may reduce cancer-related fatigue and state anxiety by fostering a calm and pleasant state, promoting focus on and acceptance of physical sensations, feelings, and thoughts without judgment, enhancing Notes. ...
Background
Cancer is a chronic condition associated with a substantial symptom burden, which can impair recovery after treatment. Investigating interventions with potential to improve self-reported disease and/or treatment effects—known as patient-reported outcomes (PROs)—is paramount to inform cancer care. The objective of this study was to evaluate the effects of a yoga therapy (YT) intervention on key PROs (ie, cancer-related fatigue, anxiety, cognitive function, depression, stress, quality of life [QoL]) among adults after treatment for cancer.
Methods
Data from 20 adults (Mage = 55.74 years, 85% female; Mtime since diagnosis = 2.83 years) who had completed treatment for cancer were analyzed for this study. In this single-subject exploratory experimental study, the YT intervention comprised a 1:1 YT session (ie, 1 participant with 1 yoga therapist) followed by 6 weekly small (ie, 2–3 participants) group YT sessions. Group sessions were facilitated by the same yoga therapist who delivered participants’ 1:1 session to ensure an in-depth personalized approach. PROs were assessed before (ie, pre-intervention) and after the 1:1 YT session (ie, during the intervention), as well as after the last group YT session (ie, post-intervention). Hierarchical linear modeling was used to analyze the data.
Results
Participants showed improvements in cancer-related fatigue, state anxiety, trait anxiety, perceived cognitive impairments, impacts of perceived cognitive impairments on QoL, and 1 dimension of QoL (ie, functional wellbeing) over time. Notably, cancer-related fatigue and state anxiety increased immediately after the 1:1 session, but showed greater improvements over time afterward (ie, during the intervention phase). No changes were observed for the remaining PROs.
Conclusion
Although results require confirmation in future trials, this study highlights the importance of continuing to investigate YT as an intervention to enhance important PROs (ie, cancer-related fatigue and state anxiety) after treatment for cancer. More research is needed to identify additional beneficial effects and factors that influence participants’ responses to 1:1 and group YT (ie, moderators and mediators).
Registration number
ISRCTN64763228
Date of registration
December 12, 2021. This trial was registered retrospectively.
URL of trial registry record
https://www.isrctn.com/ISRCTN64763228
Published Protocol
Brunet, J., Wurz, A., Hussien, J., Pitman, A., Conte, E., Ennis, J. K., . . . & Seely, D. (2022). Exploring the Effects of Yoga Therapy on Heart Rate Variability and Patient-Reported Outcomes After Cancer Treatment: A Study Protocol. Integrative Cancer Therapies, 21, 15347354221075576.
... Additionally, both yoga and resistance training have the potential to decrease the release of inflammatory mediators, which may lead to pain relief, improved functional ability and enhanced quality of life. [42][43][44] Despite the potential advantages of combined yoga and resistance training (CYRT), there is currently a lack of studies investigating its effectiveness for patients living with JIA. ...
Introduction
Enthesitis-related arthritis (ERA) is a category of juvenile idiopathic arthritis (JIA). The complications of JIA include pain, muscle weakness, limited movement and worsening quality of life. Yoga is an effective exercise therapy for rheumatoid arthritis and may have similar benefits for JIA. Considering the limitation of yoga for strengthening muscles, combined yoga and resistance training (CYRT) may compensate for the shortcomings and provide more benefits for JIA patients. Despite this, there is currently a lack of studies investigating the effectiveness of CYRT for JIA patients. Due to the inaccessibility of traditional exercise therapy, home-based exercise is needed. The study aims to assess the effectiveness of home-based CYRT on JIA.
Methods and analysis
This is a 12-week randomised single-blind controlled trial study. 60 patients with ERA will be randomised into two groups: the home-based exercise group (HBE) and the health education (HE) group. The HBE group (n=30) will perform the CYRT programme 3 times a week at home for 12 weeks and receive HE. The HE group (n=30) will only receive HE. The outcomes include primary outcome (pain levels) and secondary outcomes (lower limb muscle strength, motion range of joint, aerobic fitness, function ability, fatigue levels, mental health, quality of life and blood biomarkers). The assessments will be conducted at baseline, postintervention (12 weeks) and follow-up (24 weeks). Data will be analysed by intention to treat.
Ethics and dissemination
This study has been approved by the Ethics Committee of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine in December 2023 (approval no. XHEC-C-2023-059-3). This study will require informed consent from all subjects and guardians of children under 18 years of age. The findings will be published in a peer-reviewed journal and international conferences.
Trial registration number
ChiCTR2300073446.
... Inflammation has also been reported to be associated with more severe positive symptoms in patients with SZ. 83,84 It has been demonstrated that meditation can modulate the levels of cytokines, suppress the activity of the proinflammatory nuclear factor-κB, increase the activity of anti-inflammatory glucocorticoid receptor and Type I interferon anti-viral genes in healthy individuals, stressed individuals, and patients with cancer. [85][86][87][88] In summary, the regulation of hallucinations and delusions in SZ through meditation may involve a complex process, and further studies should confirm these possible mechanisms. ...
Aim
This study investigated the impact of an 8‐month daily‐guided intensive meditation‐based intervention (iMI) on persistent hallucinations/delusions and health‐related quality of life (QoL) in male inpatients with schizophrenia with treatment‐refractory hallucinations and delusions (TRHDs).
Methods
A randomized controlled trial assigned 64 male inpatients with schizophrenia and TRHD equally to an 8‐month iMI plus general rehabilitation program (GRP) or GRP alone. Assessments were conducted at baseline and the third and eighth months using the Positive and Negative Syndrome Scale (PANSS), 36‐Item Short Form‐36 (SF‐36), and Five Facet Mindfulness Questionnaire (FFMQ). Primary outcomes measured PANSS reduction rates for total score, positive symptoms, and hallucinations/delusions items. Secondary outcomes assessed PANSS, SF‐36, and FFMQ scores for psychotic symptoms, health‐related QoL, and mindfulness skills, respectively.
Results
In the primary outcome, iMI significantly improved the reduction rates of PANSS total score, positive symptoms, and hallucination/delusion items compared with GRP at both the third and eighth months. Treatment response rates (≥25% reduction) for these measures significantly increased in the iMI group at the eighth month. Concerning secondary outcomes, iMI significantly reduced PANSS total score and hallucination/delusion items, while increasing scores in physical activity and mindfulness skills at both the third and eighth months compared with GRP. These effects were more pronounced with an 8‐month intervention compared with a 3‐month intervention.
Conclusions
An iMI benefits patients with TRHDs by reducing persistent hallucinations/delusions and enhancing health‐related QoL. Longer iMI duration yields superior treatment outcomes.
... A trial on breast cancer survivors compared the impact of twelveweek restorative Iyengar yoga intervention and health education on saliva cortisol concentration at baseline, post-intervention, and at three-month follow-up, showing no significant differences in the magnitude of change in cortisol slope or total daily cortisol output from baseline to the average of both follow-up time points. However, a major limitation of this trial was the small size of the study (n = 16) and control (n = 15) groups [55]. ...
Breast cancer is one of the most prevalent cancers in women worldwide, often accompanied by significantpsychological distress and hormonal imbalances, including elevated cortisol levels. Cortisol, asa crucial hormone secreted in response to physical and psychological stress, plays an important role inregulation of numerous human body systems. A vast number of studies showed that chronic stress andprolonged hypersecretion of cortisol promote carcinogenesis and tumor growth. Because of the knownrelaxing effects of yoga and its ability to lower cortisol levels, complementary therapies including integratedyoga programs have gained attention due to their potential to mitigate the adverse effects ofcancer and its treatment. To this day, multiple studies to evaluate the positive impact of yoga on loweringcortisol levels in breast cancer patients have been carried out. This review aims to shed light onhow cortisol level impacts cancer development and progression as well as summarize the beneficialeffect of yoga on cortisol levels in breast cancer patients and its potential as an adjunctive therapy.
... The randomized controlled study by Bower et al. investigated the impact of a 12-week Iyengar yoga intervention on inflammation-related gene expression in breast cancer (BC) survivors experiencing persistent fatigue. [26] The findings revealed that the yoga group exhibited decreased activity of the pro-inflammatory transcription factor NF-κB, increased anti-inflammatory glucocorticoid receptor activity, and reduced cyclic amp responsive element binding protein (CREB) family transcription factor activity compared to the control group. In addition, while the control group showed an increase, the yoga group maintained stable levels of the soluble tumor necrosis factor (TNF) receptor type II, a marker of proinflammatory cytokine activity. ...
Yoga, an ancient practice rooted in Indian philosophy, has gained widespread popularity for its numerous physical and mental health benefits. In the recent years, there has been growing interest in understanding how yoga influences gene expression and epigenetic modifications. This narrative review investigates the molecular mechanisms, by which yoga influences gene expression, focusing on deoxyribonucleic acid (DNA) methylation, and histone modifications. Research literature was sourced from various databases to select randomized clinical trials and comparative cohort studies examining yoga's impact on gene expression and epigenetic changes. Our findings suggest that yoga could exert anti-inflammatory effects, as it downregulates pro-inflammatory cytokines, soluble interleukin IL-2 receptor gene expression, and transcription factors. Yoga also boosts the innate antiviral response and brain health by enhancing natural defense genes and microRNA-29c expression. Notably, it activates telomerase, linked with cellular longevity, and promotes nitric oxide synthetase and neuroprotective gene expression, implying benefits for ocular health. In addition, yoga fosters DNA repair and cellular integrity maintenance by increasing oxoguanine glycosylase one protein and p53 gene expression. However, the diversity of yoga interventions in these studies complicates direct comparisons and broader application. The current research primarily focuses on short-term outcomes, offering a limited understanding of yoga's long-term epigenetic impacts. Future research should address these gaps by studying the enduring effects of Yoga, personalizing interventions, and contrasting techniques.
... Anti-cancer medicines frequently come with a number of negative side effects, which lower overall quality of life. These include persistent non-resolving inflammation [1,2]; and impaired immunological function [3,4]. Major issues include persistent inflammation and weakened cellular immunity since they both foster a pro-tumor environment that could speed up the disease's progression [5]. ...
The death rate from cancer is declining as a result of earlier identification and more advanced treatments. Nevertheless, a number of unfavourable adverse effects, including prolonged, long-lasting inflammation and reduced immune function, usually coexist with anti-cancer therapies and lead to a general decline in quality of life. Improvements in standardized comprehensive therapy and early identification of a variety of aggressive tumors remain the main objectives of cancer research. Tumor markers in those with cancer are tumor associated proteins that are clinically significant. Even while several tumor markers are routinely used, they don't always provide reliable diagnostic information. Serum cytokines are promising markers of tumor stage, prognosis, and responsiveness to therapy. In fact, several cytokines are currently proposed as potential biomarkers in a variety of cancers. It has actually been proposed that the study of circulatory cytokines together with biomarkers that are particular to cancer can enhance and accelerate cancer diagnosis and prediction , particularly via blood samples that require minimal to the absence of invasion. The purpose of this review was to critically examine relevant primary research literature in order to elucidate the role and importance of a few identified serum cytokines as prospective therapeutic targets in oncological diseases.
... Therefore, post-operative exercise interventions can maintain and restore somatic function and healthy body composition in the affected arm and effectively control the development of lymphoedema (Hasenoehrl et al., 2020). Post-operative exercise interventions for breast cancer patients can also have a positive effect on the alleviation of cancerrelated fatigue in radiotherapy or chemotherapy breast cancer patients (Al-Majid et al., 2015), and several studies have shown that yoga practice can effectively inhibit the growth of inflammatory factors in cancer (Bower et al., 2014;Taso et al., 2014;Vardar Yağlı et al., 2015). This may be related to the production of large amounts of skeletal muscle-derived IL-6 during exercise, which inhibits the secretion of IL-1β and TNF-α, the main substances that cause fatigue, while promoting the secretion of beta-endorphins from the pituitary gland and improving the body's tolerance. ...
Purpose
Breast cancer is one of the most common malignant cancers in women, seriously endangering the physical and mental health of patients. In this study, we developed an app for breast cancer patients undergoing radiotherapy or chemotherapy with a focus on exercise interventions, supplemented by nutritional and psychological interventions, to verify the applicability of the app for these patients and its impact on their quality of life, sleep, and psychological state. We also investigated the patients’ experience and perceptions of the app.
Methods
A total of 17 participants, aged 42–58 years, were recruited for this study using a mixed-methods design, including quantitative group pre-and post-test scores and qualitative interview results. The participants used the app for 8–18 weeks depending on their radiotherapy or chemotherapy cycle. During the radiotherapy or chemotherapy period, the participants used the “Yun Dong Ru Kang” exercise rehabilitation app to perform aerobic exercises twice a week, as well as rehabilitation exercises appropriate to their radiotherapy or chemotherapy stage, and used the app on their own the rest of the time. The primary results included their scores on the PSSUQ overall assessment usability questionnaire, the users’ use of the app, and the results of the interviews; the secondary indicators were quality of life, sleep status, and anxiety and depression status.
Results
An overall score of 6.2 (out of 7 points) on the PSSUQ questionnaire indicates the high usability; the average use time per subject per week was 97.69 ± 11.82 min, which exceeds the minimum use time, but the average use time tended to decrease as the use time was postponed. Promoted articles on nutritional diets received the most hits. The results of the interviews were consistent with the questionnaire scores, with the majority of participants believing that the means of exercise should be enriched and the interface optimized, while the reduction in the length of use was related to the participants’ own state of learning about calisthenics. In the results of the Breast Cancer-Specific Scale FACT-B, there was a significant increase (p < 0.05) in the Emotional Status dimension score and a significant decrease (p < 0.05) on the Additional Concerns dimension score. In the results of the Pittsburgh Sleep Quality Inventory PSQI, there was a non-significant improvement in all items except for a significant increase (p < 0.05) for the Hypnotic Medication item. In the Hospital Anxiety and Depression Scale (HADS), there was no significant improvement in any of the anxiety and depression factors.
Conclusions
The “Yun Dong Ru Kang “app has certain applicability, and the use of the exercise rehabilitation app may effectively reduce the negative impact of chemotherapy side effects on the quality of life, sleep and depression of breast cancer patients in the chemotherapy or radiotherapy phase. Before it is put into use in the future, the app should be enriched with exercise tools, the interface should be optimized, and articles on nutrition and diet should be promoted.
... Forest plot of the physical activity and diurnal cortisol slope meta-analysis(Allen et al., 2019;Banasik et al., 2009;Bei et al., 2017;Bogg and Slatcher, 2015;Bower et al., 2014;Brendgen et al., 2017;Bruce et al., 2002;Chin et al., 2018;Chandwani et al., 2014;Corey et al., 2014;Daly et al., 2014;Di Corrado et al., 2014;DuBose and McKune, 2014;Gariani et al., 2019;Gibson et al., 2016;Guseman et al., 2016;Hansen et al., 2012;Hilcove et al., 2020;Ho et al., 2016a;Ho et al., 2016b;Ho et al., 2016c;Ho et al., 2018;Holleman et al., 2012;Hsiao et al., 2012;Ice, 2005;Ice et al., 2004;Keiver et al., 2015;Mikkelsen et al., 2017;Pauly et al., 2019;Peterson et al., 2014;Pulopulos et al., 2020;Ratcliff et al., 2016;Sabiston et al., 2018;Schmalzl et al., 2018;Schutter et al., 2017;Strahler et al., 2010;Strahler et al., 2020;Tam et al., 2014;Thompson et al., 2012;van Reedt Dortland et al., 2013;van Santen et al., 2010;Wen, 2018;Yu et al., 2020;Zeiders et al., 2018). ...
Physical activity participation is associated with effective stress coping, indicated by decreases in both physiological stress reactivity and perceived stress. Quantifying the effect of physical activity on the diurnal regulation of one key physiological stress indicator, the stress hormone, cortisol, across studies may demonstrate the extent to which physical activity participation is associated with diurnal HPA axis regulation. We meta-analyzed studies examining relations between physical activity participation and indices of HPA axis regulation: the diurnal cortisol slope and the cortisol awakening response. We also examined moderators of the relation. The analysis revealed a small, non-zero negative averaged correlation between physical activity and the diurnal cortisol slope (r = -0.043, 95% CI [-0.080, -0.004]). Examination of sample sociodemographic differences, study design characteristics, cortisol measurement methods, and physical activity variables as moderators revealed few effects on the relation between physical activity and diurnal cortisol slope. We did not observe lower levels of variability in the mean cortisol awakening response at higher levels of physical activity participation, and moderator analyses showed little evidence of reductions in heterogeneity for this effect. We found some evidence of systematic publication bias. Findings suggest higher physical activity is associated with a steeper diurnal cortisol slope. However, the cortisol awakening response did not differ by physical activity level. Future studies testing the physical activity and cortisol regulation association should use standardized physical activity measures, follow guidelines for better quality cortisol sampling collection and analysis, and test relations in large-scale empirical studies to confirm the direction and causality of the effect.
Objectives
Mind-body therapies are a group of treatments based on the theory of mind-body medicine, which are effective for a wide range of illnesses. However, there are no bibliometric papers that have examined the topic of mind-body therapies. Therefore, it is necessary to review and sort out the current status, hotspots and frontiers of mind-body therapies.
Methods
Studies related to mind-body therapies during the period of Web of Science 1999-01/2024-07 were searched, and R language was applied to analyze the data and CiteSpace, Vosviewer software, was used to generate visualization maps.
Results
A total of 29,710 relevant articles were included in the study. The country with the highest number of publications was the United States, followed by China and the United Kingdom, and the prolific author was Wang Yuan. Common keywords were acupuncture, quality of life, depression, and pain. The current study focuses on the promotion and application of mind-body therapies in various diseases, the main applicable diseases and the application in special groups.
Conclusion
This study presents the current status and trend of research on mind-body therapies, and inflammatory interventions and higher-level research assessment methods are potential hotspots, which can help researchers to clarify hotspots and explore new directions.
Background
Cancer-related cognitive impairment can interfere with daily functioning and negatively affect quality of life. To date, there are no validated treatments. Yoga may be a promising intervention that combines physical activity and meditation to improve cognition.
Objectives
The aim of this study was to assess the feasibility of a randomized controlled trial with yoga, physical activity, and waitlist control arms in colorectal cancer survivors, determine effect sizes, and explore differences among groups.
Methods
Interventions included 2 weekly 90-minute sessions over 12 weeks. Participants were assessed before, after, and 3 months after completion of the intervention. Measures included feasibility and acceptability, attention (Attentional Function Index, Attention Network Test, Digit Span, Digit Substitution Test, Trail Making Test), and circulating immune markers (interleukin [IL] 1β, tumor necrosis factor α, IL-6, IL-8, IL-12p70, IL-1 receptor antagonist, tumor necrosis factor receptor II, C-reactive protein, and neopterin). Data analyses included descriptive statistics, comparative analyses, Cohen d statistics, and reliable improvement percentages.
Results
Enrollment, retention, and intervention fidelity rates were 39%, 74%, and >75%, respectively. Exploratory analyses showed the yoga group improved performance in alertness at 3 months postintervention at time 3, with 60% of the group demonstrating reliable improvement, and improved cognitive control at time 3, with 30% of the group demonstrating reliable improvement ( P < .05).
Conclusion
Findings suggest that this randomized controlled trial study is feasible, and yoga may have a positive benefit on cognition.
Implication for Practice
Yoga is a possible intervention, but to optimize function in colorectal cancer survivors, further validation is needed.
Abstract
Background and Purpose: Multiple sclerosis is the most common autoimmune inflammatory
demyelinating disease of the central nervous system that affects the myelinated axons of the central nervous
system and causes neurological deterioration. The prevalence of this disease in women is reported to be 3
times that of men. In recent years, more people with the disease have sought alternative drug therapies to
manage symptoms, including mind-body therapies such as yoga, meditation, breathing, and relaxation
techniques. The present study was conducted with the aim of investigating the effect of eight weeks of yoga
training on the serum levels of tumor necrosis factor alpha, interleukin 6, interleukin 10 and body
composition in women with multiple sclerosis.
Materials and Methods: In this semi-experimental study, 20 women with multiple sclerosis who were
referred to the medical centers of Semnan city (mean±SD; age, 36.75±6.10 years; body mass index,
26.88±6.02 kg/m2; and with EDSS index >3.5) were selected and randomly divided into two groups of
yoga training (n=10) and control (n=10). The experimental group performed yoga training for eight weeks,
three sessions per week (24 sessions) in an indoor hall with a temperature of 25-26°C. The training protocol
started with performing two sets of 10 seconds for 15 movements and to observe the overload principle
every two weeks, 5 seconds were added for each training movement and one movement was added to the
training protocol, where at the final week number of movements reached 18 movements and 15 seconds.
During this period, the control group had no regular physical activity and had normal daily activities. In
order to determine and control the training pressure, the Borg’s rate of perceived exertion (RPE) scale was
used. Statistical analysis of the data was performed by using the repeated measures of ANOVA,
independent t-test and dependent t-test at a significance level of p≤0.05.
Results: The results of this study showed a significant decrease in the serum levels of tumor necrosis factor
alpha, interleukin 6 and interleukin 10 in the experimental group compared to the control group after eight
weeks of training (p=0.001). However, no significant difference was observed in the body composition of
women with multiple sclerosis compared to the control group after eight weeks of yoga (p>0.05).
Conclusion: Finally, the results of this research showed that eight weeks of yoga training by reducing
inflammatory cytokines and adjusting the serum index of tumor necrosis factor alpha and interleukin 6, can
be used as a complementary treatment along with drug treatments for patients with multiple sclerosis.
Keywords: Yoga, Interleukin 6, Interleukin 10, Tumor Necrosis Factor alpha, Multiple Sclerosis.
How to cite this article: Maddah E, Avandi SM, Haghshenas R, Poorhabibi H. The effect of eight-week
yoga training on serum levels of interleukin 6, interleukin 10, tumor necrosis factor alpha and body
composition in women with multiple sclerosis. J Sport Exerc Physiol. 2024;17(3):1-15.
Background
Many cancer survivors experience a wide range of symptoms closely linked to psychological problems, highlighting the need for psychological treatment, one of the most popular being mindfulness. The use of the internet has greatly increased in the last decade, and has encouraged the use of remote-based interventions to help people living with cancer access treatment remotely via devices.
Objective
The primary aim of this study was to explore the efficacy of internet-based mindfulness interventions on the physical symptoms of people living with cancer, where physical symptoms are defined as distressing somatic experiences (eg fatigue, insomnia, and pain) regardless of the underlying cause. The secondary aim was to investigate interventions for the quality of life (QoL).
Methods
This study followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Relevant articles were systematically searched using electronic databases, namely Scopus, Medline through PubMed, Cumulated Index in Nursing and Allied Health Literature (CINAHL) through EBSCOhost, and Cochrane Central Database. Randomized controlled and pilot trials involving adults and/or older adults with cancer and using remote-based mindfulness interventions compared to usual care were included. The quality of the trials included in this study was assessed using the revised Cochrane risk of bias, version 2.0. This study estimated the standardized mean difference (SMD) and mean difference (MD) with 95% CI. The I ² test was used to identify potential causes of heterogeneity. Publication bias was assessed using contour-enhanced funnel plots and the Egger linear regression test to reveal a small study effect.
Results
The initial search yielded 1985 records, of which 13 studies were ultimately included. After treatment, remote-based mindfulness significantly reduced fatigue (SMD −0.94; 95% CI: −1.56 to −0.33; P =.002), sleep disturbance (SMD −0.36; 95% CI: −0.60 to −0.12; P =.004), and improved physical function (SMD .25; 95% CI: 0.09 to 0.41; P =.002) compared to that observed before treatment. However, compared with usual care, remote-based mindfulness showed a statistically significant reduction only in sleep disturbance (SMD: −0.37; 95% CI: −0.58 to −0.16; P =.0006) after treatment. Moreover, remote-based mindfulness was not statistically significant in reducing pain both within and between groups.
Conclusions
Remote-based mindfulness shows promise in reducing sleep disturbances; however, its impact on fatigue, pain, and physical function may be limited.
Background
Hypothyroidism (HT) is the most prevalent endocrine disorder, affecting approximately one in 10 out of 35 adults, with a higher prevalence in females and the elderly.
Purpose
This systematic review (SR) aimed to discuss the effects of yoga on markers and comorbid conditions of HT.
Methods
The SR was registered with the PROSPERO (PROSPERO 2022 CRD42022312990). Google Scholar, PubMed, Cochrane, and EMBASE were searched for the relevant English language interventional studies published from 31 December 1947 to 31 December 2023 by using the keywords ‘meditation OR breath regulation OR yoga OR yoga nidra AND hypothyroidism OR hypothyreosis OR underactive thyroid OR low thyroid’. Of the 4078 screened studies, eight eligible studies (three RCTs, two pilot studies, two pre-post trials, and one case study) with 421 HT patients (392 females and 29 males) and three to six-month yoga interventions were included. Two independent review authors extracted study characteristics and synthesised them descriptively. RCTs and NRSIs were assessed for risk-of-bias (RoB) using Cochrane tools RoB2 and ROBINS-1.
Results
The findings suggest that yoga effectively improves the thyroid profile, lipid profile, heart rate variability, pulmonary functions, anxiety, depression, and quality of life among HT patients.
Conclusion
Yoga may be an inexpensive add-on preventive and therapeutic option for HT. The clinical and methodological heterogeneity among the studies did not allow for meta-analysis (MA). Well-designed MAs are warranted by including rigorous RCTs to draw valid conclusions and defined mechanisms regarding the efficacy of yoga practices/interventions on HT.
Background and Purpose: Multiple sclerosis is the most common autoimmune inflammatory demyelinating disease of the central nervous system that affects the myelinated axons of the central nervous system and causes neurological deterioration. The prevalence of this disease in women is reported to be 3 times that of men. In recent years, more people with the disease have sought alternative drug therapies to manage symptoms, including mind-body therapies such as yoga, meditation, breathing, and relaxation techniques. The present study was conducted with the aim of investigating the effect of eight weeks of yoga training on the serum levels of tumor necrosis factor alpha, interleukin 6, interleukin 10 and body composition in women with multiple sclerosis.
Materials and Methods: In this semi-experimental study, 20 women with multiple sclerosis who were referred to the medical centers of Semnan city (mean±SD; age, 36.75±6.10 years; body mass index, 26.88±6.02 kg/m2; and with EDSS index >3.5) were selected and randomly divided into two groups of yoga training (n=10) and control (n=10). The experimental group performed yoga training for eight weeks, three sessions per week (24 sessions) in an indoor hall with a temperature of 25-26°C. The training protocol started with performing two sets of 10 seconds for 15 movements and to observe the overload principle every two weeks, 5 seconds were added for each training movement and one movement was added to the training protocol, where at the final week number of movements reached 18 movements and 15 seconds. During this period, the control group had no regular physical activity and had normal daily activities. In order to determine and control the training pressure, the Borg’s rate of perceived exertion (RPE) scale was used. Statistical analysis of the data was performed by using the repeated measures of ANOVA, independent t-test and dependent t-test at a significance level of p≤0.05.
Results: The results of this study showed a significant decrease in the serum levels of tumor necrosis factor alpha, interleukin 6 and interleukin 10 in the experimental group compared to the control group after eight weeks of training (p=0.001). However, no significant difference was observed in the body composition of women with multiple sclerosis compared to the control group after eight weeks of yoga (p>0.05).
Conclusion: Finally, the results of this research showed that eight weeks of yoga training by reducing inflammatory cytokines and adjusting the serum index of tumor necrosis factor alpha and interleukin 6, can be used as a complementary treatment along with drug treatments for patients with multiple sclerosis.
Background:
Fatigue, cognitive impairment, anxiety, depression, and sleep disturbance are cancer-related behavioral symptoms (CRBS) that may persist years after early-stage breast cancer (BC), affecting quality of life. We aimed at generating a predictive model of long-term CRBS clusters among BC survivors four years post-diagnosis.
Methods:
Patients with early-stage BC were included from the CANcer TOxicity (NCT01993498). Our outcome was the proportion of patients reporting CRBS clusters four years post-diagnosis (≥3 severe CRBS). Predictors, including clinical, behavioral, and treatment-related characteristics, Behavioral Symptoms Score (BSS; 1 point per severe CRBS at diagnosis) and a pro-inflammatory cytokine (IL-1b, IL-6, TNFα)-genetic risk score, were tested using multivariable logistic regression, implementing bootstrapped Augmented Backwards Elimination. A two-sided p-value < 0.05 defined statistical significance.
Results:
In the development cohort (N = 3555), 642 patients (19.0%) reported a cluster of CRBS at diagnosis and 755 (21.2%) did so four years post-diagnosis. Younger age (adjusted Odds Ratio [aOR] for 1-year decrement: 1.012; 95% Confidence Interval [CI] 1.003-1.020); previous psychiatric disorders (aOR vs no: 1.27; 95% CI 1.01-1.60); and BSS (aOR ranged from 2.17 [1.66-2.85] for BSS = 1 vs 0 to 12.3 [7.33-20.87] for BSS = 5 vs 0) were predictors of reporting a cluster of CRBS (AUC 0.73 [95%CI 0.71-0.75]). Genetic risk score was not predictive of CRBS. Results were confirmed in the validation cohort (N = 1533).
Conclusion:
Younger patients with previous psychiatric disorders and higher baseline symptom burden have greater risk of long-term clusters of CRBS. Our model might be implemented in clinical pathways to improve management and test the effectiveness of risk mitigation interventions among breast cancer survivors.
Background:
Integrative oncology combines conventional and complementary, or integrative, therapies for a holistic treatment of cancer patients. Yoga is increasingly used as a complementary therapy for cancer patients, but there is no direct evidence for its effect on cancer pathophysiology like tumor response, or patient outcome like overall survival.
Summary:
In this narrative review, we present in detail published studies from randomized clinical trials on complementary yoga therapy for cancer patients, including details about the biochemical mechanisms involved. Medicinal hatha yoga with breathing, postures, meditation, and relaxation enhances the quality of life of cancer patients by providing both psychological and physiological health benefits, highlighting the interconnectedness of mind and body. Yoga therapy reduces stress levels improving heart rate variability, leading to changes in hormonal regulation (e.g. cortisol), reduced oxidative stress and improved immune function with reduced inflammation. Still, the biochemical effects of yoga on the cancer disease itself are unrevealed.
Key messages:
More clinical and basic research is needed for further establishment of yoga as complementary therapy in oncology.
Inflammation serves as the body’s defensive mechanism against both external and internal entities that pose a threat to homeostasis. However, an excessive response, whether acute or chronic, in terms of either intensity or duration, can lead to damage to one’s own tissues. While acute inflammation is relatively easier and quicker to address, chronic inflammation is linked with long-term damage and persistent ailments that can reduce both the quality and duration of life. The aspects of chronic inflammation are often overlooked, making it even more crucial to pay attention to them. This chapter delves into the scientific evidence associating various factors with the risk of developing chronic inflammation, causing inflammatory pathologies. Additionally, we strive to present basic strategies, supported by scientific studies, that can be adopted to mitigate these risk factors.
Sarcopenia is prevalent among 11–25% of adult cancer survivors, depending on the cancer type, although the available data on post-treatment survivors in Japan are limited. If cancer patients develop cachexia, they may experience sustained weight loss as a result, ultimately leading to sarcopenia. Conversely, some patients experience post-treatment weight gain, resulting in sarcopenic obesity. Both sarcopenia and obesity elevate the risk of cardiovascular diseases and mortality; therefore, the importance of sarcopenia prevention and management is undeniable. The Guidelines for Exercise for Cancer Survivors recommend continued physical activity. Recent studies have reported the effectiveness of multimodal interventions, combining pharmacological, nutritional, and exercise approaches, necessitating multidisciplinary care for post-treatment sarcopenia. Innovative health interventions using mobile devices have also gained attention. However, studies on sarcopenia in post-treatment cancer survivors, especially those regarding exercise interventions, remain scarce in Japan, primarily due to limited insurance coverage for such post-treatment interventions and workforce challenges. It is clear that some cancer survivors have sarcopenia, which can lead to worse survival and secondary illness. While the benefits of exercise are clear, a comprehensive approach to sarcopenia is a further challenge for the future.
Background
Multiple sclerosis (MS) is a chronic inflammatory disease affecting the central nervous system, often leading to poor sleep quality and diminished quality of life (QoL) for affected patients. Sleep disturbances in MS do not always correlate linearly with other symptoms such as anxiety, depression, fatigue, or pain. Various approaches, including stress reduction techniques such as mindfulness-based interventions, have been proposed to manage MS-related sleep issues.
Objective
The aim of this study was to evaluate the effects of the mindfulness-based body scan technique on sleep quality and QoL in patients with MS using both subjective (questionnaires) and objective (electronic portable device) measures.
Methods
A single-case study was performed involving a 31-year-old woman diagnosed with relapsing-remitting MS. The patient practiced the mindfulness-based body scan technique daily before bedtime and outcomes were compared to measures evaluated at baseline.
Results
The mindfulness-based body scan intervention demonstrated positive effects on both sleep quality and overall QoL. Biometric data revealed a notable dissociation between daily stress levels and sleep quality during the intervention period. Although self-report instruments indicated significant improvement, potential biases were noted.
Conclusions
While this study is limited to a single patient, the promising outcomes suggest the need for further investigation on a larger scale. These findings underscore the potential benefits of the mindfulness-based body scan technique in managing sleep disturbances and enhancing QoL among patients with MS.
Purpose of Review
The goal of this review is to summarize updates to the broad array of complementary therapies available for cancer pain. This paper will serve as a reference for clinicians managing pain in cancer patients.
Recent Findings
Patients are embracing integrative therapies in growing numbers; clinicians must be prepared to incorporate these therapies into patients’ existing treatment regimens. This requires knowledge regarding risks, benefits, and potential interactions with existing cancer therapies.
Summary
Integrative cancer pain management strategies have shown promise, with several proven effective for the management of cancer pain. Energy therapies, including acupuncture, and biologicals and nutraceuticals including overall diet and vitamin D, have the highest level of evidence for efficacy. The remaining therapies discussed in this chapter may be beneficial for patients on a case-by-case basis; risks and benefits of each individual therapy as described in the text must be further assessed in future rigorous trials to further clarify the role of these complementary therapies in cancer pain management.
Chronic inflammation is central to the pathogenesis of many chronic inflammatory conditions. This review aims to analyze whether the practice of yoga, or yogic meditation and breathing, has any effect on the levels of inflammatory cytokines and other inflammatory markers in patients with various chronic inflammatory diseases such as rheumatoid arthritis, neoplastic disorders, and asthma, as well as in healthy subjects, compared to usual care or sham interventions. A comprehensive search of databases (PubMed, CENTRAL, Embase, and CINAHL) was performed. Randomized controlled trials (RCTs) that evaluated the effects of yoga as an intervention on inflammatory markers were analyzed. A total of 26 studies were included. Only two studies had a low risk of bias (RoB); 24 other studies had a high RoB. Most studies (n=24) reported a favorable outcome with yoga, irrespective of the type of yoga used, the condition studied, and the duration of the intervention. The commonly reported inflammatory markers included IL-6 (n=17), tumor necrosis factor-alpha (TNF-a) (n=13), and C-reactive protein (CRP) (n=10). Most studies showed a significant reduction in inflammatory markers in the yoga group (YG) compared to the control group (CG). Few studies also showed significant improvement in markers of cellular immunity (interferon gamma (IFN-g), IL-10, and transforming growth factor-beta (TGF-b); n=2 each) and improved mucosal defense (IgA, IL-6, and IL-2; n=2 each). A meta-analysis of IL-6, TNF-a, and CRP showed yoga had a favorable effect on the levels of these markers, but it was not statistically significant. Current evidence suggests that yoga can be a complementary intervention for various chronic inflammatory conditions. However, the quality of the evidence is poor, along with considerable heterogeneity. In the future, investigators should describe the intervention better, with a uniform assortment of outcome measures and treatment conditions, to generate high-quality evidence.
Advances have been made in cancer screening and detection over the last few decades; however, this is counterbalanced by the growing elderly population. Thus, the diagnosis of cancer remains one of the leading causes of death in the United States. As cancers are identified at earlier stages of diagnosis, surgical intervention remains the mainstay of treatment. Recent efforts have focused on enhanced recovery after surgery (ERAS), optimizing surgical technique, postoperative pain control, and fluid management. While there has been significant focus devoted to the perioperative surgical home, these efforts may not have appropriately focused on the prehabilitation phase.
Major surgery can lead to a decrease in physiological and functional capacity by as much as 40% in individuals who do not succumb to complications (Lawrence VA et al., J Am Coll Surg. 199:762–772, 2004). Varying factors can prolong the recovery period, while physical function factors such as nutrition and physical fitness are more intuitive. Anxiety and depression may also negatively impact recovery (Munafò MR, Stevenson J, J Psychosom Res. 51:589–596, 2001). A more novel term has begun to appear in the literature. Prehabilitation is defined as the attention to factors impacting recovery prior to surgery and the postoperative period (Li C et al., Surg Endosc. 27:1072–1082, 2013; Carli F et al., Br J Surg. 97:1187–1197, 2010).
In the United States, the time to treatment initiation (TTI) has gradually increased over the last decades for surgical cancer care. The median TTI varies in the literature between 4 and 5 weeks (Li C et al., Surg Endosc. 27:1072–1082, 2013; Khorana AA et al., PLoS One. 14:e0213209, 2019). This month prior to surgical care provides an opportune time not only for traditional medical optimization but also for nutritional, physical fitness, and mental well-being optimization. Focusing on prehabilitation prior to surgical intervention can improve quality of life, decrease depression and anxiety, and increase functional capacity. It can also potentially decrease the length of hospital stay and complication rate, increasing physical and mental capacity, which is particularly beneficial in oncologic care as additional therapy modalities may be required.
Engaging in contemplative practice like meditation, yoga, and prayer, is beneficial for psychological and physical well-being. Recent research has identified several underlying psychological and biological pathways that explain these benefits. However, there is not yet consensus on the underlying overlapping physiological mechanisms of contemplative practice benefits. In this article, we integrate divergent scientific literatures on contemplative practice interventions, stress science, and mitochondrial biology, presenting a unified biopsychosocial model of how contemplative practices reduce stress and promote physical health. We argue that engaging in contemplative practice facilitates a restorative state termed “deep rest,” largely through safety signaling, during which energetic resources are directed toward cellular optimization and away from energy-demanding stress states. Our model thus presents a framework for how contemplative practices enhance positive psychological and physiological functioning by optimizing cellular energy consumption.
Objective
Aging is associated with increased pro-inflammatory gene expression and systemic inflammation, and psychosocial stress may accelerate these changes. Mindfulness interventions show promise for reducing psychosocial stress and extending healthspan. Inflammatory pathways may play a role. In a sample of lonely older adults, we tested whether mindfulness training reduces proinflammatory gene expression and protein markers of systemic inflammation.
Methods
Lonely older adults (65–85 years; N = 190) were randomly assigned to an 8-week Mindfulness-Based Stress Reduction (MBSR) or matched Health Enhancement Program (HEP). Blood was drawn pre- and post-intervention and at 3-month follow-up. In peripheral blood mononuclear cells (PBMCs), RNA profiling was used to assess transcriptional regulation by pro-inflammatory NF-kB as well as β-adrenergic CREB, antiviral IRF, and glucocorticoid receptor (GR) transcription factors. Plasma was assayed for proinflammatory markers IL-6 and CRP. Analyses tested time (pre, post, follow-up) by condition (MBSR versus HEP) effects.
Results
MBSR reduced NF-kB ( d = .17, p = .028) but did not alter CREB ( d = .10, p = .20), IRF ( d = .13, p = .086), or GR activity ( d = .14, p = .063) relative to HEP over time. Contrary to predictions, there were no time × condition effects of MBSR compared to HEP on reducing circulating IL-6 or CRP.
Conclusions
In lonely older adults, MBSR reduced cellular pro-inflammatory gene regulation in ways that would predict reduced disease risk. However, no similar effect was observed for circulating protein markers of inflammation. These results provide specificity about how mindfulness interventions may impact distinct inflammatory markers among aging adults in ways that may have important implications for healthspan.
Trial Registration
Clinical Trials identifier NCT02888600
The Pandemic of Covid-19 is wreaking havoc to healthcare systems all over the world. Although, no treatment has been approved till now. The aim of the present study is to summarize the existing evidence of RCT (random control trial) examining the effect of yoga on immune system. This will connect the traditional knowledge and clinical evidence together for future translation research on covid-19 prophylaxis. A systematic review was conducted as per the PRISMA guidelines. The search was conducted using Pub Med, Science direct and EMASE database for 2000 years. Search resulted 310 articles and finally 25 articles are included for systematic review. The finding suggests that regular yoga practices boost the immune system by down regulating pro-inflammatory markers with increasing level of antibodies and anti-viral immune réponses.In conclusion, the study speculated yoga as a cost effective adjuvant for fighting against COVID-19.
One of the most common integrative medicine (IM) modalities is yoga and related practices. Previous work has shown that yoga may improve wellness in healthy people and have benefits for patients. However, the mechanisms of how yoga may positively affect the mind-body system are largely unknown. Here we have assessed possible rapid changes in global gene expression profiles in the peripheral blood mononuclear cells (PBMCs) in healthy people that practiced either a comprehensive yoga program or a control regimen. The experimental sessions included gentle yoga postures, breathing exercises, and meditation (Sudarshan Kriya and Related Practices - SK&P) compared with a control regimen of a nature walk and listening to relaxing music. We show that the SK&P program has a rapid and significantly greater effect on gene expression in PBMCs compared with the control regimen. These data suggest that yoga and related practices result in rapid gene expression alterations which may be the basis for their longer term cell biological and higher level health effects.
This report summarizes the current evidence on the effects of yoga interventions on various components of mental and physical health, by focussing on the evidence described in review articles. Collectively, these reviews suggest a number of areas where yoga may well be beneficial, but more research is required for virtually all of them to firmly establish such benefits. The heterogeneity among interventions and conditions studied has hampered the use of meta-analysis as an appropriate tool for summarizing the current literature. Nevertheless, there are some meta-analyses which indicate beneficial effects of yoga interventions, and there are several randomized clinical trials (RCT's) of relatively high quality indicating beneficial effects of yoga for pain-associated disability and mental health. Yoga may well be effective as a supportive adjunct to mitigate some medical conditions, but not yet a proven stand-alone, curative treatment. Larger-scale and more rigorous research with higher methodological quality and adequate control interventions is highly encouraged because yoga may have potential to be implemented as a beneficial supportive/adjunct treatment that is relatively cost-effective, may be practiced at least in part as a self-care behavioral treatment, provides a life-long behavioural skill, enhances self-efficacy and self-confidence and is often associated with additional positive side effects.
Previously it was shown that a brief yoga-based lifestyle intervention was efficacious in reducing oxidative stress and risk of chronic diseases even in a short duration. The objective of this study was to assess the efficacy of this intervention in reducing stress and inflammation in patients with chronic inflammatory diseases.
This study reports preliminary results from a nonrandomized prospective ongoing study with pre-post design.
The study was conducted at the Integral Health Clinic, an outpatient facility conducting these yoga-based lifestyle intervention programs for prevention and management of chronic diseases.
Patients with chronic inflammatory diseases and overweight/obese subjects were included while physically challenged, and those on other interventions were excluded from the study.
A pretested intervention program included asanas (postures), pranayama (breathing exercises), stress management, group discussions, lectures, and individualized advice. Outcome measures: There was a reduction in stress (plasma cortisol and β-endorphin) and inflammation (interleukin [IL]-6 and tumor necrosis factor [TNF]-α) at day 0 versus day 10.
Eighty-six (86) patients (44 female, 42 male, 40.07 ± 13.91 years) attended this program. Overall, the mean level of cortisol decreased from baseline to day 10 (149.95 ± 46.07, 129.07 ± 33.30 ng/mL; p=0.001) while β-endorphins increased from baseline to day 10 (3.53 ± 0.88, 4.06 ± 0.79 ng/mL; p=0.024). Also, there was reduction from baseline to day 10 in mean levels of IL-6 (2.16 ± 0.42, 1.94 ± 0.10 pg/mL, p=0.036) and TNF-α (2.85 ± 0.59, 1.95 ± 0.32 pg/mL, p=0.002).
This brief yoga-based lifestyle intervention reduced the markers of stress and inflammation as early as 10 days in patients with chronic diseases; however, complete results of this study will confirm whether this program has utility as complementary and alternative therapy.
Psychological distress and coping related to a breast cancer diagnosis can profoundly affect psychological adjustment, possibly resulting in the disruption of circadian rest/activity and cortisol rhythms, which are prognostic for early mortality in metastatic colorectal and breast cancers, respectively.
This study aims to explore the relationships of cancer-specific distress and avoidant coping with rest/activity and cortisol rhythm disruption in the period between diagnosis and breast cancer surgery.
Fifty-seven presurgical breast cancer patients provided daily self-reports of cancer-specific distress and avoidant coping as well as actigraphic and salivary cortisol data.
Distress and avoidant coping were related to rest/activity rhythm disruption (daytime sedentariness, inconsistent rhythms). Patients with disrupted rest/activity cycles had flattened diurnal cortisol rhythms.
Maladaptive psychological responses to breast cancer diagnosis were associated with disruption of circadian rest/activity rhythms. Given that circadian cycles regulate tumor growth, we need greater understanding of possible psychosocial effects in cancer-related circadian disruption.
Evidence suggests that inflammation may drive fatigue in cancer survivors. Research in healthy populations has shown reduced inflammation with higher dietary intake of ω-3 polyunsaturated fatty acids (PUFAs), which could potentially reduce fatigue. This study investigated fatigue, inflammation, and intake of ω-3 and ω-6 PUFAs among breast cancer survivors.
Six hundred thirty-three survivors (mean age, 56 years; stage I to IIIA) participating in the Health, Eating, Activity, and Lifestyle Study completed a food frequency/dietary supplement questionnaire and provided a blood sample assayed for C-reactive protein (CRP) and serum amyloid A (30 months after diagnosis) and completed the Piper Fatigue Scale and Short Form-36 (SF-36) vitality scale (39 months after diagnosis). Analysis of covariance and logistic regression models tested relationships between inflammation and fatigue, inflammation and ω-3 and ω-6 PUFA intake, and PUFA intake and fatigue, controlling for three incremental levels of confounders. Fatigue was analyzed continuously (Piper scales) and dichotomously (SF-36 vitality ≤ 50).
Behavioral (P = .003) and sensory (P = .001) fatigue scale scores were higher by increasing CRP tertile; relationships were attenuated after adjustment for medication use and comorbidity. Survivors with high CRP had 1.8 times greater odds of fatigue after full adjustment (P < .05). Higher intake of ω-6 relative to ω-3 PUFAs was associated with greater CRP (P = .01 after full adjustment) and greater odds of fatigue (odds ratio, 2.6 for the highest v lowest intake; P < .05).
Results link higher intake of ω-3 PUFAs, decreased inflammation, and decreased physical aspects of fatigue. Future studies should test whether ω-3 supplementation may reduce fatigue among significantly fatigued breast cancer survivors.
To clarify the biological rationale for social regulation of gene expression, this study sought to identify the specific immune cell types that are transcriptionally sensitive to subjective social isolation (loneliness). Using reference distributions for the expression of each human gene in each major leukocyte subtype, we mapped the cellular origin of transcripts found to be differentially expressed in the circulating immune cells from chronically lonely individuals. Loneliness-associated genes derived primarily from plasmacytoid dendritic cells, monocytes, and, to a lesser extent, B lymphocytes. Those dynamics reflected per-cell changes in the expression of inducible genes and related more strongly to the subjective experience of loneliness than to objective social network size. Evolutionarily ancient myeloid antigen-presenting cells appear to have evolved a transcriptional sensitivity to socioenvironmental conditions that may allow them to shift basal gene expression profiles to counter the changing microbial threats associated with hostile vs. affine social conditions.
Although drug development has advanced for autoimmune diseases, many current therapies are hampered by adverse effects and the frequent destruction or inactivation of healthy cells in addition to pathological cells. Targeted autoimmune therapies capable of eradicating the rare autoreactive immune cells that are responsible for the attack on the body's own cells are yet to be identified. This Review presents a new emerging approach aimed at selectively destroying autoreactive immune cells by specific activation of tumour necrosis factor receptor 2 (TNFR2), which is found on autoreactive and normal T lymphocytes, with the potential of avoiding or reducing the toxicity observed with existing therapies.
Purpose
Chronic inflammation is believed to contribute to the development and progression of breast cancer. Systemic C-reactive protein (CRP) and serum amyloid A (SAA) are measures of low-grade chronic inflammation and potential predictors of cancer survival.
Patients and Methods
We evaluated the relationship between circulating markers of inflammation and breast cancer survival using data from the Health, Eating, Activity, and Lifestyle (HEAL) Study (a multiethnic prospective cohort study of women diagnosed with stage 0 to IIIA breast cancer). Circulating concentrations of CRP and SAA were measured approximately 31 months after diagnosis and tested for associations with disease-free survival (approximately 4.1 years of follow-up) and overall survival (approximately 6.9 years of follow-up) in 734 disease-free breast cancer survivors. Cox proportional hazards models were used with adjustment for potential confounding factors to generate hazard ratios (HRs) and 95% CIs.
Results
Elevated SAA and CRP were associated with reduced overall survival, regardless of adjustment for age, tumor stage, race, and body mass index (SAA P trend < .0001; CRP P trend = .002). The HRs for SAA and CRP tertiles suggested a threshold effect on survival, rather than a dose-response relationship (highest v lowest tertile: SAA HR = 3.15; 95% CI, 1.73 to 5.65; CRP HR = 2.27; 95% CI, 1.27 to 4.08). Associations were similar and still significant after adjusting for self-reported history of cardiovascular events and censoring cardiovascular disease deaths. Elevated CRP and SAA were also associated with reduced disease-free survival, although these associations were of borderline significance (SAA P trend = .04; CRP P trend = .07).
Conclusion
Circulating SAA and CRP may be important prognostic markers for long-term survival in breast cancer patients, independent of race, tumor stage, and body mass index.
Objectives. This study compares the effects of an integrated yoga program with brief supportive therapy in breast cancer outpatients undergoing adjuvant radiotherapy at a cancer center.
Eighty-eight stage II and III breast cancer outpatients are randomly assigned to receive yoga (n = 44) or brief supportive therapy (n = 44) prior to radiotherapy treatment. Assessments include diurnal salivary cortisol levels 3 days before and after radiotherapy and self-ratings of anxiety, depression, and stress collected before and after 6 weeks of radiotherapy.
Analysis of covariance reveals significant decreases in anxiety (P < .001), depression (P = .002), perceived stress (P < .001), 6 a.m. salivary cortisol (P = .009), and pooled mean cortisol (P = .03) in the yoga group compared with controls. There is a significant positive correlation between morning salivary cortisol level and anxiety and depression.
Yoga might have a role in managing self-reported psychological distress and modulating circadian patterns of stress hormones in early breast cancer patients undergoing adjuvant radiotherapy.
To determine the effects of a long-term exercise intervention on two prominent biomarkers of inflammation (C-reactive protein (CRP) and interleukin-6 (IL-6)) in elderly men and women.
Single-blind, randomized, controlled trial: The Lifestyle Interventions and Independence for Elders (LIFE) Trial.
The Cooper Institute, Dallas, Texas; Stanford University, Stanford, California; University of Pittsburgh, Pittsburgh, Pennsylvania; and Wake Forest University, Winston-Salem, North Carolina.
Four hundred twenty-four elderly (aged 70-89), nondisabled, community-dwelling men and women at risk for physical disability.
A 12-month moderate-intensity physical activity (PA) intervention and a successful aging (SA) health education intervention.
CRP and IL-6.
After adjustment for baseline IL-6, sex, clinic site, diabetes mellitus, treatment group, visit, and group-by-visit interaction, the PA intervention resulted in a lower (P=.02) IL-6 concentration than the SA intervention. Adjusted mean IL-6 at month 12 was 8.5% (0.21 pg/mL) higher in the SA than the PA group. There were no significant differences in CRP between the groups at 12 months (P=.09). Marginally significant interaction effects of the PA intervention according to baseline functional status (P=.05) and IL-6 (above vs below the median; P=.06) were observed. There was a greater effect of the PA intervention on participants with lower functional status and those with a higher baseline IL-6.
Greater PA results in lower systemic concentrations of IL-6 in elderly individuals, and this benefit is most pronounced in individuals at the greatest risk for disability and subsequent loss of independence.
To determine the prevalence of cancer-related fatigue syndrome (CRFS) in a population of disease-free breast cancer survivors and to investigate the relationship between CRFS and clinical variables.
Women (200) were recruited. All participants were between 3 months and 2 years after completion of primary therapy for breast cancer and were disease free. Subjects completed a diagnostic interview for CRFS and structured psychiatric interview. Participants also completed quality of life, mood and fatigue questionnaires, and provided a blood sample for haematological and biochemical analysis and a 24-h urine specimen for cortisol estimation. Subjects wore a wrist actigraph for 7 days to measure activity and sleep.
Sixty women (30% of participants) were found to fulfil the criteria for CRFS. There were statistically significant differences between fatigued and non-fatigued women with respect to fatigue severity (p<0.01), mood (p<0.01) and quality of life scores (p<0.05). There were significant differences in blood variables including raised total white cell count and lower sodium (all p<0.02). There was no difference in the 24h urinary free cortisol levels. Actigraphic data demonstrated significant differences in sleep quality and disturbance, but not in overall levels of daytime activity or circadian rhythm.
CRFS affects 30% of women after breast cancer treatment and has significant effects on quality of life and mood. There is some evidence that CRFS is related to sleep disturbance or to a persistent inflammatory or immune response.
The measurement of cortisol in saliva provides the basic scientist as well as the clinician with a reliable tool for investigations of hypothalamus-pituitary-adrenal axis activity. Since saliva samples can be obtained stress-free and independent from medically trained personnel this method may be well suited for use in psychobiological studies. This overview intends to give a comprehensive introduction to the method of salivary cortisol assessment and to briefly discuss its application in different scientific disciplines.
Little is known about the mechanisms converting psychosocial stress into cellular dysfunction. Various genes, up-regulated in atherosclerosis but also by psychosocial stress, are controlled by the transcription factor nuclear factor kappaB (NF-kappaB). Therefore, NF-kappaB is a good candidate to convert psychosocial stress into cellular activation. Volunteers were subjected to a brief laboratory stress test and NF-kappaB activity was determined in peripheral blood mononuclear cells (PBMC), as a window into the body and because PBMC play a role in diseases such as atherosclerosis. In 17 of 19 volunteers, NF-kappaB was rapidly induced during stress exposure, in parallel with elevated levels of catecholamines and cortisol, and returned to basal levels within 60 min. To model this response, mice transgenic for a strictly NF-kappaB-controlled beta-globin transgene were stressed by immobilization. Immobilization resulted in increased beta-globin expression, which could be reduced in the presence of the alpha1-adrenergic inhibitor prazosin. To define the role of adrenergic stimulation in the up-regulation of NF-kappaB, THP-1 cells were induced with physiological amounts of catecholamines for 10 min. Only noradrenaline resulted in a dose- and time-dependent induction of NF-kappaB and NF-kappaB-dependent gene expression, which depended on pertussis-toxin-sensitive G protein-mediated phosphophatidylinositol 3-kinase, Ras/Raf, and mitogen-activated protein kinase activation. Induction was reduced by alpha(1)- and beta-adrenergic inhibitors. Thus, noradrenaline-dependent adrenergic stimulation results in activation of NF-kappaB in vitro and in vivo. Activation of NF-kappaB represents a downstream effector for the neuroendocrine response to stressful psychosocial events and links changes in the activity of the neuroendocrine axis to the cellular response.
Yoga has been practiced for thousands of years to improve physical and emotional well-being. Empirical research on yoga has been ongoing for several decades, including several recent studies conducted with cancer patients and survivors.
This review provides a general introduction to yoga and a detailed review of yoga research in cancer.
Nine studies conducted with cancer patients and survivors yielded modest improvements in sleep quality, mood, stress, cancer-related distress, cancer-related symptoms, and overall quality of life. Studies conducted in other patient populations and healthy individuals have shown beneficial effects on psychological and somatic symptoms, as well as other aspects of physical function.
Results from the emerging literature on yoga and cancer provide preliminary support for the feasibility and efficacy of yoga interventions for cancer patients, although controlled trials are lacking. Further research is required to determine the reliability of these effects and to identify their underlying mechanisms.
Purpose: This study seeks to define immunologic and inflammatory variables associated with persistent post-treatment fatigue in breast cancer survivors.
Experimental Design: Leukocyte subsets, plasma inflammatory markers, and ex vivo proinflammatory cytokine production were assessed in 50 fatigued and nonfatigued breast cancer survivors recruited ≥2 years after successful primary therapy. Multivariate statistical analyses were used to define a composite immunologic biomarker of fatigue risk.
Results: Fatigued breast cancer survivors were distinguished from nonfatigued survivors by increased ex vivo monocyte production of interleukin (IL)-6 and tumor necrosis factor-α following lipopolysaccharide stimulation, elevated plasma IL-1ra and soluble IL-6 receptor (sIL-6R/CD126), decreased monocyte cell-surface IL-6R, and decreased frequencies of activated T lymphocytes and myeloid dendritic cells in peripheral blood (all P < 0.05). An inverse correlation between sIL-6R and cell-surface IL-6R was consistent with inflammation-mediated shedding of IL-6R, and in vitro studies confirmed that proinflammatory cytokines induced such shedding. Multivariate linear discriminant function analysis identified two immunologic markers, the ratio of sIL-6R to monocyte-associated IL-6R and decreased circulating CD69⁺ T lymphocytes, as highly diagnostic of fatigue (P = 0.0005), with cross-validation estimates indicating 87% classification accuracy (sensitivity = 0.83; specificity = 0.83).
Conclusion: These results extend links between fatigue and inflammatory markers to show a functional alteration in proinflammatory cytokine response to lipopolysaccharide and define a prognostic biomarker of behavioral fatigue.
Relaxation techniques are established in managing of cardiac patients during rehabilitation aiming to reduce future adverse cardiac events. It has been hypothesized that relaxation-training programs may significantly improve cardiac autonomic nervous tone. However, this has not been proven for all available relaxation techniques. We tested this assumption by investigating cardiac vagal modulation during yoga.We examined 11 healthy yoga practitioners (7 women and 4 men, mean age: 43 +/- 11; range: 26-58 years). Each individual was subjected to training units of 90 min once a week over five successive weeks. During two sessions, they practiced a yoga program developed for cardiac patients by B.K.S. Iyengar. On three sessions, they practiced a placebo program of relaxation. On each training day they underwent ambulatory 24 h Holter monitoring. The group of yoga practitioners was compared to a matched group of healthy individuals not practicing any relaxation techniques. Parameters of heart rate variability (HRV) were determined hourly by a blinded observer. Mean RR interval (interval between two R-waves of the ECG) was significantly higher during the time of yoga intervention compared to placebo and to control (P < 0.001 for both). The increase in HRV parameters was significantly higher during yoga exercise than during placebo and control especially for the parameters associated with vagal tone, i.e. mean standard deviation of NN (Normal Beat to Normal Beat of the ECG) intervals for all 5-min intervals (SDNNi, P < 0.001 for both) and root mean square successive difference (rMSSD, P < 0.01 for both). In conclusion, relaxation by yoga training is associated with a significant increase of cardiac vagal modulation. Since this method is easy to apply with no side effects, it could be a suitable intervention in cardiac rehabilitation programs.
Although we generally experience our bodies as being biologically stable across time and situations, an emerging field of research is demonstrating that external social conditions, especially our subjective perceptions of those conditions, can influence our most basic internal biological processes-namely, the expression of our genes. This research on human social genomics has begun to identify the types of genes that are subject to social-environmental regulation, the neural and molecular mechanisms that mediate the effects of social processes on gene expression, and the genetic polymorphisms that moderate individual differences in genomic sensitivity to social context. The molecular models resulting from this research provide new opportunities for understanding how social and genetic factors interact to shape complex behavioral phenotypes and susceptibility to disease. This research also sheds new light on the evolution of the human genome and challenges the fundamental belief that our molecular makeup is relatively stable and impermeable to social-environmental influence.
Lonely older adults have increased expression of pro-inflammatory genes as well as increased risk for morbidity and mortality. Previous behavioral treatments have attempted to reduce loneliness and its concomitant health risks, but have had limited success. The present study tested whether the 8-week Mindfulness-Based Stress Reduction (MBSR) program (compared to a Wait-List control group) reduces loneliness and downregulates loneliness-related pro-inflammatory gene expression in older adults (N=40). Consistent with study predictions, mixed effect linear models indicated that the MBSR program reduced loneliness, compared to small increases in loneliness in the control group (treatment condition×time interaction: F(1,35)=7.86, p=.008). Moreover, at baseline, there was an association between reported loneliness and upregulated pro-inflammatory NF-κB-related gene expression in circulating leukocytes, and MBSR downregulated this NF-κB-associated gene expression profile at post-treatment. Finally, there was a trend for MBSR to reduce C Reactive Protein (treatment condition×time interaction: (F(1,33)=3.39, p=.075). This work provides an initial indication that MBSR may be a novel treatment approach for reducing loneliness and related pro-inflammatory gene expression in older adults.
Cancer-related fatigue afflicts up to 33% of breast cancer survivors, yet there are no empirically validated treatments for this symptom.
The authors conducted a 2-group randomized controlled trial to determine the feasibility and efficacy of an Iyengar yoga intervention for breast cancer survivors with persistent post-treatment fatigue. Participants were breast cancer survivors who had completed cancer treatments (other than endocrine therapy) at least 6 months before enrollment, reported significant cancer-related fatigue, and had no other medical conditions that would account for fatigue symptoms or interfere with yoga practice. Block randomization was used to assign participants to a 12-week, Iyengar-based yoga intervention or to 12 weeks of health education (control). The primary outcome was change in fatigue measured at baseline, immediately post-treatment, and 3 months after treatment completion. Additional outcomes included changes in vigor, depressive symptoms, sleep, perceived stress, and physical performance. Intent-to-treat analyses were conducted with all randomized participants using linear mixed models.
Thirty-one women were randomly assigned to yoga (n = 16) or health education (n = 15). Fatigue severity declined significantly from baseline to post-treatment and over a 3-month follow-up in the yoga group relative to controls (P = .032). In addition, the yoga group had significant increases in vigor relative to controls (P = .011). Both groups had positive changes in depressive symptoms and perceived stress (P < .05). No significant changes in sleep or physical performance were observed.
A targeted yoga intervention led to significant improvements in fatigue and vigor among breast cancer survivors with persistent fatigue symptoms.
Unlabelled:
We searched databases for controlled clinical studies, and performed a meta-analysis on the effectiveness of yoga interventions on pain and associated disability. Five randomized studies reported single-blinding and had a higher methodological quality; 7 studies were randomized but not blinded and had moderate quality; and 4 nonrandomized studies had low quality. In 6 studies, yoga was used to treat patients with back pain; in 2 studies to treat rheumatoid arthritis; in 2 studies to treat patients with headache/migraine; and 6 studies enrolled individuals for other indications. All studies reported positive effects in favor of the yoga interventions. With respect to pain, a random effect meta-analysis estimated the overall treatment effect at SMD = -.74 (CI: -.97; -.52, P < .0001), and an overall treatment effect at SMD = -.79 (CI: -1.02; -.56, P < .0001) for pain-related disability. Despite some limitations, there is evidence that yoga may be useful for several pain-associated disorders. Moreover, there are hints that even short-term interventions might be effective. Nevertheless, large-scale further studies have to identify which patients may benefit from the respective interventions.
Perspective:
This meta-analysis suggests that yoga is a useful supplementary approach with moderate effect sizes on pain and associated disability.
Chronic threat and anxiety are associated with pro-inflammatory transcriptional profiles in circulating leukocytes, but the causal direction of that relationship has not been established. This study tested whether a cognitive-behavioral stress management (CBSM) intervention targeting negative affect and cognition might counteract anxiety-related transcriptional alterations in people confronting a major medical threat.
One hundred ninety-nine women undergoing primary treatment of stage 0-III breast cancer were randomized to a 10-week CBSM protocol or an active control condition. Seventy-nine provided peripheral blood leukocyte samples for genome-wide transcriptional profiling and bioinformatic analyses at baseline, 6-month, and 12-month follow-ups.
Baseline negative affect was associated with >50% differential expression of 201 leukocyte transcripts, including upregulated expression of pro-inflammatory and metastasis-related genes. CBSM altered leukocyte expression of 91 genes by >50% at follow-up (group × time interaction), including downregulation of pro-inflammatory and metastasis-related genes and upregulation of type I interferon response genes. Promoter-based bioinformatic analyses implicated decreased activity of NF-κB/Rel and GATA family transcription factors and increased activity of interferon response factors and the glucocorticoid receptor as potential mediators of CBSM-induced transcriptional alterations.
In early-stage breast cancer patients, a 10-week CBSM intervention can reverse anxiety-related upregulation of pro-inflammatory gene expression in circulating leukocytes. These findings clarify the molecular signaling pathways by which behavioral interventions can influence physical health and alter peripheral inflammatory processes that may reciprocally affect brain affective and cognitive processes.
Fatigue is a notable clinical problem in cancer survivors, and understanding its pathophysiology is important. The current study sought to determine biomarkers of fatigue that exist before cancer treatment. Relationships between the expression of latent Epstein-Barr virus (EBV) and cytomegalovirus (CMV) and fatigue were examined in 158 women newly diagnosed with breast cancer or awaiting a positive diagnostic result. Higher CMV antibody titers, but not EBV antibody titers, were associated with a greater likelihood of being fatigued. Associations between fatigue and higher CMV antibody titers remained after controlling for alcohol use, smoking, comorbidities, depressive symptoms, age, BMI, cancer stage, and sleep problems. More sleep problems and higher levels of depressive symptoms were also associated with a greater likelihood of being fatigued. CMV antibody titers, but not EBV antibody titers, were associated with higher levels of C-reactive protein (CRP), but CRP was not associated with fatigue. When the cellular immune system is compromised, reactivation of latent herpesviruses may fuel chronic inflammatory responses. Prior work has suggested that fatigue may be related to inflammation and its associated sickness behaviors; accordingly, our findings may be tapping into this same physiological substrate.
To investigate the associations between level of fatigue and various potential inflammatory biomarkers for fatigue after multivariate adjustments for possible confounders in a sample of 299 disease-free survivors of breast cancer (BCSs) at a mean of 4 years post diagnosis.
Medical record data were used for cancer-related information, and a follow-up mailed survey collected data on fatigue, depression, anxiety and insomnia symptoms as well as information on demographics, physical health, medication and lifestyle. Blood samples drawn at an outpatient examination were analyzed for leukocyte count, high sensitivity C-reactive Protein (CRP), interleukin 1 receptor antagonist (IL-1ra), interleukin-6 (IL-6), soluble tumor necrosis factor receptor type 1 (sTNF-R1) and neopterin.
Fatigue levels were significantly and positively associated with hsCRP (p<.001) and leukocyte count (p=.018), but not with levels of IL-1ra, IL-6, sTNF-R1 or neopterin in unadjusted analyses. Only hsCRP remained significantly associated with fatigue levels in the fully adjusted models (p=.020). Depression and self-rated health also remained independently associated with fatigue; however these variables were not significantly associated with hsCRP in multivariate analyses.
In general, and after adjustment for potential confounders, our hypotheses of positive associations between fatigue and several inflammatory markers were not confirmed. However, a small but independent association between level of fatigue and hsCRP was observed and supports the hypothesis that low-grade inflammation could play a role in the pathogenesis of fatigue in BCSs.
Fatigue, depression, and sleep disturbance are common adverse effects of cancer treatment and frequently co-occur. However, the possibility that inflammatory processes may underlie this constellation of symptoms has not been examined.
Women (N = 103) who had recently finished primary treatment (ie, surgery, radiation, chemotherapy) for early-stage breast cancer completed self-report scales and provided blood samples for determination of plasma levels of inflammatory markers: soluble tumor necrosis factor (TNF) receptor II (sTNF-RII), interleukin-1 receptor antagonist, and C-reactive protein.
Symptoms were elevated at the end of treatment; greater than 60% of participants reported clinically significant problems with fatigue and sleep, and 25% reported elevated depressive symptoms. Women treated with chemotherapy endorsed higher levels of all symptoms and also had higher plasma levels of sTNF-RII than women who did not receive chemotherapy (all P < .05). Fatigue was positively associated with sTNF-RII, particularly in the chemotherapy-treated group (P < .05). Depressive symptoms and sleep problems were correlated with fatigue but not with inflammatory markers.
This study confirms high rates of behavioral symptoms in breast cancer survivors, particularly those treated with chemotherapy, and indicates a role for TNF-α signaling as a contributor to postchemotherapy fatigue. Results also suggest that fatigue, sleep disturbance, and depression may stem from distinct biologic processes in post-treatment survivors, with inflammatory signaling contributing relatively specifically to fatigue.
Innate immune responses are regulated by microorganisms and cell death, as well as by a third class of stress signal from the nervous and endocrine systems. The innate immune system also feeds back, through the production of cytokines, to regulate the function of the central nervous system (CNS), and this has effects on behaviour. These signals provide an extrinsic regulatory circuit that links physiological, social and environmental conditions, as perceived by the CNS, with transcriptional 'decision-making' in leukocytes. CNS-mediated regulation of innate immune responses optimizes total organism fitness and provides new opportunities for therapeutic control of chronic infectious, inflammatory and neuropsychiatric diseases.
To examine the effect of regular Iyengar yoga practice on measures of self-perceived psychosocial function and diurnal salivary cortisol secretion in stage II-IV breast cancer survivors (n = 18).
Women were randomly assigned to attend yoga practice for 90 min twice weekly for 8 weeks (n = 9) or to a wait-listed, noninterventional control group (n = 9). Traditional Iyengar yoga routines that progressively increased in difficulty as participants gained strength and flexibility were used. At baseline and after the 8-week study period, women completed self-report instruments to document various aspects of psychosocial and physical functioning, and collected salivary samples for cortisol analysis four times during the day for two consecutive days.
The yoga group had lower morning and 5 p.m. salivary cortisol and improved emotional well-being and fatigue scores.
Breast cancer survivors are at risk for chronic psychosocial distress that may alter activity of the hypothalamic-pituitary-adrenal axis, resulting in aberrant regulation of cortisol secretion and increased risk of immune dysfunction and cancer progression. Regular yoga practice may be a low-risk, cost-effective way to improve psychosocial functioning, fatigue, and regulation of cortisol secretion in breast cancer survivors. These findings require validation with a larger randomized study.
Fatigue is highly prevalent in the general population and is one of the most common side effects of cancer treatment. There is growing evidence that pro-inflammatory cytokines play a role in cancer-related fatigue, although the molecular mechanisms for chronic inflammation and fatigue have not been determined. The current study utilized genome-wide expression microarrays to identify differences in gene expression and associated alterations in transcriptional activity in leukocytes from breast cancer survivors with persistent fatigue (n=11) and non-fatigued controls (n=10). We focused on transcription of inflammation-related genes, particularly those responsive to the pro-inflammatory NF-κB transcription control pathway. Further, given the role of glucocorticoids as key regulators of inflammatory processes, we examined transcription of glucocorticoid-responsive genes indicative of potential glucocorticoid receptor (GR) desensitization. Plasma levels of cortisol were also assessed. Consistent with hypotheses, results showed increased expression of transcripts with response elements for NF-κB, and reduced expression of transcripts with response elements for glucocorticoids (p<.05) in fatigued breast cancer survivors. No differences in plasma levels of cortisol were observed. These data indicate that increased activity of pro-inflammatory transcription factors may contribute to persistent cancer-related fatigue and provide insight into potential mechanisms for tonic increases in NF-κB activity, specifically decreased expression of GR anti-inflammatory transcription factors.
To address the mechanisms underlying hatha yoga's potential stress-reduction benefits, we compared inflammatory and endocrine responses of novice and expert yoga practitioners before, during, and after a restorative hatha yoga session, as well as in two control conditions. Stressors before each of the three conditions provided data on the extent to which yoga speeded an individual's physiological recovery.
A total of 50 healthy women (mean age, 41.32 years; range, 30-65 years), 25 novices and 25 experts, were exposed to each of the conditions (yoga, movement control, and passive-video control) during three separate visits.
The yoga session boosted participants' positive affect compared with the control conditions, but no overall differences in inflammatory or endocrine responses were unique to the yoga session. Importantly, even though novices and experts did not differ on key dimensions, including age, abdominal adiposity, and cardiorespiratory fitness, novices' serum interleukin (IL)-6 levels were 41% higher than those of experts across sessions, and the odds of a novice having detectable C-reactive protein (CRP) were 4.75 times as high as that of an expert. Differences in stress responses between experts and novices provided one plausible mechanism for their divergent serum IL-6 data; experts produced less lipopolysaccharide-stimulated IL-6 in response to the stressor than novices, and IL-6 promotes CRP production.
The ability to minimize inflammatory responses to stressful encounters influences the burden that stressors place on an individual. If yoga dampens or limits stress-related changes, then regular practice could have substantial health benefits.
The number of African American (AA) patients living with heart failure (HF) has been increasing, especially among the economically disadvantaged. Yoga therapy has been found to improve physical and psychological parameters among healthy individuals, but its effect in patients with HF remains unknown. The purpose of this study was to examine the effects of yoga therapy on cardiovascular endurance (VO2peak), flexibility, quality of life (QoL), and inflammatory markers on medically stable HF patients.
Forty patients (38 AA, 1 Asian, and 1 Caucasian) with systolic or diastolic HF were randomized to the yoga group (YG, n = 21) or the control group (CG, n = 19). All patients were asked to follow a home walk program. Premeasurement and postmeasurement included a treadmill stress test to peak exertion, flexibility, interleukin-6 (IL-6), C-reactive protein (CRP), and extracellular superoxide dismutase (EC-SOD). QoL was assessed by the Minnesota Living with Heart Failure Questionnaire (MLwHFQ).
The statistical analyses (assessed by ANOVA and t-tests) were significant for favorable changes in the YG, compared with those in the CG, for flexibility (P = 0.012), treadmill time (P = 0.002), VO2peak (P = 0.003), and the biomarkers (IL-6, P = 0.004; CRP, P = 0.016; and EC-SOD, P = 0.012). Within the YG, pretest to posttest scores for the total (P = 0.02) and physical subscales (P < 0.001) of the MLwHFQ were improved.
Yoga therapy offered additional benefits to the standard medical care of predominantly AA HF patients by improving cardiovascular endurance, QoL, inflammatory markers, and flexibility.
Biomarkers of radiation-induced behavioral symptoms, such as fatigue, have not been identified. Studies linking inflammatory processes to fatigue in cancer survivors led us to test the hypothesis that activation of the proinflammatory cytokine network is associated with fatigue symptoms during radiation therapy for breast and prostate cancer.
Individuals with early-stage breast (n = 28) and prostate cancer (n = 20) completed questionnaires and provided blood samples for determination of serum levels of interleukin 1beta (IL-1beta) and IL-6 at assessments conducted before, during, and after a course of radiation therapy. Serum markers of proinflammatory cytokine activity, including IL-1 receptor antagonist and C-reactive protein, were examined in a subset of participants. Random coefficient models were used to evaluate the association between changes in cytokine levels and fatigue.
As expected, there was a significant increase in fatigue during radiation treatment. Changes in serum levels of inflammatory markers C-reactive protein and IL-1 receptor antagonist were positively associated with increases in fatigue symptoms (Ps < 0.05), although serum levels of IL-1beta and IL-6 were not associated with fatigue. These effects remained significant (Ps < 0.05) in analyses controlling for potential biobehavioral confounding factors, including age, body mass index, hormone therapy, depression, and sleep disturbance.
Results suggest that activation of the proinflammatory cytokine network and associated increases in downstream biomarkers of proinflammatory cytokine activity are associated with fatigue during radiation therapy for breast and prostate cancer.
Low-grade inflammatory responses may be related to the pathogenesis of cancer-related fatigue (CRF). We investigated circulating levels of various inflammatory markers in relation to chronic CRF (6 month duration) in Norwegian long-term survivors of testicular cancer (TCSs). We compared 92 TCSs with chronic CRF (cases) to 191 TCS without (controls) at median age 45 years (range 23-73), and median 11 years post-treatment (range 5-20). Chronic CRF was defined using the Fatigue Questionnaire, while plasma concentrations of cytokines and serum CRP were determined by various immunoassays. Higher levels of interleukin-1 receptor antagonist (IL-1ra) (p=.002) and C-Reactive protein (CRP) (p=.036) were found in cases compared to controls. No differences were observed for interleukin-6 (IL-6), soluble Tumor Necrosis Factor Receptor type 1 (sTNF-R1) or neopterin. Both IL-1ra and CRP were correlated with physical but not with mental fatigue. In logistic regression analyses IL-1ra and CRP explained 3.5% and 2.8%, respectively, of the variance in chronic CRF. Single adjustments for depression, anxiety and neuroticism each raised the models' explained variance to approximately 35%. Those factors did not significantly alter the relationship between chronic CRF and IL-1ra/CRP. BMI and smoking emerged as possible confounding factors. These results indicate that chronic CRF in TCSs is associated with higher levels of circulating IL-1ra and CRP, possibly mediated by physiological morbidity. Hence, the findings lend some support to the hypothesis that low-grade inflammatory processes are involved in the pathogenesis of chronic CRF in cancer survivors.
Chronic infections, obesity, alcohol, tobacco, radiation, environmental pollutants, and high-calorie diet have been recognized as major risk factors for the most common types of cancer. All these risk factors are linked to cancer through inflammation. Although acute inflammation that persists for short-term mediates host defense against infections, chronic inflammation that lasts for long term can predispose the host to various chronic illnesses, including cancer. Linkage between cancer and inflammation is indicated by numerous lines of evidence; first, transcription factors nuclear factor-kappaB (NF-kappaB) and signal transducers and activators of transcription 3 (STAT3), two major pathways for inflammation, are activated by most cancer risk factors; second, an inflammatory condition precedes most cancers; third, NF-kappaB and STAT3 are constitutively active in most cancers; fourth, hypoxia and acidic conditions found in solid tumors activate NF-kappaB; fifth, chemotherapeutic agents and gamma-irradiation activate NF-kappaB and lead to chemoresistance and radioresistance; sixth, most gene products linked to inflammation, survival, proliferation, invasion, angiogenesis, and metastasis are regulated by NF-kappaB and STAT3; seventh, suppression of NF-kappaB and STAT3 inhibits the proliferation and invasion of tumors; and eighth, most chemopreventive agents mediate their effects through inhibition of NF-kappaB and STAT3 activation pathways. Thus, suppression of these proinflammatory pathways may provide opportunities for both prevention and treatment of cancer.
Soluble tumour necrosis factor receptors (sTNF-Rs) play a role as modulators of the biological function of tumour necrosis factor-alpha (TNF-alpha) in an agonist/antagonist pattern. In various pathologic states the production and release of sTNF-Rs may mediate host response and determine the course and outcome of disease by interacting with TNF-alpha and competing with cell surface receptors. The determination of sTNF-Rs in body fluids such as plasma or serum is a new tool to gain information about immune processes and provides valuable insight into a variety of pathological conditions. Regarding its immediate clinical use, sTNF-Rs levels show high accuracy in the follow-up and prognosis of various diseases. In HIV infection and sepsis, sTNF-Rs concentrations strongly correlate with the clinical stage and the progression of disease and can be of predictive value. Determination of sTNF-Rs also gives useful information for monitoring cancer and autoimmune diseases. The information provided is often even superior to that obtained with classical disease markers, probably due to the direct involvement of the "TNF system" in the pathogenetic mechanisms in these patients. The available data imply that the measurement of sTNF-Rs, especially of the sTNF-R 75kD type, is a useful adjunct for quantification of the Th1-type immune response, similar to other immune activation markers such as neopterin and beta 2-microglobulin. Endogenous sTNF-Rs concentrations appear to reflect the activation state of the TNF-alpha/TNF receptor system.
The interleukin-1 receptor antagonist (IL-1Ra) is a member of the IL-1 family that binds to IL-1 receptors but does not induce any intracellular response. Two structural variants of IL-1Ra have previously been described: a 17-kDa form that is secreted from monocytes, macrophages, neutrophils, and other cells (sIL-1Ra) and an 18-kDa form that remains in the cytoplasm of keratinocytes and other epithelial cells, monocytes, and fibroblasts (icIL-1Ra). An additional 16-kDa intracellular isoform of IL-1Ra has recently been described in neutrophils, monocytes, and hepatic cells. Both of the major isoforms of IL-1Ra are transcribed from the same gene through the use of alternative first exons. The two promoters regulating transcription of the secreted and intracellular forms have been cloned, and some of the functional cis-acting DNA regions have been characterized. The production of IL-1Ra is stimulated by many substances including adherent IgG, other cytokines, and bacterial or viral components. The tissue distribution of IL-1Ra in mice indicates that sIL-1Ra is found predominantly in peripheral blood cells, lungs, spleen, and liver, while icIL-1Ra is found in large amounts in skin. Studies in transgenic and knockout mice indicate that IL-1Ra is important in host defense against endotoxin-induced injury. IL-1Ra is produced by hepatic cells with the characteristics of an acute phase protein. Endogenous IL-1Ra is produced in numerous experimental animal models of disease as well as in human autoimmune and chronic inflammatory diseases. The use of neutralizing anti-IL-1Ra antibodies has demonstrated that endogenous IL-1Ra is an important natural antiinflammatory protein in arthritis, colitis, and granulomatous pulmonary disease. Treatment of human diseases with recombinant human IL-1Ra showed an absence of benefit in sepsis syndrome. However, patients with rheumatoid arthritis treated with IL-1Ra for six months exhibited improvements in clinical parameters and in radiographic evidence of joint damage.
Over the past 20 years, a significant effort has been made to define a role for the neuroendocrine system in the regulation of immunity. It was expected that these experimental findings would help to establish a strategy for the development of clinical interventions to either suppress or augment immunological function for disease prevention. However, the translation of these basic experimental findings into clinical interventions has been difficult. Possible explanations for this difficulty are that the findings from human and animal studies do not agree and/or that the results obtained within one species are rarely verified in the other. Our goal in writing this review is to address this issue by summarizing the published findings from human studies and comparing them to published findings from animal studies. Although far from being exhaustive, this review summarizes and discusses at least the past 10 years of findings in which a change in immunity and a change in catecholamine levels and/or stimulation of the beta(2)-adrenergic receptor has been documented.
Fatigue is a common problem among cancer patients and survivors, yet the mechanisms underlying the occurrence and persistence of this symptom are not known. Activation of the immune system may evoke feelings of fatigue, which are mediated by proinflammatory cytokines. We examined whether fatigued breast cancer survivors would show elevations in proinflammatory cytokines and markers of cytokine activity compared with nonfatigued survivors. Differences in lymphocyte subsets, cortisol, and behavioral symptoms associated with proinflammatory cytokines were also assessed.
Forty breast cancer survivors (20 fatigued, 20 nonfatigued) provided blood samples at visits scheduled to control for diurnal variability. Cytokines, soluble markers of cytokine activity, and cortisol were measured by immunoassay and lymphocyte subsets by flow cytometry. Participants also completed questionnaires measuring demographic, medical, and behavioral variables.
Fatigued breast cancer survivors had significantly higher serum levels of several markers associated with proinflammatory cytokine activity than nonfatigued survivors, including interleukin-1 receptor antagonist (IL-1ra), soluble tumor necrosis factor receptor type II (sTNF-RII), and neopterin. They were also more likely to report behavioral problems that co-occur with fatigue in the context of immune activation. Fatigued survivors had significantly lower serum levels of cortisol than the nonfatigued group as well as differences in two lymphocyte populations.
Fatigued breast cancer survivors showed elevations in serum markers associated with proinflammatory cytokine activity an average of 5 years after diagnosis. Results suggest mechanisms through which enduring immune activation may occur, including alterations in cortisol and in lymphocyte subsets.
Overproduction of IL-6, a proinflammatory cytokine, is associated with a spectrum of age-related conditions including cardiovascular disease, osteoporosis, arthritis, type 2 diabetes, certain cancers, periodontal disease, frailty, and functional decline. To describe the pattern of change in IL-6 over 6 years among older adults undergoing a chronic stressor, this longitudinal community study assessed the relationship between chronic stress and IL-6 production in 119 men and women who were caregiving for a spouse with dementia and 106 noncaregivers, with a mean age at study entry of 70.58 (SD = 8.03) for the full sample. On entry into this portion of the longitudinal study, 28 of the caregivers' spouses had already died, and an additional 50 of the 119 spouses died during the 6 years of this study. Levels of IL-6 and health behaviors associated with IL-6 were measured across 6 years. Caregivers' average rate of increase in IL-6 was about four times as large as that of noncaregivers. Moreover, the mean annual changes in IL-6 among former caregivers did not differ from that of current caregivers even several years after the death of the impaired spouse. There were no systematic group differences in chronic health problems, medications, or health-relevant behaviors that might have accounted for caregivers' steeper IL-6 slope. These data provide evidence of a key mechanism through which chronic stressors may accelerate risk of a host of age-related diseases by prematurely aging the immune response.
Study protocols in endocrinological research and the neurosciences often employ repeated measurements over time to record changes in physiological or endocrinological variables. While it is desirable to acquire repeated measurements for finding individual and group differences with regard to response time and duration, the amount of data gathered often represents a problem for the statistical analysis. When trying to detect possible associations between repeated measures and other variables, the area under the curve (AUC) is routinely used to incorporate multiple time points. However, formulas for computation of the AUC are not standardized across laboratories, and existing differences are usually not presented when discussing results, thus causing possible variability, or incompatibility of findings between research groups. In this paper, two formulas for calculation of the area under the curve are presented, which are derived from the trapezoid formula. These formulas are termed 'Area under the curve with respect to increase' (AUCI) and 'Area under the curve with respect to ground' (AUCG). The different information that can be derived from repeated measurements with these two formulas is exemplified using artificial and real data from recent studies of the authors. It is shown that depending on which formula is used, different associations with other variables may emerge. Consequently, it is recommended to employ both formulas when analyzing data sets with repeated measures.
Motivation:
In microarray studies it is often of interest to identify upstream transcription control pathways mediating observed changes in gene expression. The Transcription Element Listening System (TELiS) combines sequence-based analysis of gene regulatory regions with statistical prevalence analyses to identify transcription-factor binding motifs (TFBMs) that are over-represented among the promoters of up- or down-regulated genes. Efficiency is maximized by decomposing the problem into two steps: (1) a priori compilation of prevalence matrices specifying the number of putative binding sites for a variety of transcription factors in promoters from all genes assayed by a given microarray, and (2) real-time statistical analysis of pre-compiled prevalence matrices to identify TFBMs that are over- or under-represented in promoters of differentially expressed genes. The interlocking JAVA applications namely, PromoterScan and PromoterStats carry out these tasks, and together constitute the TELiS database for reverse inference of transcription factor activity.
Results:
In two validation studies, TELiS accurately detected in vivo activation of NF-kappaB and the Type I interferon system by HIV-1 infection and pharmacologic activation of the glucocorticoid receptor in peripheral blood mononuclear cells. The population-based statistical inference underlying TELiS out-performed conventional statistical tests in analytic sensitivity, with parametric studies demonstrating accurate identification of transcription factor activity from as few as 20 differentially expressed genes. TELiS thus provides a simple, rapid and sensitive tool for identifying transcription control pathways mediating observed gene expression dynamics.
Inflammation is a human being's primary defense against threats to homeostasis that are encountered every day. Especially in old age, when regulatory mechanisms responsible for inflammatory responses may be ineffective or damaged, the result can be adverse pathological conditions, and an increased risk of morbidity and mortality. The inflammation response is a plastic network composed of redundant signaling among several different mediators. These mediators have a reciprocal relationship with other biological sub-systems, including hormone regulation, the autonomic nervous system, and oxidative/anti-oxidant balance. Studying this complex architecture requires parallel and multiple research strategies from epidemiological to biochemical level, from observational studies to innovative intervention approaches. Given that the inflammatory response is a critical age-related process, understanding its regulatory action is essential in avoiding hazardous consequences in old age.
Interferon-alpha is a potent inducer of the cytokine network and is notorious for causing behavioral alterations. Studies on interferon-alpha-treated patients reveal at least two distinct syndromes: 1) a mood/cognitive syndrome that appears late during interferon-alpha therapy is responsive to antidepressants and is associated with activation of neuroendocrine pathways and altered serotonin metabolism; and 2) a neurovegetative syndrome characterized by psychomotor slowing, and fatigue that appears early during interferon-alpha treatment is antidepressant nonresponsive and may be mediated by alterations in basal ganglia dopamine metabolism. Findings from interferon-alpha may provide important clues regarding the pathophysiology and treatment of cytokine-induced behavioral changes in medically ill patients, while also potentially modeling the development of neuropsychiatric symptoms in patients without medical disorders.
Yoga has become increasingly popular in Western cultures as a means of exercise and fitness training; however, it is still depicted as trendy as evidenced by an April 2001 Time magazine cover story on "The Power of Yoga." There is a need to have yoga better recognized by the health care community as a complement to conventional medical care. Over the last 10 years, a growing number of research studies have shown that the practice of Hatha Yoga can improve strength and flexibility, and may help control such physiological variables as blood pressure, respiration and heart rate, and metabolic rate to improve overall exercise capacity. This review presents a summary of medically substantiated information about the health benefits of yoga for healthy people and for people compromised by musculoskeletal and cardiopulmonary disease.
During the past decade, our understanding of the pathophysiology of coronary artery disease (CAD) has undergone a remarkable evolution. We review here how these advances have altered our concepts of and clinical approaches to both the chronic and acute phases of CAD. Previously considered a cholesterol storage disease, we currently view atherosclerosis as an inflammatory disorder. The appreciation of arterial remodeling (compensatory enlargement) has expanded attention beyond stenoses evident by angiography to encompass the biology of nonstenotic plaques. Revascularization effectively relieves ischemia, but we now recognize the need to attend to nonobstructive lesions as well. Aggressive management of modifiable risk factors reduces cardiovascular events and should accompany appropriate revascularization. We now recognize that disruption of plaques that may not produce critical stenoses causes many acute coronary syndromes (ACS). The disrupted plaque represents a "solid-state" stimulus to thrombosis. Alterations in circulating prothrombotic or antifibrinolytic mediators in the "fluid phase" of the blood can also predispose toward ACS. Recent results have established the multiplicity of "high-risk" plaques and the widespread nature of inflammation in patients prone to develop ACS. These findings challenge our traditional view of coronary atherosclerosis as a segmental or localized disease. Thus, treatment of ACS should involve 2 overlapping phases: first, addressing the culprit lesion, and second, aiming at rapid "stabilization" of other plaques that may produce recurrent events. The concept of "interventional cardiology" must expand beyond mechanical revascularization to embrace preventive interventions that forestall future events.
The daytime log-cortisol slope appears to be of growing importance in studying the relationship between stress and health. How best to estimate that slope with minimal burden to the participants and the cost of the study is a decision often made without empiric foundation.
In 50 older participants, the authors examined cortisol assay comparability across laboratories, assay reliability, test-retest reliability of slopes, and comparability of slope estimates for two, three, and four samples per day.
The authors demonstrate in an older sample that 1) assay reliability is a relatively minor issue, that one assay per saliva sample suffices; 2) the use of a sample obtained at wake time for each participant appears to be a preferred anchor for the slope estimate in comparison to a sample 30 minutes postwake time; 3) self-reported times appear preferable to automatic time recording; and 4) test-retest reliability of slopes, however, is not sufficiently high to base a slope estimate on one day; minimally two days and preferably three should be required.
Whether these conclusions apply to other populations, or using other protocols, is not assured, but the study itself provides a model that can be used to check research decisions. Unnecessarily imposing a burdensome protocol has both ethical and scientific ramifications and should be carefully avoided.
Aging is associated with increases of sympathetic nervous system activation implicated in the onset of hypertension and cardiovascular disease. The purpose of this study was to examine whether the practice of Tai Chi Chih (TCC), a movement-based relaxation practice, would acutely promote decreases of sympathetic activity in elderly persons.
The sample included two groups of older men and women (age > or = 60 years): TCC practitioners (n = 19) and TCC-naïve participants (n = 13). Participants were recruited after completing a 25-week randomized trial of TCC or health education. TCC practitioners performed TCC for 20 minutes, and TCC-naïve participants passively rested. Preejection period, blood pressure, and heart rate were measured before and after the task. A subsample (n = 8) returned for a second evaluation and performed videotape-guided stretching for 20 minutes to evaluate the effects of slow-moving physical activity on sympathetic activity.
Results showed that TCC performance significantly decreased sympathetic activity as indexed by preejection period (p =.01). In contrast, there was no change in preejection period following passive rest or slow-moving physical activity. Neither blood pressure nor heart rate changed after TCC performance.
This study is the first to our knowledge to assess the acute effects of TCC practice on sympathetic activity in older adults. TCC performance led to acute decreases in sympathetic activity, which could not be explained by physical activity alone. Further study is needed to determine whether the acute salutary effects of TCC on autonomic functioning are sustained with ongoing practice in older adults.
The assessment of systemic inflammation by means of laboratory tests often complements the results of medical examination. Traditionally, the erythrocyte sedimentation rate and leukocytosis with left shift are diagnostic markers for inflammatory and infectious diseases. The levels of acute-phase proteins--especially C-reactive protein--are used to assess both the presence of inflammation and any response to treatment. The determination of C-reactive protein levels may be advised in three types of pathological situation: infection, acute or chronic inflammation, and evaluation of metabolic risk. Procalcitonin is useful as a marker of sepsis and severe infection. The concentration of serum amyloid A predicts the chances of survival of patients with secondary (AA) amyloidosis. Ferritin and its glycosylated form are of interest in the study of specific diseases such as adult-onset Still's disease. Markers of cartilage and bone turnover are complementary to these markers of inflammation. Although cytokine serum levels are transiently crucial to the generation of inflammation, their usefulness in the clinic is still under investigation. Serum concentrations of cytokine inhibitors or soluble cytokine receptors, as well as the clinical response of patients to treatment with cytokine antagonists, might generate important information for monitoring autoinflammatory diseases.
Background:
The rapid pace of life, eating habits, and environmental pollution have increased stress levels and its related disorders. The complex molecular response to stress is mediated by stress genes and a variety of regulatory pathways. Oxidative stress is internal damage caused by reactive oxygen species. Increasing evidence suggests that chronic psychosocial stress may increase oxidative stress, which in turn may contribute to aging, and etiology of coronary diseases, cancer, arthritis, etc. Psychophysiological concomitants of meditation have been extensively researched, but there are very little data available on biochemical activity leading to relieving stress by causing a relaxation response by Sudarshan Kriya (SK). SK is a breathing technique that involves breathing in three different rhythms. It is preceded by Ujjayi Pranayam (long and deep breaths with constriction at the base of throat) and Bhastrika (fast and forceful breaths through nose along with arm movements).
Methods:
Forty-two SK practitioners and 42 normal healthy controls were recruited for our study. The practitioners had practiced SK for at least 1 year. Selected normal healthy controls did not perform any conventional physical exercise or any formal stress management technique. Whole blood was used for glutathione peroxidase estimation and red blood cell lysate was used for superoxide dismutase activity assay and for glutathione estimation. White blood cells were isolated from fresh blood and assayed for gene expression using reverse transcriptase-polymerase chain reaction. The parameters studied are antioxidant enzymes, genes involved in oxidative stress, DNA damage, cell cycle control, aging, and apoptosis.
Results:
A better antioxidant status both at the enzyme activity and RNA level was seen in SK practitioners. This was accompanied by better stress regulation and better immune status due to prolonged life span of lymphocytes by up-regulation of antiapoptotic genes and prosurvival genes in these subjects.
Conclusions:
Our pilot study provides the first evidence suggesting that SK practice may exert effects on immunity, aging, cell death, and stress regulation through transcriptional regulation.