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Tai Chi, Cellular Inflammation, and Transcriptome Dynamics in Breast Cancer Survivors With Insomnia: A Randomized Controlled Trial
Abstract
Mind-body therapies such as Tai Chi are widely used by breast cancer survivors, yet effects on inflammation are not known. This study hypothesized that Tai Chi Chih (TCC) would reduce systemic, cellular, and genomic markers of inflammation as compared with cognitive behavioral therapy for insomnia (CBT-I).
In this randomized trial for the treatment of insomnia, 90 breast cancer survivors with insomnia were assigned to TCC or CBT-I for 2-hour sessions weekly for 3 months. At baseline and postintervention, blood samples were obtained for measurement of C-reactive protein and toll-like receptor-4-activated monocyte production of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF), with a random subsample (n = 48) analyzed by genome-wide transcriptional profiling.
Levels of C-reactive protein did not change in the TCC and CBT-I groups. Levels of toll-like receptor-4-activated monocyte production of IL-6 and TNF combined showed an overall reduction in TCC versus CBT-I (P < .02), with similar effects for IL-6 (P = .07) and TNF (P < .05) alone. For genome-wide transcriptional profiling of circulating peripheral blood mononuclear cells, expression of genes encoding proinflammatory mediators showed an overall reduction in TCC versus CBT-I (P = .001). TELiS promoter-based bioinformatics analyses implicated a reduction of activity of the proinflammatory transcription factor, nuclear factor-κB, in structuring these differences.
Among breast cancer survivors with insomnia, 3 months of TCC reduced cellular inflammatory responses, and reduced expression of genes encoding proinflammatory mediators. Given the link between inflammation and cancer, these findings provide an evidence-based molecular framework to understand the potential salutary effects of TCC on cancer survivorship.
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... Mindfulness-based interventions aid the recovery of the immune system, and the resulting immune changes show a shift from a carcinogenic cytokine profile to a more normalized profile. Meditation and other mindfulness-based practices have improved inflammatory biomarker levels common in patients with chronic hematological cancer (eg, tumor necrosis factor-α [TNF-α], interleukin [IL]-6 [IL-6], IL-8, and C-reactive protein [CRP]), as well as in populations such as patients with insomnia disorder, survivors of cancer, and older adults [39][40][41][42]. These specific cytokines and proteins are the most common inflammatory cytokines closely associated with chronic hematological cancer disease progression, symptoms, and sleep disturbances across all hematologic malignancy subtypes [11,43,44]. ...
... Research further demonstrates that patients with chronic hematological cancer are interested in smartphone apps as a means of self-managing their health [38][39][40]. As of April 2020, there were approximately 55 mobile apps marketed to patients with or survivors of cancer available in the Google Play and Apple App stores, offering mostly educational content and information for caregivers. ...
... 47), and inflammation biomarkers (Cohen d s =0.41-0.50) [39]. The meta-analysis by Duong et al [86] suggests somewhat stronger effects of mindfulness (standardized mean difference 0.50) and relaxation (standardized mean difference 0.94) interventions on fatigue. ...
Background:
To address the need for long-term, accessible, nonpharmacologic interventions targeting sleep in patients with chronic hematological cancer, we propose the first randomized controlled trial to determine the effects of a consumer-based mobile meditation app, Calm, on sleep disturbance in this population.
Objective:
This study aims to test the efficacy of daily meditation delivered via Calm compared with a health education podcast control group in improving the primary outcome of self-reported sleep disturbance, as well as secondary sleep outcomes, including sleep impairment and sleep efficiency; test the efficacy of daily meditation delivered via Calm compared with a health education podcast control group on inflammatory markers, fatigue, and emotional distress; and explore free-living use during a 12-week follow-up period and the sustained effects of Calm in patients with chronic hematological cancer.
Methods:
In a double-blinded randomized controlled trial, we will recruit 276 patients with chronic hematological cancer to an 8-week app-based wellness intervention-the active, daily, app-based meditation intervention or the health education podcast app control group, followed by a 12-week follow-up period. Participants will be asked to use their assigned app for at least 10 minutes per day during the 8-week intervention period; complete web-based surveys assessing self-reported sleep disturbance, fatigue, and emotional distress at baseline, 8 weeks, and 20 weeks; complete sleep diaries and wear an actigraphy device during the 8-week intervention period and at 20 weeks; and complete blood draws to assess inflammatory markers (tumor necrosis factor-α, interleukin-6, interleukin-8, and C-reactive protein) at baseline, 8 weeks, and 20 weeks.
Results:
This project was funded by the National Institutes of Health National Cancer Institute (R01CA262041). The projects began in April 2022, and study recruitment is scheduled to begin in October 2022, with a total project duration of 5 years. We anticipate that we will be able to achieve our enrollment goal of 276 patients with chronic hematological cancers within the allotted project time frame.
Conclusions:
This research will contribute to broader public health efforts by providing researchers and clinicians with an evidence-based commercial product to improve sleep in the long term in an underserved and understudied cancer population with a high incidence of sleep disturbance.
Trial registration:
ClinicalTrials.gov NCT05294991; https://clinicaltrials.gov/ct2/show/NCT05294991.
International registered report identifier (irrid):
PRR1-10.2196/39007.
... Together, several previous studies provide strong evidence for the beneficial effects of meditation by modulating the basic cellular pathways. Nevertheless, most of the previous studies are 1) cross-sectional studies (evaluating only one time point) (26)(27)(28)(29)(30), 2) done on highly experienced meditators (26,27), 3) small sample sized (26-28, 30, 31), 4) tested on handpicked nonspecific biomarkers (29,30), and 5) confounded with different lifestyle and diet (26,29,30). ...
... Together, several previous studies provide strong evidence for the beneficial effects of meditation by modulating the basic cellular pathways. Nevertheless, most of the previous studies are 1) cross-sectional studies (evaluating only one time point) (26)(27)(28)(29)(30), 2) done on highly experienced meditators (26,27), 3) small sample sized (26-28, 30, 31), 4) tested on handpicked nonspecific biomarkers (29,30), and 5) confounded with different lifestyle and diet (26,29,30). ...
... Together, several previous studies provide strong evidence for the beneficial effects of meditation by modulating the basic cellular pathways. Nevertheless, most of the previous studies are 1) cross-sectional studies (evaluating only one time point) (26)(27)(28)(29)(30), 2) done on highly experienced meditators (26,27), 3) small sample sized (26-28, 30, 31), 4) tested on handpicked nonspecific biomarkers (29,30), and 5) confounded with different lifestyle and diet (26,29,30). ...
Significance
Several studies on the impact of yoga and meditation on mental and physical health have demonstrated beneficial effects. However, the potential molecular mechanisms and critical genes involved in this beneficial outcome have yet to be comprehensively elucidated. This study identified and characterized the transcriptional program associated with advanced meditation practice, and we bioinformatically integrated various networks to identify meditation-specific core network. This core network links several immune signaling pathways, and we showed that this core transcriptional profile is dysfunctional in multiple sclerosis and severe COVID-19 infection. Very importantly, we demonstrated that the meditative practice enhanced immune function without activating inflammatory signals. Together, these results make meditation an effective behavioral intervention for treating various conditions associated with a weakened immune system.
... Twenty-four studies, including 21 randomized control trials, 2 cross-sectional, and 1 single group pre-& post-comparison study, qualified for inclusion in this systematic review. Since one of studies for inflammatory biomarkers led to 3 articles being published [16][17][18] (Table 1), there were 26 articles [12,[41][42][43][44][45] from 24 studies available for data analysis. As shown in Fig. 1, the final 24 studies include those for inflammatory biomarkers only (10), for oxidative biomarkers only (6), for neurotrophic markers only (1), for both inflammatory and oxidative (4), for both inflammatory and neurotrophic (2), and for both oxidative and neurotrophic (1). ...
... TC practice has been shown to promote general health and improve neural activities, mood, memory, cognition, and neural plasticity. It was assumed that TC might be able to affect some inflammatory factors to promote general health [11,12]. In the human body at the cellular and genetic level, cytokines are the primary messenger molecules of inflammatory response that are released from leukocytes, microglia, and astrocytes [13,14], which can be divided into two groups (Type 1 and Type 2) based on their promotion or inhibition of inflammation [13]. ...
... Type 1 cytokines are pro-inflammatory that include interleukin (IL) -1β, IL-1α, IL-2,6, 8,12, Tumor Necrosis Factor (TNF)-α, interferon (IFN)-γ, and C-reactive protein (CRP); while Type 2 cytokines are anti-inflammatory that include IL-4, 5, 10, 12 and 13 [13][14][15]. Also Nuclear factor (NF)-kβ, a family of key transcription factors of immune cells like M1 macrophages that produce pro-inflammatory cytokines such as IL-1, IL-6, IL-12, TNF-α and chemokines [38], were found to decrease [12,24]. ...
Introduction
: As an effective holistic therapeutic exercise program, Tai Chi has been widely used for patients with a variety of neurological disorders. In last 1-2 decades, there has been an increase in the number of research studies that examined the Tai Chi effects on biomarkers including inflammatory cytokines, oxidative stressors, and neurotrophic factors. Thus, the purpose of this article was to review such effects and their possible implication to neurorehabilitation.
Method
: In this systematic review, we searched Tai Chi-related articles from the last 15 years until July 2020 that had investigated changes of biomarkers after Tai Chi practice. The search identified 24 studies (21 randomized control trials, 2 cross-sectional studies, and 1 single group pre- and post- comparison) that were included in our analysis. Results: Tai Chi practice may be able to 1) reduce pro-inflammatory contributors (Interleukins -1, 6, 10, 12, tumor necrosis factor, the nuclear factor kappa-light-chain-enhancer of activated B cells, and the C-reactive protein) and increase anti-inflammatory cytokines (Interleukins -10 and 13); 2) decrease oxidative stress factors (like plasma 8-isoprostane, malondialdehyde, and protein carbonylation); and 3) increase neurotrophic factors (brain-derived neurotrophic factor, and N-Acetylaspartate).
Conclusions
: Tai Chi practice mediates anti-inflammation, anti-oxidative stress, and neural plasticity indicating its effect on modulating the pathophysiology of neurodegeneration and on potential effectiveness in neurorehabilitation.
... Twenty-four studies, including 21 randomized control trials, 2 cross-sectional, and 1 single group pre-& post-comparison study, qualified for inclusion in this systematic review. Since one of studies for inflammatory biomarkers led to 3 articles being published [16][17][18] (Table 1), there were 26 articles [12,[41][42][43][44][45] from 24 studies available for data analysis. As shown in Fig. 1, the final 24 studies include those for inflammatory biomarkers only (10), for oxidative biomarkers only (6), for neurotrophic markers only (1), for both inflammatory and oxidative (4), for both inflammatory and neurotrophic (2), and for both oxidative and neurotrophic (1). ...
... TC practice has been shown to promote general health and improve neural activities, mood, memory, cognition, and neural plasticity. It was assumed that TC might be able to affect some inflammatory factors to promote general health [11,12]. In the human body at the cellular and genetic level, cytokines are the primary messenger molecules of inflammatory response that are released from leukocytes, microglia, and astrocytes [13,14], which can be divided into two groups (Type 1 and Type 2) based on their promotion or inhibition of inflammation [13]. ...
... Type 1 cytokines are pro-inflammatory that include interleukin (IL) -1β, IL-1α, IL-2,6, 8,12, Tumor Necrosis Factor (TNF)-α, interferon (IFN)-γ, and C-reactive protein (CRP); while Type 2 cytokines are anti-inflammatory that include IL-4, 5, 10, 12 and 13 [13][14][15]. Also Nuclear factor (NF)-kβ, a family of key transcription factors of immune cells like M1 macrophages that produce pro-inflammatory cytokines such as IL-1, IL-6, IL-12, TNF-α and chemokines [38], were found to decrease [12,24]. ...
Objective(s)
To identify effects of Tai Chi practice on inflammatory biomarkers.
Data Sources
With PubMed, Scopus, Medline, PEDro, and CINAHL search engines, Tai Ji, Tai Chi, Tai Chi Quan, biomarkers, cytokines, inflammatory, and inflammation were used to search in peer-reviewed English journals from last 10 years until July 2020. Inclusion criteria were randomized control trials (RCT) with Tai Chi as one of interventions in subjects who were 18 years and older.
Study Selection
One-hundred nineteen articles met the criteria through scanning the titles, abstracts, and keywords initially and then by discussion if needed by 3 reviewers.
Data Extraction
With PRISMA method for evaluation, 16 RCT studies were qualified for further analysis. Data extracted included participant and exercise characteristics, the outcomes measures, and study results.
Data Synthesis
These studies include 7 in adults with cancers. 3 in community-dwelling older adults, and 1 in older adults with HIV, depression, metabolic syndrome, periodontal disease, amnesia, or chronic pain. Decreased proinflammatory contributors were found including interleukins (IL-1, 2, 6, 8, 12,), Tumor necrosis factor (TNF-α), interferon (IFN-γ), Necrotic factor (NF-kβ), C-reactive protein, soluble cell adhesion molecule, and peripheral monocytes like CD14+ and CD16+ monocytes; while increased anti-inflammatory cytokines were only found in IL-10 and 13. The changes of these biomarkers seemed not associated with the subjects’ medical conditions. Improved anti-inflammatory responses are seen in studies with exercise parameters of 60 minutes/each, 3 times or more each week for a minimum of 12 weeks.
Conclusions
Tai Chi is an excellent exercise program to improve body anti-inflammatory capacity, primarily through the inhibition of pro-inflammatory biomarkers. Regardless of medical conditions, a person can benefit from practicing TC with proper exercise parameters.
Author(s) Disclosures
Authors have no relevant financial or non-financial relationships to disclose
... Among the 26 studies, findings from 14 Tai Chi trials (13 RCTs and 1 NRCT) were reported (Figure 1), including six conducted in the United States, [30][31][32][33][34][35][36][37][38][39][40][41][42][43] six conducted in China [44][45][46][47][48][49][50] (one in Hong Kong special administrative region of China), [51][52][53] and one each conducted in Thailand 54 and Iran, 55 respectively. The sample sizes ranged from nine to 57 in each group. ...
... We summarized the study characteristics in Table S3. Seven trials were conducted in survivors of breast cancer, 30,[32][33][34][35][36][37][38][39][40][41][42][43]54,55 three in lung cancer, 47-50 two in head & neck cancer, 46,51-53 one in prostate cancer, 31 and one in mixed cancer. 45 The disease stage varied from stage 0 to IV with different treatments including chemotherapy, radiotherapy, chemoradiotherapy, and surgery. ...
... We summarized the intervention characteristics in Table S4. A variety of Tai Chi forms were used, including 24-form Yang style Tai Chi (n = 4), [45][46][47][48][49] adapted Yang style Tai Chi (n = 2), 31-37 8-form Tai Chi (n = 2), 30,44 18-form Tai Chi Qi Gong (n = 2), [51][52][53][54] Tai Chi Chih (n = 2), [38][39][40][41] Qigong/Tai Chi easy (n = 1), 42,43 and adapted 20-form Tai Chi (n = 1). 55 Despite the differences, Tai Chi is commonly described as a "mind-body" exercise that involves "physical exercise" (or "movement"), "breathing," and "meditation" (or "mindfulness"), hence a "meditative movement" (Table S4). ...
To manage acute, long‐term, and late effects of cancer, current guidelines recommend moderate‐to‐vigorous intensity aerobic and resistance exercise. Unfortunately, not all cancer survivors are able or willing to perform higher intensity exercise during difficult cancer treatments or because of other existing health conditions. Tai Chi is an equipment‐free, multicomponent mind–body exercise performed at light‐to‐moderate intensity that may provide a more feasible alternative to traditional exercise programs for some cancer survivors. This systematic review evaluated the therapeutic efficacy of Tai Chi across the cancer care continuum. We searched MEDLINE/PubMed, Embase, SCOPUS, and CINAHL databases for interventional studies from inception to 18 September 2020. Controlled trials of the effects of Tai Chi training on patient‐reported and objectively measured outcomes in cancer survivors were included. Study quality was determined by the RoB 2 tool, and effect estimates were evaluated using the Best Evidence Synthesis approach. Twenty‐six reports from 14 trials (one non‐randomized controlled trial) conducted during (n = 5) and after treatment (after surgery: n = 2; after other treatments: n = 7) were included. Low‐level evidence emerged to support the benefits of 40–60 min of thrice‐weekly supervised Tai Chi for 8–12 weeks to improve fatigue and sleep quality in cancer survivors. These findings need to be confirmed in larger trials and tested for scaling‐up potential. Insufficient evidence was available to evaluate the effects of Tai Chi on other cancer‐related outcomes. Future research should examine whether Tai Chi training can improve a broader range of cancer outcomes including during the pre‐treatment and end of life phases. Tai Chi training may improve fatigue and sleep quality in cancer survivors. Future research should examine a broader range of outcomes, particularly during difficult cancer treatments and for those with significant comorbidities.
... An RCT examining effects of Tai-Chi showed decreased leukocyte inflammatory gene expression in breast cancer survivors with insomnia. 260 Compared to breast cancer survivors assigned to CBT for insomnia (CBT-I) those in the Tai-Chi condition (both 3 months of weekly sessions) showed greater reductions in monocyte production of IL-6 and TNF; and reduced leukocyte gene expression for proinflammatory mediators. Bioinformatics analyses inferred that these transcriptional changes were representative of reduced NF-kB signaling, and increased Type I Interferon anti-viral responding and antibody-making genesmirroring the CTRA pattern-over 3 months, and that these transcriptional changes were largely accounted for by monocytes. ...
... Bioinformatics analyses inferred that these transcriptional changes were representative of reduced NF-kB signaling, and increased Type I Interferon anti-viral responding and antibody-making genesmirroring the CTRA pattern-over 3 months, and that these transcriptional changes were largely accounted for by monocytes. 260 Physical exercise is another physical-based stress management approach that has been used in cancer patients. 73 Physical exercise interventions targeting physical activity, strength, and aerobic fitness have been shown to produce beneficial effects in cancer patients. ...
The relationship between psychosocial factors and cancer has intrigued people for centuries. In the last several decades there has been an expansion of mechanistic research that has revealed insights regarding how stress activates neuroendocrine stress-response systems to impact cancer progression. Here, we review emerging mechanistic findings on key pathways implicated in the effect of stress on cancer progression, including the cellular immune response, inflammation, angiogenesis, and metastasis, with a primary focus on the mediating role of the sympathetic nervous system. We discuss converging findings from preclinical and clinical cancer research that describe these pathways and research that reveals how these stress pathways may be targeted via pharmacological and mind-body based interventions. While further research is required, the body of work reviewed here highlights the need for and feasibility of an integrated approach to target stress pathways in cancer patients to achieve comprehensive cancer treatment.
... Furthermore, we established a connection between insomnia and pain, depression, anxiety and/or a reduced quality of life [27,43,53,54,58,[63][64][65]. Various types of treatments for insomnia include pharmacological therapies (e.g., hypnotica, sedativa, antidrepressiva, neuroleptics, antihistamine, hormones (melatonin) and herbal extracts) [28,30,42,44,48,57] [29,[31][32][33][34][35][36][37][38][39][40][41]44,46,47,[49][50][51][52][55][56][57]59,61,62,[66][67][68][69][70][71]. Most of the patients with comorbid cancer-related insomnia (that means around 25-50%) are treated pharmacologically [31]. ...
... There is a need and use of complementary and alternative medical methods in cancer patients with cancer-related insomnia. Recent research has shown that complementary and alternative treatments may provide a clinically relevant benefit in cancer-related insomnia [29,[31][32][33][34][35][36][37][38][39][40][41]44,46,47,[49][50][51][52][55][56][57]59,61,62,[66][67][68][69][70][71]]. ...
Introduction:
Sleep disorders, especially insomnia, are very common in different kinds of cancers, but their prevalence and incidence are not well-known. Disturbed sleep in cancer is caused by different reasons and usually appears as a comorbid disorder to different somatic and psychiatric diagnoses, psychological disturbances and treatment methods. There can be many different predictors for sleep disturbances in these vulnerable groups, such as pre-existing sleep disorders, caused by the mental status in cancer or as side effect of the cancer treatment.
Methods:
A systematic literature review of 8073 studies was conducted on the topic of sleep and sleep disorders in cancer patients. The articles were identified though PubMed, PsycInfo and Web of Knowledge, and a total number of 89 publications were qualified for analysis.
Results:
The identified eighty-nine studies were analyzed on the topic of sleep and sleep disorders in cancer, twenty-six studies on sleep and fatigue in cancer and sixty-one studies on the topic of sleep disorders in cancer. The prevalence of sleep disturbences and/or sleep disorders in cancer was up to 95%.
Discussion:
Sleep disturbances and sleep disorders (such as insomnia, OSAS, narcolepsy and RLS; REM-SBD) in cancer patients can be associated with different conditions. Side effects of cancer treatment and cancer-related psychological dysfunctions can be instigated by sleep disturbances and sleep disorders in these patients, especially insomnia and OSAS are common. An evidence-based treatment is necessary for concomitant mental and/or physical states.
... 7 For example, Tai Chi interventions are linked to changes in genomic markers of inflammation among cancer patients, including cellular inflammatory responses and proinflammatory mediators. 8 A recent study of Tai Chi among older adults with chronic pain demonstrated changes in levels of the opioid system hormone beta-endorphin among participants who completed at least 70% of intervention sessions. 9 Practicing Tai Chi can improve physical functioning, including musculoskeletal strength, cardiovascular fitness, and balance. ...
Background
Approximately one-half of all adults with HIV experience chronic pain. Needed are nonpharmacological approaches to improve pain management in this population.
Methods
For this study, we conducted in-depth qualitative interviews (n = 20) with thirteen adults with HIV and 7 HIV care providers regarding their perceptions of Tai Chi for chronic pain management. The interviews were audio recorded, transcribed, double-coded, and analyzed using applied thematic analysis.
Results
HIV patients had limited prior exposure to Tai Chi and had not previously considered this practice for pain management. However, after viewing a brief video demonstration of Tai Chi, patients recognized potential benefits, including relaxation, stress reduction, and pain lessening. Patients were surprised by the gentle nature of Tai Chi and expressed enthusiasm to learn more about Tai Chi. HIV healthcare providers similarly had limited knowledge of Tai Chi for pain management. HIV care providers shared several helpful insights on the potential implementation of Tai Chi with this population.
Conclusions
Adults with HIV and healthcare providers were optimistic that Tai Chi would reduce stress and ease chronic pain. These data suggest that Tai Chi would be of interest to HIV patients and care providers as a novel pain management strategy.
... However, practicing Taichi seems to provide anti-inflammation effect. Training programs with Taichi 120 min a week for 3 and 4 months, respectively, are reportedly to show the trend to decrease TNF-α and IL-6 in breast cancer survivors with insomnia [46] and in older adults with insomnia [47]. The present study confirmed that 24-week Taichi training without or with the combination of resistance band training similarly and significantly reduced TNF-α and IL-6 in the patients with T2DM, which were not changed in the control group (Table 2). ...
This study evaluated the effect of 24-week Taichi training and Taichi plus resistance band training on pulmonary diffusion capacity and glycemic control in patients with Type 2 diabetes mellitus (T2DM). Forty-eight patients with T2DM were randomly divided into three groups: Group A—Taichi training: practiced Taichi 60 min/day, 6 days/week for 24 weeks; Group B—Taichi plus resistance band training: practiced 60-min Taichi 4 days/week plus 60-min resistance band training 2 days/week for 24 weeks; and Group C–controls: maintaining their daily lifestyles. Stepwise multiple regression analysis was applied to predict diffusion capacity of the lungs for carbon monoxide (DLCO) by fasting blood glucose, insulin, glycosylated hemoglobin (HbA1c), tumour necrosis factor alpha (TNF-α), von Willebrand Factor (vWF), interleukin-6 (IL-6), intercellular adhesion molecule 1 (ICAM-1), endothelial nitric oxide synthase (eNOS), nitric oxide (NO), endothelin-1 (ET-1), vascular endothelial growth factor, and prostaglandin I-2. Taichi with or without resistance band training significantly improved DLCO, increased insulin sensitivity, eNOS and NO, and reduced fasting blood glucose, insulin, HbA1c, TNF-α, vWF, IL-6, ICAM-1, and ET-1. There was no change in any of these variables in the control group. DLCO was significantly predicted (R² = 0.82) by insulin sensitivity (standard-β = 0.415, P<0.001), eNOS (standard-β = 0.128, P = 0.017), TNF-α (standard-β = -0.259, P = 0.001), vWF (standard-β = -0.201, P = 0.007), and IL-6 (standard-β = -0.175, P = 0.032) in patients with T2DM. The impact of insulin sensitivity was the most important predictor for the variation of DLCO based on the multiple regression modeling. This study demonstrates that 24-week Taichi training and Taichi plus resistance band training effectively improve pulmonary diffusion capacity and blood glycemic control in patients with T2DM. Variation of DLCO is explained by improved insulin sensitivity and endothelial function, and reduced inflammatory markers, including TNF-α, vWF, and IL-6.
... So far, many studies have been conducted on insomnia in breast cancer patients. The therapeutic effects of CBT-I, acupuncture, Tai Chi, and mindfulness-based interventions on insomnia in breast cancer patients have been proven by multiple randomized controlled trials [59][60][61][62][63][64]. There is also a systematic review that evaluated the therapeutic effect of CBT-I [65]. ...
Background
Symptoms of insomnia are highly prevalent in patients with breast cancer. There are a large number of pharmacological and non-pharmacological interventions that can be used for the management of insomnia in breast cancer patients; however, their comparative effectiveness and acceptability remain uncertain. This review aims to evaluate the efficacy and acceptability of different interventions for insomnia in breast cancer patients using a Bayesian network meta-analysis (NMA).
Methods
We will perform a comprehensive literature search in PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and PsycINFO from inception to November 2022. We will include randomized controlled trials (RCTs) that compared the effects of different interventions on the management of insomnia in breast cancer patients. We will assess the risk of bias assessment using a modified Cochrane instrument. We will conduct a Bayesian random-effects framework NMA to estimate relative effects of interventional procedures. We will use Grading of Recommendations Assessment, Development and Evaluation to rate the certainty of evidence.
Discussion
To our knowledge, this will be the first systematic review and network meta-analysis to compare the effectiveness and acceptability of all currently available interventions for insomnia in patients with breast cancer. The results of our review will help provide more evidence for the treatment of insomnia in breast cancer patients.
Systematic review registration
PROSPERO registration number CRD42021282211.
... Many sleep disturbances and disorders are treatable, often using non-pharmaceutical therapeutic strategies, thereby make it an appealing treatment target in order to reduce trauma-related neuroinflammation and improve patients' lives [115]. Cognitive behavioral therapy (CBT), the gold-standard treatment for insomnia, has proven to be an efficient way of improving sleep quality and restoring inflammatory levels [145][146][147]. CBT has also proven effective in TBI patients and show promise for mitigating patients' inflammationrelated symptoms such as depression, anxiety and pain [148], along with other nonpharmaceutical strategies such as blue light therapy, problem solving treatment, and combined sleep hygiene interventions [149]. ...
Sleep disturbances are widely prevalent following a traumatic brain injury (TBI) and have the potential to contribute to numerous post-traumatic physiological, psychological, and cognitive difficulties developing chronically, including chronic pain. An important pathophysiological mechanism involved in the recovery of TBI is neuroinflammation, which leads to many downstream consequences. While neuroinflammation is a process that can be both beneficial and detrimental to individuals’ recovery after sustaining a TBI, recent evidence suggests that neuroinflammation may worsen outcomes in traumatically injured patients, as well as exacerbate the deleterious consequences of sleep disturbances. Additionally, a bidirectional relationship between neuroinflammation and sleep has been described, where neuroinflammation plays a role in sleep regulation and, in turn, poor sleep promotes neuroinflammation. Given the complexity of this interplay, this review aims to clarify the role of neuroinflammation in the relationship between sleep and TBI, with an emphasis on long-term outcomes such as pain, mood disorders, cognitive dysfunctions, and elevated risk of Alzheimer’s disease and dementia. In addition, some management strategies and novel treatment targeting sleep and neuroinflammation will be discussed in order to establish an effective approach to mitigate long-term outcomes after TBI.
... Computational bioinformatics of differentially expressed genes has shown immunological modulation as a dominant target of differential expression in yoga practitioners (Khokhar, Tomo, Gadwal, & Purohit, 2022). Furthermore, when Tai Chi was performed by groups of breast cancer survivors and older adults, relevant changes in gene expression modulation of immune pathways were observed (Irwin et al., 2014). This study revealed an overall reduction, in PBMCs, of IL-6 and TNFα, both as proteins and as mRNAs. ...
Many environmental and lifestyle related factors may influence the physiology of the brain and body by acting on fundamental molecular pathways, such as the hypothalamus-pituitary-adrenal axis (HPA) and the immune system. For example, stressful conditions created by adverse early-life events, unhealthy habits and low socio-economic status may favor the onset of diseases linked to neuroendocrine dysregulation, inflammation and neuroinflammation. Beside pharmacological treatments used in clinical settings, much attention has been given to complementary treatments such as mind-body techniques involving meditation that rely on the activation of inner resources to regain health. At the molecular level, the effects of both stress and meditation are elicited epigenetically through a set of mechanisms that regulate gene expression as well as the circulating neuroendocrine and immune effectors. Epigenetic mechanisms constantly reshape genome activities in response to external stimuli, representing a molecular interface between organism and environment. In the present work, we aimed to review the current knowledge on the correlation between epigenetics, gene expression, stress and its possible antidote, meditation. After introducing the relationship between brain, physiology, and epigenetics, we will proceed to describe three basic epigenetic mechanisms: chromatin covalent modifications, DNA methylation and non-coding RNAs. Subsequently, we will give an overview of the physiological and molecular aspects related to stress. Finally, we will address the epigenetic effects of meditation on gene expression. The results of the studies reported in this review demonstrate that mindful practices modulate the epigenetic landscape, leading to increased resilience. Therefore, these practices can be considered valuable tools that complement pharmacological treatments when coping with pathologies related to stress.
... [11] The results of several clinical trials demonstrated that Tai Chi reduces inflammatory responses and improves QoL, muscle strength, shoulder function, bone formation, and insomnia in patients with breast cancer. [12,13] Several studies have shown that Qigong improves QoL and relieves depression and anxiety. [14] The objective of this review was to evaluate the efficacy of Tai Chi and Qigong in improving QoL and reducing fatigue in patients with breast cancer and cancer survivors. ...
Tai Chi is a slow-moving exercise that incorporates deep and steady breathing. Qigong is a self-guided workout that involves breathing exercises and meditation. Tai Chi, as it is practiced today, incorporates Qigong. The objective of this review was to evaluate the efficacy of Tai Chi and Qigong in improving the quality of life and reducing fatigue among patients with breast cancer. Three electronic medical databases (PubMed, Scopus, and Web of Science) were searched from their inception up to July 2021. Nine systematic reviews and meta-analyses were included in this narrative review. Quality assessment was independently conducted by the first two authors (SG and CEO) using a measurement tool to assess systematic reviews. Three systematic reviews and meta-analyses reported the effects of Tai Chi and Qigong on cancer-related fatigue and four reported their effects on the quality of life of patients with breast cancer. Tai Chi and Qigong are beneficial, safe, low-impact, and low-intensity therapeutic exercises for patients with breast cancer that can improve their quality of life and psychological health and can be utilized as adjunctive therapies for the management of fatigue, if appropriately recommended. The evidence that Tai Chi and Qigong reduce fatigue and improve health-related quality of life among patients with breast cancer is moderate.
... To our knowledge, this is the first study to investigate the effects of an online mindfulness program on immune-related biomarkers and gene expression. Contrary to our hypothesis, the blood of those who completed the course showed no change in RNA expression of the CTRA gene set as a whole, nor was there a significant change in the expression of genes regulated by NF-κB, CREB, AP-1, IRF-1 or IRF-2 as shown in previous studies of mind-body interventions (Black et al., 2013;Irwin et al., 2014Irwin et al., , 2015Morledge et al., 2013). Our study data are clinically important to help define a lower limit of engagement with an online mediation modality using standard meditative practices for beginners in terms of its ability to influence immune function as measured by gene analysis and other assays of inflammatory pathways. ...
Objectives
Prior studies of mindfulness meditation have demonstrated anti-inflammatory and immunoregulatory effects but whether meditation courses delivered online can exert similar effects is poorly understood. Barriers to large scale implementation of traditional mindfulness meditation programs has created an increased interest in the effect of less time- and resource-intensive online meditation courses. The purpose of this study was to determine whether a 6-week online mindfulness program with low time demands on nurses would lead to changes in gene expression, cytokine profiles, telomerase activity, and cortisol profiles.
Methods
This was a randomized, parallel pilot study comparing an online mindfulness-based stress management program to an active control group from December 2018 to May 2019. Healthy nurses with above average levels of perceived stress were randomized to receive a 6-week online mindfulness-based stress management program including ≥5 minutes daily meditation practice or listen to relaxing music for ≥5 minutes daily as the control arm. Blood samples were collected at baseline and after 6 weeks, and various self-reported measures of stress, physical and emotional health were collected at baseline, after 6 weeks, and after 12 weeks. Whole transcriptome mRNA sequencing of whole blood at baseline and after 6 weeks was performed along with measurement of plasma IL-6, IL-8, IL-10, TNF-α, and IFN-γ. Peripheral blood mononuclear cells were isolated, and telomerase activity was measured. Diurnal salivary cortisol profiles were assessed at baseline and after 6 weeks. The primary outcome was change over time in a pre-determined set of 53 genes representative of the immune-related changes seen with stress, which was analyzed using a mixed linear model. Secondary outcomes included all other self-reported measures and biomarkers mentioned above.
Results
A total of 61 nurses were randomized, with 52 having sufficient data to include in the final analysis. After 6 weeks, nurses in the control group reported significant reductions in stress as measured by the Perceived Stress Scale while those in the mindfulness group did not. However, after 12 weeks, the mindfulness group also showed a significant reduction in stress. When compared to the control group, no significant changes in RNA gene expression or any other biomarkers were observed in the nurses who participated in the mindfulness program.
Conclusions
Our study found that this brief online mindfulness-based intervention was effective in reducing stress in nurses, albeit with a delayed effect compared to listening to relaxing music. Regarding immunoregulatory effects, there were no significant differences between treatment and control groups in transcriptomic or other tested biomarkers of immune function. This study provides evidence for a floor effect of mindfulness on transcriptional and circulating biomarkers of immune function.
... 17 Potential interventions targeting inflammation include increasing physical activity, improving sleep, reducing stress, and administering drugs that block inflammatory pathways. [64][65][66][67][68][69][70][71][72] This study has many strengths, including the large cohort, long follow-up, and inclusion of matched controls. However, there are several limitations that should be considered in evaluating our findings. ...
PURPOSE
To examine longitudinal relationships between levels of C-reactive protein (CRP) and cognition in older breast cancer survivors and noncancer controls.
METHODS
English-speaking women age ≥ 60 years, newly diagnosed with primary breast cancer (stage 0-III), and frequency-matched controls were enrolled from September 2010 to March 2020; women with dementia, neurologic disorders, and other cancers were excluded. Assessments occurred presystemic therapy/enrollment and at annual visits up to 60 months. Cognition was measured using the Functional Assessment of Cancer Therapy-Cognitive Function and neuropsychological testing. Mixed linear effect models tested for survivor-control differences in natural log (ln)-transformed CRP at each visit. Random effect–lagged fluctuation models tested directional effects of ln-CRP on subsequent cognition. All models controlled for age, race, study site, cognitive reserve, obesity, and comorbidities; secondary analyses evaluated if depression or anxiety affected results.
RESULTS
There were 400 survivors and 329 controls with CRP specimens and follow-up data (average age of 67.7 years, range: 60-90 years). The majority of survivors had stage I (60.9%), estrogen receptor–positive (87.6%) tumors. Survivors had significantly higher adjusted mean ln-CRP than controls at baseline and 12-, 24-, and 60-month visits (all P < .05). Higher adjusted ln-CRP predicted lower participant-reported cognition on subsequent visits among survivors, but not controls ( P interaction = .008); effects were unchanged by depression or anxiety. Overall, survivors had adjusted Functional Assessment of Cancer Therapy-Cognitive Function scores that were 9.5 and 14.2 points lower than controls at CRP levels of 3.0 and 10.0 mg/L. Survivors had poorer neuropsychological test performance ( v controls), with significant interactions with CRP only for the Trails B test.
CONCLUSION
Longitudinal relationships between CRP and cognition in older breast cancer survivors suggest that chronic inflammation may play a role in development of cognitive problems. CRP testing could be clinically useful in survivorship care.
... Moreover, CBT-I, tai chi, and mindfulness all have been found to have durable effects in the treatment of insomnia, with improvement in insomnia symptoms sustained over the long term one-year follow-up [162,163]. With administration of any one of the treatment approaches for insomnia, improvements in insomnia are coupled with decreases in sympathetic activity, decreases in levels of systemic inflammation including CRP, decreases in cellular inflammation such as stimulated monocyte production of proinflammatory cytokines, and a reversal of inflammatory transcriptional profile [167][168][169]. Insomnia treatment effects on systemic inflammation especially robust in those who achieve full clinical remission of insomnia [170]. ...
Thermoregulation and sleep are tightly coordinated, with evidence that impairments in thermoregulation as well as increases in ambient temperature increase the risk of sleep disturbance. As a period of rest and low demand for metabolic resources, sleep functions to support host responses to prior immunological challenges. In addition by priming the innate immune response, sleep prepares the body for injury or infection which might occur the following day. However when sleep is disrupted, this phasic organization between nocturnal sleep and the immune system becomes misaligned, cellular and genomic markers of inflammation are activated, and increases of proinflammatory cytokines shift from the nighttime to the day. Moreover, when sleep disturbance is perpetuated due to thermal factors such as elevated ambient temperature, the beneficial crosstalk between sleep and immune system becomes further imbalanced. Elevations in proinflammatory cytokines have reciprocal effects and induce sleep fragmentation with decreases in sleep efficiency, decreases in deep sleep, and increases in rapid eye movement sleep, further fomenting inflammation and inflammatory disease risk. Under these conditions, sleep disturbance has additional potent effects to decrease adaptive immune response, impair vaccine responses, and increase vulnerability to infectious disease. Behavioral interventions effectively treat insomnia and reverse systemic and cellular inflammation. Further, insomnia treatment redirects the misaligned inflammatory- and adaptive immune transcriptional profiles with the potential to mitigate risk of inflammation-related cardiovascular, neurodegenerative, and mental health diseases, as well as susceptibility to infectious disease.
... The transcriptomic level of NF-kappa B was significantly reduced in breast cancer survivors after 12 weeks of Iyenger Yoga intervention (39). Among the breast cancer survivors, Mindbody therapy like Tai Chi significantly reduced the gene expression of TNF-α, a similar trend has been shown by the IL-6 but it was not statistically significant (40). Yoga practice is shown to increase the expression of the hTERT gene restraining the cellular aging process in hypertensive patients (41). ...
Current evidence suggests obesity alters the expression of various genes related to oxidative stress, inflammation, and aging. The complementary therapy like yoga-based lifestyle intervention (YBLI) is used as an adjunct therapy to modern medicine. This study examines the efficacy of 12-weeks of YBLI with standard care (SC) on the expression of genes related to oxidative stress, inflammation, and aging in obese adults.
This was a two-arm parallel randomized control trial implemented at Integral Health Clinic (IHC), an outpatient facility that regularly conducted YBLI programs for the prevention of lifestyle diseases like obesity and diabetes in the Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi. Blood samples at baseline and weeks 2,4 and 12 were collected from 72 adults (male n=21; female n=51) of age 20-45 years with a body–mass index (BMI) of 25–35 kg/m2 who were randomized to receive either a 12-week SC (n=36) or YBLI (n=36). SC included recommendations for the management of obesity as per Indian guidelines including a low-calorie individualized diet and physical activity. Asana (physical postures), pranayama (breathing exercises), and meditation were included in the YBLI. Primary outcomes were relative fold changes in the expression of genes associated with oxidative stress (Nuclear factor-kappa B [NF-Kappa B]), inflammation (Tumour necrosis factor-α [TNFα], interleukin-6 [IL-6]), and aging (human telomerase reverse transcriptase [TERT]) in peripheral blood mononuclear cells between the two groups at week-12.
There were no significant changes in fold change of TERT, IL-6, and NF-kappa B between the groups at week 12. The relative fold change of TERT was significantly greater in the YBLI group (p=<0.0001) vs the SC group at 2 weeks. TERT expression was significantly increased at week 2 though the change was greater in the YBLI group (p<0.0001). TNF-α gene expression was significantly lower at weeks 2 and 4, compared to baseline level, in the SC group but it increased at week 12.
The results while did not confirm our hypothesis, are important to share with the scientific society, to be able to improve prospective study designs and find optimal time/intervention/biological marker settings for this highly important scientific field.
... Activation of the inflammatory markers initiates the inflammatory and immunerelated diseases [81]. It was also found that PSD induces an increase in the secretion of growth hormones, prolactin, and decreased cortisol levels in the second half of the night which is corroborated by the enhanced spontaneous monocytic production of proinflammatory cytokines levels [82]. Chronic sleep deprivation in mice resulted in hyperphagia, ER stress, and activation of the unfolded protein response system. ...
Sleep deprivation (SD) is emulating an epidemic imparting detrimental effects ranging from immediate repercussions like vehicle accidents to very serious neurological disorders. All age groups are vulnerable to SD either because of lifestyle or illness. This imposes a significant burden on public health and safety. SD triggers an array of inflammatory responses, and neuroinflammation is one of the most common complications. Changes in circulation levels of pro- and anti-inflammatory cytokines caused by SD are associated with higher and lower levels of inflammation, respectively. SD-induced astrogliosis, microgliosis, impaired glymphatic clearance, BBB disruption, and release of inflammatory cytokines are the main sources of neuroinflammation. This review addresses the clinical and experimental SD and the associated activation of neuroinflammatory signaling via NF-κB, TNF-α, CREB, TLR, Nrf2, JAK-STAT, MAPK, and mTOR proteins. Major neurodegenerative disorders (e.g., Alzheimer's disease (AD), Parkinson's disease (PD), and Amyotrophic lateral sclerosis (ALS) all have these signaling molecules as crucial participants in their etiology. Hence, SD has a strong association with the initiation and progression of neurodegenerative diseases. Further research in this area is warranted to understand the role of the activated neuroinflammatory pathways in the initiation, progression, and manifestations of neurological disorders.
... In doing so, this study contributes to a longstanding question in psychoneuroimmunology about whether stress management interventions enhance or suppress stimulated cytokine production (Carlson et al., 2003). To date, mindfulness and mind-body interventions have shown no effects or reductions in stimulated cytokine production in midlife adults with inflammatory disease or breast cancer (Elsenbruch et al., 2005;Witek-Janusek et al., 2008;Zautra et al., 2008;Irwin et al., 2014;Kiecolt-Glaser et al., 2014). Together with this previous work, the current study suggests that intervention effects on stimulated cytokine response depend heavily on disease status and lifespan factors. ...
Loneliness is a potent psychosocial stressor that predicts poor health and mortality among older adults, possibly in part by accelerating age-related declines in immunocompetence. Mindfulness interventions have shown promise for reducing loneliness and improving markers of physical health. In a sample of lonely older adults, this two-arm parallel trial tested whether mindfulness training enhances stimulated interleukin-6 (IL-6) production, a measure of innate immune responsivity. Lonely older adults (65-85 years; N=190) were randomized to an 8-week Mindfulness-Based Stress Reduction (MBSR) or control Health Enhancement Program (HEP) intervention. Lipopolysaccharide (LPS)-stimulated production of IL-6 was measured in vitro by blinded outcome assessors at pre-intervention, post-intervention, and 3-month follow-up. Mixed-effects linear models tested time (pre, post, follow-up) by condition (MBSR vs. HEP) effects. As predicted, a significant time × condition effect on stimulated IL-6 production was observed across pre, post, and follow-up timepoints. Significant MBSR vs. HEP differences emerged from pre- to post-intervention (p=.009, d=.38) and from pre-intervention to 3-month follow-up (p=.017, d=.35), with larger increases in IL-6 production following MBSR compared to HEP. No study-related adverse events were reported. Results show that mindfulness training may be effective for boosting innate immunocompetence among lonely older adults. Given that immunocompetence tends to decline with age, mindfulness training may help to counteract the effects of aging and psychosocial stress on infection risk and recovery from injury.
... For example, a study with older adults found that a 16-week Tai Chi intervention administered prior to VZV vaccination produced a substantially higher level of anti-VZV immunity than vaccine alone (Irwin et al., 2007). These approaches might also be effective for reducing post-COVID symptoms and underlying immune dysregulation, as we have shown among cancer survivors with persistent fatigue, sleep disturbance, and depression (Bower et al., 2014(Bower et al., , 2015Irwin et al., 2014). A key advantage of psychosocial and behavioral interventions in the context of COVID is their ability to improve mental, physical, and (in the case of prosocial interventions) social and community well-being. ...
The brain and immune system are intricately connected, and perturbations in one system have direct effects on the other. This review focuses on these dynamic psychoneuroimmune interactions and their implications for mental and physical health in the context of the COVID-19 pandemic. In particular, we describe how psychological states influence antiviral immunity and the vaccine response, and how immune changes triggered by COVID (either via infection with SARS-CoV-2 or associated stressors) can influence the brain with effects on cognition, emotion, and behavior. We consider negative psychological states, which have been the primary focus of psychological research in the context of COVID-19 (and psychoneuroimmunology more generally). We also consider positive psychological states, including positive affect and eudaimonic well-being, given increasing evidence for their importance as modulators of immunity. We finish with a discussion of interventions that may be effective in improving immune function, the neuro-immune axis, and ultimately, mental and physical health.
... For instance, sleep disturbance has been associated with higher CRP (Irwin et al., 2016) and lower IGF-1 (Chennaoui et al., 2020). Further indirect evidence supporting a role of sleep in influencing neuro-immune responses derives from clinical research, where sleep improvements following non-pharmacological sleep interventions have been associated with a reduction of inflammatory markers (Irwin et al., 2014(Irwin et al., , 2014bIrwin, b et al., 2014Irwin, b et al., , 2014bCarroll et al., 2015) and an increase of neurotrophic factors concentration (Rusch et al., 2015). ...
This study aimed to investigate the long-term association between subjective sleep disturbance and depressive symptoms in older adults, and ascertain whether this association is partially mediated by neuro-immune markers, while testing the moderation of sex using conditional process analyses, i.e., combinations of mediation and moderation analyses. We analysed data of 2124 participants aged 50 and above from the English Longitudinal Study of Ageing (ELSA) across three waves of data collection. Sleep disturbance was assessed in 2008/9, serum levels of high sensitivity C-reactive protein (hs-CRP), insulin like growth factor-1 (IGF-1), white blood cell (WBC) count in 2012/2013, and self-reported depressive symptoms in 2016/2017. After accounting for health-related and psychosocial confounders, results showed that sleep disturbance significantly predicted depressive symptoms at follow-up in the whole sample and hs-CRP in women, but not in men. Hs-CRP also predicted depressive symptoms only in women. Moreover, hs-CRP significantly mediated the association between sleep disturbance and depressive symptoms in women, but not in men. The association between sleep disturbance and IFG-1was marginal, and the latter did not mediate the association between sleep and depressive symptoms neither in women nor in men. Results on WBC count were all non-significant. In conclusion, sleep disturbance resulted significantly associated with depressive symptoms in a long-term follow-up. Moreover, ELSA data provide preliminary evidence that increased inflammation may mediate this association in women. Future longitudinal studies may advance the knowledge in the field considering the mediating role of proinflammatory cytokines such as interleukin-6.
... Mitochondrial dynamics are involved in the regulation of adenosine triphosphate (ATP) synthesis, oxidative stress, and apoptosis and are closely related to breast cancer invasion and metastasis [5,39]. A study has shown that after physical exercise, plasma ATP levels increased, mitochondrial membrane potential (MMP) increased, and glutathione (GSH) synthesis increased while malondialdehyde (MDA) synthesis decreased, and moderate-intensity exercise can alleviate CRF [40,41]. Finally, it can restore the body function of breast cancer survivors by dredging the meridians. ...
Objective:
This study is aimed at evaluating the effect of Chinese traditional Wushu (CTW) on cancer-related fatigue (CRF), sleep quality, and upper limb dysfunction. Data Sources. We searched studies containing randomized controlled trials up to July 2021 in PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang database, and China Biological Medicine on this topic.
Methods:
A randomized controlled trial of CTW on major outcome indicators such as CRF, sleep quality, and upper limb dysfunction of breast cancer survivors. Study screening, data extraction, and risk of bias assessment were performed independently by two reviewers. Meta-analysis was conducted with Stata 16.0 software. The quality of the evidence was assessed by the Cochrane Collaboration Risk of Bias (ROB2.0).
Results:
Eighteen studies met the requirements for meta-analysis (n = 1331). We found that CTW has no obvious effect on improving breast cancer survivors' CRF (SMD = -0.733; P = 0.059; I 2 = 89.3%), but it can effectively improve their sleep quality (WMD = -2.266; P = 0.022; I 2 = 99.2%) and upper limb dysfunction (SMD = 1.262; P ≤ 0.001; I 2 = 88.5%).
Conclusion:
Although more studies on this topic are needed to prove the effectiveness of this method, the results of our review show that CTW is significantly helpful for better sleep and upper limb dysfunction. But the effects on CRF will need to be confirmed further. Implications for Cancer Survivors. In the future intervention process, to verify the effectiveness of CTW on improving CRF for breast cancer survivors, it would be suggested to pay close attention to breast cancer survivors' response to exercise, achieve regular follow-up, strictly conduct the intervention scheme on the premise of ensuring absolute security, and reduce the loss of intervention objects.
... Emerging research suggests that levels of fatigue in cancer patients are associated with an array of psychosocial and genetic factors, with underlying biology involving changes in multiple markers of inflammation (Bower, 2014;Berger et al., 2015). Multimodal mind-body interventions, including Qigong and Tai Chi, have shown promise for alleviating cancer-related fatigue Liu et al., 2021), possibly through their impact on inflammation (Irwin et al., 2014(Irwin et al., , 2015Bower and Irwin, 2016;Kinney et al., 2019). The evidence for links between posture and fatigue in cancer has not been previously described. ...
Theories of embodied cognition hypothesize interdependencies between psychological well-being and physical posture. The purpose of this study was to assess the feasibility of objectively measuring posture, and to explore the relationship between posture and affect and other patient centered outcomes in breast cancer survivors (BCS) with persistent postsurgical pain (PPSP) over a 12-week course of therapeutic Qigong mind-body training. Twenty-one BCS with PPSP attended group Qigong training. Clinical outcomes were pain, fatigue, self-esteem, anxiety, depression, stress and exercise self-efficacy. Posture outcomes were vertical spine and vertical head angles in the sagittal plane, measured with a 3D motion capture system in three conditions: eyes open (EO), eyes open relaxed (EOR) and eyes closed (EC). Assessments were made before and after the Qigong training. The association between categorical variables (angle and mood) was measured by Cramer’s V. In the EO condition, most participants who improved in fatigue and anxiety scales also had better vertical head values. For the EOR condition, a moderate correlation was observed between changes in vertical head angle and changes in fatigue scale. In the EC condition, most of the participants who improved in measures of fatigue also improved vertical head angle. Additionally, pain severity decreased while vertical spine angle improved. These preliminary findings support that emotion and other patient centered outcomes should be considered within an embodied framework, and that Qigong may be a promising intervention for addressing biopsychosocially complex interventions such as PPSP in BCSs.
... We presented characteristics of some included studies in Table 2. All RCTs are in English, [17][18][19][20][21][22][23][24][25] publishing between 2006 and 2015. The details are shown in Table 2. ...
Background:
Taijiquan, as a supplementary and alternative method, has attracted more and more attention in the treatment of breast cancer. But up to now, no systematic review has been performed to evaluate the efficacy of Taijiquan in the treatment of breast cancer. In this study, Cochrane systematic review method will be used to evaluate the effect of Taijiquan in the rehabilitation process of breast cancer patients after treatment.
Methods:
PubMed, Embase. com, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and SinoMed will be searched to identify relevant studies up to May 31, 2021. We will include randomized controlled trials (RCTs) of the application of Taijiquan in post-treatment breast cancer patients. We will use the Cochrane bias risk assessment tool to assess the quality of included RCTs. We will use Stata 13.0 to perform pairwise meta-analyses using the inverse variance method. Subgroup analyses and sensitivity analyses will be conducted to investigate the sources of heterogeneity.
Results:
The results of this study will be published in a peer-reviewed journal.
Conclusion:
This study will comprehensively evaluate the efficacy of Taijiquan in the rehabilitation treatment of breast cancer. The results of this study will provide high-quality evidence to support clinical practice and guidelines development.
... Furthermore, trials examining the effects of mind-body interventions on markers of inflammation among clinical populations, including cancer survivors, have shown mixed and null findings . This pattern holds for studies that compare the effects of two active interventions (e.g., mindfulness meditation versus health education, cognitive behavioral therapy versus health education) (Irwin et al., 2014;Janelsins et al., 2011;Malarkey et al., 2013;Oken et al., 2010). In addition to including a third, usual care control, future research should examine how to bolster any possible beneficial effects of CBSM and health promotion in both the short-and long-term. ...
Cognitive behavioral stress management (CBSM) improves quality of life and mitigates stress biology in patients with early-stage cancer, including men with localized prostate cancer. However, treatments for advanced prostate cancer like androgen deprivation therapy (ADT) can lead to significant symptom burden that may be further exacerbated by stress-induced inflammation and cortisol dysregulation. The aim of this study was to examine the effects of CBSM (versus an active health promotion control) on circulating inflammatory markers and cortisol in men with advanced prostate cancer.
Methods:
Men with stage III or IV prostate cancer (N = 192) who had undergone ADT within the last year were randomized to CBSM or health promotion. Both interventions were 10 weeks, group-based, and delivered online. Venous blood was drawn at baseline, 6 months, and 12 months to measure circulating levels of CRP, IL-6, IL-8, IL-10, and TNF-α. Saliva samples were collected at awakening, 30 minutes after awakening, evening, and night for two consecutive days at baseline, 6-months, and 12-months to measure diurnal cortisol slopes.
Results:
Mixed modeling analyses demonstrated that changes in inflammatory markers and cortisol did not differ by intervention. Men in both CBSM and health promotion showed decreases in IL-10, IL-8, and TNF-α from baseline to 6 months (β=-3.85--5.04, p's=.004-<.001). However, these markers generally demonstrated a rebound increase from 6 to 12 months (β=1.91-4.06, p's=.06-<.001). Men in health promotion also demonstrated a flatter diurnal cortisol slope versus men in CBSM at 6 months (β=-2.27, p=.023), but not at 12 months. There were no intervention effects on CRP, IL-6, or overall cortisol output.
Conclusions:
Contrary to hypotheses, CBSM did not lead to changes in the circulating inflammatory markers and cortisol relative to health promotion. CBSM may be associated with healthy diurnal cortisol rhythm because of its focus on cognitive behavioral approaches to stress management. More research is needed to understand the impact of CBSM and health promotion on biomarkers among men with advanced prostate cancer.
... 24, 25, 39) studies, respectively, were included in the meta-analysis of exercise and combined interventions (15 studies included CRP levels). All exercise studies not included in the meta-analysis reported no significant change in CRP in the intervention group (27%, 4/15; refs.[40][41][42][43]. ...
Background:
Adiponectin, leptin, and pro- and anti-inflammatory cytokines are implicated in breast cancer risk and recurrence. Weight loss, via the dynamic interplay of energy balance through exercise and/or caloric restriction decreases risk of breast cancer recurrence.
Methods:
We investigated the effects of lifestyle modifications (exercise only, or combined caloric restriction and exercise) on adipokines, IL-2, IL-6, IL-8, IL-10, CRP, and TNF-α biomarkers in breast cancer survivors. Searches were completed in June and July of 2019 to identify randomized controlled trials that met inclusion criteria. Weighted mean difference was calculated using random- or fixed- effects models based on the heterogeneity of the studies.
Results:
2501 records were identified with 30 ultimately meeting inclusion criteria of the systematic review. 21 studies provided data suitable for meta-analysis. We observed leptin levels were significantly reduced in the exercise only group compared to sedentary control (WMD -5.66; 95% CI, -11.0 to -0.33, p = 0.04).
Conclusion:
Leptin may be a primary mediator of exercise-induced improvements in breast cancer recurrence.
Impact:
This is the first review and meta-analysis to examine combined exercise and caloric restriction programs in breast cancer survivors. Future studies should further examine combined programs and their efficacy for altering leptin.
Objective
Poor sleep is associated with increased inflammation, thereby increasing the risk of chronic diseases and mortality. However, the effects of behavioral sleep interventions on the upstream inflammatory system are unknown among family care partners (CP). The present study explored the role of a behavioral sleep intervention program on inflammatory gene expression.
Methods
This was part of a randomized controlled trial of a sleep intervention for dementia care dyads with sleep problems. Thirty dyads were randomized to sleep intervention or control groups. Sleep outcomes for CP were assessed with 1 week of actigraphy and sleep diary, and the Pittsburgh Sleep Quality Index. Other information included CP demographics, body mass index, and intensity of caregiving tasks. All outcomes were collected at baseline, post-treatment, and 3-month follow-up.
Results
Neither group showed any significant differential changes in gene expression from baseline to post-treatment or 3-month follow-up. A decrease in inflammatory gene expression was significantly associated with more nights of good sleep (i.e. nights without trouble falling or staying asleep at night). This finding remained significant after controlling for group (intervention/control), timepoint (baseline, post-treatment, and 3-month follow-up), and CP characteristics (e.g. age and ethnicity).
Conclusions
Although better sleep was associated with decreased inflammatory gene expression, this study did not demonstrate any benefits of a behavioral sleep intervention over control, most likely due to a small sample. Studies with larger sample sizes are needed to test the specific aspects of disturbed sleep that relate to inflammatory biology among CP of persons living with dementia.
Tai Chi, a traditional Chinese martial art and health exercise, has gained significant global attention and recognition. The clinical benefits of Tai Chi have been studied extensively in recent decades. We conducted a systematic search of PubMed, Web of Science, EMBASE databases, and the China National Knowledge Infrastructure, identifying and reviewing 241 clinical trials on the benefits of Tai Chi from their inception to June 1, 2023. Most of these studies have consistently demonstrated the positive impact of Tai Chi on balance, cognitive function, mood regulation, sleep quality, pain relief, cardiorespiratory function, and overall health. In the future, the key to fostering the ongoing development of this field lies in comprehensive research on standardized study designs and reporting, the scope of Tai Chi applications, and the core factors influencing its efficacy. http://links.lww.com/AHM/A94
La conexión entre el cuerpo y la mente es algo que el conocimiento científico actual no ha logrado comprender completamente y surge la necesidad de adoptar un nuevo enfoque en esta relación para abordar desafíos médicos, especialmente enfermedades físicas o mentales que carecen de soluciones efectivas con la medicina convencional debido a efectos secundarios o resistencia al tratamiento. La importancia de estar abierto a nuevas perspectivas, considerando que las intervenciones mente-cuerpo han sido investigadas durante miles de años es un aspecto crucial. Estas intervenciones, como ejercicios, meditaciones, técnicas de respiración y prácticas de conciencia, están siendo redescubiertas y demuestran cómo el cuerpo afecta a la mente y viceversa, mejorando el estado general de una persona y su calidad de vida, así como aliviando síntomas que anteriormente solo podían tratarse con medicamentos, muchas veces con efectos secundarios dañinos o no tolerados. Se mencionan aspectos como la conciencia, la regulación emocional, el estado corporal, el lenguaje, el sistema inmunológico y la nutrición como componentes que describen el estado de una persona en un momento dado de su vida. El texto concluye enfatizando la necesidad de realizar más investigaciones para obtener nueva información y soluciones que mejoren la calidad de vida humana y amplíen los límites del conocimiento. E idealmente, se promueve un enfoque holístico y multidisciplinario para abordar desafíos médicos y mejorar la salud y el bienestar de las personas.
Background and objective
As the population ages, the health of older adults is becoming a public health concern. Falls are a significant threat to their health due to weakened balance. This study aims to investigate the beneficial effects of Tai Chi on fall prevention and balance improvement in older adults.
Methods
We conducted a systematic review and meta-analysis of randomized controlled trials related to Tai Chi, falls, and balance ability, searching PubMed, Embase, and Cochrane Library databases from their establishment until December 31, 2022. Two independent reviewers performed the search, screening of results, extraction of relevant data, and assessment of study quality. This study followed the PRISMA guidelines for systematic review and meta-analysis.
Results
Totally 24 RCTs were included for meta-analysis, and the results showed that Tai Chi can effectively reduce the risk of falls in older adults (RR: 0.76, 95% CI: 0.71 to 0.82) and decrease the number of falls (MD [95% CI]: −0.26 [−0.39, −0.13]). Tai Chi can also improve the balance ability of older adults, such as the timed up and go test (MD [95% CI]: −0.69 [−1.09, −0.29]) and the functional reach test (MD [95% CI]: 2.69 [1.14, 4.24]), as well as other balance tests such as single-leg balance test, Berg balance scale, and gait speed (p < 0.05). Subgroup analysis showed that Tai Chi is effective for both healthy older adults and those at high risk of falls (p < 0.001), and its effectiveness increases with the duration and frequency of exercise. In addition, the effect of Yang-style Tai Chi is better than that of Sun-style Tai Chi.
Conclusion
Tai Chi is an effective exercise for preventing falls and improving balance ability in older adults, whether they are healthy or at high risk of falling. The effectiveness of Tai Chi increases with exercise time and frequency. Yang-style Tai Chi is more effective than Sun-style Tai Chi.
Systematic review registration
https://clinicaltrials.gov/, identifier CRD42022354594.
Objectives
Meditative practices have grown in popularity, but the results of meditative intervention studies on immune functioning have been inconsistent. Although prior reviews have been conducted, the present meta-analysis provides a more comprehensive and updated examination.
Methods
One hundred and five eligible studies, including mindfulness-based, movement-based, and meditation-focused, meditative interventions with biological markers of immune functioning were analyzed. The current work (a) incorporates a greater number of studies available for review, (b) examines the overall magnitude of the effect of meditative interventions on immune functioning, (c) examines the effects of health on some individual level biomarkers (i.e., NF-κB, IgA, and IL-6), (d) compares different types of meditative interventions and (e) reveals the effect of various theoretical (e.g., the health of participants) and methodological (e.g., delivery of interventions) moderators.
Results
The meta-analysis indicated that meditative interventions, including formal meditation, mindfulness-based, and movement-based, have a small but significant effect on immune functioning (g = 0.181, k = 105, p < 0.001) as compared to controls (g = -0.001, p = 0.982). Furthermore, the results indicated that the effect of meditative interventions on immune functioning remained robust, regardless of the type of control condition.
Conclusions
The present meta-analysis suggests a small and significant effect of meditative interventions on immune functioning and serves to clarify inconsistent results in the literature. Further, it provides insight into both theoretical and methodological moderators for future research. Meditative interventions could be implemented in various formats and modalities, especially among those with physiological and psychological disorders.
Preregistration
The present meta-analysis was not preregistered.
Sleep has a homeostatic role in the regulation of the immune system and serves to constrain activation of inflammatory signalling and expression of cellular inflammation. In patients with rheumatoid arthritis (RA), a misaligned inflammatory profile induces a dysregulation of sleep-wake activity, which leads to excessive inflammation and the induction of increased sensitivity to pain. Given that multiple biological mechanisms contribute to sleep disturbances (such as insomnia), and that the central nervous system communicates with the innate immune system via neuroendocrine and neural effector pathways, potential exists to develop prevention opportunities to mitigate the risk of insomnia in RA. Furthermore, understanding these risk mechanisms might inform additional insomnia treatment strategies directed towards steering and reducing the magnitude of the inflammatory response, which together could influence outcomes of pain and disease activity in RA.
Neurodegenerative diseases (ND) have received increasing attention due to their irreversibility, but there is still no means to completely cure ND in clinical practice. Mindfulness therapy (MT), including Qigong, Tai Chi, meditation, and yoga, etc., has become an effective complementary treatment modality in solving clinical and subclinical problems due to its advantages of low side effects, less pain, and easy acceptance by patients. MT is primarily used to treat mental and emotional disorders. In recent years, evidence has shown that MT has a certain therapeutic effect on ND with a potential molecular basis. In this review, we summarize the pathogenesis and risk factors of Alzheimer’s disease (AD), Parkinson’s disease (PD), and amyotrophic lateral sclerosis (ALS), relating to telomerase activity, epigenetics, stress, and the pro-inflammatory transcription factor nuclear factor kappa B (NF-κB) mediated inflammatory response, and analyze the molecular mechanism basis of MT to prevent and treat ND, to provide possible explanations for the potential of MT treatments for ND.
Meditation is a naturalistic practice that integrates the mind and body. Some clinicians think that it also has an impact “on the soul”. There are several meditation-based therapies, such as mindfulness, yoga, Tai Chi, etc. This chapter attempts to summarize the benefits of meditation across multiple psychiatric and medical conditions. Meditation has shown to improve depression and anxiety with demonstrated benefits also evident from the existing literature. Findings from empirical studies and clinical experiences offer insights into the possible utilization of meditative and mindfulness techniques as adjunct treatment modalities to the current standards of care. Meditative therapies for attention deficit (ADHD) may offer treatments with minimal side effects and cost-effective. In summary, mindfulness meditation can be used as an adjunct to the current standard treatments of psychotherapy and pharmacotherapies for mental health disorders in children and adolescents.KeywordsMeditationMental HealthDepressionAnxietyChildren
The author anylise some conceptions of social truth. He especially underline the conventional conception of social truth. Social situation in Russian society leads to understanding of triple character of social truth. It may be overcome on the basis of new public treatment and because of social and economic reforms.
Background
Two related lifestyle behaviors associated with sleep disturbance are sedentary behavior and physical exercise participation. We aimed to use a population-based study to disentangle the relationships between sedentary behavior, exercise, and sleep disturbance based on blood-cell-based inflammatory biomarkers.
Methods
A total of 22,599 participants from the National Health and Nutrition Examination Survey (NHANES) were included in the analyses. Sleep disturbance was assessed according to the NHANES questionnaire. Exercise participation ansd sedentary behavior were evaluated by the global physical activity questionnaire. The inflammatory biomarkers in the examination were white blood cell (WBC) count, neutrophil count (NEU), neutrophil-to-lymphocyte ratio (NLR), and systemic immune inflammation index (SII). A complex multistage sampling design and weighted multivariable logistic regression were applied for further analysis. Mediation models were constructed to figure out the mediating role of inflammatory biomarkers.
Results
The weighted prevalence of sleep disturbance was 24.17%. Sedentary behavior and exercise were associated with sleep disturbance after full adjustment [for sedentary behavior, OR (95% CI): 1.261 (1.154, 1.377); for exercise, OR (95% CI): 0.849 (0.757, 0.953)]. In severe sedentary behavior groups, the mitigation effect of exercise on sleep disturbance was observed [OR (95% CI): 0.687 (0.551, 0.857)]. For the mechanism, strong associations were detected between inflammatory biomarkers and sleep disturbance. Mediation analysis showed that WBC, NEU, NLR, and SII mediated the statistical association between sedentary behavior and sleep disturbance with proportions (%) of 2.09, 2.27, 1.76, and 0.82, respectively.
Conclusions
Our data suggested that sedentary behavior was a risk factor for sleep disturbance. Blood-cell-based inflammatory biomarkers were an easily accessible and cost-effective strategy for identifying sleep disturbance and also significantly mediated the association between sedentary behavior and sleep disturbance. Exercise was proved to be effective in severe sedentary behavior groups to improve sleep disturbance symptoms, while the internal mechanism needed further exploration.
Previous investigations have demonstrated that interleukin-6 (IL-6), C reactive protein (CRP), tumor necrosis factoralpha (TNF-alpha), in Coronavirus disease 2019 (COVID-19) patients are considerably increased, and their progressive elevation are clinical threat indicators of disease severity. The purpose of this systematic review is to evaluate the efficacy of physiotherapy, specifically chest physiotherapy, on different cytokines in Covid-19 and non-covid-19 patients. The main complications and symptoms of this virus are as follows; a dry cough, fever, and progressive dyspnea. Quickly, the coronavirus, which is named SARS-CoV-21, has spread worldwide, causing severe lung inflammation, respiratory distress syndrome, cardiac and renal injury, especially in comorbidities patients. Approximately 96% of the cases experience mild respiratory symptoms; some progress to pneumonia, respiratory insufficiency, acute respiratory distress syndrome, and multiorgan failure. The overall mortality rate per number of diagnosed cases is 4.6%; it can range from 0.2% to 15% according to age and health problems. Combination MeSH and text terms were used to perform the search strategy. Interventions in RCTs and clinical trials with or without comparison were assessed. Six studies met the inclusion criteria. Studies demonstrated that physiotherapy could have an effect on TNF-alpha, IL-6, IL-10, IL-1β and CRP.
Objectives:
To assess the effectiveness of Cognitive Behavioral Therapy for Insomnia (CBT-I) on cardiometabolic health biomarkers.
Method:
Cochrane CENTRAL, Embase, Medline, and PsycINFO were searched, and records were screened by two independent reviewers. Inclusion criteria were adult population, delivery of CBT-I, randomized controlled trial design, ≥1 cardiometabolic health outcome, and peer-review. Hedge's g effect sizes were calculated, and the quality of the evidence was appraised using the Cochrane Risk of Bias 2 tool.
Results:
After screening 1649 records, 15 studies were included (total N = 2067). Inflammatory markers (CRP, IL-6, TNF-α), blood pressure (SBP, DBP), and glycemic regulation (HbA1c) were most frequently reported (in ≥3 studies each). HbA1c and CRP were reduced in the CBT-I group compared to the control group (in 3 studies each). Effects varied or were null for IL-6, TNF-α, SBP, and DBP. Six studies were judged as low, four as moderate, and five as high risk of bias.
Conclusion:
CBT-I was most consistently associated with improved HbA1c and CRP, which are relatively temporally stable, suggesting influences on enduring habits rather than short-term behavior changes. High risk of bias limits the interpretation of findings. Methodologically adequate studies are needed to better understand cardiometabolic effects of CBT-I.
To explore the clinical efficacy and possible mechanism of Tai Ji Quan for post-stroke depression (PSD), literature related to Tai Ji Quan and PSD were retrieved from China National Knowledge Infrastructure (CNKI), Wanfang Academic Journal Full-text Database (Wanfang), Chongqing VIP Database (CQVIP), China Biology Medicine Disc (CBM), and PubMed, screened and then summarized. The results showed that Tai Ji Quan could effectively improve the depression and quality of life of stroke patients, and there were differences in the clinical efficacy among different training programs. Tai Ji Quan has the characteristics of “regulating mind”, “regulating breath”, and “regulating body”. It may achieve the effect of “combined physique-spirit treatment” by improving social psychology, increasing the level of neurotrophin, regulating neuroendocrine, reducing inflammatory factors, and regulating neural circuits.
Background
NLRP3 inflammasome and its related antiviral inflammatory factors have been implicated in the pathogenesis of type 2 diabetes mellitus (T2DM) and insulin resistance, but its contribution to pre-diabetes remains poorly understood.
Objective
To investigate the effects and the potential mechanism of Tai Chi intervention on NLRP3 inflammasome and its related inflammatory factors in the serum of middle-aged and older people with pre-diabetes mellitus (PDM).
Methods
40 pre-diabetic subjects were divided into a pre-diabetic control group (PDM-C group, N=20) and a Tai Chi group (PDM-TC group, N=20) by random number table. 10 normoglycemic subjects (NG) were selected as controls. We measured clinical metabolic parameters and collected blood samples before and after the 12 weeks of Tai Chi intervention. Antiviral inflammatory factors in serum were detected by enzyme-linked immunosorbent assay.
Results
The blood glucose, insulin resistance, and inflammation in PDM groups were higher than those in the NG group (P<0.05 and P<0.01, respectively). The results also suggested that 12 weeks of Tai Chi intervention could reduce body weight, blood pressure, blood glucose, insulin resistance, blood lipid, and the expressions of serum inflammatory factors in the pre-diabetic population.
Conclusion
Tai Chi intervention may improve blood glucose, lipid levels, and insulin resistance in middle-aged and elderly pre-diabetic patients by reducing the level of NLRP3 inflammasome and its related inflammatory factors.
Yoga is an ancient Indian technique of healthy living. Numerous studies have corroborated yoga’s beneficial effects, including a favorable influence on autonomic function and negative emotions. Extensive research in the last few decades has revealed the critical role that yoga can play in eradicating stress. This has laid to the foundation for a scientific understanding of pathophysiological changes attributed to stress, particularly at the molecular and genetic levels. This primarily has helped understand the epigenetic and genetic mechanisms at play to induce and alleviate stress, particularly those related to emotional aberrations. As research has indicated, negative emotions are translated into vascular inflammation appropriately accentuated by a sympathetic predominant autonomic function. This cascade is bolstered by multiple factors, including activation of “stressor” genes and elaborating hormones, including steroids with sometimes nocuous consequences, particularly when chronic. Yoga has been categorically found to have inhibited each and every one of these baneful effects of stress. In fact, it also changes the neuronal circuits that potentiate such a plethora of pathological changes. This, in turn, has accentuated yoga’s relevance as a powerful preventive intervention in noncommunicable diseases (NCD). NCDs, including heart disease, stroke, and rheumatological disorders, are essentially inflammatory diseases that perpetuate inflammation in different beds like vascular or joint spaces. The precise mechanism by which yoga induces such beneficial changes is yet to be delineated. However, a cornucopia of pointers indicates that neural, endocrine, immunological, cellular, genetic, and epigenetic mechanisms are at play. This chapter attempts to cobble together newfangled research to delineate a medical model for this 5000-year-old practice from India. This is imperative, as a mechanistic model of this ancient-but-complex system would enable a more comprehensive understanding of its mechanism and reveal its yet-undiscovered positive health effects.
Tai Chi could alleviate depression, while the biological mechanisms underlying this effect remains unelucidated. This study recruited 18 community-dwelling older persons with a pre-post testing design, aiming to unveil the potential epigenetic effect by which Tai Chi in the alleviation of depression, using methylation of BDNF promoter as the biomarker. The methylation levels (determined by pyrosequencing using saliva samples) of the targeted BDNF sequence were positively associated with the existence and severity of depressive symptoms (measured with the 9-item Patient Health Questionnaire). Both methylation levels and depression decreased significantly after the Tai Chi intervention. Demethylation of BDNF promoter might be one of the potential mechanisms underlying the holistic depression alleviating effect of Tai Chi. BDNF methylation may potentially serve as a screening, diagnostic as well as disease activity biomarker to determine treatment effects for depression. Further adequately powered studies are needed to verify and strengthen our findings.
Lower limb osteoarthritis (OA) is a chronic, multifactorial disease characterized by impaired physical function, chronic pain, compromised psychological health and decreased social functioning. Chronic inflammation plays a critical role in the pathophysiology of OA. Tai Chi is a type of classical mind-body exercise derived from ancient Chinese martial arts. Evidence supports that Tai Chi has significant benefits for relieving lower limb OA symptoms. Using a biopsychosocial framework, this review aims to elucidate the beneficial effects of Tai Chi in lower limb OA and disentangle its potential mechanisms from the perspective of biology, psychology, and social factors. Complex biomechanical, biochemical, neurological, psychological, and social mechanisms, including strengthening of muscles, proprioception improvement, joint mechanical stress reduction, change of brain activation and sensitization, attenuation of inflammation, emotion modulation and social support, are discussed.
A growing body of evidence indicates that patients with cancer who receive cytotoxic treatments (such as chemotherapy or radiotherapy) have an increased risk of accelerated physical and cognitive ageing. Furthermore, accelerated biological ageing is a suspected driving force behind many of these observed effects. In this Review, we describe the mechanisms of biological ageing and how they apply to patients with cancer. We highlight the important role of specific behavioural factors, namely stress, sleep and lifestyle-related factors such as physical activity, weight management, diet and substance use, in the accelerated ageing of patients with cancer and cancer survivors. We also present a framework of how modifiable behaviours could operate to either increase the risk of accelerated ageing, provide protection, or promote resilience at both the biological level and in terms of patient-reported outcomes.
Exercise promotes general metabolic wellness not only by preserving musculoskeletal function, increasing muscle flexibility, increasing cardiopulmonary fitness, decreasing inflammation, increasing blood flow, and improving mental health, but also by promoting bone health, decreasing the risk of osteoporosis, improving postural stability, reducing risk of falling and fractures, and range of motion, increasing lifespan, and improving quality of life. At the molecular level, beneficial effects of exercise are related, in part, to increase in insulin sensitivity, decrease in CRP and IL-6 levels, enhancement in heart function, increase in growth factors such as BDNF, IGF, and VEGF, and decrease inflammation in brain and peripheral tissues. These parameters contribute to maintenance of cognitive function.
Study objectives:
To investigate the comparative efficacy of cognitive behavioral therapy (CBT), Tai Chi Chih (TCC), and sleep seminar education control (SS) on the primary outcome of insomnia diagnosis, and secondary outcomes of sleep quality, fatigue, depressive symptoms, and inflammation in older adults with insomnia.
Design:
Randomized controlled, comparative efficacy trial.
Setting:
Los Angeles community.
Patients:
123 older adults with chronic and primary insomnia.
Interventions:
Random assignment to CBT, TCC, or SS for 2-hour group sessions weekly over 4 months with follow-up at 7 and 16 months.
Measurements:
Insomnia diagnosis, patient-reported outcomes, polysomnography (PSG), and high-sensitivity C-reactive protein (CRP) levels.
Results:
CBT performed better than TCC and SS in remission of clinical insomnia as ascertained by a clinician (P < 0.01), and also showed greater and more sustained improvement in sleep quality, sleep parameters, fatigue, and depressive symptoms than TCC and SS (all P values < 0.01). As compared to SS, CBT was associated with a reduced risk of high CRP levels (> 3.0 mg/L) at 16 months (odds ratio [OR], 0.26 [95% CI, 0.07-0.97] P < 0.05). Remission of insomnia was associated with lower levels of CRP (P < 0.05) at 16 months. TCC was associated with improvements in sleep quality, fatigue, and depressive symptoms as compared to SS (all P's < 0.05), but not insomnia remission. PSG measures did not change.
Conclusions:
Treatment of late-life insomnia is better achieved and sustained by cognitive behavioral therapies. Insomnia treatment and remission reduces a marker of inflammatory risk, which has implications for cardiovascular morbidity and diabetes observed with sleep disturbance in epidemiologic surveys.
Over two-thirds of the 11.4 million cancer survivors in the United States can expect long-term survival, with many others living with cancer as a chronic disease controlled by ongoing therapy. Behavioral comorbidities often arise during treatment and persist long term to complicate survival and reduce quality of life. This review focuses on depression and insomnia with an emphasis on understanding the role of cancer-specific factors and their contribution to the prevalence of these behavioral comorbidities in cancer patients following cancer diagnosis and treatment. The clinical significance of depression and insomnia for cancer patients is further stressed by epidemiological observations that link depression and insomnia to cancer morbidity and mortality risk.
To identify molecular mechanisms underlying the prospective health advantages associated with psychological well-being, we analyzed leukocyte basal gene expression profiles in 80 healthy adults who were assessed for hedonic and eudaimonic well-being, as well as potentially confounded negative psychological and behavioral factors. Hedonic and eudaimonic well-being showed similar affective correlates but highly divergent transcriptome profiles. Peripheral blood mononuclear cells from people with high levels of hedonic well-being showed up-regulated expression of a stress-related conserved transcriptional response to adversity (CTRA) involving increased expression of proinflammatory genes and decreased expression of genes involved in antibody synthesis and type I IFN response. In contrast, high levels of eudaimonic well-being were associated with CTRA down-regulation. Promoter-based bioinformatics implicated distinct patterns of transcription factor activity in structuring the observed differences in gene expression associated with eudaimonic well-being (reduced NF-κB and AP-1 signaling and increased IRF and STAT signaling). Transcript origin analysis identified monocytes, plasmacytoid dendritic cells, and B lymphocytes as primary cellular mediators of these dynamics. The finding that hedonic and eudaimonic well-being engage distinct gene regulatory programs despite their similar effects on total well-being and depressive symptoms implies that the human genome may be more sensitive to qualitative variations in well-being than are our conscious affective experiences.
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 determine the efficacy of a novel behavioral intervention, Tai Chi Chih, to promote sleep quality in older adults with moderate sleep complaints.
Randomized controlled trial with 16 weeks of teaching followed by practice and assessment 9 weeks later. The main outcome measure was sleep quality, as assessed by the Pittsburgh Sleep Quality Index (PSQI).
General community at 2 sites in the US between 2001 and 2005.
Volunteer sample of 112 healthy older adults, aged 59 to 86 years. Intervention: Random allocation to Tai Chi Chih or health education for 25 weeks.
Among adults with moderate sleep complaints, as defined by PSQI global score of 5 or greater, subjects in the Tai Chi Chih condition were more likely to achieve a treatment response, as defined by PSQI less than 5, compared to those in health education (P < 0.05). Subjects in the Tai Chi Chih condition with poor sleep quality also showed significant improvements in PSQI global score (P < 0.001) as well as in the sleep parameters of rated sleep quality (P < 0.05), habitual sleep efficiency (P < 0.05), sleep duration (P < 0.01), and sleep disturbance (P < 0.01).
Tai Chi Chih can be considered a useful nonpharmacologic approach to improve sleep quality in older adults with moderate complaints and, thereby, has the potential to ameliorate sleep complaints possibly before syndromal insomnia develops.
ClinicalTrials.gov Identifier: NCT00118885.
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.
This report presents selected estimates of complementary and alternative medicine (CAM) use among U.S. adults and children, using data from the 2007 National Health Interview Survey (NHIS), conducted by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS). Trends in adult use were assessed by comparing data from the 2007 and 2002 NHIS.
Estimates were derived from the Complementary and Alternative Medicine supplements and Core components of the 2007 and 2002 NHIS. Estimates were generated and comparisons conducted using the SUDAAN statistical package to account for the complex sample design.
In 2007, almost 4 out of 10 adults had used CAM therapy in the past 12 months, with the most commonly used therapies being nonvitamin, nonmineral, natural products (17.7%) and deep breathing exercises (12.7%). American Indian or Alaska Native adults (50.3%) and white adults (43.1%) were more likely to use CAM than Asian adults (39.9%) or black adults (25.5%). Results from the 2007 NHIS found that approximately one in nine children (11.8%) used CAM therapy in the past 12 months, with the most commonly used therapies being nonvitamin, nonmineral, natural products (3.9%) and chiropractic or osteopathic manipulation (2.8%). Children whose parent used CAM were almost five times as likely (23.9%) to use CAM as children whose parent did not use CAM (5.1%). For both adults and children in 2007, when worry about cost delayed receipt of conventional care, individuals were more likely to use CAM than when the cost of conventional care was not a worry. Between 2002 and 2007 increased use was seen among adults for acupuncture, deep breathing exercises, massage therapy, meditation, naturopathy, and yoga. CAM use for head or chest colds showed a marked decrease from 2002 to 2007 (9.5% to 2.0%).
To conduct a systematic review of reports on the physical and psychological effects of Tai Chi on various chronic medical conditions.
Search of 11 computerized English and Chinese databases.
Randomized controlled trials, nonrandomized controlled studies, and observational studies published in English or Chinese.
Data were extracted for the study objective, population characteristics, study setting, type of Tai Chi intervention, study design, outcome assessment, duration of follow-up, and key results.
There were 9 randomized controlled trials, 23 nonrandomized controlled studies, and 15 observational studies in this review. Benefits were reported in balance and strength, cardiovascular and respiratory function, flexibility, immune system, symptoms of arthritis, muscular strength, and psychological effects.
Tai Chi appears to have physiological and psychosocial benefits and also appears to be safe and effective in promoting balance control, flexibility, and cardiovascular fitness in older patients with chronic conditions. However, limitations or biases exist in most studies, and it is difficult to draw firm conclusions about the benefits reported. Most indications in which Tai Chi was applied lack a theoretical foundation concerning the mechanism of benefit. Well-designed studies are needed.
Recognition that psychological and behavioral factors play an important role in insomnia has led to increased interest in therapies targeting these factors. A review paper published in 1999 summarized the evidence regarding the efficacy of psychological and behavioral treatments for persistent insomnia. The present review provides an update of the evidence published since the original paper. As with the original paper, this review was conducted by a task force commissioned by the American Academy of Sleep Medicine in order to update its practice parameters on psychological and behavioral therapies for insomnia.
A systematic review was conducted on 37 treatment studies (N = 2246 subjects/patients) published between 1998 and 2004 inclusively and identified through Psyclnfo and Medline searches. Each study was systematically reviewed with a standard coding sheet and the following information was extracted: Study design, sample (number of participants, age, gender), diagnosis, type of treatments and controls, primary and secondary outcome measures, and main findings. Criteria for inclusion of a study were as follows: (a) the main sleep diagnosis was insomnia (primary or comorbid), (b) at least 1 treatment condition was psychological or behavioral in content, (c) the study design was a randomized controlled trial, a nonrandomized group design, a clinical case series or a single subject experimental design with a minimum of 10 subjects, and (d) the study included at least 1 of the following as dependent variables: sleep onset latency, number and/or duration of awakenings, total sleep time, sleep efficiency, or sleep quality.
Psychological and behavioral therapies produced reliable changes in several sleep parameters of individuals with either primary insomnia or insomnia associated with medical and psychiatric disorders. Nine studies documented the benefits of insomnia treatment in older adults or for facilitating discontinuation of medication among chronic hypnotic users. Sleep improvements achieved with treatment were well sustained over time; however, with the exception of reduced psychological symptoms/ distress, there was limited evidence that improved sleep led to clinically meaningful changes in other indices of morbidity (e.g., daytime fatigue). Five treatments met criteria for empirically-supported psychological treatments for insomnia: Stimulus control therapy, relaxation, paradoxical intention, sleep restriction, and cognitive-behavior therapy.
These updated findings provide additional evidence in support of the original review's conclusions as to the efficacy and generalizability of psychological and behavioral therapies for persistent insomnia. Nonetheless, further research is needed to develop therapies that would optimize outcomes and reduce morbidity, as would studies of treatment mechanisms, mediators, and moderators of outcomes. Effectiveness studies are also needed to validate those therapies when implemented in clinical settings (primary care), by non-sleep specialists. There is also a need to disseminate more effectively the available evidence in support of psychological and behavioral interventions to health-care practitioners working on the front line.
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.
Although chemotherapy for breast cancer can increase inflammation, few studies have examined predictors of this phenomenon. This study examined potential contributions of demographics, disease characteristics, and treatment regimens to markers of inflammation in response to chemotherapy for breast cancer. Thirty-five women with stage I-III-A breast cancer (mean age 50 years) were studied prior to cycle 1 and prior to cycle 4 of anthracycline-based chemotherapy. Circulating levels of inflammatory markers with high relevance to breast cancer were examined, including C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), Interleukin-1 receptor antagonist (IL1-RA), vascular endothelial growth factor (VEGF), soluble intercellular adhesion molecule-1 (sICAM-1), Interleukin- (IL-6), soluble P-selectin (sP-selectin), and von Willebrand factor (vWf). Chemotherapy was associated with elevations in VEGF (p ≤ 0.01), sICAM-1 (p ≤ 0.01), sP-selectin (p ≤ 0.02) and vWf (p ≤ 0.05). Multiple regression analysis controlling for age and body mass index (BMI) showed that higher post-chemotherapy levels of inflammation were consistently related to higher pre-chemotherapy levels of inflammation (ps ≤ 0.05) as well as to certain disease characteristics. Post-chemotherapy IL-6 levels were higher in patients who had larger tumors (p ≤ 0.05) while post-chemotherapy VEGF levels were higher in patients who had smaller tumors (p ≤ 0.05). Post-chemotherapy sP-selectin levels were highest in women who had received epirubicin, cytoxan, 5fluorouracil chemotherapy (p ≤ 0.01). These findings indicate that chemotherapy treatment can be associated with elevations in certain markers of inflammation, particularly markers of endothelial and platelet activation. Inflammation in response to chemotherapy is most significantly related to inflammation that existed prior to chemotherapy but also potentially to treatment regimen and to certain disease characteristics.
Patients with cancer experience a host of behavioral alterations that include depression, fatigue, sleep disturbances, and cognitive dysfunction. These behavioral comorbidities are apparent throughout the process of diagnosis and treatment for cancer and can persist well into the survivorship period. There is a rich literature describing potential consequences of behavioral comorbidities in patients with cancer including impaired quality of life, reduced treatment adherence, and increased disease-related morbidity and mortality. Medical complications of cancer and its treatment such as anemia, thyroid dysfunction, and the neurotoxicity of cancer chemotherapeutic agents account in part for these behavioral changes. Nevertheless, recent advances in the neurosciences and immunology/oncology have revealed novel insights into additional pathophysiologic mechanisms that may significantly contribute to the development of cancer-related behavioral changes. Special attention has been focused on immunologic processes, specifically activation of innate immune inflammatory responses and their regulation by neuroendocrine pathways, which, in turn, influence CNS functions including neurotransmitter metabolism, neuropeptide function, sleep-wake cycles, regional brain activity, and, ultimately, behavior. Further understanding of these immunologic influences on the brain provides a novel conceptual framework for integrating the wide spectrum of behavioral alterations that occur in cancer patients and may reveal a more focused array of translational targets for therapeutic interventions and future research. Such developments warrant complementary advances in identification of cancer patients at risk as well as those currently suffering, including an increased emphasis on the status of behavior as a "sixth vital sign" to be assessed in all cancer patients throughout their disease encounter.
The cytokine interferon-β is a regulator of cell replication and function, including invasion and induction of angiogenesis. The goal of this study was to determine whether the expression of interferon-β by cells in the epidermis correlated with terminal differentiation. In situ hybridization analysis and immunohistochemical staining of formalin-fixed, paraffin-embedded specimens of normal human and murine epidermis and human and murine skin tumors of epithelial origin revealed that only differentiated, nondividing cells of the epidermis expressed interferon-β protein. Keratinocyte cultures established from the epidermis of 3 d old mice were maintained under conditions permitting continuous cell division or induction of differentiation. Continuously dividing cells did not produce interferon-β whereas nondividing differentiated cells expressing keratin 1 did. Growth-arrested, undifferentiated keratinocytes also expressed interferon-β protein. Neutralizing interferon-β in the culture medium inhibited differentiation, but the addition of exogenous interferon-β did not stimulate differentiation. These data indicate that interferon-β is produced by growth-arrested, terminally differentiated keratinocytes.
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.
Over two-thirds of the 11.4 million cancer survivors in the United States can expect long-term survival, with many others living with cancer as a chronic disease controlled by ongoing therapy. However, behavioral co-morbidities often arise during treatment and persist long-term to complicate survival and reduce quality of life. In this review, the inter-relationships between cancer, depression, and sleep disturbance are described, with a focus on the role of sleep disturbance as a risk factor for depression. Increasing evidence also links alterations in inflammatory biology dynamics to these long-term effects of cancer diagnosis and treatment, and the hypothesis that sleep disturbance drives inflammation, which together contribute to depression, is discussed. Better understanding of the associations between inflammation and behavioral co-morbidities has the potential to refine prediction of risk and development of strategies for the prevention and treatment of sleep disturbance and depression in cancer survivors.
A diagnosis of cancer and subsequent treatments place demands on psychological adaptation. Behavioral research suggests the importance of cognitive, behavioral, and social factors in facilitating adaptation during active treatment and throughout cancer survivorship, which forms the rationale for the use of many psychosocial interventions in cancer patients. This cancer experience may also affect physiological adaptation systems (e.g., neuroendocrine) in parallel with psychological adaptation changes (negative affect). Changes in adaptation may alter tumor growth-promoting processes (increased angiogenesis, migration and invasion, and inflammation) and tumor defense processes (decreased cellular immunity) relevant for cancer progression and the quality of life of cancer patients. Some evidence suggests that psychosocial intervention can improve psychological and physiological adaptation indicators in cancer patients. However, less is known about whether these interventions can influence tumor activity and tumor growth-promoting processes and whether changes in these processes could explain the psychosocial intervention effects on recurrence and survival documented to date. Documenting that psychosocial interventions can modulate molecular activities (e.g., transcriptional indicators of cell signaling) that govern tumor promoting and tumor defense processes on the one hand, and clinical disease course on the other is a key challenge for biobehavioral oncology research. This mini-review will summarize current knowledge on psychological and physiological adaptation processes affected throughout the stress of the cancer experience, and the effects of psychosocial interventions on psychological adaptation, cancer disease progression, and changes in stress-related biobehavioral processes that may mediate intervention effects on clinical cancer outcomes. Very recent intervention work in breast cancer will be used to illuminate emerging trends in molecular probes of interest in the hope of highlighting future paths that could move the field of biobehavioral oncology intervention research forward.
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.
To evaluate the effects of a behavioral intervention, Tai Chi Chih (TCC) on circulating markers of inflammation in older adults.
A prospective, randomized, controlled trial with allocation to two arms, TCC and health education (HE), 16 weeks of intervention administration, and 9 weeks follow-up.
A total of 83 healthy older adults, aged 59 to 86 years.
The primary endpoint was circulating levels of interleukin 6 (IL-6). Secondary outcomes were circulating levels of C-reactive protein, soluble IL-1 receptor antagonist, soluble IL-6 receptor, soluble intercellular adhesion molecule, and IL-18. Severity of depressive symptoms, sleep quality, and physical activity was also assessed over the treatment trial.
Among those older adults with high levels of IL-6 at entry, a trend for a treatment group by time interaction was found (F[1,70] = 3.48, p = 0.07), in which TCC produced a drop of IL-6 levels comparable to those found in TCC and HE subgroups who had low levels of IL-6 at entry (t72's = 0.80, 1.63, p's >0.10), whereas IL-6 in HE remained higher than the TCC and HE subgroups with low entry IL-6 (t72 = 2.47, p = 0.02; t72 = 1.71, p = 0.09). Decreases in depressive symptoms in the two treatment groups correlated with decreases of IL-6 (r = 0.28, p <0.05). None of the other cellular markers of inflammation changed in TCC versus HE.
TCC can be considered a useful behavioral intervention to reduce circulating levels of IL-6 in older adults who show elevated levels of this inflammatory marker and are at risk for inflammation-related morbidity.
The mediators and cellular effectors of inflammation are important constituents of the local environment of tumours. In some types of cancer, inflammatory conditions are present before a malignant change occurs. Conversely, in other types of cancer, an oncogenic change induces an inflammatory microenvironment that promotes the development of tumours. Regardless of its origin, 'smouldering' inflammation in the tumour microenvironment has many tumour-promoting effects. It aids in the proliferation and survival of malignant cells, promotes angiogenesis and metastasis, subverts adaptive immune responses, and alters responses to hormones and chemotherapeutic agents. The molecular pathways of this cancer-related inflammation are now being unravelled, resulting in the identification of new target molecules that could lead to improved diagnosis and treatment.
To evaluate the effects of a behavioral intervention, Tai Chi, on resting and vaccine-stimulated levels of cell-mediated immunity (CMI) to varicella zoster virus (VZV) and on health functioning in older adults.
A prospective, randomized, controlled trial with allocation to two arms (Tai Chi and health education) for 25 weeks. After 16 weeks of intervention, subjects were vaccinated with VARIVAX, the live attenuated Oka/Merck VZV vaccine licensed to prevent varicella.
Two urban U.S. communities between 2001 and 2005.
A total of 112 healthy older adults aged 59 to 86.
The primary endpoint was a quantitative measure of VZV-CMI. Secondary outcomes were scores on the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36).
The Tai Chi group showed higher levels of VZV-CMI than the health education group (P<.05), with a significant rate of increase (P<.001) that was nearly twice that found in the health education group. Tai Chi alone induced an increase in VZV-CMI that was comparable in magnitude with that induced by varicella vaccine, and the two were additive; Tai Chi, together with vaccine, produced a substantially higher level of VZV-CMI than vaccine alone. The Tai Chi group also showed significant improvements in SF-36 scores for physical functioning, bodily pain, vitality, and mental health (P<.05).
Tai Chi augments resting levels of VZV-specific CMI and boosts VZV-CMI of the varicella vaccine.
Nearly two-thirds of elderly patients treated for depression fail to achieve symptomatic remission and functional recovery with first-line pharmacotherapy. In this study, we ask whether a mind-body exercise, Tai Chi Chih (TCC), added to escitalopram will augment the treatment of geriatric depression designed to achieve symptomatic remission and improvements in health functioning and cognitive performance.
: One hundred twelve older adults with major depression age 60 years and older were recruited and treated with escitalopram for approximately 4 weeks. Seventy-three partial responders to escitalopram continued to receive escitalopram daily and were randomly assigned to 10 weeks of adjunct use of either 1) TCC for 2 hours per week or 2) health education (HE) for 2 hours per week. All participants underwent evaluations of depression, anxiety, resilience, health-related quality of life, cognition, and inflammation at baseline and during 14-week follow-up.
Subjects in the escitalopram and TCC condition were more likely to show greater reduction of depressive symptoms and to achieve a depression remission as compared with those receiving escitalopram and HE. Subjects in the escitalopram and TCC condition also showed significantly greater improvements in 36-Item Short Form Health Survey physical functioning and cognitive tests and a decline in the inflammatory marker, C-reactive protein, compared with the control group.
: Complementary use of a mind-body exercise, such as TCC, may provide additional improvements of clinical outcomes in the pharmacologic treatment of geriatric depression.
This study aimed to validate the effects of a simplified, gentle form of t'ai chi chuan in patients with type 2 diabetes and who are also obese.
The study was designed to be a randomized controlled trial.
This study was conducted in the department of metabolism and endocrinology at Cheng Ching Hospital, in Taichung, Taiwan.
The study subjects were hospital-based patients with type 2 diabetes and who were also obese (ages 40-70, with a body-mass index [BMI] range of 30-35). The patients were randomly selected and grouped into t'ai chi exercise (TCE) and conventional exercise (CE) groups.
After receiving instruction in t'ai chi, the TCE group and the CE group practiced three times per week, including one practice session lasting up to 1 hour, for 12 weeks.
Hemoglobin A1C, serum lipid profile, serum malondialdehyde, and C-reactive protein were measured. Physical parameters of body weight and BMI were also measured. Diet and medications of participants were monitored carefully while biochemical and physical conditions were analyzed.
After 12 weeks, hemoglobin A1C values of the TCE group did not decrease (8.9 ± 2.7% : 8.3 ± 2.2%; p = 0.064). BMI (33.5 ± 4.8 : 31.3 ± 4.2; p = 0.038) and serum lipids, including triglyceride (214 ± 47 mg/dL : 171 ± 34 mg/dL; p = 0.012) and high density lipoprotein cholesterol (38 ± 16 mg/dL : 45 ± 18 mg/dL; p = 0.023) had significant improvements. Serum malondialdehyde tended to decrease from baseline (2.66 ± 0.78 μmol/L : 2.31 ± 0.55 μmol/L; p = 0.035), and C-reactive protein also decreased (0.39 ± 0.19 mg/dL : 0.22 ± 0.15 mg/dL; p = 0.014). No improvements occurred in BMI, lipids, and oxidative stress profiles in the CE group.
T'ai chi exercise practiced by patients who are obese and have type 2 diabetes is efficient and safe when supervised by professionals and helps improve parameters, such as BMI, lipid profile, C-reactive protein, and malondialdehyde. Periodic monitoring of blood glucose, blood pressure, heart rate, breathing, physical fitness, and symptoms of discomfort of patients who exercise helps prevent injury. Simple, gentle TCE can be applied as regular daily exercise for patients with type 2 diabetes even when such patients are obese.
On page #### of this issue, Pierce and colleagues 1 present some of the most persuasive evidence yet that chronic inflammation might increase the risk of breast cancer recurrence. In a multi-site study of 734 women treated successfully for early stage breast cancer, high levels of circulating acute phase proteins (APPs) ~3 years after treatment were associated with a 2-fold elevation in the risk of subsequent disease recurrence and mortality. Risk ratios were similar across primary tumor types (stage, ER/PR status), and independent of potential confounders such as age, estrogen level, and adiposity. These results are consistent with previous studies linking circulating inflammatory markers to progression of metastatic breast cancer 2–8. However, the findings of Pierce et al. are novel in suggesting that serum inflammatory markers might provide early information about disease recurrence risk in patients with no history of metastatic disease and no current evidence of cancer. If the present findings are replicated in larger cohorts with more recurrent cases, post-treatment APP monitoring could provide new a strategy for assessing the risk of breast cancer recurrence in apparently cured patients.
Complementary and alternative medicine (CAM) use has increased in recent years, with at least 42% of individuals in the United States using some form of CAM in 1997. CAM includes a variety of modalities, ranging from nutritionally based interventions to behavioral techniques. This article reviews the status of CAM use among women with breast cancer. Patients are increasingly incorporating CAM into cancer prevention and treatment regimens. The prevalence of CAM use by breast cancer patients varies; however, it is typically higher than among individuals in the general population. Commonly used CAMs among women with breast cancer include nutritional/dietary supplements, relaxation strategies, and various types of social support groups. Apart from psychosocial interventions, little scientific evidence exists regarding the efficacy of CAM use for breast cancer patients. A common theme seen in many studies is that CAM use in women with breast cancer is highly correlated with increased psychosocial distress.
This study examined the effect of a cognitive-behavioral stress management (CBSM) intervention on emotional well-being and immune function among women in the months following surgery for early-stage breast cancer.
Twenty-nine women were randomly assigned to receive either a 10-week CBSM intervention (n=18) or a comparison experience (n=11). The primary psychological outcome measure was benefit finding. The primary immune function outcome measure was in vitro lymphocyte proliferative response to anti CD3.
Women in the CBSM intervention reported greater perceptions of benefit from having breast cancer compared to the women in the comparison group. At 3-month follow-up, women in the CBSM group also had improved lymphocyte proliferation. Finally, increases in benefit finding after the 10-week intervention predicted increases in lymphocyte proliferation at the 3-month follow-up.
A CBSM intervention for women with early-stage breast cancer facilitated positive emotional responses to their breast cancer experience in parallel with later improvement in cellular immune function.
We sought to investigate the effects of sleep loss on high-sensitivity C-reactive protein (CRP) levels.
Concentrations of high-sensitivity CRP are predictive of future cardiovascular morbidity. In epidemiologic studies, short sleep duration and sleep complaints have also been associated with increased cardiovascular morbidity. Two studies were undertaken to examine the effect of acute total and short-term partial sleep deprivation on concentrations of high-sensitivity CRP in healthy human subjects.
In Experiment 1, 10 healthy adult subjects stayed awake for 88 continuous hours. Samples of high-sensitivity CRP were collected every 90 min for 5 consecutive days, encompassing the vigil. In Experiment 2, 10 subjects were randomly assigned to either 8.2 h (control) or 4.2 h (partial sleep deprivation) of nighttime sleep for 10 consecutive days. Hourly samples of high-sensitivity CRP were taken during a baseline night and on day 10 of the study protocol.
The CRP concentrations increased during both total and partial sleep deprivation conditions, but remained stable in the control condition. Systolic blood pressure increased across deprivation in Experiment 1, and heart rate increased in Experiment 2.
Both acute total and short-term partial sleep deprivation resulted in elevated high-sensitivity CRP concentrations, a stable marker of inflammation that has been shown to be predictive of cardiovascular morbidity. We propose that sleep loss may be one of the ways that inflammatory processes are activated and contribute to the association of sleep complaints, short sleep duration, and cardiovascular morbidity observed in epidemiologic surveys.
Inflammation is associated with increased risk of cardiovascular disorders, arthritis, diabetes mellitus, and mortality. The effects of sleep loss on the cellular and genomic mechanisms that contribute to inflammatory cytokine activity are not known.
In 30 healthy adults, monocyte intracellular proinflammatory cytokine production was repeatedly assessed during the day across 3 baseline periods and after partial sleep deprivation (awake from 11 pm to 3 am). We analyzed the impact of sleep loss on transcription of proinflammatory cytokine genes and used DNA microarray analyses to characterize candidate transcription-control pathways that might mediate the effects of sleep loss on leukocyte gene expression.
In the morning after a night of sleep loss, monocyte production of interleukin 6 and tumor necrosis factor alpha was significantly greater compared with morning levels following uninterrupted sleep. In addition, sleep loss induced a more than 3-fold increase in transcription of interleukin 6 messenger RNA and a 2-fold increase in tumor necrosis factor alpha messenger RNA. Bioinformatics analyses suggested that the inflammatory response was mediated by the nuclear factor kappaB inflammatory signaling system as well as through classic hormone and growth factor response pathways.
Sleep loss induces a functional alteration of the monocyte proinflammatory cytokine response. A modest amount of sleep loss also alters molecular processes that drive cellular immune activation and induce inflammatory cytokines; mapping the dynamics of sleep loss on molecular signaling pathways has implications for understanding the role of sleep in altering immune cell physiologic characteristics. Interventions that target sleep might constitute new strategies to constrain inflammation with effects on inflammatory disease risk.
Accumulating evidence suggests that sleep disturbance is associated with inflammation and related disorders including cardiovascular disease, arthritis, and diabetes mellitus. This study was undertaken to test the effects of sleep loss on activation of nuclear factor (NF)-kappaB, a transcription factor that serves a critical role in the inflammatory signaling cascade.
In 14 healthy adults (seven women; seven men), peripheral blood mononuclear cell NF-kappaB was repeatedly assessed, along with enumeration of lymphocyte subpopulations, in the morning after baseline sleep, partial sleep deprivation (awake from 11 pm to 3:00 am), and recovery sleep.
In the morning after a night of sleep loss, mononuclear cell NF-kappaB activation was significantly greater compared with morning levels following uninterrupted baseline or recovery sleep, in which the response was found in female but not in male subjects.
These results identify NF-kappaB activation as a molecular pathway by which sleep disturbance may influence leukocyte inflammatory gene expression and the risk of inflammation-related disease.
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com) for pro-viding music during the TCC session; and the intervention instructors Jennifer Levin; Roberta Taggert). ClinicalTrials.gov, NCT00690196. The authors report no conflicts of interest. Affiliations of authors: Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience
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Merrill Collins (www.SpiralingMusic.com) for pro-viding music during the TCC session; and the intervention instructors (Kate Hollister, Jennifer Levin; Roberta Taggert). ClinicalTrials.gov, NCT00690196. The authors report no conflicts of interest. Affiliations of authors: Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience, Los Angeles, CA (MRI, RO, ECB, TW, CC, NS, JMGA, JM, PN, JEB, SC);
UCLA David Geffen School of Medicine, Los Angeles, CA; Division of Health Policy and Management, UCLA Fielding School of Public HealthPAG); Division of Cancer Prevention and Control Research
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