Article

Tai Chi, Cellular Inflammation, and Transcriptome Dynamics in Breast Cancer Survivors With Insomnia: A Randomized Controlled Trial

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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. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

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... Among 26 articles, 13 articles met the inclusion criteria. [1][2][3][4][5][6][7][8][9][10][11][12][13] There were two sets of articles that describe the same studies. 3,4,7,8 The authors combined the two articles for one study, 3,4 and included one article for the other study. ...
... 3,4,7,8 The authors combined the two articles for one study, 3,4 and included one article for the other study. 8 Among the 11 studies, 9 studies were randomized controlled studies [1][2][3][4][5][6][8][9][10][11] and 2 studies were quasiexperimental studies. 12,13 Results Current randomized controlled studies on t'ai chi and chronic inflammation are summarized in Table 1. ...
... 12,13 Results Current randomized controlled studies on t'ai chi and chronic inflammation are summarized in Table 1. [1][2][3][4][5][6][8][9][10][11] Among these 9 studies, 3 were conducted in middle-aged or older cancer survivors, 3,4,6,9 4 studies were conducted in other subgroups of older adults (healthy older adults, and older adults with insomnia, depression, or mild cognitive impairment), 2,5,8,11 1 study was conducted in HIV-infected adults, 1 and 1 study was conducted in women with elevated cardiovascular disease risk. 10 All studies, except for 1, 10 included an active control group that received health education, cognitive behavioral therapy, or other interventions. ...
... No study could be selected for ayurveda, chelation, energy healing therapy, folk medicine, reiki, vitamin, massage, music therapy, and qi gong. Of the 40 studies selected, 12 focused on melatonin as possible intervention for insomnia disorder [60][61][62][63][64][65][66][67][68][69][70][71], 9 on meditative movement therapies [72][73][74][75][76][77][78][79][80] (particularly, n = 1 on yoga [72], 6 on mindfulness [73][74][75][78][79][80] and 2 on tai chi [76.77]), 7 on exercise [81][82][83][84][85][86][87], 5 on natural herbal pharmacotherapy [88][89][90][91][92], 2 on light exposure [93,94], 2 on transcranial magnetic stimulation (rTMS) [95,96], 1 on homeopathy [97], 1 on hypnotherapy [98], and 1 on dietary supplements [99]. Two studies which evaluated exercise [82,83], one study evaluating melatonin [61], and one study evaluating natural herbal pharmacotherapy [88] were not included in the meta-analysis as complete data were not available. ...
... Included studies focused on different age categories, specifically: 5 studies focused on children and adolescents (<18 years) [60][61][62]67,68], 23 studies focused on working-age adults (18-65 years) [70][71][72][73]75,78,79,[81][82][83][84]86,87,[89][90][91][92][94][95][96][97][98][99], and 2 studies focused on elderly (>65 years) [65,80]. Ten studies used mixed age samples with adult and elderly participants [63,64,66,69,74,76,77,85,87,93]. One study was composed of only male participants [86] and two studies of only female participants [72,73], while all other studies recruited mixed samples of both female and male participants. ...
... Twenty studies referred to the Diagnostic and Statistical Manual of Mental Disorder (n = 18, DSM IV; DSM IV TR; DSM-5) [62,63,65,66,68,[70][71][72][73]80,81,86,87,90,91,95,96,98] or the International statistical classification of diseases and related health problems (n = 2, ICD-10) [88,97] for the diagnosis of insomnia, two studies used International Classification of Sleep Disorders (ICSD) [92,93], three used the Research Diagnostic Criteria for Insomnia Disorder [78,82,83] and eight studies used more than one of these categorizations together [69,[76][77][78][79]82,84,89]. Of the remaining studies, seven used criteria consistent with DSM-5 categorization [60,62,64,67,85,89,94]. ...
Article
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Insomnia is a prevalent disorder and it leads to relevant impairment in health-related quality of life. Recent clinical guidelines pointed out that Cognitive-Behavior Therapy for Insomnia (CBT-I) should be considered as first-line intervention. Nevertheless, many other interventions are commonly used by patients or have been proposed as effective for insomnia. These include melatonin, light exposure, exercise, and complementary and alternative medicine. Evaluation of comparable effectiveness of these interventions with first-line intervention for insomnia is however still lacking. We conducted a systematic review and network meta-analysis on the effects of these interventions. PubMed, PsycInfo, PsycArticles, MEDLINE, and CINAHL were systematically searched and 40 studies were included in the systematic review, while 36 were entered into the meta-analysis. Eight network meta-analyses were conducted. Findings support effectiveness of melatonin in improving sleep-onset difficulties and of meditative movement therapies for self-report sleep efficiency and severity of the insomnia disorder. Some support was observed for exercise, hypnotherapy, and transcranial magnetic resonance, but the number of studies for these interventions is still too small. None of the considered interventions received superior evidence to CBT-I, which should be more widely disseminated in primary care.
... 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). ...
Article
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.
... 25 There are consistent reports of the benefits of Qigong for treating cancer-related fatigue and improving quality of life. 25,[31][32][33] Other benefits of Qigong in this cohort include the improvement of depression, anxiety, 12,33-37 cognitive function, 38 immune system markers, [38][39][40] and potentially survival. 41,42 Among the various styles of Qigong studied in cancer patients, 25 those involving Tai Chi, 32,40,[43][44][45] Chan Chuang 46 and Six Healing Sound Qigong 47 have reported significant improvement of sleep outcomes following the intervention. ...
... 25,[31][32][33] Other benefits of Qigong in this cohort include the improvement of depression, anxiety, 12,33-37 cognitive function, 38 immune system markers, [38][39][40] and potentially survival. 41,42 Among the various styles of Qigong studied in cancer patients, 25 those involving Tai Chi, 32,40,[43][44][45] Chan Chuang 46 and Six Healing Sound Qigong 47 have reported significant improvement of sleep outcomes following the intervention. 48 By contrast, one study of breast cancer survivors participating in 5 weeks of Guolin Qigong during radiotherapy did not detect any significant change in sleep. ...
... 33 Despite some inconsistent findings in the literature, a recent meta-analysis indicated that Qigong has a beneficial effect on sleep difficulty in cancer patients. 32 Several studies also suggest that Qigong has the potential to mediate the inflammatory response, [38][39][40]42 with growing evidence that Qigong and other mind-body training reduced the expression of inflammation-related genes and the activity of pro-inflammatory transcription factor Nf-kB. 49 As studies have shown a connection between chronic inflammation and immune suppression on sleep, 16,[50][51][52] the aforementioned findings suggest that Qigong may present significant clinical potential in the immunoprevention of insomnia in cancer patients. ...
Article
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Background Up to 80% of cancer patients experience insomnia that significantly affects their quality of life. This pilot qualitative study investigated the feasibility and effects of a 3-week Qigong (mind-body exercise) intervention with a 1-week follow-up in cancer patients experiencing insomnia. Methods Cancer patients with insomnia who had completed radiotherapy or chemotherapy treatment and/or were at least 8 weeks post-cancer-related surgery were recruited. Primary outcomes were feasibility outcomes, which included recruitment, retention, attendance, completion of assessment, adverse events and participant feedback via a questionnaire and focus group/individual interview. Secondary outcomes on insomnia severity and sleep quality were measured using the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI) at baseline, mid, post-intervention and follow-up. Results Seven participants were recruited and two withdrew from the study. The participant retention rate was 71.4% with an overall attendance rate of more than 84% and participants were able to complete all required assessments. An adverse event relating to the worsening of existing musculoskeletal condition was reported. Qualitative analysis of participant feedback identified 4 emerging themes: (1) experience from Qigong intervention; (2) class preferences; (3) barriers to participation; and (4) recommendation for improvement. Participants reported increased relaxation, improved sleep and energy level, better upper body flexibility and reduced stress. Both ISI and PSQI scores improved significantly ( P < .05). Conclusion This study demonstrated that it is feasible to employ the current clinical trial design using Qigong intervention on insomnia in cancer patients. Preliminary data suggest that the intervention may improve sleep outcomes, however, these findings need to be confirmed by future robust randomized controlled trials. Trial registration The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12618001670268) http://www.ANZCTR.org.au/ACTRN12618001670268.aspxon10October2018 .
... The studies found that the production of IL-6 and TNFα decrease dafter MBI practice. Irwin et al., 39 found that practice of Tai chi over 12 or 16 weeks restored the increasing amount (%) of monocyte expressing IL-6, TNF, and co-expressing IL-6 and TNF, significantly. 39 Interestingly, tai chi practice induced IL-6 and TNF level reduction after 2 months, and the effect maintained over one year during follow up. ...
... Irwin et al., 39 found that practice of Tai chi over 12 or 16 weeks restored the increasing amount (%) of monocyte expressing IL-6, TNF, and co-expressing IL-6 and TNF, significantly. 39 Interestingly, tai chi practice induced IL-6 and TNF level reduction after 2 months, and the effect maintained over one year during follow up. ...
... 43 Another study also showed that NF-κB decreased in breast cancer patients experiencing insomnia. 39 In elderly, MBIs have been proven to reduce loneliness rate and NF-kB level. 44 Even though the NF-κB expression decreased, but IRF1 activity increased in patients practicing MBIs. ...
Article
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Mind body interventions (MBIs) are exercise that emphasizes the use of brain and body to assist the healing process and to manage symptoms in order to improve wellbeing. The MBIs are expected to be a supporting therapy for patients with autoimmune disease such as systemic lupus erythematosus (SLE), to improve patients’ activities, reduce fatigue, stress, and depression.One type of MBIs that could be potentially applied in Indonesia is latihan pasrah diri (LPD). Studies showed that MBIs can affect the expression of pro- and anti-inflammatory mediators. Nuclear factor-κB(NF-κB) is a transcription factor that controls gene expression related to many physiological responses including inflammation, proliferation, cell differentiation, and apoptosis. NF-κB can be activated through canonical and alternative pathway. This literature review aimed to identify the role of NF-κB as consequence of practicing MBIs in SLE patients. We searched for relevant publications in the MEDLINE/Pub Med and Google Scholar with no date restriction. This review revealed that abnormal NF-κB could mediate autoimmune condition in SLE pathogenesis. MBIs are expected to be a supportive treatment that can help to control NF-κB expression in SLE patients. LPD as an Indonesian original MBI is expected as a suitable techniques that can be applied in patients with SLE in Indonesia. Further studies on the effect of LPD on NF-κB expression in patients with SLE need to be further explored.
... 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). ...
Article
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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.
... Elevations in systemic, cellular, and genomic markers of inflammation have been found in women with breast cancer who experience persistent post-treatment fatigue [66][67][68]. Prior randomized controlled trials have found that mind-body interventions are associated with robust and sustained (i.e., one-year follow-up) decreases in markers of systemic inflammation such as Creactive protein (CRP) and interleukin-6 (IL-6), decreases of TLR-4 stimulated production of pro-inflammatory cytokines, and decreases in the expression of genes regulated by the transcription factor NFκB [59,[69][70][71]. Further, Tai Chi and Qigong are also associated with decreased blood pressure and cortisol [44,48,[50][51][52]72,73]. While some studies did not find effects of mind-body interventions on pro-inflammatory cytokines [46,73], a recent meta-analysis [55] showed that mind-body interventions reduce markers of inflammation such as CRP and possibly IL-6, and reverse inflammatory gene expression profiles [69,70]. ...
... Prior randomized controlled trials have found that mind-body interventions are associated with robust and sustained (i.e., one-year follow-up) decreases in markers of systemic inflammation such as Creactive protein (CRP) and interleukin-6 (IL-6), decreases of TLR-4 stimulated production of pro-inflammatory cytokines, and decreases in the expression of genes regulated by the transcription factor NFκB [59,[69][70][71]. Further, Tai Chi and Qigong are also associated with decreased blood pressure and cortisol [44,48,[50][51][52]72,73]. While some studies did not find effects of mind-body interventions on pro-inflammatory cytokines [46,73], a recent meta-analysis [55] showed that mind-body interventions reduce markers of inflammation such as CRP and possibly IL-6, and reverse inflammatory gene expression profiles [69,70]. Seemingly inconsistent findings that may be due to variation in selection of the control condition [59,70,71], sample population, intervention protocol and fidelity, control for confounding factors, and length of treatment and follow-up, are addressed in this study design [19,59,70,71]. ...
... Further, Tai Chi and Qigong are also associated with decreased blood pressure and cortisol [44,48,[50][51][52]72,73]. While some studies did not find effects of mind-body interventions on pro-inflammatory cytokines [46,73], a recent meta-analysis [55] showed that mind-body interventions reduce markers of inflammation such as CRP and possibly IL-6, and reverse inflammatory gene expression profiles [69,70]. Seemingly inconsistent findings that may be due to variation in selection of the control condition [59,70,71], sample population, intervention protocol and fidelity, control for confounding factors, and length of treatment and follow-up, are addressed in this study design [19,59,70,71]. Overall, available literature provides compelling evidence that pro-inflammatory cytokines and the signaling pathways associated with inflammatory activation contribute to fatigue during and particularly after cancer treatment [59,[69][70][71]. ...
Article
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Fatigue is often one of the most commonly reported symptoms in prostate cancer survivors, but it is also one of the least understood cancer-related symptoms. Fatigue is associated with psychological distress, disruptions in sleep quality, and impairments in health-related quality of life. Moreover, inflammatory processes and changes related to the hypothalamic-pituitary-adrenal (HPA) axis and/or autonomic nervous system may also play a role in cancer-related fatigue. Thus, effective treatments for fatigue in prostate cancer survivors represent a current unmet need. Prior research has shown that Tai Chi Qigong, a mind-body exercise intervention, can improve physical and emotional health. Herein, we describe the protocol of the ongoing 3-arm randomized controlled Health Empowerment & Recovery Outcomes (HERO) clincal trial. One hundred sixty-six prostate cancer survivors with fatigue are randomized to a modified Tai Chi Qigong intervention (TCQ), intensity-matched body training intervention (BT), or usual care (UC) condition. Guided by biopsychosocial and psychoneuroimmunology models, we propose that TCQ, as compared to BT or UC will: i) reduce fatigue (primary outcome) in prostate cancer survivors; ii) reduce inflammation; and iii) regulate the expression of genes from two major functional clusters: a) inflammation, vasodilation and metabolite sensing and b) energy and adrenergic activation. Assessments are conducted at baseline, the 6-week midpoint of the intervention, and 1 week, 3 months, and 12 months post-intervention. If our findings show that TCQ promotes recovery from prostate cancer and its treatment, this type of intervention can be integrated into survivorship care plans as the standard of care. The study's findings will also provide novel information about underlying biobehavioral mechanisms of cancer-related fatigue. Trial registration number: NCT03326713; clinicaltrials.gov.
... 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. ...
Article
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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.
... Breast cancer is a chronical clinical setting with persistent symptoms of body and mind, and TCC may have a positive effect on it. Several clinical trials found TCC reduced inflammatory responses and improved quality of life, muscle strength, shoulder function, bone formation, and insomnia in breast cancer patients (37)(38)(39)(40)(41). Two early reviews published in 2007 and 2010, respectively, both found that the effect of TCC for breast cancer patients to improve QOL and symptoms was not definite (42,43). ...
... Dysregulation of the HPA axis and the increased levels of pro-inflammatory cytokines [interleukin (IL)-6 and tumor necrosis factor (TNF-α)] could produce fatigue (102). TCC decreases cortisol, IL-6 and TNFα in cancer survivors that might reduce cancer-related fatigue (35,37,103). TCC increases oxygen intake that might improve shoulder function and strength of in patients with breast cancer (104). ...
Article
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Background: Tai Chi Chuan(TCC), as a mind-body exercise, may have a positive impact on physical function and psychological well-being in breast cancer patients. The latest systematic review and meta-analysis of TCC for breast cancer was made 4 years ago and some new clinical trials about it were published. We remade a systematic review and meta-analysis to evaluate the effect of TCC in breast cancer patients. Methods: In this systematic review and meta-analysis, we searched MEDLINE (via PubMed), EMBASE (via embase.com), CENTRAL, CNKI, COVIP, Wanfang, Chaoxing, CiNii, J-SSTAGE, DBpia, and ThaiJO with no language restrictions from inception to December 31, 2018 (updated on February 16, 2020), for randomized clinical trials comparing TCC with non-exercised therapy in breast cancer patients. The primary outcome was quality of life in patients with breast cancer and data pooled by a random-effects model. Subgroup analyses were conducted to estimate the effect of different durations of TCC for breast cancer patients. This study was registered in PROSPERO, number CRD 4201810326. Results: Fifteen articles involving a total of 885 breast cancer participants were included in this review. Compared with non-exercised therapy, TCC had a significant effect on quality of life in breast cancer patients (SMD = 0.37, 95% CI 0.15–0.59, p = 0.001), and subgroup analysis found that TCC showed beneficial effect in 12 weeks and 25 weeks (12 weeks: SMD = 0.40, 95% CI 0.19–0.62, p = 0.0003; 25 weeks: SMD = 0.38, 95% CI 0.15–0.62, p = 0.002). Meta-analyses of secondary outcomes showed that 3 weeks TCC increased shoulder function (SMD = 1.08, 95% CI 0.28–1.87, p = 0.008), 12 weeks TCC improved pain (SMD = 0.30, 95% CI 0.08–0.51, p = 0.007), shoulder function (SMD = 1.34, 95% CI 0.43–2.25, p = 0.004), strength of arm (SMD = 0.44, 95% CI 0.20–0.68, p = 0.0004), and anxiety (MD = −4.90, 95% CI −7.83 to −1.98, p = 0.001) in breast cancer patients compared with the control group. Conclusions: TCC appears to be effective on some physical and psychological symptoms and improves the quality of life in patients with breast cancer. Additional randomized controlled trials with a rigorous methodology and low risk of bias are needed to provide more reliable evidence.
... Finally, 20 articles were included in this review (Fig. 1). Of these 20 articles, 13 were in English [30,[35][36][37][38][39][40][41][42][43][44][45][46], and the other seven in Chinese [47][48][49][50][51][52][53]. All articles were published between 2003 and 2017. ...
... All articles were published between 2003 and 2017. The four articles published by Mustian et al. [30,[43][44][45] and the two articles published by Irwin et al. [35,39] were each regarded as a single trial in this review due to the same group of participants: only two articles, i.e. one for each group of papers [30,35], were included in data analysis. Thus, 16 RCTs were finally included in this review [30,[35][36][37][38][40][41][42][46][47][48][49][50][51][52][53]. ...
Article
Background and purpose: Tai chi has been suggested as a potential effective intervention for improving function and wellbeing in breast cancer patients. This systematic review evaluated the current evidence for the effectiveness of tai chi in patients with breast cancer. Methods: Randomized Controlled Trials (RCTs) evaluating the effects of tai chi in breast cancer patients were identified through searches in OVID MEDLINE, AMED, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, CNKI, VIP, and Wanfang Data, up to June 2019. Meta-analyses were performed for results syntheses. Results: Sixteen RCTs involving 1268 participants were included in this review. It was demonstrated that tai chi is no different from conventional supportive care interventions in improving fatigue, sleeping quality, depression or body mass index at either 3 months or 6 months; however it significantly improves overall quality of life (QoL) at 3 months. Moreover, tai chi, when offered as an adjunct to conventional therapy, is more effective in improving fatigue at 3 months, and QoL at 3 months and 6 months compared to conventional therapy alone. Conclusion: Tai chi shows no improvement in fatigue compared with conventional supportive interventions, but it significantly relieves fatigue symptom for breast cancer patients when used with conventional supportive care interventions. Tai chi versus conventional supportive care interventions, and as an adjunct to conventional therapy is effective in improving QoL for breast cancer patients.
... 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]]. ...
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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.
... They reported that a 12-week Yang-style Tai Chi Chuan intervention for three times per week with 60 min per time can exert more positive effects on bone health of breast cancer patients. In 2011 and 2014, similar to what Oh et al. found, two studies examined the influences of Tai Chi Chuan exercise on inflammatory markers in breast cancer patients and also reported positive effects [27,28]. Twelve-week Yang-style Tai Chi Chuan intervention (60 min × 3 times/week) and 3-month Tai Chi Chuan intervention (120 min per week) were applied in the two studies, respectively. ...
... Twelve-week Yang-style Tai Chi Chuan intervention (60 min × 3 times/week) and 3-month Tai Chi Chuan intervention (120 min per week) were applied in the two studies, respectively. Besides the effects of TCE on inflammatory markers, the expression of genes encoding pro-inflammatory mediators was found lower after TCE by Irwin et al. [27], while Janelsins et al. [28] also reported that the level of insulin remained stable after TCE but increased after control intervention when compared to pre-intervention. However, conflicting results also emerged in recent years. ...
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Traditional Chinese exercise (TCE) has gradually become one of the widespread complementary therapies for treatment and recovery of cancers. However, evidence based on the systematic evaluation of its efficacy is lacking, and there appears to be no conclusion regarding the setting of TCE interventions. The purpose of this systematic review is to summarize the current randomized controlled trials (RCTs) that outline the effects of TCE on cancer patients. Relevant studies were searched by GOOGLE SCHOLAR, SCIENCEDIRECT, and WEB OF SCIENCE using "traditional Chinese exercise" and "cancer." Only RCTs published in peer-reviewed English journals were included. A total of 27 studies covering 1616 cancer patients satisfied the eligibility criteria for this review. Despite the methodological limitation and relatively high risk of bias possessed by some included studies, positive evidence was still detected on the effects of TCE on these cancer-related health outcomes in physical, psychological, and physiological parameters. The 60-min or 90-min course of TCE intervention for two to three times per week for 10 to 12 weeks was found to be the most common setting in these studies and has effectively benefited cancer patients. These findings add scientific support to encourage cancer patients to practice TCE during or after conventional medical treatment. Nevertheless, future well-designed RCTs with improved methodology and larger sample size on this field are much warranted for further verification.
... The benefits of mindfulness practices appear to extend beyond improving mental health outcomes, as we and others have found the mindfulness based interventions including mindfulness meditation, tai chi, and yoga, have robust effects on inflammatory biology [30][31][32][33][34]. Inflammation is found to be increased in persons experiencing social adversity, and because inflammation represents a key hallmark of chronic disease risk and biological aging [35][36][37], changes in inflammatory biology provide a mechanistic understanding of why stressed persons show increased risk for adverse physical and mental health outcomes [1,38]. ...
... The benefits of mindfulness practices appear to extend beyond improving mental health outcomes, as we and others have found the mindfulness based interventions including mindfulness meditation, tai chi, and yoga, have robust effects on inflammatory biology [30][31][32][33][34]. Inflammation is found to be increased in persons experiencing social adversity, and because inflammation represents a key hallmark of chronic disease risk and biological aging [35][36][37], changes in inflammatory biology provide a mechanistic understanding of why stressed persons show increased risk for adverse physical and mental health outcomes [1,38]. Indeed, mindfulness based interventions have been found to have robust effects to induce a down-regulation of inflammatory gene expression even after relatively short (6 week) interventions [32,34], with further evidence that monocyte production of proinflammatory cytokines in response to an inflammatory challenge is reduced as early as 8 weeks after onset of a mindfulness intervention [33,39]. Moreover, mindfulness based interventions can reduce circulating markers of inflammation such as C-reactive protein [40], a predictor of chronic disease risk including diabetes and cardiovascular disease [38], although it appears that these effects take longer to emerge (i.e., months) and may require more intensive practice of the treatment [31,32,41,42]. ...
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Objective: Latino immigrants experience acculturative stress and increased depression risk. Mindfulness meditation improves depressive symptoms, yet the vast majority of research has focused on English speaking populations. Methods: In this randomized clinical trial with 2 parallel treatment groups, adults with moderate levels of perceived stress (n = 76) were recruited from the Los Angeles community from October 2015 to March 2016, stratified into Spanish- (n = 36) and English speaking (n = 40) language groups, and randomized for 6 weeks of treatment with standardized mindful awareness practices (MAPs) or health education (HE). Main outcome measure was depressive symptoms, measured by the Beck Depression Inventory. Results: Using an intent-to-treat analysis, the primary outcome, depressive symptoms as indexed by the Beck Depression Inventory, showed greater improvement in MAPs vs. HE, with a between-group post-intervention mean difference of -2.2 (95% CI -4.4 - -0.07) and effect size of 0.28; similar effect sizes were found in the the Spanish- (0.29) and English speaking (0.30) groups. MAPs showed significant improvement relative to HE on secondary outcome of mindfulness with between group difference of 10.7 (95% CI4.5-16.9), but not perceived stress. Conclusion: The comparable efficacy of Spanish and English formats of mindfulness meditation in improving depressive symptoms suggests that this community based intervention may mitigate depression risk in Latino adults who are experiencing social adversity. Trial registration: ClinicalTrials.gov NCT03545074.
... 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. ...
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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.
... For example, a series of studies have linked pro-social behavior to reduced CTRA expression (Nelson-Coffey et al., 2017;Seeman, Merkin, Goldwater, & Cole, 2019); these finding revealed significant reductions in CTRA gene expression in people who performed kind acts for others over a 5-week period or participated in a 9-month pro-social intergenerational helping program. Furthermore, well-being practices such as mindfulness meditation, mind-body therapies such as Tai Chi, and stress management are also associated with reduced expression of inflammatory genes (Black et al., 2013;Boyle et al., 2019;Creswell et al., 2012;Irwin et al., 2014). ...
... In addition to the focus on inflammatory, immune, antiviral, and oxidative stress pathways (Bhasin et al., 2013;Black et al., 2014;Dhawan et al., 2018;Guatam et al., 2019;Harkess et al., 2016;Irwin et al., 2014;Irwin et al., 2015;Kaliman et al., 2014;Li et al., 2005;Sharma et al., 2008), the review found numerous studies that investigated the effect of alternative approaches on telomere length and activity (Conklin et al., 2018;Epel et al., 2016;Gautam et al., 2019;Hoge et al., 2013;M. Tolahunase et al., 2017;M. ...
Article
Incorporating omics into non-pharmacological intervention research design could provide a better understanding of the variability in response to these interventions. It would also provide evidence for precision-based non-pharmacological interventions, including interventions focused on symptoms. The purpose of this manuscript was to present examples of studies that have used omics to examine response to non-pharmacological intervention. Using the interventions of exercise, diet (related to obesity), cognitive based therapy, and alternative mind-body practices (meditation, yoga, and tai chi), PubMed was searched to identify studies that incorporated genomic or other omic approaches as part of a non-pharmacological intervention. The review identified genes associated with the effectiveness of each of the interventions. Although there were no genes that were associated with all four interventions, there were nine genes that were the focus of more than one intervention ( ACE, BDNF, COMT, CXCL8, IL6, SL6A4, TNF, GSTM1, PTGER3). All nine of these genes were either directly or indirectly biologically related to one another, suggesting that this cadre of genes could serve as an initiation point for investigations using omic approaches to better understand response to non-pharmacological interventions.
... Differential CTRA activity may potentially contribute to the favorable health effects associated with positive psychological well-being, as eudaimonic dimensions such as having purpose in life and experiencing personal growth have also been linked to increased longevity 2 across adult life (Hill and Turiano, 2014;Steptoe et al., 2015;Zaslavsky et al., 2014). More broadly, these findings are also consistent with research connecting reduced CTRA to other positive psychological processes including cognitive-behavioral stress management ( Antoni et al., 2012), and to lifestyle practices such as yoga, meditation, mindfulness, and Tai Chi ( Black et al., 2013;Bower et al., 2014;Creswell et al., 2012;Irwin et al., 2014). Such research suggests that experiencing life and social relationships as meaningful might favorably affect health, particularly given that elevated CTRA is associated with increased risk of several disease states (Cole, 2013(Cole, , 2019Cole, Capitanio, et al., 2015;Knight et al., 2016;Simons et al., 2017). ...
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Previous research has identified a link between experiencing life as meaningful and purposeful—what is referred to as “eudaimonia”—and reduced expression of a stress-induced gene profile known as the “conserved transcriptional response to adversity” (CTRA). In the current study, we examine whether similar links between eudaimonic well-being and CTRA reduction occur in a sample of 56 individuals with a particularly strong engagement with virtual worlds: avid online videogame players. Results consistently linked higher eudaimonic well-being, and more specifically the social well-being subdomain of eudaimonia, to lower levels of CTRA gene expression. That favorable psychobiological relationship between eudaimonia and CTRA appeared most strongly among individuals reporting high levels of positive psychosocial involvement with gaming. Findings are consistent with the hypothesis that committed social/recreational activity may help damp CTRA expression especially among persons who are already experiencing some kind of threshold of positive eudaimonic experience.
... 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]. ...
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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.
... 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. ...
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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. ...
Article
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.
... 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. ...
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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.
... 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. ...
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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.
... 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. ...
Article
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. ...
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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.
... 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). ...
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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.
... 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). ...
Article
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. ...
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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.
Article
Most chronic diseases, caused by lifestyle factors, appear to be linked to inflammation. Inflammation is activated mechanistically, and nuclear factor-κB (NF-κB) is a significant mediator. NF-κB, one of the most studied transcription factors, was first identified in the nucleus of B lymphocytes almost three decades ago. This protein has a key function in regulating the human immune system, and its dysregulation has been linked to many chronic diseases including asthma, cancer, diabetes, rheumatoid arthritis, inflammation, and neurological disorders. Physiologically, many cytokines have been discovered that activate NF-κB. Pathologically, environmental carcinogens such as cigarette smoke, radiation, bacteria, and viruses can also activate this transcription factor. NF-κB activation controls expression of more than 500 genes, and most are deleterious to the human body when dysregulated. More than 70,000 articles have been published regarding NF-κB. This review emphasizes the upside and downside of NF-κB in normal and disease conditions and the ways in which we can control this critical transcription factor in patients.
Article
Gene expression profiling studies of people exposed to chronic threat have identified a Conserved Transcriptional Response to Adversity (CTRA) in circulating immune cells. This physiological pattern is characterized by up-regulated expression of genes involved in inflammation and down-regulated expression of genes involved in Type I interferon responses. The CTRA is mediated by beta-adrenergic signaling pathways that transduce sympathetic nervous system activity into changes in transcription factor activity and hematopoietic output of myeloid lineage immune cells (monocytes, neutrophils, and dendritic cells). Recent research has begun to identify the CNS processes that regulate peripheral CTRA activity, define its implications for disease, and explore the role of positive psychosocial factors in buffering such effects. The CTRA provides a genomic framework for understanding PNI relationships and connecting macro-level psychosocial processes to the micro-level biology of health and disease.
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The review describes the major mechanisms for the initiation and maintenance of comorbid insomnia and arterial hypertension based on the relevant pathogenetic scenarios of insomnia such as the concept of sympathetic activation, the neurobiological model of insomnia, and stress-diathesis model (or 3-P model). The clinical data are lacking, and available clinical studies indicate the association between blood pressure levels and the hyperactivation of the central nervous system during sleep, characterized by electroencephalographic β-activity, and with sleep latency. However, biologically active substances involved in “neurogenic inflammation” also play a significant role in homeostasis maintenance following the exposure to endogenous and exogenous stress factors. The functions of interleukin-6, gamma-aminobutyric acid, substance P, melatonin, serotonin and orexin in normal and pathological conditions indicate their contribution to the development of comorbid insomnia and hypertension. We emphasize the role of insomnia as a separate nosological unit, comorbid with hypertension, as well as the importance of research of molecular mechanisms underlying the association between insomnia and arterial hypertension aimed at identification of therapeutic targets and prognostic markers.
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The discovery of reciprocal connections between the central nervous system, sleep and the immune system has shown that sleep enhances immune defences and that afferent signals from immune cells promote sleep. One mechanism by which sleep is proposed to provide a survival advantage is in terms of supporting a neurally integrated immune system that might anticipate injury and infectious threats. However, in modern times, chronic social threats can drive the development of sleep disturbances in humans, which can contribute to the dysregulation of inflammatory and antiviral responses. In this Review, I describe our current understanding of the relationship between sleep dynamics and host defence mechanisms, with a focus on cytokine responses, the neuroendocrine and autonomic pathways that connect sleep with the immune system and the role of inflammatory peptides in the homeostatic regulation of sleep. Furthermore, I discuss the therapeutic potential of harnessing these reciprocal mechanisms of sleep–immune regulation to mitigate the risk of inflammatory and infectious diseases. Sleep enhances immune defences, and afferent signals from immune cells promote sleep. However, in response to chronic stressors, the normally adaptive function of sleep can become dysregulated, with implications for inflammatory and antiviral responses.
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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.
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The field of psychoneuroimmunology (PNI) examines interactions among psychological and behavioral states, the brain, and the immune system. Research in PNI has elegantly documented effects of stress at multiple levels of the neuro‐immune network, with profound implications for both physical and mental health. In this review, we consider how the neuro‐immune network might be influenced by “positive” psychological and behavioral states, focusing on positive affect, eudaimonic well‐being, physical activity, and sleep. There is compelling evidence that these positive states and behaviors are associated with changes in immune activity in the body, including reductions in peripheral inflammatory processes relevant for physical health. Growing evidence from animal models also suggests effects of positive states on immune cells in the brain and the blood‐brain barrier, which then impact critical aspects of mood, cognition, and behavior. Tremendous advances are being made in our understanding of neuro‐immune dynamics; one of the central goals of this review is to highlight recent preclinical research in this area and consider how we can leverage these findings to investigate and cultivate a healthy neuro‐immune network in humans.
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Introduction: Insomnia is a prevalent and significant public health concern. Insomnia can lead to increased inflammatory markers associated with chronic diseases such as cardiovascular disease, diabetes, and cancer. Studies suggest that mindfulness-based interventions (MBIs) are more easily delivered within the community than Cognitive Behavioral Therapy for insomnia (CBT-I) which was recommended as the preferred non-pharmacological treatment by the American Academy of Sleep Medicine, are effective in insomnia treatment, and can reduce inflammatory markers level in older individuals with insomnia. This study aims to compare the effectiveness of a MBI to CBT-I in young and middle-aged individuals with insomnia disorder and explore its effect on nuclear factor kappa B (NF-κB), a transcription factor that controls the expression of genes involved in inflammation. Methods and analysis: This report describes a protocol for a randomized controlled trial. Seventy eligible participants will be assigned to Mindfulness-Based Joyful Sleep (MBJS) or CBT-I for 2-hour sessions weekly for 8 weeks. The primary outcome is sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI), severity of insomnia symptoms assessed by the Insomnia Severity Index (ISI), and sleep parameters recorded using sleep diary and polysomnography (PSG). Secondary outcomes include perceived stress, anxiety, and depression.The exploratory outcome is serum level of NF-κB. Outcomes will be evaluated at baseline, the end of the Intervention Period, and at a 3-month follow-up. Data will be analyzed using general linear models, specifically analysis of covariance and analysis of variance will be used.
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Background: Sleep problems affect physical and emotional well-being as well as immune system function. Evidence has demonstrated an improvement in sleep problems in patients with cancer through the use of mind-body medicine (MBM). In the current study, the authors sought to elucidate the prevalence of sleep problems and the use of MBM in adult cancer survivors. Methods: The authors analyzed data from the 2017 US National Health Interview Survey (NHIS) to estimate the prevalence of sleep problems and use of MBM in adult cancer survivors using means, standard deviations, weighted frequencies, and distributions. Backward stepwise multiple logistic regression analyses were used to identify independent predictors of MBM use within the past 12 months: age, sex, ethnicity, region, educational level, employment, and time since cancer diagnosis. Results: A weighted total of 13,750,028 cancer survivors (59.2%) reported sleep problems. For the most part, survivors with sleep problems were aged ≥40 years, female, and non-Hispanic white. More survivors with (weighted N = 3,794,493; 27.6%) compared with without (weighted N = 1,695,435; 17.9%) sleep problems used MBM. Among cancer survivors with sleep problems, the most commonly used mind-body practice was spiritual meditation (weighted N = 1,972,578; 14.3%), followed by yoga (weighted N = 1,695,553; 17.9%). The use of MBM was independently predicted by being female, living in the western United States, having a higher educational level, and being employed. Conclusions: The high prevalence of sleep problems in cancer survivors is a major health issue that needs to be addressed. A considerable number of cancer survivors with sleep problems use MBM. This finding warrants the investigation of MBM concepts as treatment options for cancer survivors experiencing sleep problems.
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Tai Chi Chuan (TCC) is a traditional Chinese exercise, its movement is slow in order to achieve a state of relaxation and balance of both body and mind. TCC shows positive effects in relieving symptoms in patients with chronic diseases and malignant diseases after treatment. Research has proven that TCC helps improve the quality of life in breast cancer patients who had undergone surgery and chemotherapy. Studies have also demonstrated that TCC may exert its effects psychologically and physiologically. In order to document current researches of TCC in a scientific way, we tried to evaluate the changes of biological markers in breast cancer survivors who has been practicing TTC and its potential benefits in reducing treatment-related adverse effects, improving immunity and personal wellbeing. Cancer survivors suffer from a variety of psychological responses including depression, sadness, anxiety, fear and adverse effects from surgery and chemotherapy. Some studies confirmed that cancer survivors’ physical and psychological functions can be improved by regular exercises. Many studies have shown that regular physical exercises are particularly important in reducing the incidence and recurrence of breast cancer, prolonging the survival of patients and even improving the side effects during and after the treatment. It has also been linked to a better quality of life (QoL) for breast cancer survivors. After surgery, the shoulder function of breast cancer survivors would be impaired and their arms would show signs and symptoms including diminished tactile sensation in the arm or armpit, weakness, stiffness and lymphedema of the surgical sided arm. Conventional exercises such as running and/or swimming involves rigorous arm movements which require full mobility of the arms and legs. Such exercises are not recommended immediately following surgery. TCC exercises may help regain upper limb functional mobility for breast cancer survivors by slow and continuous movement of upper limb. Practicing TCC in a smooth and relaxed way will lessen tension and promote relaxation which may alleviate stress, depression and anxiety. TCC has been demonstrated in improving psychological well-being of breast cancer survivors by reducing anxiety or depression through stabilizing the level of cortisol and serotonin. Studies showed that TCC improves immunity in breast cancer survivors by means of hematological markers and cytokines. In this review, there were only four randomized controlled trials have made use of biological markers to monitor the effects of TCC in breast cancer survivors although most researchers tend to assess by means of aerobic capacity, muscular strength, and flexibility, as well as QOL. None of the studies investigated the relationship between TCC and treatment-related adverse effects or immunity through changes in biological markers. Therefore, researchers could develop the use of more cytokines, stressors (melatonin), activated natural killer cells, free radicals, biochemical markers or c-miRNAs to determine the effects of TCC.
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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.
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Background: Effective preventative health interventions are essential to maintain well-being among healthcare professionals and the public, especially during times of health crises. Several studies have suggested that Tai Chi and Qigong (TQ) have positive impacts on the immune system and its response to inflammation. The aim of this review is to evaluate the current evidence of the effects of TQ on these parameters. Methods: Electronic searches were conducted on databases (Medline, PubMed, Embase and ScienceDirect). Searches were performed using the following keywords: “Tai Chi or Qigong” and “immune system, immune function, immunity, Immun*, inflammation and cytokines”. Studies published as full-text randomized controlled trials (RCTs) in English were included. Estimates of change in the levels of immune cells and inflammatory biomarkers were pooled using a random-effects meta-analysis where randomised comparisons were available for TQ versus active controls and TQ versus non-active controls. Results: Nineteen RCTs were selected for review with a total of 1686 participants and a range of 32 to 252 participants within the studies. Overall, a random-effects meta-analysis found that, compared with control conditions, TQ has a significant small effect of increasing the levels of immune cells (SMD, 0.28; 95% CI, 0.13 to 0.43, p = 0.00), I2 = 45%, but not a significant effect on reducing the levels of inflammation (SMD, −0.15; 95% CI, −0.39 to 0.09, p = 0.21), I2 = 85%, as measured by the systemic inflammation biomarker C-reactive protein (CRP) and cell mediated biomarker cytokines. This difference in results is due to the bidirectional regulation of cytokines. An overall risk of bias assessment found three RCTs with a low risk of bias, six RCTs with some concerns of bias, and ten RCTs with a high risk of bias. Conclusions: Current evidence indicates that practising TQ has a physiologic impact on immune system functioning and inflammatory responses. Rigorous studies are needed to guide clinical guidelines and harness the power of TQ to promote health and wellbeing.
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Many studies have consistently demonstrated an epigenetic link between environmental stimuli and physiological as well as cognitive responses. Epigenetic mechanisms represent a way to regulate gene activity in real time without modifying the DNA sequence, thus allowing the genome to adapt its functions to changing environmental contexts. Factors such as lifestyle, behavior, and the practice of sitting and moving mindful activities have been shown to be important means of environmental enrichment. Such practices, which include mindfulness meditation, Vipassana, Yoga, Tai Chi, and Quadrato Motor Training, have been reported to positively impact well-being. In fact, they can be considered emotional and attentional regulatory activities, which, by inducing a state of greater inner silence, allow the development of increased self-awareness. Inner silence can therefore be considered a powerful tool to counteract the negative effects of overabundant environmental noise, thanks to its power to relieve stress-related symptoms. Since all these positive outcomes rely on physiological and biochemical activities, the molecular and epigenetic mechanisms influenced by different mindful practices have recently started to be investigated. Here, we review some of the findings that could allow us to uncover the mechanisms by which specific practices influence well-being.
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Breast cancer diagnosis, surgery, adjuvant therapies and survivorship can all be extremely stressful. In women, concerns about body image are common as a result of the disease and can affect interpersonal relationships, possibly leading to social isolation, increasing the likelihood for mood disorders. This is particularly relevant as women are at greater risk to develop anxiety and depressive symptoms in response to highly stressful situations. Here we address the mechanisms and the pathways activated as a result of stress and contributing to changes in the pathophysiology of breast cancer, as well as the potential of stress management factors and interventions in buffering the deleterious effects of chronic stress in a gender perspective. An improved understanding of the biological mechanisms linking stress-management resources to health-relevant biological processes in breast cancer patients could reveal novel therapeutic targets and help clarifying which psychosocial interventions can improve cancer outcomes, ultimately offering a unique opportunity to improve contemporary cancer treatments.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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%).
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
Article
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.
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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.