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Martial arts: mindful exercise to combat stress

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Stress can promote cardiovascular and metabolic responses that may favor the development of a number of diseases, especially when it is experienced chronically. Mindfulness (MF) practices are adaptations from eastern meditative techniques which are utilized in different psycho-social therapies for promotion of physical and mental health. The psychological construct of MF refers to a special form of attention to internal and external phenomena in the present moment, including openness to experience in a non-critical attitude (i.e. without judgments). Mindfulness-based practices and interventions are particularly effective in promoting health for clinical conditions involving chronic stress, anxiety and depressive symptoms. Similarly, regular exercise has multifarious benefits for health, especially activities that strongly integrate both psychological and physiological training. Such is the case for martial arts (MA), the whole of which could be classified as mindful movements. Given that MA requires expenditure of energy done with a high level of concentration, engagement in this form of exercise may provide an interesting and novel strategy for enhancing physical and mental benefits. The regular practice of MA could elevate MF levels of practitioners and thus influence positively on stress management and therefore quality of life and well-being.
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European Journal of Human Movement, 2015: 34, 34-51
MARTIAL ARTS: MINDFUL EXERCISE
TO COMBAT STRESS
Wesley Naves-Bittencourt 1; Arilson Mendonça-de-Sousa 1;
Matthew Stults-Kolehmainen 2; Eduardo Fontes 1;
Cláudio Córdova 1; Marcelo Demarzo 3; Daniel Boullosa 1
1. Post - Graduation in Physical Education. Catholic University of Brasília, Brazil.
2. Department of Biobehavioral Sciences, Teachers College, Columbia University, USA.
3. "Mente Aberta" Brazilian Center for Mindfulness and Health Promotion, Department of
Preventive Medicine, Universidade Federal de São Paulo, Brazil.
__________________________________________________________________________________________________________________
ABSTRACT
Stress can promote cardiovascular and metabolic responses that may favor the development of a
number of diseases, especially when it is experienced chronically. Mindfulness (MF) practices are
adaptations from eastern meditative techniques which are utilized in different psycho-social
therapies for promotion of physical and mental health. The psychological construct of MF refers to a
special form of attention to internal and external phenomena in the present moment, including
openness to experience in a non-critical attitude (i.e. without judgments). Mindfulness-based
practices and interventions are particularly effective in promoting health for clinical conditions
involving chronic stress, anxiety and depressive symptoms. Similarly, regular exercise has
multifarious benefits for health, especially activities that strongly integrate both psychological and
physiological training. Such is the case for martial arts (MA), the whole of which could be classified
as mindful movements. Given that MA requires expenditure of energy done with a high level of
concentration, engagement in this form of exercise may provide an interesting and novel strategy
for enhancing physical and mental benefits. The regular practice of MA could elevate MF levels of
practitioners and thus influence positively on stress management and therefore quality of life and
well-being.
Key Words: mindfulness, meditation, exercise, attention, stress, depression
RESUMEN
El estrés genera respuestas cardiovasculares y metabólicas que pueden favorecer el desarrollo de
diversas enfermedades, especialmente cuando es experimentado de forma crónica. Las prácticas de
atención plena son adaptaciones de técnicas meditativas orientales que son utilizadas en diferentes
terapias psicosociales para la promoción de la salud física y mental. El constructo psicológico de la
atención plena se refiere a una forma especial de atención hacia fenómenos internos y externos en
el momento presente, con una actitud no crítica hacia la experiencia (i.e. sin juicios). Las prácticas y
las intervenciones basadas en la atención plena son particularmente efectivas en la promoción de la
salud en condiciones clínicas que incluyen estrés crónico, ansiedad y síntomas depresivos. Del
mismo modo, el ejercicio regular posee múltiples beneficios para la salud, especialmente aquellas
actividades que integran sólidamente tanto el entrenamiento psicológico como el fisiológico. Este es
el caso de las artes marciales que podrían ser caracterizadas como ejercicios con atención plena.
Dado que las artes marciales requieren de un gasto energético, al mismo tiempo que altos niveles
de concentración, podríamos considerar la adhesión a esta modalidad de ejercicio como una
estrategia novedosa e interesante para el incremento de los beneficios físicos y mentales asociados.
La práctica regular de artes marciales puede elevar los niveles de atención plena e influir así
positivamente en el tratamiento del estrés y, por lo tanto, en el bienestar y la calidad de vida de sus
practicantes.
Palabras clave: atención plena, meditación, ejercicio, atención, estrés, depresión
__________________________________________________________________________________________________________________
Correspondence:
Daniel Alexandre Boullosa Álvarez
Post - Graduation in Physical Education. Catholic University of Brasília, Brazil
QS 07, LT1 S/N - Sala 111 - Bloco G. 71966-700 Águas Claras DF Brasil. d_boullosa@yahoo.es
Submitted: 12/05/2015
Accepted: 03/06/2015
Wesley Naves-Bittencourt; Arilson Mendonça-de-Sousa Martial arts
INTRODUCTION
The subtle and silent transition from health to illness occurs with the
rupture of homeostasis. Under normal conditions, physical and psychological
stressors contribute to complex bodily reactions that promote positive
adaptations thus increasing tolerance capacity for adverse situations (Lipp et
al., 2002). In contrast, chronic stress is associated with a number of adverse
physiological alterations (Demarzo et al., 2014) and worse lifestyle behaviors
(Stults-Kolehmainen & Sinha, 2014), which can result in the development of
cardiovascular, metabolic and mental pathologies (Hammen, 2005).
Among the diverse contemplative experiences (i.e. focused attention, open
monitoring, compassion, loving kindness), the millenarian practice of
Mindfulness (MF) is highlighted as a meditative technique characterized by the
continuous and wide-attention monitoring to present perceptual experiences
with the absence of judgment or value judgment (Kabat-Zinn, 1998). The
psychological construct of MF is constituted by two main components: i)
attention processing to internal (cognitive, emotional and somatic) and
external perceptions (routine and daily life experiences); ii) attitude of open
and non-critical monitoring to those experiences (Bishop et al., 2004). In the
Western World, MF practice is an adaptation of contemplative Eastern
techniques that has gained increasing recognition, and is mainly applied
through mindfulness-based interventions by medical and psychosocial
therapists (Demarzo et al., 2014; Neale, 2006). Studies suggest that this
particular kind of attention, through well-structured practices and programs,
may contribute to positive alterations in health, such as better autonomic
control of heart rate (Tacón et al., 2003; Mankus et al., 2013) and lower systolic
blood pressure (Zeidan et al., 2010), but especially improved control of chronic
stress (Chiesa & Serretti, 2009; Ludwig & Kabat-Zinn, 2008; Biegel et al., 2009).
Moreover, interventions based on these techniques have demonstrated positive
results in clinical populations exhibiting elevated symptoms of anxiety (Hoge et
al., 2013; Khoury et al., 2013) and depression (Joo et al., 2010; Sanders, 2010).
Further, results from recent studies suggest that expert Buddhist meditators
present lower activity of neural structures (e.g., amygdala, insular cortex and
orbital frontal gyrus) related to the control of emotional responses to
sensations and thoughts (Davidson & Begley, 2012) which in turn control
autonomic, endocrine and immunological axes.
Some fundamental practices in MF programs include movements executed
with full attention to internal physical sensations, which could help regulate
physiological responses to chronic stress (Demarzo et al., 2014). During these
activities, the attention is intentionally directed to interoceptive and
proprioceptive sensations, such as feeling how much tension each muscle
generates while walking, or feeling the breath and heartbeats while breathing
European Journal of Human Movement, 2015: 34, 34-51 35
Wesley Naves-Bittencourt; Arilson Mendonça-de-Sousa Martial arts
deeply and slowly. Indeed, these techniques have been referred to as mindful
movements which have demonstrated various physical and mental benefits
(Demarzo et al., 2014; LaForge, 2012). It is well recognized that physical
exercise in itself plays an important role in stress regulation and health
promotion, because its practice favors the development of physiological
regulatory mechanisms for the control of acute and chronic stress, apart from
promoting immediate psychological benefits (Huang et al., 2013). Consequently,
these practices may be particularly effective at combining both physical and
psychological aspects of training.
A martial art (MA) is the combination of physical movements with strategy
and a variety of precise and coordinated techniques conducted for combat
purposes. Each of these are embedded within a structured philosophy,
knowledge-base, system of values and tradition (Green, 2001). Moreover, a MA
is a practice that also strives for an aesthetic representation during combat,
without focus on its destructive potential. It is common to find in the same MA
one modality in which the opponents fight thorough physical contact, and
another in which there is an individual simulation of combat without physical
contact. In karatê they are called kumite and kata, in taekwondo gyeorugi and
poomsaee, and in wushu sanda and taolu. Within taiji quan, for instance, it is
recognized that the execution of combat movements without physical contact
(taolu) is an exercise with an important meditative component (Yu, 1996;
Abbott & Lavretsky, 2013). This system integrates body and mind because its
practice demands constant attention and focus on the execution of movements
(Yu, 1996; Diepersloot, 1997). Results from validated questionnaires (Park,
Reilly-Spong, & Gross, 2013) suggest that MA practice favors MF in daily tasks
and experiences and, consequently, influencing stress control related issues
(Caldwell et al., 2010, 2011; Nedeljkovic et al., 2012a; Lothes, Hakan, & Kassab,
2013).
Nowadays, primary prevention health programmes that include meditation
practice associated with MA are recognized and promoted by public health
systems. However, it is important at the current time to determine precise and
evidence-based methodologies and training protocols for healthcare
practitioners. Moreover, although meditation with full attention is present in
some MA (Abbott & Lavretsky, 2013), little is known about the demands and
characteristics of attention systems for each MA, style and technique. This
dearth of information limits the validity of exercise prescriptions which focus
on this form of physical activity. Therefore, the purpose of this literature review
was to search evidence that supports the validity of regular MA practice as a
mindful movement for stress management.
European Journal of Human Movement, 2015: 34, 34-51 36
Wesley Naves-Bittencourt; Arilson Mendonça-de-Sousa Martial arts
METHOD
The search for relevant articles was performed independently by two
researchers in May of 2014. This was conducted in the Pubmed database (see
Figure 1) and included only articles reporting original data in the English
language. The keywords utilized were: (martial arts OR Asian martial arts OR
wushu OR gong fu OR aikido OR karate OR judo OR taekwondo OR taiji OR tai chi)
AND (mindfulness OR meditation OR mental health OR stress OR stress
management).
FIGURE 1: Keywords utilized in Pubmed database.
Inclusion criteria for the identified articles included the following: (a) a MA
was utilized as a mode of exercise in at least one group of participants; and (b)
at least one parameter related to mental health, stress management,
dispositional MF or meditation-related indices was evaluated (see Figure 2).
Articles focusing on high-level sport were excluded.
European Journal of Human Movement, 2015: 34, 34-51 37
Wesley Naves-Bittencourt; Arilson Mendonça-de-Sousa Martial arts
FIGURE 2: Search strategy and selection criteria.
RESULTS
In the initial search, 376 studies were found, from which 60 met the
inclusion criteria. From these studies, 51 were excluded when exhibiting one of
the following characteristics: (a) being a literature review; or (b) being a study
related to injuries and training methodologies in high performance sports. In
this regard, some authors did not suggest a link to health promotion in
competitive sports and were thus excluded. Nine studies were further
evaluated (see Table 1).
European Journal of Human Movement, 2015: 34, 34-51 38
Wesley Naves-Bittencourt; Arilson Mendonça-de-Sousa Martial arts
TABLE 1
Description of selected studies from Pubmed according to established criteria.
References Subject
characteristics
Purposes Methods Assessments Results Conclusions
TAYLOR-
PILIAE et al.,
2006
39 men and
women;
average age of
66 years old.
To observe
changes in
psycho-social
aspects in
persons with
cardiac risk
factors after
12 weeks of
taiji quan (TJ)
practice.
60 minute
classes, 3
sessions per
week over 12
weeks. Data
collection
before, after 6
and 12 weeks
of
intervention.
Questionnaire
s for POMS,
PSS, TCSE and
session
frequency.
Improvement
in mood state,
perceived
stress. Self-
efficacy to
overcome
practice
barriers.
12 weeks of
TJ improves
mood and
regulates
stress and
self-efficacy.
ROBINS et
al., 2006
59 men and
women HIV
patients; age >
18 years old.
To observe the
effects of TJ
practice on
biopsychosoci
al factors in
individuals
with different
stages of AIDS.
TJ groups of
spiritual
therapy and
stress control
based on
cognitive
behavior.
Sessions of TJ
with 60
minute
duration, 1
session per
week over 10
weeks.
Comparisons
between the
stress level
and coping
(DIS);
psychological
stress of
patients with
HIV (IES) and
quality of life
related to
health (FAHI).
TJ group
quality of life,
social welfare
and
emotional
welfare;
psychological
stress related
to HIV.
TJ helps to
control
stress in
patients
with HIV
and
presents as
an
alternative
therapy for
HIV
patients.
ESCH et al.,
2007
21 men and
women; age >
18 years old.
To observe the
practice of TJ
on the
regulation of
psychological
and physical
stress.
90 minute
classes, 12
sessions over
18 weeks.
Stress level
through blood
pressure,
heart rate,
salivary
cortisol (SC)
and perceived
stress.
SC; scores
at SF-36
questionnaire
..
TJ decreases
negative
stress and
helps with
the control
of
psychologic
al and
physiologica
l stress.
WANG, 2008
30 men and
women;
students with
average age of
24 years old.
To observe the
effects of TJ on
perceptions of
the self-rated
mental and
physical
health.
Classes of TJ 2
sessions a
week, 60
minutes each
over 12
weeks. Data
collected
before and
after
intervention.
Physical and
mental
aspects with
SF-36v2
questionnaire
.
Improvement
s in physical
and mental
health;
body pain;
and
emotional
and social
functions.
TJ improves
self-
perception
of health
and may
extend
benefits to
groups
different
from
elderly.
European Journal of Human Movement, 2015: 34, 34-51 39
Wesley Naves-Bittencourt; Arilson Mendonça-de-Sousa Martial arts
TABLE 1 (Continuation)
CALDWELL
et al., 2010
166 men and
women with
age ranging
from 18 and
41 years old.
To observe
changes in
mindfulness
(MF) with
Pilates, TJ and
GYROKINESIS
® and to
determine if
these are
related to
changes in
perceived
stress, mood,
self-efficiency,
self-regulation
and sleep
quality.
15 week
intervention;
Data
collection
before, during
and after
intervention
through
questionnaire
s.
The MF level
was evaluated
through
FFMQ, sleep
quality
through PSQI;
others
instruments
were; FDMS,
PSS4 e SRE.
TJ MF. MF
improved
sleep quality,
self-
regulation
and self-
efficiency,
mood and
perceived
stress.
Body motion
activities,
such as TJ,
improve MF,
sleep
quality,
mood,
perceived
stress, self-
efficiency
and self-
regulation.
CALDWELL
et al., 2011
208 men and
women with
age between
18 and 48
years old.
To determine
if TJ classes
change levels
of MF and if
these changes
are related to
mood,
perceived
stress, self-
efficiency and
self-regulation
and sleep
quality.
Classes of TJ.
2 sessions per
week, 50 min
each over 15
weeks. Total
of 25h
intervention.
Control group
classes, 1
session per
week, 150
min or 2
sessions per
week, 75 min
each. Total of
37 h and 30
min of
instructions.
MF level and
related
variables
were assessed
with several
instruments
(FFMQ, FDMS,
PSS4, SRE and
PSQI)
of MF found
only in TJ
group. MF
shows
relationship
with welfare,
and sleep
quality.
The practice
of TJ
promotes
benefits of
MF and
personal
welfare.
NEDELJKOVI
C et al., 2012
70 men and
women;
students with
age between
23 and 50
years old.
To observe the
impact of TJ
practice on the
self-
perception of
MF and self-
compassion.
TJ classes
twice a week
over 12
weeks.
Evaluation
before, after
and 2 months
after
intervention.
MF level
evaluated
with FMI-SF.
Self-
compassion
evaluated
with the SCS.
in self-
attribution to
MF
immediately
after
intervention
and 2 months
later.
TJ practice
can improve
self-
attribution
of MF and
self-
compassion
in healthy
individuals.
European Journal of Human Movement, 2015: 34, 34-51 40
Wesley Naves-Bittencourt; Arilson Mendonça-de-Sousa Martial arts
TABLE 1 (Continuation)
NEDELJKOVI
C et al., 2012
70 men and
women, with
age between
23 and 50
years old.
To investigate
the effects of
regular
practice of TJ
to
physiological
and
psychological
stress
responses in
healthy men
and women.
Control and
intervention
groups over
12 weeks.
Evaluation
during a
stress test to
verify the
stress
reactivity
(TSST).
Physiological
stress
measured by
levels of SC,
heart rate
(HR) and
alpha-
amylase in
saliva
samples.
Perceived
psychological
stress
measured
with PSS and
VAS;
depression
with ADS-K
and CES-D;
mood with
MDMQ.
in CS
reactivity, HR,
alpha-
amylase and
perceived
stress.
Positive in
response to
psycho-social
stress.
TJ practice
decreases
physiologica
l and
psychologic
al stress
reactivity.
LOTHES,
HAKAN and
KASSAB,
2013
STUDY 1:159
men and
women
practitioners
of Aikido (AK);
20 non-
practitioners
as control
group.
STUDY 2:
12 men and
women in
intervention
group; 20
men and
women in
control group.
STUDY 1: To
evaluate
changes in MF
with AK
training.
STUDY 2: To
determine
whether MF is
affected by
different
stages of AK
practice.
STUDY 1:
Online
questionnaire
s that evaluate
the level of
MF and notion
of self-
consciousness
(MAAS) in
practitioners
of AK. STUDY
2: Evaluation
of each
expertise
stage (0, 2, 5
and 9 months
of practice).
Control group
did not
participated
in any activity
and was also
evaluated in
same periods.
MF was
evaluated
with specific
validated
instruments
(KIMS and
MAAS).
STUDY 1:
practitioners
and black
belts had
higher MF
than controls
and less
expertise.
STUDY 2: MF
with each
expertise
level. AK
practitioners
MF than
control
group.
The practice
of AK is able
to increase
MF, being
higher as
the
expertise
level
increases.
POMS: Profile of Mood States. PSS: Perceived Stress Scale. TCSE: Tai Chi exercise self-efficacy. DIS: Dealing with Illness
Scale. IES: Impact of Events Scale. FAHI: Functional Assessment of HIV Infection. SF-36: Short Form Health Survey 36.
FFMQ: Five Facet Mindfulness Questionnaire. PSQI: Pittsburgh Sleep Quality Index. FDMS: Four Dimensional Mood Scale.
PSS4: Perceived Stress Scale - 4. SRE: Self-Regulatory Self-Efficacy Scale. FMI-SF: Freiburg Mindfulness Inventory
Short Form. SCS: Self-Compassion Scale. TSST: Trier Social Stress Test. VAS: Visual Analogue Scale. ADS-K: Allgemeine
Depressionsskala - Kurzform. CES-D: Center for Epidemiological Studies Depression Scale. MDMQ: Multidimensional
Mood State Questionnaire. MAAS: Mindful Attention Awareness Scale. KIMS: Kentucky Inventory of Mindfulness Skills
European Journal of Human Movement, 2015: 34, 34-51 41
Wesley Naves-Bittencourt; Arilson Mendonça-de-Sousa Martial arts
Among the 9 studies analyzed, 8 utilized taiji quan as intervention and only
one of the studies utilized another MA, i.e. aikido (Lothes, Hakan, & Kassab,
2013). Moreover, only two studies (Esch et al., 2007; Nedeljkovic et al., 2012b)
also evaluated physiological parameters to evaluate the impact of the
interventions for stress management. In others two studies (Caldwell et al.,
2010, 2011), participants that practised a MA were compared with others who
were involved in another activity, such as Pilates, quiet reading, and/or
discussion and learning groups.
The studies showed positive changes in stress perception with programs
ranging from 10 to 18 weeks (Robins et al., 2006; Taylor-Piliae et al., 2006;
Esch et al., 2007; Wang, 2008; Caldwell et al., 2010, 2011; Nedeljkovic et al.,
2012a, 2012b) and 1 study demonstrated that stress management capacity
remained stronger at 1 month follow-up post training (Esch et al., 2007). Also, a
significant reduction of psychological stress for HIV infected individuals
(Robins et al., 2006) and improved perceived stress levels for patients with
cardiovascular risk (Taylor-Piliae et al., 2006) were found. The results also
showed reduction of cortisol and alpha-amylase levels, helping to control heart
rate reactivity during stressful situations (Taylor-Piliae et al., 2006; Esch et al.,
2007), which altogether indicate that the practice of MA seems to have a
positive effect for the management of chronic stress.
MF levels were elevated more through the practice of MA (Caldwell. et al.,
2010; Nedeljkovic et al., 2012a; Lothes, Hakan, & Kassab, 2013) than other
activities, such as reading, suggesting that the longer an individual devotes time
to such practice, the greater are the improvements (Lothes, Hakan, & Kassab,
2013).
These studies suggested that, in general, MA were able to positively
influence both stress management and MF levels as well as to influence health
related parameters. Apart from this, MA have been demonstrated to be more
effective when compared to others forms of physical activity and leisure. MA
practice has resulted in greater improvements for MF levels and for stress
management than Pilates (Caldwell et al., 2010) and recreational activities
(Caldwell. et al., 2010; Nedeljkovic et al., 2012a, 2012b). Furthermore, studies
by Caldwell et al. (2010), Nedeljkovic et al. (2012a, 2012b) and Lothes, Hakan
and Kassab, (2013) concluded that taiji quan and aikido were able to elevate MF
levels through MA training. In addition, Lothes, Hakan and Kassab, (2013)
suggested that the length of time devoted to training influences MF levels, with
experienced individuals demonstrating greater levels compared to novice or
moderately trained individuals.
Taiji quan practice resulted in positive changes in stress perception for
training programs of 10 weeks (Taylor- Piliae et al., 2006), 12 weeks
(Nedeljkovic et al., 2012a, 2012b; Taylor-Piliae et al., 2006; Wang, 2008), 15
European Journal of Human Movement, 2015: 34, 34-51 42
Wesley Naves-Bittencourt; Arilson Mendonça-de-Sousa Martial arts
weeks (Caldwell et al., 2010, 2011), and 18 weeks duration (Esch et al., 2007).
The duration of the sessions in all the studies was between 50 and 60 min, with
two sessions per week. As expected, the results did not show important
differences when related to time of the sessions.
The benefits achieved through taiji quan practice seem to be maintained for
a period after the end of the training programs. For instance, Esch et al. (2007)
demonstrated that stress management capacity remained stronger at 1 month
follow-up post training. Further, Nedeljkovic et al. (2012a, 2012b) suggested
from their results that alterations can persist up to 2 months.
The objective of four of the studies analyzed (Caldwell et al., 2010, 2011;
Nedeljkovic et al., 2012a; Lothes, Hakan, & Kassab, 2013) was to observe the
effect of MA practice on changes in MF levels. The other five studies observed
the effects of MA practice on stress and health. Wang (2008) observed that taiji
quan seems to improve the self-perception of mental and physical health. The
study by Robins et al. (2006) found a significant reduction in psychological
stress of HIV infected individuals using taiji quan as intervention. Taylor-Piliae
et al. (2006) observed that taiji quan could improve perceived stress levels
after 12 weeks of intervention in patients at risk for cardiovascular disease.
Another two studies found similar results after similar interventions in healthy
students (Caldwell et al., 2010, 2011).
Other parameters related to stress, such as perception in sleep quality,
humor, self-regulatory abilities, self-efficacy (Caldwell et al., 2010, 2011),
quality of life and social and emotional well being (Robins et al., 2006) also
showed significant and positive changes after MA intervention. Meanwhile,
positive changes in physiological markers related to stress were recorded in
the studies of Nedeljkovic et al. (2012b) and Esch et al. (2007), thus suggesting
that taiji quan practice was also able to reduce cortisol and alpha-amylase
levels, while helping to control heart rate reactivity during stressful situations.
DISCUSSION
The results of the present review suggest that the practice of some MA, like
mindful exercise, favorably affects stress management (Demarzo et al., 2014;
Brown & Ryan, 2003) and trait MF (Caldwell et al., 2010, 2011; Nedeljkovic et
al., 2012a; Lothes, Hakan, & Kassab 2013). MA training can be characterized as
meditative movements as it is a performance that simultaneously stimulates
both body and mind (Faggianelli & Lukoff, 2006; Waysun, 1990; Wang et al.,
2009). Therefore, MA may provide multiple pathways to stress management,
which may contribute to a better control of dysfunctional stress (Demarzo et al.,
2014) and ultimately physical and mental health.
MA training is capable of promoting physiological adaptations in blood
pressure (Esch et al., 2007; Tsai et al., 2003), heart rate and circulating levels of
European Journal of Human Movement, 2015: 34, 34-51 43
Wesley Naves-Bittencourt; Arilson Mendonça-de-Sousa Martial arts
cortisol and alpha-amylase (Esch et al., 2007; Nedeljkovic et al., 2012b), and
psychological adaptations (Zhang et al., 2012) including changes in humour
(Caldwell et al., 2010, 2011; Taylor-Piliae et al., 2006), anxiety and depression
levels (Caldwell et al., 2010, 2011; Wang et al., 2009; Li, Hong, & Chan, 2001;
Chou et al., 2004; Yau, 2008), sleep quality (Caldwell et al., 2010, 2011), and
attention processing (Converse et al., 2014). In addition to the aforementioned
outcomes, taiji quan specifically has been demonstrated to increase bone
density (Zhang & Fu, 2008), control glucose (Chang et al., 2008) and lipid levels
(Rosado-Pérez et al., 2013), and also has induced a greater antioxidant effect
when compared to moderate intensity exercises (Rosado-Pérez et al., 2013).
Moreover, Toskovic, Blessing and Williford (2002) suggested that taekwondo
could be prescribed for cardiovascular conditioning and weight control, while
Milanez et al. (2012) showed that regular karate training promoted positive
adaptations in cardiorespiratory capacity. Overall, these previous findings
confirm the positive impact that MA could have on different physiological and
psychological health related parameters.
Dermazo et al. (2014) previously suggested that the increase of MF
capacity through physical exercise could be associated with a greater
perception of somatic sensations, body temperature fluctuations, and changes
in respiratory rhythm. Meanwhile, it is worth mentioning that the results of
recent studies suggest that individuals with elevated levels of self-perception
show a greater activation of the insula and, therefore, an enhanced perception
of small changes in heart and respiratory rates, for example, in patients with
panic syndrome (Davidson & Begley, 2012). These enhanced perceptions
associated with the physiological and hormonal changes have a positive effect
on stress management.
Taiji quan and aikido are modalities that incorporate important meditative
components (Yu, 1996; Gleason, 1995; Hu, 1995; Santos & Coutinho, 2004;
Faggianelli & Lukoff, 2006) and, following previous findings, it could be said
that these modalities significantly increased MF levels as measured by
internationally utilized questionnaires. Moreover, greater practice time was
related to greater control of attention. Furthermore, when comparing MA to
other intellectual and physical activities, MA practitioners demonstrate more
favourable changes across a variety of different outcomes (Caldwell et al., 2010,
2011; Wang et al., 2010; Lakes & Hoyt, 2004) with some studies demonstrating
that benefits associated with MA practice may be observed up to 2 months after
the end of the activity (Nedeljkovic et al., 2012b; Wang et al., 2010). Thus, it
would seem that the practice of mindful movements could further improve
stress management and health maintenance in comparison to exercising
without a meditative component (Demarzo et al., 2014; Rosado-Pérez et al.,
2013). This could indicate that meditative monitoring and concentration during
European Journal of Human Movement, 2015: 34, 34-51 44
Wesley Naves-Bittencourt; Arilson Mendonça-de-Sousa Martial arts
a simulation of combat, in addition to respiratory control, would demand
greater levels of attention. However, this aspect has not been addressed yet and
further studies are needed.
Previously, it has been suggested that MF can act as a mediator between
physical activity and cardiovascular responses to stress, thus indicating the
possibility that higher levels of physical fitness are associated with better MF
levels and enhanced stress responses (Demarzo et al., 2014). Based on this
assumption, it would be possible to infer the reciprocal activity between: (a)
MA vs. Stress; (b) MF vs. Stress; (c) and MA associated with MF, working as a
mindful movement, for the physical and psychological regulation of stress (see
Figure 3).
FIGURE 3: Diagram showing the reciprocal activity between martial arts, mindfulness,
mindful exercise, and stress.
According to Binder (2007), Asian MA have many aspects in common with
other forms of physical activity and exercise; however, MA tend to value self-
knowledge and self-control, while performing a form of self-defence that
includes ethical and philosophical qualities. Therefore, certain characteristics of
MA could help to promote psycho-social changes in addition to physiological
and psychological adaptations, and probably MF levels may moderate or
mediate this process (Demarzo et al, 2014).
Given that individuals experience greater levels of MF with greater volume
of MA practice (Lothes, Hakan, & Kassab, 2013), starting these practices early
could be very useful for prophylactic purposes (Chou, 2008). Consequently,
focusing on developing MA techniques in formative stages could contribute to
European Journal of Human Movement, 2015: 34, 34-51 45
Wesley Naves-Bittencourt; Arilson Mendonça-de-Sousa Martial arts
better physical and psychological development for individuals with this
exposure. Additionally, these interventions could also mitigate the occurrence
of side effects as well potentially help to minimize the dosage of certain
medications (Abbott & Lavretsky, 2013; Chan, 2011; Kabat-Zinn, 2003). These
avenues of health enhancement should be further investigated to expand the
benefits of MA practice for public health.
It should be pointed out that there are a wide variety of MA styles and
techniques and that this variation is favourable for individuals with different
interests, preferences and physical capacities. Providing individuals with
choices and the option to select the most appropriate technique for their own
needs may help to enhance motivation and thus adherence. Such programming
could be provided in a variety of different settings thus creating opportunities
for both personal mastery and collective practice with a number of other
participants, magnifying educational objectives and a wide swath of health
parameters (Oliveira et al., 2001).
MA practice, which is associated with facets of MF, can promote body
consciousness and stimulate body expression, thus improving not only health
outcomes but also essential aspects of the school curriculum (Wall, 2005).
Therefore, including MA within a school setting may promote the development
of cognitive, behavioural and affective abilities (Lakes & Hoyt, 2004; Wall,
2008). In consideration of the potential role of MA for children and adolescents,
Lakes & Hoyt (2004) have suggested that taekwondo in school can improve
children’s social behaviour, attention levels and self-esteem. In addition,
Converse et al. (2014) concluded that taiji quan training seems to reduce
deficits in attention and hyperactivity in young adults. Overall, these findings
reinforce the potentially important role that MA practice could have, not only in
clinical but also in educational settings.
One limitation of the current review is the small number of studies
reporting data on the effect of MA on health status (Bu et al., 2010). Taiji quan
was utilized as the most common intervention therefore limiting the
comparison between various MA modalities and styles. Further studies should
clarify what MA modalities (e.g. combat vs. simulation) promote greater
changes in MF and stress management. Additionally, it should be tested if MA
practices alone or combined with other forms of meditation and physical
activity could provide more benefits for physical and psychological health when
compared to mindfulness-based interventions (e.g., mindfulness-based stress
reduction, MBSR) or increases in physical activity levels alone (e.g., walking
programs, etc.). Of note, further research would verify if the practice of MA in a
periodized fashion may magnify and prolong benefits associated with MA,
enhance interest and enjoyment, and accommodate changes in life
circumstances (e.g., travelling, holidays).
European Journal of Human Movement, 2015: 34, 34-51 46
Wesley Naves-Bittencourt; Arilson Mendonça-de-Sousa Martial arts
CONCLUSIONS
The practice of MA appears to provide several benefits for the management
of chronic stress. These positive effects could be based on the dual nature of MA
which includes the benefits of both PA and meditative/mindful components.
Future studies should compare different MA modalities while analyzing
different physiological and psychological adaptations for a better
understanding of the impact of MA practice on the control of chronic stress and
other health related benefits.
ACKNOWLEDGEMENTS
We would like to thank Lauri Abreu for suggesting this interesting topic
and Cintia Ramari for her contributions in an earlier version of the manuscript.
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To better explain daily fluctuations in physical activity and sedentary behavior, investigations of motivation are turning from social cognitive frameworks to those centered on affect, emotion and automaticity, such as the Affect and Health Behavior Framework (AHBF), Integrated Framework and Affective-Reflective Theory (ART). This shift has necessitated: (a) re-examination of older theories and their constructs, such as drives, needs and tensions and (b) an inspection of competing theories from other fields that also attempt to explain dynamic changes in health behaviors. The Dynamical Model of Desire, Elaborated Intrusion Theory and others commonly share with AHBF the idea that human behavior is driven strongly by desires and/or the similar concepts of wants, urges, and cravings. These affectively-charged motivation states (ACMS) change quickly and may better explain physical activity behavior from one moment to the next. Desires for movement predominantly derive from negative but also positive reinforcement. Data from clinical populations with movement dysfunction or psychiatric disorders provides further evidence of these drivers of movement. Those with Restless Legs Syndrome, akathisia, tic disorders and exercise dependence all report strong urges to move and relief when it is accomplished. Motor control research has identified centers of the brain responsible for wants and urges for muscular movement. Models elaborated herein differentiate between wants, desires, urges and cravings. The WANT model (Wants and Aversions for Neuromuscular Tasks) conceptualizes desires for movement and rest as varying by magnitude, approach or avoidance-orientation (wants versus aversions) and as occupying independent dimensions instead of opposite ends of the same axis. For instance, one hypothetically might be in a state of both high desire for movement and rest simultaneously. Variations in motivation states to move and rest may also be associated with various stress states, like freezing or fight and flight. The first validated instrument to measure feelings of desire/want for movement and rest, the CRAVE Frontiers in Psychology | www.frontiersin.org 1 November 2020 | Volume 11 | Article 568390 Stults-Kolehmainen et al. Desire, Urge and State Motivation Scale (Cravings for Rest and Volitional Energy Expenditure) is already shedding light on the nature of these states. With these advances in theory, conceptual modeling and instrumentation, future investigations may explore the effects of desires and urges for movement and sedentary behavior in earnest.
... Inactivity prevention is necessary because the patterns of communication difficulties, anxiety, and lack of social interaction typical of this population tend to be associated with low levels of participation in moderate to high-intensity physical activities and greater amounts of time spent engaging in sedentary behaviours [28]. In this sense, martial arts training can also be helpful to reduce stress and anxiety/depression symptoms in autistic children [29,30]. In particular, the practice of judo has shown positive results in typically developing adolescents [31]. ...
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