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Research Article
Assessment of Cardiovascular Parameters during Meditation
with Mental Targeting in Varsity Swimmers
Tyvin A. Rich,1,2 Robert Pfister,3John Alton,4David Gerdt,5and Martin Baruch5
1Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
2Hampton University Proton erapy Institute, 40 Enterprise Parkway, Hampton, VA 23666, USA
3Department of Statistics, University of Virginia, Charlottesville, VA, USA
4Center for the Study of Complementary and Alternative Medicine, University School of Nursing, Charlottesville, VA, USA
5Empirical Technologies Corporation, P.O. Box 8175, Charlottesville, VA, USA
Correspondence should be addressed to Tyvin A. Rich; tyvinr@gmail.com
Received August ; Accepted November
Academic Editor: Karen Nieber
Copyright © Tyvin A. Rich et al. is is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Introduction. Athletes who developan immunosuppressed state because of intensive training get upper respiratory infections (URIs)
and may respond to meditation. Reective exercise (RE), a westernized form of Qigong, combines meditation, breathing, and
targeted mental attention to an internal pulsatile sensation, previously shown to protect varsity swimmers from URIs during the
height of training. We report here the evaluation of cardiovascular parameters measured during meditation combined with targeted
imagery (interoception) in a cohort of varsity swimmers taught RE. Methods. irteen subjects were enrolled on a prospective
protocol that used the CareTaker, a noninvasive cardiovascular monitor before, during, and aer RE training. Questionnaires
regarding targeted mental imagery focusing on a pulsatile sensation were collected. e cardiovascular parameters include heart
rate, blood pressure, and heart rate variability (HRV). Results. Increased variance in the subjects’ BP and HRV was observed over
the training period of weeks. In nine subjects there was an increased low frequency (LF) HRV that was signicantly (𝑝 < 0.05)
associated with the subject’s awareness of the pulsatile sensation that makes up a basic part of the RE practice. Summary.ese
data support further evaluation of HRV measurements in subjects while meditating with mental imagery. is direction could
contribute to better understanding of neurocardiac mechanisms that relate meditation to enhanced immunity.
1. Introduction
e stress of intense training of college swimmers can result
in physiologic changes that predispose them to frequent
upper respiratory infections (URIs). Studies have reported
URI incidences of –% during training periods ranging
from to weeks [–] while other studies showed an -week
incidence of respiratory illness of % []. ese ill eects
canbethwartedbythepracticeofreectiveexercise(RE,
a westernized form of Qigong) [] shown by a reduction of
URIs in varsity swimmers who maintained practice []. e
enhanced athletic performance associated with combinations
of breathing, relaxation, meditation, guided imagery, and
slow movement exercises supports the notion that these
practices can enhance immunity [–].
One mechanism that could be involved with the benecial
eects of RE is through modulation of the neuroimmune
system reected by activity of the vagus nerve []. In
some studies vagal function has been assessed by measuring
autonomic activity with heart rate variability (HRV) and
this, in turn, has been found to be inversely related to
levels of inammatory markers []. Useful insight into this
hypothesis is illustrated by the CARDIA study where over ve
thousand men and women of similar ages to the UVA swim
team members were evaluated over years with analog EKG
signals in the resting position []. Digitized R-waves were
used to calculate R-R intervals and heart rate for low and
high frequency bands on -second epochs. ese cardiac
covariates and other measures of wellbeing (blood pressure,
bloodsugar,BMI,physicalactivity,andsmokinghistory)
Hindawi Publishing Corporation
Evidence-Based Complementary and Alternative Medicine
Volume 2016, Article ID 7923234, 5 pages
http://dx.doi.org/10.1155/2016/7923234
Evidence-Based Complementary and Alternative Medicine
were inversely related to levels of proinammatory cytokines
(C-reactiveproteinandIL-)andpossiblymediatedby
the vagal cholinergic anti-inammatory pathway []. ey
support the practice of monitoring of HRV to look for a
wellness marker especially with studying real time changes
associated with exercises like RE.
We have previously evaluated thirty-two volunteers
practicing meditation while heart rate and blood pressure
were monitored with a noninvasive device (CareTaker can
be viewed at http://www.empiricaltechnologies.com/). We
found RE elevated cardiovascular variance of heart rate vari-
ability(HRV),bloodpressure,andincreasedlowfrequency
to high frequency ratios of HRV and blood pressure which
we interpreted as autonomic modulation (unpublished obser-
vations). ese ndings indicated cardiovascular measure-
mentsofHRVandBPwerefeasibleduringmeditationand
guided us in the design of a subsequent trial. We report here
a study with university varsity swimmers taught RE for the
rst time and monitored with the CT device before, during,
and aer training. We postulated that we would identify
HRV correlates consistent with autonomic regulation and
associated with inammatory suppression that could account
for the protection aorded swimmers taught this routine. We
also assessed with questionnaires the individual’s perception
of a targeted internal pulse sensation (interoception) [] that
formspartoftheREmethod.
2. Methods
e study population consisted of thirteen varsity swimmers
( males and females) who were enrolled at the University
of Virginia in their rst (), second (), third (), fourth
(), or graduate () year. One had taken a course in Qigong
two years before, did yoga but not regularly, one had
taken a class in Buddhist meditation, and one had been
previously treated with hypnosis for anxiety attacks and
these were not permitted during RE training. One subject
claimed to have frequent respiratory illnesses but the other
said they occurred rarely. e practice of RE was higher
during the training period ( to times per week) and
dropped to about once or twice per week at the last interview.
eir initial systolic and diastolic blood pressure taken at
rest just prior to meditation sessions ranged from to
/ to and varied a little over the course of training.
Although anti-inammatory, antiallergy, and decongestant
medications were allowed to be taken freely by the subjects
they were not used during RE training. All subjects signed
a University of Virginia School of Medicine IRB approved
consent form and the study was conducted according to IRB
guidelines.
2.1. RE Training. RE combines three elements into a sin-
gle - to -minute routine. e three elements are ()
reverse abdominal breathing technique, () a set of uid
slow movements coordinated with the breathing technique,
and () sensory meditation in standing, seated, and supine
positions. e swimmers learned the entire RE routine in
sessions, each lasting approximately hour. ereaer, the
instructor met with the swimmers additional half-hour
practice sessions over a -week period.
Some forms of traditional Qigong use reverse abdominal
breathing, but the type of breathing RE uses has distinct,
nuanced features: () breathing is “light,” exclusively through
the nostrils; () the breathing cycle is approximately
seconds for inhalation and seconds for exhalation; () lower
abdominal muscles gently contract in sync with inhalation
and relax in sync with exhalation; () teeth of the upper and
lower jaw lightly touch together, which causes the mastoid
muscles of the jaw to ex mildly; () the tongue is lied up
to ll the upper palate with the tip resting behind the front
teeth.
e complete RE routine is a -phase process that takes
approximately minutes to complete. Phase consists of
doing the slow movement set, coordinated with the breathing
technique, which takes approximately minutes to complete.
Phase involves – minutes of sensory meditation in the
standing position, with the hands placed alternately in front
of the chest, the lower abdomen, or the head. During phase
, the practitioner lies down in a supine position or else sits
upright in a chair and then performs the breathing technique
for approximately minutes.
At some point during the -minute meditation, the
practitioner may begin to feel an emergent vascular sensation
(the targeted pulse) in the lower abdomen that ascends
with the inhalation into the sinus cavity of the head. e
practitioner may experience this sensation as a subtle pulsing
in the sinus cavity or forehead region or as a general increase
in cranial pressure. On the exhalation, the pulsing or pressure
subsides, and the practitioner senses what appears to be the
return of this decreased pulsing or pressure to the lower
abdomen. e primary goal of RE practice is to acquire
and sustain this emergent sensation throughout the full
minutes of phase . Once acquired, the sensation tends
to become distinctly more vascular and less of a pressure
phenomenon.
e estimates of the number of subjects needed to test our
hypothesis were based on the experience about RE training in
UVa swimmers [] and a separate volunteer study conducted
with the CT on volunteers previously taught RE (unpublished
observations). From the rst study the impression was that
swimmers are well motivated to learn this meditation tech-
nique and that a majority of them continue to practice during
the sports season. e CT data on volunteers that shows
a robust shi in their cardiovascular dynamics during RE
meditation have been used to estimate that a minimum of
subjects was recommended to reject the null hypothesis of no
eect on the low frequency component of the R-R intervals
(with probability of .). is number was calculated under
the assumption that current estimates of the mean dierences
between meditation and rest and their standard deviation
were accurate.
2.2. CareTaker Measurements. Baseline CareTaker (CT)
measurementswerecollectedbytheresearchnurseinasep-
arate location from the RE training at specic appointment
times during the day. e CT data were collected in the same
time interval each day (e.g., to p.m.) to minimize circadian
Evidence-Based Complementary and Alternative Medicine
Rest
Control
RE
6
7
8
9
10
11
Log (ms2)
23451
Sessions
Log total RRI variability
(a)
1
2
3
4
5
6
7
Log (mmHg2)
23451
Sessions
Rest
Control
RE
Log total systolic blood pressure variability
(b)
F : During session , subjects rested for minutes followed by minutes of uninstructed breathing. is -minute period is called the
control period in the gures above. During sessions through , subjects rested for minutes, followed by minutes of reective exercises
(RE).
variation. e rst data collection was prior to beginning RE,
then at the end of the second week (aer the rst RE sessions
had taught the basics), and then at the end of the third and
fourth weeks, and the last measurement was weeks later.
e CT data were collected by a Velcro cu placed on the
base of the right thumb and aer a brief pressure adjustment
period, a baseline of minutes was started. e subjects were
asked to begin to meditate for minutes. If the practice of
meditation had not yet been taught, the subject was asked to
sit quietly and to relax with eyes closed for minutes.
3. Results
e data summarizing the analysis of HRV and blood
pressure are shown in Table and show there is some increase
in the RRI with meditation. ere is less variation in the BP.
e data in Figure show that there is marked variation in
RRI and blood pressure over the meditation sessions.
3.1. Signal Analysis. e CareTaker device records a series of
blood pressure readings at Hz. Heartbeats are detected by
a process provided by ET, Inc. []. e CareTaker unit has
been directly compared to intra-arterial catheter measure-
ments and to EKGs in hospitalized patients and shows a high
one to one correlation with the heart beat measured by those
conventional methods (EmpiricalTechnologies, unpublished
data,personalcommunication).Intheanalysisusedhere,the
process applies a smoothing algorithm to the blood pressure
series, indicating peaks above a moving threshold. For each of
the heartbeats, the systolic blood pressure is calculated. e
interbeat intervals are calculated as the dierences between
T
Session Task RRI (ms)
RRI total
variance
(ms2)
Systolic BP
(mmHg)
Rest .
Control .
Rest .
Meditation .
Rest .
Meditation .
Rest .
Meditation .
Rest .
Meditation .
RRI = R-R interval; LF = normalized low frequency; HF = normalized high
frequency; BP = blood pressure.
the peak times. Additionally, outliers in the interbeat interval
series were deleted on a case-by-case basis to account for
potential missed heartbeats or other aberrations. Outliers
in the systolic blood pressure series were deleted if they
exceeded times a median absolute deviation from the
median within a minute-long window.
Fourier spectral power was calculated by applying the
Lomb periodogram method for unevenly sampled data. R
Code for these calculations was provided by e Stowers
Institute for Medical Research [, ]. Low frequency power
(.–. Hz) and high frequency power (.–. Hz) were
Evidence-Based Complementary and Alternative Medicine
T
Session Subjects Pulse 𝑝value
.
.
.
.
Subjects refers to the number of subjects available to record data during
each session. Pulse refers to the number of subjects who recorded feeling a
pulse while performing the RE exercises. e 𝑝values are for Kendall Tau-
bcorrelationtestsofthesubjectivepulseresponseandtheincreaseinLF
power.
calculated as the area under the Lomb spectral density
over the respective frequency bands, multiplied by total
sample variance. For presentation purposes, these values are
presented in log-scale (R development core team, ) [].
As with many longitudinal studies, the data contains
missing values due to missed appointments and in cases
dropping out of the study before the rd measurement. is
is a potential source of bias, but it is assumed that the missing
values are missing completely at random.
Kendall’s Tau-b correlation test is performed to test
for association between a subjective “pulse” sensation and
variousstatisticsincludingtheLFHRVcomponent.e
relationship between these variables is shown as a boxplot
in Figure and Table . e data indicate that there is a
statistically signicant correlation with the sensation of the
pulse and LF HRV.
4. Discussion
RE meditation has previously been shown to protect var-
sity swimmers from URIs at the height of seasonal inci-
dence where aggregated cold/u symptoms were signicantly
reduced by RE when practiced at least once per week [].
e RE practitioners did not dier from nonpractitioners
in demographic or lifestyle characteristics, medical history,
supplement or medication use, or belief in RE. Also, like our
data presented here, not all swimmers acknowledged feeling
of the pulse sensation. In the present study we observed
increased variance of blood pressure and HRV during an
eight-week training period which covered approximately the
same time period of intense training and high seasonal
incidence of URI as the previous RE swim study. High
variability of HRV cardiovascular parameters is associated
with healthy conditions when compared to the blunted values
that are seen with chronic disease states like heart failure
and a variety of pathologic conditions []. e HRV changes
found in our subjects in a period as short as to weeks of
RE practice resemble observations of benecial eects that
can accrue from a meditation technique like the relaxation
response [].
e spectral analysis of the HRV in our swimmers shows
that the LF component increased with training and is con-
sistent with previous observations made in volunteers who
practiced RE (unpublished observations) and in seasoned
meditators []. e LF HRV parameter detected in both
Rest
Control
RE without pulse
23451
Sessions
RE with pulse
5
6
7
8
9
Log (ms2/Hz)
Log LF RRI variability
F : Duri ng session , subjects rested for m inutes, followed by
minutes of uninstructed breathing. is -minute period is called
the control period in the gures above. During sessions through ,
subjects rested for minutes, followed by minutes of reective
exercises (RE).
newly taught and seasoned RE practitioners suggests that
there is a high level of autonomic balance and that modula-
tion by the cardioneuroimmune network may be related to
the protection from URIs in practicing swimmers. Although
some have suggested that neuroimmunity is mainly bolstered
by the HF component (the parasympathetic network) of the
HRV, a recent review of the correlations of HRV and inam-
mationsuggeststheopposite[].HRVtimedomainindices
like SDNN, SDNN index, and SD ANN and LF frequency-
domain measures have signicant associations with lower
levels of inammatory markers. Traditional “vagal measure”
like LF HRV, a complex measure reecting both parasym-
pathetic and sympathetic activity, is the more commonly
associated measure linked to low inammatory markers
[]. is observation coupled with a newer understanding
of the mechanisms of eerent vagal signaling with a lung
inammation model shed new light on the anti-inammatory
role of the vagus at the biomolecular level []. More
germane to our clinical picture, the use of vagal stimulation
(aerent pathways) has been shown to suppress inammatory
responses [, ]. e importance of vagal signaling in the
inammatory pathway is not disputed, as these accumulating
data raise questions about the contribution of voluntary
vagal stimulation through meditation and mental targeting in
regulating immunity by a cardioneuroimmune mechanism.
Conflict of Interests
e authors declare that there is no conict of interests
regarding the publication of this paper.
Evidence-Based Complementary and Alternative Medicine
Acknowledgment
isstudywassupportedbyagrantfromtheContemplative
Sciences Center, School of Medicine, University of Virginia.
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