Article

Effects of Buddhist Walking Meditation on Glycemic control and Vascular function in Patients with Type 2 Diabetes

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Abstract

Objective: To investigate and compare the effects of Buddhist walking meditation and traditional walking on glycemic control and vascular function in patients with type 2 diabetes mellitus. Methods: Twenty three patients with type 2 diabetes (50-75 years) were randomly allocated into traditional walking exercise (WE; n=11) or Buddhism-based walking meditation exercise (WM; n=12). Both groups performed a 12-week exercise program that consisted of walking on the treadmill at exercise intensity of 50-70% maximum heart rate for 30min/session, 3 times/week. In the WM training program, the participants performed walking on the treadmill while concentrated on foot stepping by voiced "Budd" and "Dha" with each foot step that contacted the floor to practice mindfulness while walking. Results: After 12 weeks, maximal oxygen consumption increased and fasting blood glucose level decreased significantly in both groups (p<0.05). Significant decrease in HbA1c and both systolic and diastolic blood pressure were observed only in the WM group. Flow-mediated dilatation increased significantly (p<0.05) in both exercise groups but arterial stiffness was improved only in the WM group. Blood cortisol level was reduced (p<0.05) only in the WM group. Conclusion: Buddhist walking meditation exercise produced a multitude of favorable effects, often superior to traditional walking program, in patients with type 2 diabetes.

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... FA meditations include Kirtan kriya (Raffone and Srinivasan, 2009;Srinivasan and Baijal, 2007;Wang et al., 2011). We also classified walking meditation as FA, as this meditation style involved concentration on the movement or position of ones arms or legs while walking (Gainey et al., 2016). The meditation intervention delivered by Curiati et al. (2005) was considered to be FA as it involved controlled breathing, body scan, and mental repetition of the word "peace," while trying to keep away any other thoughts and concentrating on a guided image of a healthy heart. ...
... In person 4 wks, 20 m/day (Gainey et al., 2016) WM: "In phase 1 (wk 1e6), 50e60% maximum HR and phase 2 (wk 7e12), 60e70% maximum HR. The sessions consisted of 10 m warm-up and general static stretching, 30 m workout and 10 m cool-down and general static stretching. ...
... Sequence generation Allocation concealment Blinding Incomplete outcome data Selective outcome reporting Other sources of bias (Azam et al., 2016) L L UC H UC L ( Barnes et al., 2001) U C U C U C U C U C U C ( Barnes et al., 2004a) H UC L L UC H ( Barnes et al., 2004b) UC UC UC H UC L (Barnes et al., 2008) H UC UC H UC H (Black et al., 2013) L UC H L UC L (Carissoli et al., 2015) U C U C U C U C H H (Carlson et al., 2015(Carlson et al., , 2013 L L L L H L (Chacko et al., 2016) L L L L L L (Chhatre et al., 2013) U C U C L L U C H (Creswell et al., 2016) L L L L H U C (Curiati et al., 2005) UC UC UC H UC H (Daubenmier et al., 2016) L L H L H H L L H UC UC L (Fan et al., 2010) UC UC UC L UC L (Fan et al., 2014) U C U C U C U C U C H (Gainey et al., 2016) L UC UC H UC H (Garland et al., 2014) L L UC H UC UC (Goldberg et al., 2014) UC UC UC H UC L (Grant et al., 2013) U C U C U C U C L H (Gregoski et al., 2011) H UC UC UC UC H (Grossman et al., 2016) U C U C L L L H (Harinath et al., 2004) L UC UC UC UC UC (Hayney et al., 2014) L L L U C L L (Hsiao et al., 2016) L L UC L UC L (Jayadevappa et al., 2007) L L L L U C L (Jedel et al., 2014) L L L L L H (Jensen et al., 2012) U C U C L L U C U C (Jung et al., 2015) H L L H U C L (Kingston et al., 2007) L L L UC UC UC L L U C U C U C H (Lipschitz et al., 2013) L UC UC L UC L (Lipschitz et al., 2015) U MacLean et al., 1997) U C L L H H H (Oken et al., 2010) U C L L U C U C L (Palta et al., 2012) UC UC UC L UC H (Parswani et al., 2013) L UC UC H UC H (Patel and North, 1975) U . Two studies used ITT analysis (Barnes et al., 2004a;Daubenmier et al., 2016). ...
... 16 In adults with T2D or type 1 diabetes, mindfulness-based interventions decrease depressive and anxiety symptoms up to one-year later. [17][18][19][20] In some cases, mindfulness-based interventions have resulted in improved glycemic control, 21,22 or blood pressure, 17,21,23 but other studies failed to find effects. [18][19][20] From a conceptual framework, mindfulness-based training theoretically may lead to improvements in metabolic and cardiovascular health through enhancing self-regulation. ...
... 16 In adults with T2D or type 1 diabetes, mindfulness-based interventions decrease depressive and anxiety symptoms up to one-year later. [17][18][19][20] In some cases, mindfulness-based interventions have resulted in improved glycemic control, 21,22 or blood pressure, 17,21,23 but other studies failed to find effects. [18][19][20] From a conceptual framework, mindfulness-based training theoretically may lead to improvements in metabolic and cardiovascular health through enhancing self-regulation. ...
... These findings raise the possibility that mindfulness training offers unique benefits for decreasing depressive symptoms and improving hyperinsulinemia and insulin resistance, early detectable precursors to T2D, in adolescents at-risk for T2D. Some previous research has found that mindfulness-based stress reduction improves glycemic control in adults with diabetes, 21,22 although results have been mixed. [18][19][20] This study cannot determine the possible explanatory mechanisms for the acute intervention effects on depressive symptoms and insulin resistance. ...
Article
Objective: (1) Evaluate feasibility and acceptability of a mindfulness-based group in adolescent girls at-risk for type 2 diabetes (T2D) with depressive symptoms, and (2) compare efficacy of a mindfulness-based versus cognitive-behavioral group for decreasing depressive symptoms and improving insulin resistance. Design and setting: Parallel-group, randomized controlled pilot trial conducted at a university. Participants: Thirty-three girls 12-17y with overweight/obesity, family history of diabetes, and elevated depressive symptoms were randomized to a six-week mindfulness-based (n=17) or cognitive-behavioral program (n=16). Interventions: Both interventions included six, one-hour weekly group sessions. The mindfulness-based program included guided mindfulness awareness practices. The cognitive-behavioral program involved cognitive restructuring and behavioral activation. Main outcome measures: Adolescents were evaluated at baseline, post-intervention, and six-months. Feasibility/acceptability were measured by attendance and program ratings. Depressive symptoms were assessed by validated survey. Insulin resistance was determined from fasting insulin and glucose, and dual energy x-ray absorptiometry was used to assess body composition. Results: Most adolescents attended ≥80% sessions (mindfulness: 92% versus cognitive-behavioral: 87%, p=1.00). Acceptability ratings were strong. At post-treatment and six-months, adolescents in the mindfulness condition had greater decreases in depressive symptoms than adolescents in the cognitive-behavioral condition (ps<.05). Compared to the cognitive-behavioral condition, adolescents in the mindfulness-based intervention also had greater decreases in insulin resistance and fasting insulin at post-treatment, adjusting for fat mass and other covariates (ps<.05). Conclusions: A mindfulness-based intervention shows feasibility and acceptability in girls at-risk for T2D with depressive symptoms. Compared to a cognitive-behavioral program, after the intervention, adolescents who received mindfulness showed greater reductions in depressive symptoms and better insulin resistance. ClinicalTrials.gov identifier: NCT02218138 clinicaltrials.gov.
... La unidad de medida del nivel de HbA1c de los estudios se expresó en porcentaje (%), no obstante, un trabajo (Gainey, Himathongkam, Tanaka & Suksom, 2016) reportó la HbA1c en mmol/mol, por lo cual, el valor se transformó a % utilizando la siguiente fórmula (Blot et al., 1988): ...
... Se identificaron 10 estudios (Armani Kian et al., 2018;Chacko, Yeh, Davis & Wee, 2016;Gainey, et al., 2016;Gre-gg, Callaghan, Hayes, & Glenn-Lawson, 2007;Hartmann et al., 2012;Murray, et al., 2017;Pearson, Wills, Woods, & Warnecke, 2018;Putiri et al., 2012;Saslow, et al., 2017;Shayeghian, Hassanabadi, Aguilar-Vafaie, Amiri & Besharat, 2016), de los cuales, cuatro fueron llevados a cabo en Estados Unidos, dos en Irán, uno en Alemania, uno en Australia, uno en Tailandia y uno en Inglaterra. ...
... Respecto a las intervenciones que incorporaron Mindfulness, mayoritariamente las sesiones duraron entre 8 a 12 semanas (Armani Kian, et al., 2018;Chacko, et al., 2016;Gainey, et al., 2016;Hartmann, et al., 2012;Murray, et al., 2017;Pearson, et al., 2018;Putiri, et al., 2012). También hubo una intervención que duró 32 semanas (Saslow, et al., 2017) y una que duró 4 horas (Gregg, et al., 2007). ...
Article
Full-text available
The purpose of this paper was to study the effectiveness of Mindfulness-based interventions on the level of glycated hemoglobin —HbA1c— in patients with type 2 diabetes mellitus —DM2—. A systematic review and preliminary meta-analytic integration was performed. The search of the studies was carried out in the following bases: PubMed, Bireme, Web of Science, SciELO, Embase, EBSCOhost, SCOPUS, Psychology Database. Ten articles were identified: four were published in the United States, two in Iran, one in Germany, one in Australia, one in Thailand and one in England. A reduction in HbA1c levels was observed using Mindfulness compared to control groups (p <0,02). In addition, according to the number of participants, sex and time of follow-up a differentiated effect was found. It was concluded that the use of interventions based on Mindfulness would have an indirect effect on the reduction of glycated hemoglobin (HbA1c).
... FA meditations include Kirtan kriya (Raffone and Srinivasan, 2009;Srinivasan and Baijal, 2007;Wang et al., 2011). We also classified walking meditation as FA, as this meditation style involved concentration on the movement or position of ones arms or legs while walking (Gainey et al., 2016). The meditation intervention delivered by Curiati et al. (2005) was considered to be FA as it involved controlled breathing, body scan, and mental repetition of the word "peace," while trying to keep away any other thoughts and concentrating on a guided image of a healthy heart. ...
... In person 4 wks, 20 m/day (Gainey et al., 2016) WM: "In phase 1 (wk 1e6), 50e60% maximum HR and phase 2 (wk 7e12), 60e70% maximum HR. The sessions consisted of 10 m warm-up and general static stretching, 30 m workout and 10 m cool-down and general static stretching. ...
... With the eyes closed and in a sequential pattern, a tension is given to a muscle group purposefully for approximately 10sec and then released for 20sec before continuing with the next muscle group. Barnes et al., 2001) U C U C U C U C U C U C ( Barnes et al., 2004a) H UC L L UC H ( Barnes et al., 2004b) UC UC UC H UC L (Barnes et al., 2008) H UC UC H UC H (Black et al., 2013) L UC H L UC L (Carissoli et al., 2015) U C U C U C U C H H (Carlson et al., 2015(Carlson et al., , 2013 L L L L H L (Chacko et al., 2016) L L L L L L (Chhatre et al., 2013) U C U C L L U C H (Creswell et al., 2016) L L L L H U C (Curiati et al., 2005) UC UC UC H UC H (Daubenmier et al., 2016) L L H L H H L L H UC UC L (Fan et al., 2010) UC UC UC L UC L (Fan et al., 2014) U C U C U C U C U C H (Gainey et al., 2016) L UC UC H UC H (Garland et al., 2014) L L UC H UC UC (Goldberg et al., 2014) UC UC UC H UC L (Grant et al., 2013) U C U C U C U C L H (Gregoski et al., 2011) H UC UC UC UC H (Grossman et al., 2016) U C U C L L L H (Harinath et al., 2004) L UC UC UC UC UC (Hayney et al., 2014) L L L U C L L (Hsiao et al., 2016) L L UC L UC L (Jayadevappa et al., 2007) L L L L U C L (Jedel et al., 2014) L L L L L H (Jensen et al., 2012) U C U C L L U C U C (Jung et al., 2015) H L L H U C L (Kingston et al., 2007) L L L UC UC UC L L U C U C U C H (Lipschitz et al., 2013) L UC UC L UC L (Lipschitz et al., 2015) U MacLean et al., 1997) U 5 and 6). Two studies used ITT analysis (Barnes et al., 2004a;Daubenmier et al., 2016). ...
Article
Meditation is a popular form of stress management, argued to mediate stress reactivity. However, many studies in this field commonly fail to include an active control group. Given the frequency with which people are selecting meditation as a form of self-management, it is important to validate if the practice is effective in mediating stress-reactivity using well-controlled studies. Thus, we aimed to conduct a meta-analysis investigating the neurobiological effects of meditation, including focused attention, open monitoring and automatic self-transcending subtypes, compared to an active control, on markers of stress. In the current meta-analysis and systematic review, we included randomised controlled trials comparing meditation interventions compared to an active control on physiological markers of stress. Studied outcomes include cortisol, blood pressure, heart-rate, lipids and peripheral cytokine expression. Forty-five studies were included. All meditation subtypes reduced systolic blood pressure. Focused attention meditations also reduced cortisol and open monitoring meditations also reduced heart rate. When all meditation forms were analysed together, meditation reduced cortisol, C - reactive protein, blood pressure, heart rate, triglycerides and tumour necrosis factor-alpha. Overall, meditation practice leads to decreased physiological markers of stress in a range of populations.
... La unidad de medida del nivel de HbA1c de los estudios se expresó en porcentaje (%), no obstante, un trabajo (Gainey, Himathongkam, Tanaka & Suksom, 2016) reportó la HbA1c en mmol/mol, por lo cual, el valor se transformó a % utilizando la siguiente fórmula (Blot et al., 1988): ...
... Se identificaron 10 estudios (Armani Kian et al., 2018;Chacko, Yeh, Davis & Wee, 2016;Gainey, et al., 2016;Gre-gg, Callaghan, Hayes, & Glenn-Lawson, 2007;Hartmann et al., 2012;Murray, et al., 2017;Pearson, Wills, Woods, & Warnecke, 2018;Putiri et al., 2012;Saslow, et al., 2017;Shayeghian, Hassanabadi, Aguilar-Vafaie, Amiri & Besharat, 2016), de los cuales, cuatro fueron llevados a cabo en Estados Unidos, dos en Irán, uno en Alemania, uno en Australia, uno en Tailandia y uno en Inglaterra. ...
... Respecto a las intervenciones que incorporaron Mindfulness, mayoritariamente las sesiones duraron entre 8 a 12 semanas (Armani Kian, et al., 2018;Chacko, et al., 2016;Gainey, et al., 2016;Hartmann, et al., 2012;Murray, et al., 2017;Pearson, et al., 2018;Putiri, et al., 2012). También hubo una intervención que duró 32 semanas (Saslow, et al., 2017) y una que duró 4 horas (Gregg, et al., 2007). ...
Article
Full-text available
Efectividad de intervenciones basadas en Mindfulness para mejorar el control de la Diabetes Mellitus tipo 2: Una revisión sistemática e integración metanalitica preliminar The purpose of this paper was to study the effectiveness of Mindfulness-based interventions on the level of glycated hemoglobin —HbA1c— in patients with type 2 diabetes mellitus —. Ten articles were identified: four were published in the United States, two in Iran, one in Germany, one in Australia, one in Thailand and one in England. A reduction in HbA1c levels was observed using Mindfulness compared to control groups (p <0,02), random model d=-.29 or r= -.143 In addition, according to the number of participants,sex and time of follow-up a differentiated effect was found. It was concluded that the use of interventions based on Mindfulness would have an indirect effect on the reduction of glycated hemoglobin (HbA1c). Meta analisis K=10 muestra un efecto (modelo aleatorio) de d=-.29 o r=-.143 de la intervencion en mindfulness comparado con control en disminucion del nivel de hemoglobina glicada o glicosilada La prueba de la hemoglobina glicosilada se basa en la medición de la cantidad de glucosa adherida a los glóbulos rojos y su resultado se expresa en porcentaje, que determina el nivel medio de glucemia durante el trimestre anterior a la prueba. Además, desde 2010, la American Diabetes Association estableció esta prueba como un examen de diagnóstico de la enfermedad: un resultado igual o superior a 6,5% determina que una persona tiene diabetes, mientras que uno de entre 5,7% y 6,4% se considera prediabetes.
... Of these, 19 articles were excluded; two articles were duplicate [22,23], one measured FMD of popliteal artery [24], two had patients with different kinds of diseases as well as T2D in the groups [25,26], three had T2D patients with peripheral arterial disease or diabetic peripheral neuropathy [27][28][29], two did not provide precise data [30,31], two additionally treated dietary control for weight loss [32,33], three involved unstructured or unsupervised exercise intervention [34][35][36], and four were just abstracts with incomplete data [37][38][39][40]. Four exercise groups (EX) with additional interventions were included after discussing because there was no difference in the effect of interventions on FMD, our major outcome, between the CON and experimental groups: (i) exercise in the hypoxic environment (16.5% O 2 , 2000 m) [41]; (ii) endothelin (ET) receptor blockade or a placebo [42]; (iii) walking meditation [43]. One AE trial which recorded the time, frequency, and intensity of exercise by a multi-record accelerometer were also included because the subjects visited the laboratory every 1 or 2 weeks [44]. ...
... One AE trial which recorded the time, frequency, and intensity of exercise by a multi-record accelerometer were also included because the subjects visited the laboratory every 1 or 2 weeks [44]. Moreover, two CON including AE on treadmill [43] and combined AE and RE in the normoxic environment [41] were included in the EX. Eventually, we selected thirteen exercise trials in eight studies by consensus. ...
... Table 1 shows the characteristics of all of the studies included. Articles were published from January 2010 [45] to June 2016 [43]. The sample size was 316. ...
Article
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Background Vascular endothelial dysfunction induced by hyperglycemia and elevated insulin resistance is a potent risk factor for cardiovascular disease and likely contributes to multiple chronic disease complications associated with aging. The aim of this study was to systematically review and quantify the effects of exercise on endothelial function (EF) in type 2 diabetes (T2D). Methods Five electronic databases were searched (until June 2017) for studies that met the following criteria: (i) randomized controlled trials; (ii) T2D aged ≥ 18 years; (iii) measured EF by brachial artery flow-mediated dilation (FMD); (iv) structured and supervised exercise intervention for ≥ 8 weeks. Results Thirteen cohorts, selected from eight studies (306 patients, average age 59 years), met the inclusion criteria. Exercise training significantly increased FMD (mean ES = 0.41, 95% CI 0.21–0.62, P < 0.001). Low to moderate intensity subgroups and aerobic exercise (AE) subgroups significantly increased FMD more than moderate to high intensity subgroups and combined AE and resistance exercise subgroups respectively (P < 0.01, P < 0.05). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessments reported that quality of evidence for all outcomes was moderate except shear rate showing low. Egger’s test showed no significant publication bias for all outcomes. Conclusion Our results suggest that in patients with T2D, lower intensity exercise has physiological meaningful effects on EF, in support of the emerging concept that the lower efforts of exercise are not necessarily less cardioprotective than higher intensity training.
... Most studies had a quantitative randomized controlled study design (4/5), 34-37 one study is uncontrolled observational study (Saeloo et al. 2012). 38 All of the studies were conducted in Asia (Thailand (4/5) [35][36][37][38] ; China (1/5)). 34 Out of five studies which were selected with randomised nature, the study by Sudsuang et al., 37 is a quasi-experimental study, but the randomization procedure was not clearly described in the article. ...
... Few other randomized clinical trials which were conducted in old patients with cardiovascular risk factors demonstrated that Buddhist walking meditation and breathing meditation-"Anapanasati" were effective in reducing blood pressure and improving vascular function. 35,36 A randomised intervention study conducted in older patients with mild-to-moderate depressive symptoms by Prakhinkit et al. 35 demonstrated significant reductions in blood pressure (systolic/diastolic) levels in response to 12-week Buddhist walking meditation and traditional walking intervention. Similarly, both groups demonstrated improvements in brachial artery structure and function. ...
... The outcome of this study further demonstrated that improvements of resting brachial diameter and FMD in Buddhist meditation group were significant against the preintervention values and against the post values of sedentary control group, 35 which shows superior effects of Buddhist walking meditation on endothelial dependent vasodilatation than the traditional walking exercises. Another randomized control study by Gainey et al. 36 showed that Buddhist walking meditation improves endotheliumdependent vasodilation in adult patients with type 2 diabetes. Significant reductions in both systolic and diastolic blood pressure levels were only observed in the Buddhist walking meditation group compared to the traditional walking exercise group. ...
Article
Full-text available
Background: High blood pressure represents an important risk factor for diseases related to cardiovascular system and is directly associated with high oxidative stress, inflammation and vascular endothelial dysfunction. Recently, there is promising data available to suggest that meditation-based low-cost and low-risk lifestyle modification strategies may provide beneficial effects on chronic inflammation, oxidative stress and maintenance of blood pressure, both in young and older adults. This review aims to summarize the evidence regarding the effectiveness of Buddhist meditation for vascular endothelial function and blood pressure. Method: A search was conducted using Ovid MEDLINE, Scopus, CINAHL and PsycINFO for articles published from 1990 to 2018. Results: Relevant articles (n = 407) were reviewed and 5 met selection criteria. Several lines of studies have provided compelling data showing that Buddhist meditation approach was effective in improving inflammation and vascular function (endothelial vasodilation and arterial stiffness) in both young and elderly cohorts. Particularly, Buddhist meditation approach has shown to be effective in reducing plasma inflammatory markers, increasing nitric oxide concentration and improving vascular endothelial function and glycemic control, which in turn can be favorable factors for demonstrated positive effects of Buddhist meditation on blood pressure and vascular function. Conclusion: This paper presents brief overview of clinical outcomes of complementary therapeutic approach of Buddhist meditation in vascular function. In future, well-structured systematic reviews are essential to report specificity of Buddhist mindfulness-based approach on vascular function, blood pressure and other cardiovascular risk factors.
... We identified 34 articles from 30 studies meeting all inclusion criteria (some articles reported different outcomes within the same study and were included as unique selections). These consisted of four PP articles [41][42][43][44], 18 mindfulness-based articles [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62], six ACT articles [38,[63][64][65][66][67], four resiliencebased articles [68][69][70][71], and single studies targeting emotional intelligence [72] and positive self-concept [73] (see Tables 1 and 2 for details about studies with control groups and studies without control groups, respectively). Control conditions varied significantly across studies. ...
... Mindfulness-based intervention studies also examined physical health outcomes ranging from diabetes-specific (e.g., HBA1C, diabetes meal planning) to more general outcomes such as blood pressure, health-related quality of life, and cortisol. Of the eight mindfulness-based studies that measured HBA1C, the most commonly studied physical outcome, four found a significant reduction post-intervention [45,51,52,54], but only two compared changes to a control condition [51,52]. In two instances, significant changes in HBA1C were not observed immediately post-intervention but instead at three-month follow-up [51] and one-month follow-up [54]. ...
... Mindfulness-based intervention studies also examined physical health outcomes ranging from diabetes-specific (e.g., HBA1C, diabetes meal planning) to more general outcomes such as blood pressure, health-related quality of life, and cortisol. Of the eight mindfulness-based studies that measured HBA1C, the most commonly studied physical outcome, four found a significant reduction post-intervention [45,51,52,54], but only two compared changes to a control condition [51,52]. In two instances, significant changes in HBA1C were not observed immediately post-intervention but instead at three-month follow-up [51] and one-month follow-up [54]. ...
Article
In patients with diabetes, psychological well-being constructs (e.g., optimism, positive affect) have been associated with superior medical outcomes, including better glucose control and lower mortality rates. Well-being interventions may be well-suited to individuals with diabetes, as they are simple to deliver, broadly applicable across a range of psychological distress, and may help increase self-efficacy and motivation for diabetes self-care. This systematic review, completed using PRISMA guidelines, examined peer-reviewed studies indexed in PubMed, PsycINFO, and/or Scopus between database inception and October 2017 that investigated the effects of well-being interventions (e.g., positive psychology interventions, mindfulness-based interventions, resilience-based interventions) on psychological and physical health outcomes in individuals with Type 1 or Type 2 diabetes. The search yielded 34 articles (N = 1635 participants), with substantial variability in intervention type, measures used, and outcomes studied; the majority found the intervention to provide benefit. Overall, results indicate that a range of well-being interventions appear to have promise in improving health outcomes in this population, but the literature does not yet provide definitive data about which specific interventions are most effective. The variability in interventions and outcomes points to a need for further rigorous, controlled, and well-powered studies of specific interventions, with well-accepted, clinically relevant outcome measures.
... Gainey et al. [46] explored the effects of a Buddhism-based walking meditation program on glycemic control, arterial stiffness, stress hormone, and vascular function in patients with type 2 diabetes mellitus. In the walking meditation condition, participants were asked to repeat the words "Budd" and "Dha" in their minds with each step in an attempt to practice mindfulness and switch attention toward the present moment. ...
... The authors speculated that a significant reduction in plasma cortisol could have influenced inflammatory processes, tension in the vascular wall, and sympathetic activity. Taken holistically, the results of Gainey and colleagues [46] indicate that simple instructions implemented during walking-related tasks to guide attention toward the present moment can lead to multifarious benefits for physical and mental health in patients with diabetes. ...
Chapter
Through the continuous scientific exploration into the deep realms of consciousness, researchers have discovered precious gems of knowledge, commonly referred to as meditation and yoga. Such “techniques” have been used for millennia as a means by which to optimize awareness, enhance compassion and empathy, and bring joy to one’s life. In the present chapter, the author briefly reviews some of the most recent and compelling studies addressing the psychological and cardiovascular effects of meditation and yoga. Special emphasis is given to mindfulness-based interventions and the traditional Indian spiritual practice of yoga. Overall, the results indicate that meditation and yoga are efficient strategies to downregulate psychophysiological arousal, facilitate handling of undesired thoughts, optimize one’s ability to deal with negative emotions, and reduce cardiovascular risk. Nevertheless, it is worth noting that the brain mechanisms that underlie the effects of meditation and yoga on psychological and cardiovascular responses are hitherto under-researched. Future studies are still necessary to further understanding of the long-term effects of meditation and yoga on emotion regulation, psychosocial skills, and cardiovascular health (e.g., blood pressure reduction and prevention of cardiovascular disease).
... While different mechanisms have been proposed, excessive psychological stress is most often thought to set the stage for CVD by causing hyperactivity of the sympathetic nervous system (SNS) and hypothalamic-pituitaryadrenal (HPA) pathways, which subsequently leads to inflammation, parasympathetic inhibition, and atherosclerosis [5][6][7]. Importantly, psychological stress reduction techniques, such as mindfulness based interventions (MBI's), have been demonstrated to improve some markers of HPA and SNS function [6][7][8][9][10]. ...
... Psychological stress reduction and mind-body therapies such as yoga, tai chi, and mindful walking have shown some improvement in subjective psychological measures of well-being, and potentially affect CVD risk [9,39,40]. However, there is limited and inconsistent evidence demonstrating potential cardioprotective benefits of such therapies [41]. ...
Article
Cardiovascular disease (CVD) has been associated with chronic psychological stress. Unremittent psychological stress causes dysregulation of the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis, which collectively promotes inflammation, atherosclerosis, and subsequent CVD risk. Stress reduction techniques, such as mindfulness meditation, have been shown to improve some markers of HPA and SNS function at rest and in response to acute stressors, suggesting that such techniques, over time, may be cardioprotective. Therefore, it may be hypothesized that eight weeks of daily mindfulness meditation, compared to a non-mindful relaxation control, may provide a novel strategy to buffer stress responses in healthy and at-risk populations, thereby lowering the risk of chronic psychological stress and the associated CVD risk as measured by arterial stiffness. The current paper outlines methodological considerations for testing this hypothesis, including appropriate acute stressors, and measurement of SNS, HPA axis and cardiovascular function. If the hypothesis is correct, mindfulness meditation would complement healthy lifestyle techniques such as exercise and diet to prevent CVD risk.
... The participants are instructed to become conscious of the otherwise automated walking process by walking slowly, *This work was not supported by any organization 1 taking small steps and by fully focusing on walking. Mindful walking has, for example, been shown to be beneficial for patients with depression [7] as well as for patients with diabetes [8]. During mindful exercises, however, participants often experience that their mind is distracted from being mindful and that they have difficulties to redirect their focus on the mindful exercise, especially patients suffering from depression [9]. ...
... The main motivation behind this work was to develop a mobile application to support individuals in mindful walking -especially those practicing mindfulness is challenging for like novices or patients with depression [9] -with the final aim to increase its benefits for example for stress reduction and the management of noncommunicable diseases [7], [8]. The way how the technical prototype was realized and how the first study with this prototype was conducted will be presented in this paper. ...
... According to a recent systemic review, [43] 7 of 8 randomized controlled trials (total 838 participants) using yoga-based programs reported significant beneficial changes in serum lipids, including a significant decline in LDL, compared to standard care, group education, or a moderate intensity exercise program. However, LDL level is not significantly changed in several meditation studies, including 12-week Buddhist walking meditation, [44] and a community-based mind-body meditative Tai Chi program. [45] Sometimes yoga-based program includes more physical activity than static regular meditation. ...
Article
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Background: Hypertension and type 2 diabetes are chronic diseases, which generally require lifetime care. Meditation and yoga can be complementary to pharmacological therapies according to the scientific evidences so far. Brain education-based meditation (BEM) is a technique, which has been known to change brain structure, psychology, and physiology of healthy adult participants. This randomized, nonblinded pilot trial aimed to examine whether BEM affects the conditions of patients with hypertension and/or type 2 diabetes compared with health education classes. Methods: We randomly allocated 48 patients with hypertension and/or type 2 diabetes to BEM (n = 24) or health education (n = 24) classes in the Ulsan Junggu Public Health Center in Korea, where the classes were run during the same period and explored the impact of 8-week practice on the serum glutamic-oxaloacetic transaminase, serum glutamic pyruvic transaminase, gamma glutamyl transpeptidase, creatinine, high-density lipoprotein cholesterol, and low-density lipoprotein (LDL) cholesterol. Total RNA was extracted to examine inflammatory gene expressions from the whole blood using PAXgene blood RNA System. In addition, self-reports on mental/physical health were evaluated. The Student's t test, chi-squared test, and analysis of covariance were used for statistical analysis. Results: The number of people who participated until the completion of the study was 14 in the control and 21 in the BEM group. After 8 weeks, LDL cholesterol level was significantly decreased in the BEM group after the intervention (13.82 mg/dL reduction, P < .05), while it was not significantly altered in the control group. The expression of inflammatory genes was significantly reduced after 8 weeks of the BEM training (0.3-, 0.5-, and 0.2-fold change for NFKB2, RELA, and IL1B, respectively, all P < .05). In the item analysis of mental/physical health self-reports, a significant improvement was confirmed as follows: increases in focus, confidence, relaxation, and happiness; decreases in fatigue, anger, and loneliness (all P < .05). There were no important adverse events or side-effects by BEM intervention. Conclusion: Compared to health education, BEM helps lower LDL cholesterol level and the inflammatory gene expression in the patients with hypertension and/or type 2 diabetes. Moreover, BEM induces positive effects on the self-reported mental/physical states, warranting further study.
... [27][28][29] Significant improvements in glycemic control, blood pressure control, and arterial stiffness have been demonstrated with walking meditation as compared to traditional walking exercise in type 2 diabetic individuals. [30] Meditation influences and modulates the activity of the brain and autonomic nervous system, with reduction in sympathetic tone and increase in parasympathetic activity, and has been associated with cardiorespiratory synchronization. [31] Mindfulness was associated with reduced myocardial oxygen consumption and had a strong positive effect on cardiovascular modulation by decreasing vasomotor tone, vascular resistance, and ventricular workload. ...
Article
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Buddhist philosophy is a way of life that transcends the borders of religion and focuses on the alleviation of suffering. The core teaching of Buddha was the Four Noble Truths: there is suffering, suffering is caused by clinging and ignorance, there is a way out of suffering and that way is the Noble Eightfold Path. The medical analogy in diabetes care would include identification of diabetes, understanding its etiopathogenesis, and how prognosis can be improved with appropriate care and management of this chronic disorder. Gaining awareness about the cause of illness and conducting our lives in a manner that nourishes and maintains long-term good health leads to improved outcomes for individuals living with diabetes and improve their overall well-being. The Noble Eightfold Path in Buddhism constitutes of right view, right resolve, right speech, right action, right livelihood, right effort, right mindfulness, and right concentration. These elements of the Eightfold Path can be taken as guiding principles in diabetes care. Buddhist meditation techniques, including mindfulness meditation-based strategies, have been used for stress reduction and management of chronic disorders such as chronic pain, depression, anxiety, hypertension, and diabetes. In this article, we focus on how Buddhist philosophy offers several suggestions, precepts, and practices that guide a diabetic individual toward holistic health.
... In walking practices, studies have shown that short walks (even for 15 min) can be therapeutic for mitigating excessive stress and stress-related diseases [18,22,26]. Also, as previous works [12,14,46,73] showed beneficial effects of different methods of breathing guidance during walking meditation sessions, we think that our device might achieve a similar effect if we suggest users to use it during a walking meditation and pay full attention to follow the guidance unlike what we did for this study (where we gave freedom to ignore the tactile intervention and asked them to prioritize the main task which was walking). ...
Article
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To assist people in practicing mindful breathing and regulate their perceived workload while not disturbing the ongoing foreground task during daily routines, we developed a mobile and personalizable pneumatic-haptic feedback device that provides programmable subtle tactile feedback. The device consists of three soft inflatable actuators embedded with DIY stretchable sensors. We introduce their simple and cost-effective fabrication method. We conducted a technical and user-based evaluation of the device. The user-based evaluation focused on the personalization of the tactile feedback based on users' experience assessed during three pilot studies. Different personalization parameters have been tested, such as two tactile patterns, different levels of intensity and frequency. We collected the participants' self-reports and physiological data. Our results show that the device has the potential of a breathing guide under certain conditions. We provide the main findings and design insights from each study and suggest recommendations for developing an on-body personalizable pneumatic-haptic feedback interface.
... Relevant studies, including our previous study, have found that mind-body exercises had the effect of reducing HbA1c in type-2 DM patients. One study showed that walking combined with meditation exercise had a better effect on HbA1c regulation than simple walking [29]; the results of our previous meta-analysis also showed that, compared with other aerobic exercise, Qigong exercise had more advantages in downregulating HbA1c level of type-2 DM patients [30]. Therefore, we considered that Tai chi as an exercise with the combination of movement and meditation could suppress sympathetic activation, thus can improve glycemic control as neutrally mediated vasoconstriction, and in the meanwhile reduce glucose delivery and uptake in skeletal muscle [31]. ...
Article
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Objective To investigate the effects of Tai chi in type 2 diabetes mellitus (type-2 DM) patients using systematic review and meta-analysis. Methods Seven electronic resource databases were searched, and randomized controlled trials on the role of Tai chi in type-2 DM patients were retrieved. The meta-analysis was performed with RevMan 5.3, and research quality evaluation was conducted with the modified Jadad scale. Results Fourteen studies, with 798 individuals related to the intervention of Tai chi on diabetes, were included. The results showed that, compared with nonexercise, Tai chi had the effect of lowering fasting blood glucose [MD = −1.39, 95% CI (−1.95, −0.84), P < 0.0001] and the subgroup effect size decreased with the increase of total exercise amount, there is no significant difference between Tai chi and other aerobic exercises [MD = −0.50, 95% CI (−1.02, 0.02), P = 0.06]; compared with nonexercise, Tai chi could reduce HbA1c [MD = −0.21, 95% CI (−0.61, 0.19), P = 0.31], and the group effect size decreased with the increase of total exercise amount. The reducing HbA1c effect of Tai chi was better than that of other aerobic exercises, but the difference was at the margin of statistical significance [MD = −0.19, 95% CI (−0.37, 0.00), P = 0.05]; compared with nonexercise, Tai chi had the effect of reducing 2 h postprandial blood glucose [MD = −2.07, 95% CI (−2.89, −1.26), P = 0.0002], there is no significant difference between Tai chi and other aerobic exercises in reducing 2 h postprandial blood glucose [MD = −0.44, 95% CI (−1.42, 0.54), P = 0.38]. Conclusion Tai chi can effectively affect the management of blood glucose and HbA1c in type-2 DM patients. Long-term adherence to Tai chi has a better role in reducing blood glucose and HbA1c levels in type 2 DM patients.
... MM in diabetes care is backed by evidence. Randomized controlled trials have demonstrated the efficacy of MM in improving glycemic control, [4][5][6] managing painful diabetic neuropathy, 7 correcting eating disorders, and alleviating depression. 8 The benefits of MM on emotional distress and quality of life are also proven. ...
Article
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The prevalence of type 2 diabetes is increasing worldwide, and the cost of managing this global epidemic is considerable, particularly in developing countries with poorer health care systems. ¹ There is, therefore, a need for a more holistic approach to diabetes management, which focuses on all aspects of diabetes, from managing blood glucose to addressing the emotional and social aspects of living with diabetes. In an expert interview, Sanjay Kalra of the Bharti Hospital, Karnal, India, discusses the role of mindfulness meditation (MM), which is the practice of working with concentrated awareness to live each moment fully, in the management of diabetes.
... Similar to the Buddhist walking meditation protocol utilized in mindfulness-based stress reduction (Kabat-Zinn, 1982), it would be beneficial to evaluate the utility of a brief session of mindfulness-based walking alone, on psychological outcomes. Notably, a 12-week Buddhist walking meditation intervention has been shown to result in greater reductions in cortisol levels as well as superior vascular improvements in comparison with a control walking group (Gainey, Himathongkam, Tanaka, & Suksom, 2016). Further investigation of the psychological benefits of mindfulness-based walking (including a single session of this protocol) would have great applications to everyday life; people could be trained to be more mindful during their daily ambulatory activity. ...
Article
Single bouts of aerobic exercise and meditation have been shown to induce positive affect. In a novel experimental paradigm, we sought to examine the effects of an acute bout of aerobic exercise and meditation, as well as exercise and meditation combined on affect among young adults. Participants (N = 110, mean age = 21.4 years) were randomly assigned to walk, meditate, walk then meditate, meditate then walk, or to sit (inactive control). All walking and meditation bouts were 10 minutes in duration. Participants’ affect was monitored before and after the intervention using the Exercise Induced Feelings Inventory. Significant group × time interaction effects were observed for three Exercise Induced Feelings Inventory subscales, including revitalization (p < .001), tranquility (p = .02), and exhaustion (p = .03); the group × time interaction for Exercise Induced Feelings Inventory positive engagement was nonsignificant (p = .16). A single bout of brisk walking or meditation, as well as a combination of walking and meditation, may positively influence affect. There is some evidence to suggest that affective benefits may be greater following meditation or a combination of meditation and walking, when compared with walking alone.
... Therefore, lowering the level of HbA1c has a good control effect on the occurrence of severe complications in patients with diabetes. One study [35] showed that walking meditation can reduce HbA1c levels in diabetic patients, while only walking does not. Therefore, we considered that Qigong as an exercise with the combination of movement and meditation could suppress sympathetic activation and thus can improve glycemic control as neutrally mediated vasoconstriction and in the meanwhile reduce glucose delivery and uptake in skeletal muscle [36]. ...
Article
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Objective The purpose of this study was to investigate the effects of Qigong on type 2 diabetes mellitus (DM) using the systematic review and meta-analysis. Methods All prospective, randomized, controlled clinical trials published in English or Chinese and involving the use of Qigong by patients with DM were searched in 7 electronic databases from their respective inception to June 2016. The meta-analysis was conducted using the Revman 5.2. The quality of the included trials was assessed using the Jadad rating scale. Two researchers independently completed the inclusion, data extraction, and quality assessment. Results Twenty-one trials with 1326 patients met the inclusion criteria and were reviewed. The meta-analysis demonstrated that, compared with no exercise, the Qigong had significant effects on fasting blood glucose (MD = −0.99, 95% CI (−1.23, 0.75), P < 0.0001), HbA1c (MD = −0.84, 95% CI (−1.02, −0.65), P < 0.0001), and postprandial blood glucose (MD = −1.55, 95% CI (−2.19, −0.91), P < 0.00001). Conclusion The Qigong training can improve the blood glucose status of the type 2 DM patients and has positive effects on the management of type 2 DM. However, future research with better quality still needs to be conducted to address the effects of Qigong on type 2 DM.
... The beneficial effects of meditation include improvement of immune parameters in patients with breast and prostate cancer and slowing the decline of CD-4 T-lymphocytes in patients with HIV [24]. A recent small study has shown that "walking meditation" improved glycaemic control assessed using HbA1c, blood pressure and blood cortisol levels [25,26]. ...
... Gainey et al., 2016 40 23 patients with T2D were randomised to traditional walking exercise or Buddhism-based walking meditation exercise. ...
Article
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Diabetes is associated with significant psychological distress. It is, therefore, important to ensure the physical and emotional as well as psychosocial wellbeing of individuals living with diabetes. Meditation-based strategies have been evaluated for their complementary role in several chronic disorders including depression, anxiety, obesity, hypertension, cardiovascular disease and diabetes. The practice of meditation is associated with reduction in stress and negative emotions and improvements in patient attitude, health-related behaviour and coping skills. There is increased parasympathetic activity with reduction in sympathetic vascular tone, stress hormones and inflammatory markers. Additionally, several studies evaluated the role of mindfulness-based stress reduction in diabetic individuals and demonstrated modest improvements in body weight, glycaemic control and blood pressure. Thus, mindfulness meditation-based intervention can lead to improvements across all domains of holistic care – biological, psychological and social. Though most of these studies have been of short duration and included small numbers of patients, meditation strategies can be useful adjunctive techniques to lifestyle modification and pharmacological management of diabetes and help improve patient wellbeing.
... [12] Gainey et al. have reported that meditation reduced glycated hemoglobin, and cortisol level in diabetic patients. [13] In our study, on the 5 th postoperative day the patients in the control group however had cortisol level below the normal reference range in comparison to the Rajyoga group patient. One possible explanation to the development of lower plasma cortisol levels may be due to the low self-esteem and passive attitude toward life observed in the control group despite being anxious to the outcomes of the surgery. ...
Article
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Introduction Rajyoga meditation is a form of mind body intervention that is promoted by the Brahma Kumaris World Spiritual University. This form of meditation can be easily performed without rituals or mantras and can be practiced anywhere at any time. The practice of Rajyoga meditation can have beneficial effects on modulating anxiety and cortisol level in patients undergoing major cardiac surgery. Materials and Methods A prospective randomized control study was carried out in a single tertiary care center. One hundred and fifty patients undergoing elective coronary artery bypass surgery were enrolled in the study. The patients were randomized in two groups namely, Group 1 (Rajyoga group) and Group 2 (Control Group). Anxiety was measured on a visual analog scale 1–10 before the start of Rajyoga training or patient counseling (T1), on the morning of the day of surgery (T2), on the 2nd postoperative day (T3), and on the 5th postoperative day (T4). The serum cortisol level was measured in the morning of the day of surgery (T1), on the 2nd postoperative day (T2) and on the 5th postoperative day (T3), respectively. Results In the study, it was seen that the anxiety level of the patients before the surgery (T1) and on the day of surgery (T2) were comparable between the two groups. However on the 2nd postoperative day (T3), the patients who underwent Rajyoga training had lower anxiety level in comparison to the control group (3.12 ± 1.45 vs. 6.12 ± 0.14, P < 0.05) and on the 5th postoperative day (T4) it was seen that Rajyoga practice had resulted in significant decline in anxiety level (0.69 ± 1.1 vs. 5.6 ± 1.38, P < 0.05). The serum cortisol level was also favorably modulated by the practice of Rajyoga meditation. Conclusion Mindbody intervention is found to effective in reducing the anxiety of the patients and modulating the cortisol level in patients undergoing wellknown stressful surgery like coronary artery bypass surgery.
... The present study and several studies for even longer periods (of up to four months) failed to demonstrate that walking can be the appropriate exercise modality to result in health and glycaemic control improvements, even in type 2 diabetics, especially when intensity is self-determined in the case of cumulative strategy recommendations. 24 In this regard, Fritz and Rosenqvist (2001), 25 27 demonstrated that walking can improve glycaemic control in type 2 diabetics, although exercise that includes at least intervals of higher intensity has a more significant impact on health promotion, and especially on HbA1c levels. It is important to note that these studies utilised target intensities (i.e. ...
Article
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Aim: This study aimed to determine if a low-carbohydrate, high-fat diet (LCHFD) provides any benefits of glycaemic control in patients with type 2 diabetes mellitus, either alone or in conjunction with physical activity. Methods: Type 2 diabetics (n = 39) were assigned into either a concurrent physical activity and LCHFD group (DiExG), LCHFD only group (DietG) or control group (ConG). Results: No significant (p > 0.05) changes were observed in glycated haemoglobin (HbA1c), glucose and insulin in either the DiExG (HbA1c: p = 0.592; 8.3% decrease, glucose: p = 0.477; 11.1% decrease and insulin: p = 0.367; 44.1% increase) or DietG (HbA1c: p = 0.822; 0% change, glucose: p = 0.108; 11.0% decrease and insulin: p = 0.976; 4.2% decrease) group. Conclusions: In this study, neither an LCHFD alone nor in combination with a physical activity programme succeeded in eliciting improvements in insulin sensitivity in the type 2 diabetics. As such, adoption of a LCHFD, either alone or in combination with physical activity, should not unequivocally be part of the treatment approach for type 2 diabetics. Furthermore, it should carefully be weighed against the benefits of more balanced dietary and/or physical activity interventions.
... Walking meditation has many health benefits, including a reduction in psychological stress symptoms [37,41,105], and improving balance and focus [14,40,76]. Novice practitioners often struggle to master the rhythmic slow movements of the practice and find balance and integration. ...
Conference Paper
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Walking meditation is a form of mindfulness training, where the act of walking provides a rhythmic meter for attentional focus. Numerous digital technologies have been created to support sitting meditation and walking practices, however, less explored is the influence of these technologies on the first person in-the-moment experience of walking meditation. In this paper, we present a study of group walking meditation,with and without an interactive soundscape that is modulated by one practitioner’s brain wave data. In orderto understand and design the interactive experience, we developed qualitative methods for data collection of the first person experience of walking meditation. Six workshops were conducted with both novice and more advanced practitioners, involving a guided walking meditation with body scan, structured writing and drawing exercises for elicitation and reflection, and a group interview. Our contribution is twofold: a descriptive model of the experience of walking meditation as represented by the analytic themes of shifting state, attention,self-regulation strategy, and immersion and reflection, together with body maps and experience timelines that visually represent patterns in the data; and a workbook comprising the set of phenomenologically inspired data collection methods, which helps participants articulate their first person experience and enhances their ability to reflect on the practice of walking meditation. The results provide insight into how practitioners divide and shift their attention between the rhythm of walking, breathing and the soundscape; and how some are able to harmonise the multiple dimensions towards a flow experience. Our study contributes to and provide resources for the experience design of interactive technologies to support mindfulness practices of walking meditation, as well as other practices where the mind/body experience is central.
... Mindfulness is not simply a relaxation technique. Rather, it is a psychological strategy that focuses on directed attention and awareness of internal experiences (e.g., emotions, physical sensations) [20][21][22] and has been associated with cardiometabolic improvements in adults as well as youth [23][24][25]. Specifically, mindfulness involves paying attention intentionally, presently, and non-judgmentally. The practice of mindfulness skills, such as meditation, breath awareness, and mindful eating have been shown to facilitate greater awareness to feelings of hunger and cravings for high sugar/high fat foods, as well as more adaptive coping with psychological distress that may prompt emotional eating patterns [26,27]. ...
Article
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Pediatric overweight and obesity are significant individual and public health issues that require an innovative approach. While evidence suggests that intensive family-based behavioral lifestyle modification can improve weight status, practical and logistical realities limit the ability of primary healthcare providers to intervene effectively. MEALs (Multidisciplinary Engagement and Learning/Mindful Eating and Active Living) is a family-based mindfulness intervention developed to address pediatric overweight and obesity, while improving healthy lifestyle behaviors through cooking classes. The incorporation of mindfulness, a psychological strategy associated with increased awareness of internal experiences, allows for a focus on the importance of healthy eating along with safe and efficacious kitchen practices. The Template for Intervention Description and Replication (TIDieR) checklist and guide is used to describe the intervention with the intention of providing necessary details to implement the intervention in clinical practice or replicate the intervention for further study. Lessons learned from pilot iterations of the intervention are provided.
... Stretching exercise intervention has been associated with arterial destiffening [21], and flexibility is associated with arterial stiffness [22]. Additionally, relaxation and meditation imbedded in yoga could lead to reductions in arterial stiffness and improvements in endothelium-dependent vasodilation via decreased sympathetic vasoconstrictor tones [23][24][25]. ...
Article
A combination of yoga and blood flow restriction, each of which elicits marked pressor responses, may further increase blood pressure and myocardial oxygen demand. To determine the impact of a combination of yoga and blood flow restriction on hemodynamic responses, twenty young healthy participants performed 20 yoga poses with/without blood flow restriction bands placed on both legs. At baseline, there were no significant differences in any of the variables between the blood flow restriction and non-blood flow restriction conditions. Blood pressure and heart rate increased in response to the various yoga poses (p<0.01) but were not different between the blood flow restriction and non-blood flow restriction conditions. Rate-pressure products, an index of myocardial oxygen demand, increased significantly during yoga exercises with no significant differences between the two conditions. Rating of perceived exertion was not different between the conditions. Blood lactate concentration was significantly greater after performing yoga with blood flow restriction bands (p=0.007). Cardio-ankle vascular index, an index of arterial stiffness, decreased similarly after yoga exercise in both conditions while flow-mediated dilation remained unchanged. In conclusion, the use of lower body blood flow restriction bands in combination with yoga did not result in additive or synergistic hemodynamic and pressor responses.
... For instance, Thai patients with T2DM who engaged in mindful walking for 3 months demonstrated greater decreases in HbA1c (p < .050) relative to walking alone [23]. ...
Chapter
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This chapter explores the efficacy of psychotherapeutic interventions for patients with type 2 diabetes mellitus (T2DM). This condition can lead to serious adverse health outcomes (e.g., cardiovascular disease, blindness, loss of limbs, etc.). Medical interventions alone are often not sufficient to manage the disease. Psychotherapy can promote behavioral change that improves medication adherence, dietary choices, exercise, stress, and other variables that affect blood sugar levels. The current chapter summarizes the trends in recent research for psychotherapeutic interventions for the management of T2DM. The results from 16 randomized controlled trials on cognitive-behavioral therapy, motivational interviewing, counseling, and mindfulness-based therapies are discussed. These interventions varied in length (3 to 18 months) and were conducted in many geographic regions (e.g., Australia, Netherlands, Saudi Arabia, Thailand, and more). Changes in biological health outcomes (i.e., HbA1c levels) were the primary focus of this chapter, but diabetes-related behavioral changes (e.g., diet and exercise) and psychological variables (e.g., stress, depression, and well-being) are also discussed. This chapter highlights that recent research has provided the most support for mindfulness-based therapies for improving blood sugar levels in patients with T2DM.
... The majority of the studies propose the use of meditation-based interventions as a complementary strategy, often delivered on separate occasions (e.g., Kudlackova et al., 2013;Stocker et al., 2019). Interestingly, compelling evidence indicates that meditation can be implemented in tandem with the exercise routine (i.e., mindful movements; Edwards & Loprinzi, 2019;Gainey et al., 2016). A recent study conducted by indicated that the continuous reallocation of attention towards memories from the past and thoughts about the future can compromise execution of certain movement patterns such as walking and make participants experience a more negative affective state when compared to a control condition. ...
Article
The present experiment sought to further understanding of the psychological and psychophysiological mechanisms underlying the effects of a single session of audio-guided meditation during moderate-intensity cycling exercise. Twenty-four healthy participants were recruited. A portable EEG device was employed to investigate the cerebral responses associated with the effects of meditation on exercise. Psychological measures were administered at three timepoints during the exercise bout. Two experimental conditions (endurance meditation [EM] and catastrophic meditation [CM]) and a control condition (CO) were administered. Participants were asked to exercise for 8 min (2 min of warm-up performed at 20% below the first ventilatory threshold + 6 min of exercise performed at the first ventilatory threshold) at 60 rpm. The EEG signal from frontal electrode sites was decomposed using Morlet Complex Wavelets, and event-related perturbation was calculated to investigate changes in beta frequency associated with the cycling phase. The results indicate that EM was sufficiently potent to ameliorate exertion and enhance affect to a greater degree than CO and CM. The neural mechanisms underlying the effects of EM appear to be associated with increased beta activity in the right frontal regions. The results of this study also indicate that exertional fatigue can be modulated through an alternative route that is not reliant upon the use of dissociative thoughts and does not require motivation to be up-regulated.
... The power analysis was performed by retrieving the data from a similar study [14]. To get statistical power of at least 95% (2-tailed α= 0.05), the minimum number of participants in each group must be 30. ...
Article
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1) Background: The primary goal of this study was to assess the effect of sand walking on Hemoglobin A1c (HbA1c), Body Mass Index (BMI), waist circumference, and quality of life among individuals with Type-2 Diabetes Mellitus (T2DM). (2) Methods: A randomized-controlled design was conducted on 66 overweight participants suffering from T2DM. Participants were randomly allocated to sand walking (SW) (n = 33) and normal walking (NW) (n = 33) groups. Participants performed moderate-intensity walking for 30 min, 3 times a week for 4 months. Participants walking on sand had statistically significant mean scores for HbA1c, BMI, waist circumference and quality of life((M = 7.32, SD = 0.47),(M = 25.77, SD = 1.366),(M = 92.94, SD = 2.59), (M = 91.48, SD = 34.08)) than those walking on leveled surface ((M = 8.38, SD = 0.77),t(52.8) = −6.73, p = 0.003, (M = 26.80, SD = 1.38), t(64) = −3.05, p = 0.001,(M = 98.12, SD = 2.16.3), t(64) = −3.75, p = 0.001, (M = 112, SD = 33.7), t(64) = −2.45, p = 0.017)respectively. (3) Conclusions: Regular SW with a healthy dietary regime for 4 months led to a statistically significant difference in HbA1c, BMI, waist circumference, and quality of life as compared to NW group.
... It incorporates the principles of traditional meditation performed in the sitting position, including breathing, awareness, concentration and relaxation, with rhythmic exercise of walking [52]. In a clinical trial investigating the comparative effects of Buddhist walking meditation and traditional walking in middle-aged and older patients with type 2 diabetes, flow-mediated dilation increased significantly in both training groups [56]. However, a reduction in arterial stiffness, as well as a decrease in hemoglobin A1c, were observed only in the Buddhist walking meditation group. ...
Article
The arterial system has two primary functions. The conduit function is to transport adequate supply of oxygen and nutrients to the tissues, and the cushioning function is to buffer and cushion the pulsatile pressure exerted by intermittent ventricular contractions. The impairments in these two functions often result from physiological changes characterized by endothelial dysfunction and arterial stiffening. Habitual physical exercise has been advocated to combat these physiological dysfunctions. However, exercise is remarkably diverse, as it can be performed in different media (water, land or snow), seasons (winter or summer), and settings (individual, pair or team). In contrast to mainstream modes of exercise including walking and running, many of the alternative or “minor” forms of exercise have been under-researched by investigators in research fields and overlooked by clinicians and practitioners in clinical settings. It remains largely unknown whether these alternative forms of exercise are associated with favorable changes in arterial stiffness and endothelium-dependent vasodilation. The current review introduces and summarizes research investigations that evaluated the impacts of these under-appreciated and overlooked exercises and their impacts on key markers of vascular functions in humans.
... According to an RCT study that compared the effects of Buddhist walking meditation to traditional walking in adults with T2D, Buddhist walking meditation was noted to significantly reduce the HbA1c, but did not significantly alter the FBG, TC, HDL-C, LDL-C, and TG [106]. ...
Article
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Studies have evidenced that epigenetic marks associated with type 2 diabetes (T2D) can be inherited from parents or acquired through fetal and early-life events, as well as through lifelong environments or lifestyles, which can increase the risk of diabetes in adulthood. However, epigenetic modifications are reversible, and can be altered through proper intervention, thus mitigating the risk factors of T2D. Mind–body intervention (MBI) refers to interventions like meditation, yoga, and qigong, which deal with both physical and mental well-being. MBI not only induces psychological changes, such as alleviation of depression, anxiety, and stress, but also physiological changes like parasympathetic activation, lower cortisol secretion, reduced inflammation, and aging rate delay, which are all risk factors for T2D. Notably, MBI has been reported to reduce blood glucose in patients with T2D. Herein, based on recent findings, we review the effects of MBI on diabetes and the mechanisms involved, including epigenetic modifications.
... Mindful walking (MW), sometimes called 'walking meditation,' is a combination of moderate physical activity and mindfulness practice [10][11][12] . Its effectiveness has been shown in improving mental health (reducing stress and depression) [13][14][15][16] , and improving clinical measures such as Hemoglobin A1C and blood pressure among diabetes patients 17 . The duration of a walking meditation (mindful walking) intervention ranges from four weeks 15 to twelve weeks 13 . ...
Article
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Background : Mindful walking (MW) interventions employ mindfulness training combined with physical activity. Wearable mobile devices have been increasingly used to measure outcomes of physical activity interventions. The purpose of this study was to understand MW participants’ attitudes towards MW and the use of mobile devices in health promotion interventions, including barriers and facilitators of intervention engagement and adherence. Few qualitative studies have documented participant experience with these two types of interventions. Method : The pilot study involved a randomized MW intervention including 38 participants with self-reported inadequate physical activity. Half of them were randomized to receive MW intervention plus a FitBit device and the other received the FitBit device only. We used a qualitative thematic analysis of the narrative data collected through open-ended survey questions at three time points. Participants in the MW intervention were asked to describe their experiences with MW, while all participants were asked to describe their experience with wearing the FitBit to track their step counts. Results: Participants reported a broad range of perceived benefits and challenges related to adopting the MW intervention and using the mobile device. Participants were generally willing to try to adopt the recommended MW practice and to see value of MW in increasing physical activity and improving overall health. Participants reported using a variety of additional device features beyond goal setting and step counts, indicating using the devices may have been effective in providing additional motivation for participants in meeting physical activity goals in both the control and intervention groups. While most of the feedback about MW (in the intervention group) and the device (all participants) was overwhelmingly positive, a minority of participants reported barriers such as lack of patience with meditation and discomfort with wearing the device. Conclusion : Most participants in the MW intervention see the health benefits of this program and most participants using the wearable physical activity tracking device reported the motivational benefits of this device. Issues with the MW intervention (e.g., lack of patience) and the wearable device (e.g., discomfort with wearing) need to be addressed in future interventions.
... This is in contrast to Nanri et al. (29), who found that restricting carbohydrate consumption by 45% -60% led to a decrease in HbA1c and improved glycemic control. Furthermore, Breukelman et al. (28) found no significant improvements with walking, which was in contrast to Gainey et al. (30), which found that walking can improve glycemic control and HbA1c in type 2 diabetics, especially at a higher intensity. ...
Article
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Background: Type 2 diabetes is a chronic metabolic disorder that can result in micro- and macrovascular complications and is complicated by an impaired healing process. Research suggests that both dietary factors and habitual physical activity influence the hemostatic system through several pathways. Objectives: The study attempted to investigate if a low-carbohydrate, high-fat diet (LCHFD), on its own or in conjunction with physical activity, could alter hematologic variables in patients with type 2 diabetes. Methods: Participants (n = 39; 31 - 71 y.) were assigned into three groups, which included either a 16 week continuous physical activity program with the consumption of an LCHFD (ExDG) (n = 13; 41 - 71 y), consuming only a LCHFD group (DietG) (n = 13; 31 - 71 y.), or a control group (ConG) (n = 13; 44 - 69 y). Participants in the ExDG were advised only to consume a diet high in fat and not consume more than 50 g of carbohydrates per day. Furthermore, participants had to walk a minimum of 10000 steps per day. The DietG were instructed to only consume a diet high in fat and low in carbohydrates, where the ConG continued with their normal daily routine. Results: No significant changes (P > 0.05) were observed in white blood cell count, neutrophils, lymphocytes, eosinophils, basophils, hemoglobin, red blood cell count, mean corpuscular volume, hematocrit, mean corpuscular hemoglobin, platelets, red blood cell distribution width, mean corpuscular hemoglobin concentration, and C-reactive protein following ExDG, DietG or in the ConG. Conclusions: A LCHFD on its own or in conjunction with physical activity does not have any effect on the measured hematologic variables in patients with type 2 diabetes. This may be due to the current popular recommendation of LCHFD not being useful in type 2 diabetics and 10000 steps being of insufficient intensity to improve hematologic parameters in type 2 diabetics.
Article
Objective To investigate improvement in balance abilities compared between walking meditation and balance training among older adults with history of fall. Interventions Walking meditation or mindfulness meditation whilst standing and moving ( n = 35) or balance training ( n = 33) 20–30 min/day, 5–7 days/week for 24 weeks was performed at home. Main outcomes The primary outcomes were dynamic balance abilities as assessed by Timed Up and Go test (TUGT), and static balance as assessed by Functional Reach Test (FRT) and Single Leg Stance Test (SLST). The secondary outcomes were quality of life as measured by the EuroQOL 5-dimensions 5-levels (EQ-5D-5L), and mental health as evaluated by the Thai Geriatric Mental Health Assessment Tool-15 (TGMHA-15). All outcomes were assessed at baseline, 6 months, and 9 months. Self-reported compliance, adverse events, and patient satisfaction were recorded at 6 and 9 months. Results The mean age was 69 years (range: 60–85). No significant difference was observed between groups for the 3 primary outcome measures. The mean difference (95% confidence interval) between groups was −0.48 (-1.40, 0.44) for TUGT, −1.11 (-3.66, 1.45) for FRT, and 0.82 (-5.03, 6.67) for SLST. The EQ-5D-5L and TGMHA-15 also showed no significant difference between groups. Most participants were in good compliance with the exercise protocol (48.3–68.0%), and no serious adverse events were reported. Conclusion Our results showed walking meditation to be comparable to balance training for improving balance abilities in older adults with history of fall. Walking meditation may be considered an alternative treatment for improving balance abilities in this patient population.
Article
Background: Mobile health solutions aimed at monitoring tasks among people with diabetes mellitus (DM) have been broadly applied. However, virtual coaches (VCs), embedded or not in mobile health, are considered valuable means of improving patients' health-related quality of life and ensuring adherence to self-care recommendations in diabetes management. Despite the growing need for effective, healthy coping digital interventions to support patients' self-care and self-management, the design of psychological digital interventions that are acceptable, usable, and engaging for the target users still represents the main challenge, especially from a psychosocial perspective. Objective: This study primarily aims to test VC interventions based on psychoeducational and counseling approaches to support and promote healthy coping behaviors in adults with DM. As a preliminary study, university students have participated in it and have played the standardized patients' (SPs) role with the aim of improving the quality of the intervention protocol in terms of user acceptability, experience, and engagement. The accuracy of users' role-playing is further analyzed. Methods: This preliminary study is based on the Obesity-Related Behavioral Intervention Trial model, with a specific focus on its early phases. The healthy coping intervention protocol was initially designed together with a team of psychologists following the main guidelines and recommendations for psychoeducational interventions for healthy coping in the context of DM. The protocol was refined with the support of 3 experts in the design of behavioral intervention technologies for mental health and well-being, who role-played 3 SPs' profiles receiving the virtual coaching intervention in a Wizard of Oz setting via WhatsApp. A refined version of the healthy coping protocol was then iteratively tested with a sample of 18 university students (mean age 23.61, SD 1.975 years) in a slightly different Wizard of Oz evaluation setting. Participants provided quantitative and qualitative postintervention feedback by reporting their experiences with the VC. Clustering techniques on the logged interactions and dialogs between the VC and users were collected and analyzed to identify additional refinements for future VC development. Results: Both quantitative and qualitative analyses showed that the digital healthy coping intervention was perceived as supportive, motivating, and able to trigger self-reflection on coping strategies. Analyses of the logged dialogs showed that most of the participants accurately played the SPs' profile assigned, confirming the validity and usefulness of this testing approach in preliminary assessments of behavioral digital interventions and protocols. Conclusions: This study outlined an original approach to the early development and iterative testing of digital healthy coping interventions for type 2 DM. Indeed, the intervention was well-accepted and proved its effectiveness in the definition and refinement of the initial protocol and of the user experience with a VC before directly involving real patients in its subsequent use and testing.
Article
Background Buddhist walking meditation (BWM) is widely practiced in many countries. However, there is a lack of evidence relating to its effectiveness for patients with heart failure (HF). Purpose To determine the effects of a six-week BWM program on exercise capacity, quality of life, and hemodynamic response in patients with chronic HF. Methods Patients with HF were randomly assigned to a BWM program or an aerobic exercise program. Each group trained at least three times a week during the six-week study period. The outcome measures included exercise capacity (six-minute walk test), disease-specific quality of life (Minnesota Living with Heart Failure Questionnaire), and hemodynamic response (blood pressure and heart rate) immediately after the six weeks of training. Results The study enrolled 48 patients with a mean age of 65 years and a New York Heart Association functional class of II and III. At baseline, there were no significant differences in their clinical and demographic characteristics or the outcome measures. Although six patients withdrew, all participants were included in the intention-to-treat analysis. There was no statistically significant increase in the functional capacity of the BWM group; however, there was a significant improvement for the aerobic group. With both groups, there was no significant improvement in quality of life or most hemodynamic responses. Conclusions The six-week BWM program did not improve the functional capacity, quality of life, or hemodynamic characteristics of the HF patients, compared with the values of the patients in the aerobic exercise program.
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The objectives of the study were to investigate the relationship between religion and hypertension, as well as the theoretical mechanism through which religion exerts effect on hypertension. A MEDLINE literature search was performed on articles describing religion and hypertension (N = 543) excluding unqualified ones such as those without expected information, those neither correcting confounding factors nor matching the comparison groups and those reporting repeated trials. Eight extra articles from references of reviews were added to the included studies. Finally, 79 articles were formerly evaluated. Briefly, there are limited trials on correlation between religion and hypertension and their results are inconsistent. First of all, longitudinal investigations, especially the high-quality ones, are deficient. Secondly, studies evaluating religion as an integral are scarce, although they can assess religions most comprehensively. Third, few studies use several religious measurements that represent distinct dimensions of religion. Moreover, divergence exists among diverse populations, even if they are assessed by the same indicator. In addition, 59% studies are concerned with an unspecified species of religion, and Christianity is studied the most among those with a specific category of religion. Finally, the possible mechanism underlying religion and hypertension is complex, which can partially explain the different results among various populations. Comprehensive evaluation of a specific religion should be encouraged. In addition, for a specific population, the correlation between religion and hypertension should be examined particularly, even if similar investigations in other populations have been conducted. Finally, more evidence focused on the effects of distinct religions/sects is also required.
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Objectives To investigate the feasibility of delivering a low-dose mindfulness-based stress reduction (MBSR) intervention among prediabetes/diabetes patients in a clinical setting. Design and setting This was a single-arm, mixed methods, feasibility study among prediabetes/diabetes patients at a healthcare center in United States. Intervention The low-dose MBSR intervention was delivered in group format over 4 waves and each wave comprised 8-10 hours of 8 sessions over 6-8 weeks. Main Outcome Measures We evaluated recruitment, adherence, and attrition rates, participants’ satisfaction, motivation and barriers of low-dose MBSR. Psychological, behavioral, and physical measures were compared between pre- and post-intervention. Results We enrolled 19 participants of 34 eligible individuals with a recruitment rate of 55.9%. Among 19 enrolled participants, 4 dropped out after baseline data collection and did not attend any session and 1 attended one session but did not finish post-intervention data collection, resulting in an attrition rate of 26.3%. Among 15 participants attending at least one session, 46.7% attended all sessions and 80.0% attended at least 5 sessions. Qualitative analysis among 11 participants indicated that 90.9% had positive overall experience with the intervention. Compared to pre-intervention, there was a significant reduction in depression score (mean reduction=5.04, SD=7.66, p=0.02), a higher proportion of engaging in flexibility exercises (42.86% vs. 85.71%, p=0.01) and a lower level of glycosylated hemoglobin (HbA1c) (mean reduction=1.43%, SD=2.54%, p=0.03) at post-intervention. Conclusions Delivering a low-dose MBSR intervention to prediabetes/diabetes patients in a primary care setting is feasible. Future studies with the randomized controlled design and large sample are warranted.
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The long-standing interest in the effects of religiosity and spirituality (R/S) on health outcomes has given rise to a large and diverse literature. We conducted a meta-analysis on research involving R/S and physiological markers of health to elucidate both the scope and mechanism(s) of this phenomenon. A combined analysis found a significant, but small, beneficial effect. Subgroup analyses found that some measures of both extrinsic and intrinsic religiosity were significantly associated with health. Several outcome measures, including blood pressure, C-reactive protein, and cardiovascular health markers, were significantly associated with R/S. Our findings suggest that R/S benefits health, perhaps through minimizing the disruptive effects of stress/depression on inflammation. We hope that researchers can use these results to guide efforts aimed at elucidating the true mechanism(s) linking religious/spiritual beliefs and physical health.
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The prevalence of diabetes (DM) is increasing, associated with low levels of physical activity (PA) and increased overweight-obesity. The benefits of PA include DM prevention, glycosylated hemoglobin and postprandial glycaemia reduction, improvement of the cardiovascular profile (decrease blood pressure and triglycerides, increase HDL cholesterol), significant proinflammatory biomarkers decrease. Besides, the PA improves sexual dysfunction, endothelial function, bioavailable nitric oxide and insulin sensitivity, increases testosterone, improves mood and self-esteem, anxiety and depression. Exercise increases glucose production; compensatory insulin secretion is altered and is exacerbated by increased catecholamine secretion. People with marked insulinopenia are at risk of ketosis. The resulting hypoglycemia is due to increased glucose uptake. PA improves polyneuropathy and cardiac autonomic neuropathy, prevents chronic kidney disease and is associated with lower levels of diabetic retinopathy. PA that considerably increases intraocular pressure is discouraged in patients with preproliferative and proliferative retinopathy or macular degradation. Exercise is contraindicated in vitreous hemorrhage. The energy requirement depends on the type, intensity and duration of the exercise. Foot care should be considered. The recommendations are reduce sedentary time, aerobic exercise at least 150 min / week and resistance exercise. An extra health check should be considered in high intensity training or high risk patients, including electrocardiogram and stress test. Consider bidimensional echocardiogram and Doppler.
Article
Many of today's most common, chronic, and costly diseases—from high blood pressure, to chronic pain—are related to stress. Mindfulness, considered a state, a trait, and a training, might help treat or prevent stress-related physical symptoms. A concise review of current scientific evidence shows that both higher levels of trait mindfulness as well as mindfulness training are associated with better psychological well-being, coping, and quality of life. Effects on objective measures of disease, however, are often non-significant or await replication. Larger trials with active control groups, clear diagnostic criteria, objective outcome measures, and longer-term follow-up are needed to generate better quality evidence. Yet, many studies do support integrating mindfulness into health care as part of self-care and disease management.
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Introduction: Mindful walking is a meditation practice that combines physical activity and mindfulness practice. Some mindful walking interventions expect four weeks of attendance (as compared with the traditional 8-week models of mindfulness-based interventions, or MBIs), a practice that could make MBIs more accessible to working-age adults. This study examined whether a 4-week mindful walking intervention increased physical activity and improved mental health outcomes. Methods: We conducted a randomized experiment among adults with inadequate physical activity (N = 38), whereby the intervention group received a four-week, one-hour-per-week mindful walking intervention and the control group received instructions to increase physical activity. Everyone in both groups received a wrist-worn step count device as participation incentive. Physical activity (as measured by the Rapid Assessment of Physical Activity questionnaire, RAPA) and other health outcomes were assessed with online surveys at baseline (T1), post-intervention (T2), and one month after the intervention (T3). Those mental health outcomes included perceived stress (Perceived Stress Scale), depression (Brief Edinburgh Depression Scale), and Mental Health Inventory (MHI). The primary outcome of device-measured step count was recorded at T1 and T2. Independent two-sample t-tests were used to compare the primary outcomes at T1. Generalized linear mixed models (GLMM) with a random intercept for each subject were used to compare the two groups on the primary outcomes at all time points. The independent variables in the model included a binary variable for group assignment (intervention vs. control), a 3-level categorical variable for time, and their interaction. Age, gender and race/ethnicity are used as covariates in the model. Estimated changes (either differences or ratios between outcomes at time points T1 and T2/T3) are reported to assess change within groups. Results: Both groups exhibited significant improvements in the RAPA measures of physical activity and depression. However, between-group differences were not statistically significant. There was no within-group or between-group difference on device-measured step count, though both groups yielded an average daily step count close to the recommended level of 8,000 steps per day for older adults. The intervention group exhibited a significant reduction in perceived stress, and this reduction was significantly greater than that of the control group at T2 (p = .025) although the difference was insignificant at T3. No significant difference in MHI was found. Discussion: While these adults with inadequate physical activity increased their physical activity, no significant between-group differences in physical activity were identified. Potential reasons for the lack of significant findings could be due to the ceiling effect (the step count device for everyone in both groups might have encouraged more activity in both groups), limited sample size and low-dose 4-week intervention used in this study. On the other hand, it is encouraging to see that this low-dose, short-duration 4-week intervention (as compared with those popular 8-week MBIs) achieved significantly greater stress reduction among the intervention group than among the control group, even though the between-group difference at one-month follow-up was statistically insignificant. Further studies with larger sample sizes and longer follow-up are needed to assess the possible benefits of these short-duration mindful walking interventions.
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Previous meta-analytic results showed beneficial effects of meditation interventions for cortisol levels. In the present meta-analysis we tested whether effects are larger for those who might be in need of such stress reduction programs due to a risk for elevated cortisol levels as compared to no-risk samples. We included RCTs that measured change in cortisol levels. Based on 10 studies using blood samples meditation interventions had a significant, medium effect from pre-to post-test compared to the control group. Upon closer inspection, this effect was only present for at-risk samples, that is, patients with a somatic illness. In the 21 studies using saliva samples the effect was small and not significant, but there was a marginally significant effect for groups living in stressful life situations. This pattern may suggest that that meditation interventions are most beneficial for at-risk populations. These interventions might provide people with strategies of stress management that can contribute to well-being. Preliminary results suggest that benefits of meditation interventions might not fade with time.
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Physical activity, including appropriate endurance and resistance training, is a major therapeutic modality for type 2 diabetes. Unfortunately, too often physical activity is an underutilized therapy. Favorable changes in glucose tolerance and insulin sensitivity usually deteriorate within 72 h of the last exercise session; consequently, regular physical activity is imperative to sustain glucose-lowering effects and improved insulin sensitivity. Individuals with type 2 diabetes should strive to achieve a minimum cumulative total of 1000 kcal · wk-1 from physical activities. Those with type 2 diabetes generally have a lower level of fitness (VO(2max)) than nondiabetic individuals, and therefore exercise intensity should be at a comfortable level (RPE 10-12) in the initial periods of training and should progress cautiously as tolerance for activity improves. Resistance training has the potential to improve muscle strength and endurance, enhance flexibility and body composition, decrease risk factors for cardiovascular disease, and result in improved glucose tolerance and insulin sensitivity. Modifications to exercise type and/or intensity may be necessary for those who have complications of diabetes. Individuals with type 2 diabetes may develop autonomic neuropathy, which affects the heart rate response to exercise, and as a result, ratings of perceived exertion rather than heart rate may need to be used for moderating intensity of physical activity. Although walking may be the most convenient low-impact mode, some persons, because of peripheral neuropathy and/or foot problems, may need to do non- weight-bearing activities. Outcome expectations may contribute significantly to motivation to begin and maintain an exercise program. Interventions designed to encourage adoption of an exercise regimen must be responsive to the individual's current stage of readiness and focus efforts on moving the individual through the various 'stages of change'.
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Background For several decades, psychological stress has been observed to be a significant challenge for medical students. The techniques and approach of mind-body medicine and group support have repeatedly demonstrated their effectiveness at reducing stress and improving the quality of the education experience. Discussion Mind-Body Skills Groups provide medical students with practical instruction in and scientific evidence for a variety of techniques that reduce stress, promote self-awareness and self-expression, facilitate imaginative solutions to personal and professional problems, foster mutual understanding among students, and enhance confidence in and optimism about future medical practice. The Center for Mind-Body Medicine, which developed this model 20 years ago, has trained medical school faculty who offer these supportive small groups to students at more than 15 US medical schools. This paper describes the model, surveys its use in medical schools, summarizes published research on it, and discusses obstacles to successful implementation as well as its benefits. Summary Mind-Body Skills groups have demonstrated their effectiveness on reducing stress in medical students; in enhancing the students’ experience of medical education; and in helping them look forward more confidently and hopefully to becoming physicians. The experience of these 15 institutions may encourage other medical schools to include mind-body skills groups in their curricula.
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OBJECTIVEdTo evaluate the feasibility of free-living walking training in type 2 diabetes patients, and to investigate the effects of interval-walking training versus continuous-walking training upon physical fitness, body composition, and glycemic control. RESEARCH DESIGN AND METHOD SdSubjects with type 2 diabetes were randomized to a control (n = 8), continuous-walking (n = 12), or interval-walking group (n = 12). Training groups were prescribed five sessions per week (60 min/session) and were controlled with an accelerometer and a heart-rate monitor. Continuous walkers performed all training at moderate intensity, whereas interval walkers alternated 3-min repetitions at low and high intensity. Before and after the 4-month intervention, the following variables were measured: VO 2 max, body composition, and glycemic control (fasting glucose, HbA 1c , oral glucose tolerance test, and continuous glucose monitoring [CGM]). RESULTSdTraining adherence was high (89 6 4%), and training energy expenditure and mean intensity were comparable. VO 2 max increased 16.1 6 3.7% in the interval-walking group (P , 0.05), whereas no changes were observed in the continuous-walking or control group. Body mass and adiposity (fat mass and visceral fat) decreased in the interval-walking group only (P , 0.05). Glycemic control (elevated mean CGM glucose levels and increased fasting insulin) wors-ened in the control group (P , 0.05), whereas mean (P = 0.05) and maximum (P , 0.05) CGM glucose levels decreased in the interval-walking group. The continuous walkers showed no changes in glycemic control. CONCLUSION SdFree-living walking training is feasible in type 2 diabetes patients. Con-tinuous walking offsets the deterioration in glycemia seen in the control group, and interval walking is superior to energy expenditure–matched continuous walking for improving physical fitness, body composition, and glycemic control.
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Rationale: Available prospective studies of obesity and asthma have used only body mass index (BMI) as an indicator for adiposity; studies using detailed obesity measures are lacking, and the role of physical fitness level and sedentary time remains unexplored in the link between obesity and asthma. Objectives: To compare various anthropometric measures of obesity in relation to childhood asthma, and to further characterize the interrelations among central obesity, physical fitness level, sedentary time, and asthma. Methods: The nationwide Taiwan Children Health Study followed 2,758 schoolchildren from fourth to sixth grade, annually collecting data regarding physical fitness, sedentary time, obesity measures (comprising body weight and height, abdominal and hip circumference, skin fold thickness, and body composition), asthma, and pulmonary function tests. The generalized estimating equation was used for 3 years of repeated measurements to analyze the interrelation among obesity, sedentary time, physical fitness level, and asthma; a structural equation model was used to explore the pathogenesis among these factors. Asthma incidence was analyzed during a 2-year follow-up among centrally obese and nonobese groups in baseline children without asthma. Measurements and main results: Central obesity most accurately predicts asthma. Low physical fitness levels and high screen time increase the risk of central obesity, which leads to asthma development. Obesity-related reduction in pulmonary function is a possible mechanism in the pathway from central obesity to asthma. Conclusions: Central obesity measures should be incorporated in childhood asthma risk predictions. Children are encouraged to increase their physical fitness levels and reduce their sedentary time to prevent central obesity-related asthma.
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Objectives: The objectives of this study were to determine the effects of the novel Buddhism-based walking meditation (BWM) and the traditional walking exercise (TWE) on depression, functional fitness, and vascular reactivity. Design: This was a randomized exercise intervention study. Settings/location: The study was conducted in a university hospital setting. Subjects: Forty-five elderly participants aged 60-90 years with mild-to-moderate depressive symptoms were randomly allocated to the sedentary control, TWE, and BWM groups. Interventions: The BWM program was based on aerobic walking exercise incorporating the Buddhist meditations performed 3 times/week for 12 weeks. Outcome measures: Depression score, functional fitness, and endothelium-dependent vasodilation as measured by the flow-mediated dilation (FMD) were the outcome measures used. Results: Muscle strength, flexibility, agility, dynamic balance, and cardiorespiratory endurance increased in both exercise groups (p<0.05). Depression score decreased (p<0.05) only in the BWM group. FMD improved (p<0.05) in both exercise groups. Significant reduction in plasma cholesterol, triglyceride, high-density lipoprotein cholesterol, and C-reactive protein were found in both exercise groups, whereas low-density lipoprotein cholesterol, cortisol, and interleukin-6 concentrations decreased only in the BWM group. Conclusions: Buddhist walking meditation was effective in reducing depression, improving functional fitness and vascular reactivity, and appears to confer greater overall improvements than the traditional walking program.
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To determine the effects of continuous aerobic exercise training (CON) vs interval aerobic exercise training (INT) on glycemic control and endothelium-dependent vasodilatation, 43 participants with type 2 diabetes were randomly allocated to the sedentary, CON, and INT groups. The CON and INT exercise training programs were designed to yield the same energy expenditure/exercise session and included walking on treadmill for 30 and 40 min/day, 3 times/week for 12 weeks. Body fatness and heart rate at rest decreased and leg muscle strength increased (all P < 0.05) in both the CON and INT groups. Fasting blood glucose levels decreased (P < 0.05) in both exercise groups but glycosylated hemoglobin levels decreased (P < 0.05) only in the INT group. Maximal aerobic capacity, flow-mediated dilation, and cutaneous reactive hyperemia increased significantly in both exercise groups; however, the magnitude of improvements was greater in the INT group. Only the INT group experienced reductions in erythrocyte malondialdehyde and serum von Willebrand factor and increases in plasma glutathione peroxidase and nitric oxide (all P < 0.05). We concluded that both continuous and interval training were effective in improving glycemic control, aerobic fitness, and endothelium-dependent vasodilation, but the interval training program appears to confer greater improvements than the continuous training program.
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The F8 and F9 genes encode for coagulation factor VIII (FVIII) and FIX, respectively, and mutations in these genes are the genetic basis of hemophilia A/B. To determine whether a sequence variation in F8/F9 is a disease-causing mutation, frequency data from a control population is needed. This study aimed to obtain data on sequence variation in F8/F9 in a set of functionally validated control chromosomes of Korean descent. We re-sequenced F8 and F9 from DNA samples of 100 Korean male control individuals with normal PT, aPTT, and FVIII activity. PCR and direct sequencing analyses were performed using primer pairs to cover all coding regions and the flanking intronic sequences. Thirteen individuals (13%) were hemizygous for sequence variations in the coding region of F8. Six (6%) had c.3780C>G (p.Asp1260Glu), five (5%) had c.3864A>C (p.Ser1288=). One each individual (1%) had c.4794G>T (p.Glu1598Asp) and c.5069 A>G (p.Glu1690Gly). Asp1260Glu and Ser1288= were known SNPs (rs1800291 and rs1800292, respectively). Glu1598Asp was assigned as a missense mutation in public databases (HGMD and HAMSTeRS), and Glu1690Gly was a novel variation. Based on the normal FVIII activities in control individuals carrying these variations (109% and 148%, respectively), they were considered to be rare SNPs. No variation was observed in F9 of control individuals. A significant proportion of control individuals carried sequence variations in F8, but not in F9. These results can be used as a reference dataset for molecular diagnosis of hemophilia A and B, particularly in Korea.
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This study tested the hypothesis that an 8-week exercise intervention supported by mobile health (mHealth) technology would improve metabolic syndrome (MetS) risk factors and heart rate variability (HRV) in a population with MetS risk factors. Participants (n = 12; three male; aged 56.9 ± 7.0 years) reported to the laboratory for assessment of MetS risk factors and fitness (VO2max) at baseline (V 0) and after 8-weeks (V 2) of intervention. Participants received an individualized exercise prescription and a mHealth technology kit for remote monitoring of blood pressure (BP), blood glucose, physical activity, and body weight via smartphone. Participants underwent 24-h ambulatory monitoring of R-R intervals following V 0 and V 2. Low and high frequency powers of HRV were assessed from the recording and the ratio of low-to-high frequency powers and low and high frequency powers in normalized units were calculated. One-way repeated measures analysis of variance showed that waist circumference (V 0: 113.1 ± 11.0 cm, V 2: 108.1 ± 14.7 cm; p = 0.004) and diastolic BP (V 0: 81 ± 6 mmHg, V 2: 76 ± 11 mmHg; p = 0.04) were reduced and VO2max increased (V 0: 31.3 ml/kg/min, V 2: 34.8 ml/kg/min; p = 0.02) with no changes in other MetS risk factors. Low and high frequency powers in normalized units were reduced (V 0: 75.5 ± 12.0, V 2: 72.0 ± 12.1; p = 0.03) and increased (V 0: 24.5 ± 12.0, V 2: 28.0 ± 12.1; p = 0.03), respectively, with no other changes in HRV. Over the intervention period, changes in systolic BP were correlated negatively with the changes in R-R interval (r = -0.600; p = 0.04) and positively with the changes in heart rate (r = 0.611; p = 0.03), with no other associations between MetS risk factors and HRV parameters. Thus, this 8-week mHealth supported exercise intervention improved MetS risk factors and HRV parameters, but only changes in systolic BP were associated with improved autonomic function.
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Background: Physical activity remains a valuable prevention for metabolic disease. The effects of Nordic walking on cardiovascular risk factors were determined in overweight individuals with normal or disturbed glucose regulation. Methods: We included 213 individuals, aged 60 ± 5.3 years and with body mass index (BMI) of 30.2 ± 3.8 kg/m(2); of these, 128 had normal glucose tolerance (NGT), 35 had impaired glucose tolerance (IGT) and 50 had type 2 diabetes mellitus (T2DM). Participants were randomized to unaltered physical activity or to 5 h per week of Nordic walking with poles, for a 4-month period. Dietary habits were unaltered. BMI, waist circumference, blood pressure, glucose tolerance, clinical chemistry, maximal oxygen uptake (peak VO(2)) and self-reported physical activity (questionnaire) were assessed at the time of inclusion and after 4 months. The participants in the exercise-intervention group kept a walking diary. Results: In the NGT exercise group, self-reported physical activity increased markedly, and body weight (-2.0 ± 3.8 kg), BMI (-0.8 ± 1.4 kg/m(2)) and waist circumference (-4.9 ± 4.4 cm) (mean ± SD) decreased. Exercise power output (12.9 ± 9.9 W) and peak VO(2) (2.7 ± 2.8 mL/kg/min) increased in the IGT exercise group. More cardiovascular risk factors were improved after exercise intervention in people with NGT compared with those with IGT or T2DM. Exercise capacity improved significantly in all three groups of participants who reported at least 80% compliance with the scheduled exercise. Conclusions: Nordic walking improved anthropometric measurements and exercise capacity. However, unsupervised Nordic walking may not provide a sufficient increase in exercise intensity to achieve ultimate health-promoting benefits on the cardiovascular parameters assessed in this study, particularly for those with disturbed glucose regulation.
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Introduction: About 1 in 3 American adults have cardiovascular disease associated with risk factors such as physical inactivity, obesity, and stress. Heart rate variability (HRV) analysis is considered a non-invasive procedure for analyzing cardiovascular autonomic influence. Depressed HRV has been linked to abnormal cardiovascular autonomic modulation. Purpose: This study evaluated the effect of Tai Chi (TC) on cardiac autonomic modulation in healthy adults with experience in TC practice. Design: 10 healthy adults, 7 females and 3 males, with an average age of 53.09 ± 7 yr were included in this study. They were asked not to consume any alcoholic or caffeinated beverages at least 24 hours before the study. Each subject practiced TC for 1 hour. HRV measurements were obtained at supine rest using Nexus biofeedback device before and after 10 min, 20 min and 30 min post TC exercise. Results: The cardiac autonomic function was assessed using frequency domain HRV analyses. Using repeated measures ANOVA and paired t-test, we found that the normalized high frequency power increased significantly from 43.02 ± 12.40% to 52.70 ± 13.20% after 30 min post TC exercise (p<0.05). In contrast, normalized low frequency power decreased significantly from 56.97 ± 12.40% to 47.29 ± 13.20% after 30 min post TC exercise (p<0.05). Conclusion: TC exercise can modulate cardiac autonomic tone by enhancing the parasympathetic activity and reducing the sympathetic activity. Long-term beneficial effects of TC on cardiac autonomic function needs further investigation.
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Previously it was shown that a brief yoga-based lifestyle intervention was efficacious in reducing oxidative stress and risk of chronic diseases even in a short duration. The objective of this study was to assess the efficacy of this intervention in reducing stress and inflammation in patients with chronic inflammatory diseases. This study reports preliminary results from a nonrandomized prospective ongoing study with pre-post design. The study was conducted at the Integral Health Clinic, an outpatient facility conducting these yoga-based lifestyle intervention programs for prevention and management of chronic diseases. Patients with chronic inflammatory diseases and overweight/obese subjects were included while physically challenged, and those on other interventions were excluded from the study. A pretested intervention program included asanas (postures), pranayama (breathing exercises), stress management, group discussions, lectures, and individualized advice. Outcome measures: There was a reduction in stress (plasma cortisol and β-endorphin) and inflammation (interleukin [IL]-6 and tumor necrosis factor [TNF]-α) at day 0 versus day 10. Eighty-six (86) patients (44 female, 42 male, 40.07 ± 13.91 years) attended this program. Overall, the mean level of cortisol decreased from baseline to day 10 (149.95 ± 46.07, 129.07 ± 33.30 ng/mL; p=0.001) while β-endorphins increased from baseline to day 10 (3.53 ± 0.88, 4.06 ± 0.79 ng/mL; p=0.024). Also, there was reduction from baseline to day 10 in mean levels of IL-6 (2.16 ± 0.42, 1.94 ± 0.10 pg/mL, p=0.036) and TNF-α (2.85 ± 0.59, 1.95 ± 0.32 pg/mL, p=0.002). This brief yoga-based lifestyle intervention reduced the markers of stress and inflammation as early as 10 days in patients with chronic diseases; however, complete results of this study will confirm whether this program has utility as complementary and alternative therapy.
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This study compared acute (15 min) yoga posture and guided meditation practice, performed seated in a typical office workspace, on physiological and psychological markers of stress. Twenty participants (39.6 ± 9.5 yr) completed three conditions: yoga, meditation, and control (i.e., usual work) separated by ≥24 hrs. Yoga and meditation significantly reduced perceived stress versus control, and this effect was maintained postintervention. Yoga increased heart rate while meditation reduced heart rate versus control (P < 0.05). Respiration rate was reduced during yoga and meditation versus control (P < 0.05). Domains of heart rate variability (e.g., SDNN and Total Power) were significantly reduced during control versus yoga and meditation. Systolic and diastolic blood pressure were reduced secondary to meditation versus control only (P < 0.05). Physiological adaptations generally regressed toward baseline postintervention. In conclusion, yoga postures or meditation performed in the office can acutely improve several physiological and psychological markers of stress. These effects may be at least partially mediated by reduced respiration rate.
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Meditation refers to a family of practices that may share many similarities, but can have differences in underlying methods and goals. Religious and spiritual associations are common but are not requisite for meditation practice and it should be recognized that the basis of many if not all practices is the training of the brain and body, a process that appears to have profound effects on both structure and function. In recent decades there has been interest regarding the effects of these ancient practices on the cardiovascular system, as meditation has intuitive appeal for benefit in this area. Though there is a relative shortage of quality data, available evidence suggests that meditation may exert beneficial effects on autonomic tone, autonomic reflexes, and decrease blood pressure acutely and after long term practice. In addition, meditation has the potential to positively influence the cardiovascular system through the mind-heart connection and the anti-inflammatory reflex. There is limited but promising data to suggest that meditation based interventions can have beneficial effects on patients with established cardiovascular disease. More high quality and unbiased studies of meditation practices on relevant endpoints in cardiovascular disease are needed, including the effects of such practices on inflammation, baseline heart rate variability, arrhythmias, myocardial infarction, and cardiovascular mortality.
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Objective: Among individuals with peripheral artery disease (PAD), we compared annual change in 6-minute walk performance between participants who neither underwent lower extremity revascularization nor walked for exercise (group 1, reference), those who walked regularly for exercise (group 2), and those who underwent lower extremity revascularization (group 3). Methods: Participants were recruited from Chicago-area vascular laboratories and followed annually. Change in 6-minute walk was calculated beginning at the study visit preceding lower extremity revascularization or exercise behavior and continuing for 1 additional year after the therapy was reported. Results are adjusted for age, sex, race, comorbidities, and other confounders. Results: Of 348 PAD participants, 43 underwent revascularization during median follow-up of 84 months. Adjusted annual declines in 6-minute walk were -96.6 feet/year for group 1, -49.9 feet/year for group 2, and -32.6 feet/year for group 3 (P < .001). Forty-one percent of revascularizations were not associated with ankle-brachial index (ABI) improvement. When group 3 was limited to participants with ABI improvement ≥0.15 after revascularization, annual adjusted changes in 6-minute walk were -97.7 feet/year for group 1, -46.5 feet/year for group 2, and +68.1 feet/year for group 3 (P < .001). When group 3 was limited to participants without ABI improvement ≥0.15 after revascularization, annual adjusted changes in 6-minute walk were -99.2 feet/year for group 1, -48.0 feet/year for group 2, and -61.7 feet/year for group 3 (P < .001). Conclusions: A large proportion of PAD participants did not have ABI improvement of at least 0.15 at follow-up study visit after revascularization. The benefits of lower extremity revascularization in patients with PAD appear closely tied to improvements in the ABI after revascularization.
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The ankle-brachial index is valuable for screening for peripheral artery disease in patients at risk and for diagnosing the disease in patients who present with lower-extremity symptoms that suggest it. The ankle-brachial index also predicts the risk of cardiovascular events, cerebrovascular events, and even death from any cause. Few other tests provide as much diagnostic accuracy and prognostic information at such low cost and risk.
Chapter
The arterial system consists of large conduit vessels that branch continuously into smaller and smaller vessels ending in arterioles and capillaries. The role of the larger (macro) arteries is to distribute flow to various organs and to provide compliance to minimize the load on the heart and to maximize pressure during diastole. The role of the smaller (micro) vessels is to control regional blood flow by varying their resistance in response to local demand. When all the cardiovascular sensors, control mechanisms, and actuators are working properly, the input impedance of the vascular system remains matched to the output impedance of the heart to maximize efficiency and energy transfer both at rest and during exercise or stress. When disease or aging alters part of the system, overall function is compromised and other parts adapt to maintain basic function but at reduced efficiency and reserve. Thus, when evaluating macrovascular versus microvascular function, reserve, and reactivity to isolate the primary culprit, one must recognize that the entire arterial system may be altered. There are a number of methods and techniques available for assessing vascular function and reactivity, the most accepted being flow-mediated dilation. In this method, microvessels in a limb are stimulated via ischemia during inflation of a blood pressure cuff and assessed by measuring flow or velocity during reactive hyperemia after cuff deflation. Macrovessels are stimulated during the reactive hyperemia and assessed by measuring the change in diameter induced by the increased flow. Other methodologies evaluate different aspects of macrovascular and microvascular function and reactivity, and macrovascular may not be separated from microvascular function unambiguously. Thus, a multifaceted approach may be necessary for a comprehensive assessment of peripheral vascular function. Key wordsArterial stiffness-Endothelial function-Flow-mediated dilation-Hyperemia
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To determine if the attainment of at least 85% of age-predicted maximal heart rate (APMHR), using the equation 220 - age, and/or at least 25,000 as the product of maximal heart rate and systolic blood pressure (rate pressure product, RPP) is an accurate indicator of exertion level during exercise stress testing. From May 1, 2009, to February 15, 2010, 238 patients (mean ± SD age, 49.3±11.9 years; 50% male) with symptoms suggestive of myocardial ischemia underwent an exercise stress test with the addition of ventilatory expired gas analysis and a myocardial perfusion study. Ventilatory expired gas analysis determined the peak respiratory exchange ratio (RER), which is considered a valid and reliable variable for quantifying a patient's exertion during exercise. Of the patients, 207 (87%) attained a peak RER of 1.00 or more, and 123 (52%) attained a peak RER of 1.10 or more. An APMHR of 85% or more and peak RPP of 25,000 or more were both ineffective in identifying patients who put forth a maximal exercise effort (ie, peak RER, ≥1.10). Perceived exertion was a significant indicator (P=.04) of patient exertion, with a threshold of 15 (6-20 scale) being an optimal cut point. The percentage of equivocal myocardial perfusion study results was significantly higher in patients who demonstrated a submaximal exercise effort by peak RER (P≤.007). Aerobic exercise testing is an integral component in the assessment of patients with suspected myocardial ischemia. Our findings indicate that the currently used percentage of APMHR and peak RPP thresholds are ineffective in quantifying a patient's level of exertion during exercise stress testing.