Group yoga improves motor function and balance long after stroke

Group yoga can improve motor function and balance in stroke survivors, even if they don't begin yoga until six months or more after the stroke, according to "Post-Stroke Balance Improves With Yoga: A Pilot Study," published online July 26 in the journal Stroke.

Forty-seven older adults, three-quarters of whom were male, participated in the study. They were divided into three sections: One section engaged in twice-weekly group yoga for eight weeks; the second section met twice weekly for group yoga and was provided with a relaxation audio recording to use at least three times weekly; and the third section received usual medical care that included no rehabilitation.

The yoga classes, taught by a registered yoga therapist, included modified yoga postures, relaxation and meditation. Classes grew more challenging each week.

Improvement in balance was statistically significant and clinically meaningful. It was also greater than previously found by other post-stroke exercise trials. Study participants reported they increasingly attempted new activities in different, more challenging environments and, while aware of potential fall risk, grew confident in maintaining their balance.

"For patients, like those in our study, natural recovery and acute rehabilitation therapy typically ends after six or, less frequently, 12 months," said Regenstrief Institute investigator Arlene Schmid, Ph.D., OTR, a rehabilitation research scientist with the Center of Excellence on Implementing Evidence-Based Practice at the Richard Roudebush VA Medical Center and assistant professor of occupational therapy at Indiana University-Purdue University Indianapolis, who led the study. "We found that yoga exercises significantly extended rehabilitation beyond the first year after stroke."

Yoga may be more therapeutic than traditional exercise because the combination of postures, breathing and meditation may produce different effects than simple exercise, according to Dr. Schmid, who plans to further study the effectiveness of group yoga to improve balance, quality of life and participation in everyday activities. She notes that yoga's mind-body connection may be what makes it more powerful and engaging than other strengthening exercise.

Reflexology Proves Beneficial For Non-Cardiology Patients

In a study examining the effects of reflexology in healthy patients and patients with heart disease, researchers have found that applying pressure to the upper the heart reflex point on the left foot had an effect on the hearts of healthy patients but not on those with cardiac disease.

The study, conducted by researchers at the University of Stirling, found that massage to the heart reflex point had a small effect on heart function in healthy patients but not in the hearts of cardiology patients. In addition, they found that when pressure was applied to areas of the feet not related to the heart there was not change in heart function.

According to reflexologists, each part of the hands and feet are connected with specific organs in the body. Applying pressure with specific thumb, finger, and hand techniques to specific organ reflex points is believed to increased blood flow to the organ.

In this study, the team focused on the upper left ball of the sole which is said to 'map' to the heart and compared this area to other areas of both feet.

Jenny Jones, Ph.D., from the School of Nursing, Midwifery & Health, explained:

"Reflexology is unique because it makes quite specific claims that it increases blood flow and this is something you can scientifically test. In our experiment with healthy people there was an inexplicable change in the heart function which occurred only when the heart reflex point area was massaged. We have no idea what caused this change se we have applied for funding to investigate this further."

Jones continued:

"Cardiology patients have problems with coronary blood flow so we wanted to find out if there was any impact on their heart function whilst receiving reflexology too. Interestingly, there was no effect on the hearts of cardiology patients; however all the patients found the treatment to be really relaxing, so it seems to be a safe and useful relaxation tool for cardiac patients to use.

We want to investigate further why the hearts of cardiology patients are not affected in the same way as the healthy volunteers, with medication being a possible cause. We also want to research and better understand why this one area of the foot - the upper left ball of the sole - had an effect on the heart."

Professor Steve Leslie, a cardiologist from the Cardiac Unit at Raigmore Hospital, said:

"Most patients responded well to conventional medicine but for some patients symptoms of cardiac disease persist despite best medical treatments. For these patients we wished to test if reflexology was safe. The results of this study, demonstrated that reflexology did not affect cardiac function, heart rate or blood pressure and therefore it would appear safe for patients, even those with significant cardiac disease to undergo reflexology. Whether reflexology can improve cardiac symptoms requires further research."

According to Jones, the complementary therapies market in the UK is huge and shows that there is a great deal of public interest in the topic.

Jones explained: "There are limitations of what we can do with clinical medicine but there has not been much scientific research available on complementary therapies such as reflexology to help people decide if they work or not.

However, if people are choosing to pay to have these complementary therapy treatments to treat symptoms when we have a health care service which is free, you need to ask what it is that these therapies offer that is missing in conventional healthcare."

The researchers plan to conduct further studies in order to determine whether the effect observed in this study is repeated in patients with various gradations of heart disease and other patients groups.

Health Benefits of 'Mindfulness-Based Practices'

Practices Derived from Buddhist Meditation Show Real Effectiveness for Certain Health Problems, Reports Journal of Psychiatric Practice

Specific types of "mindfulness practices" including Zen meditation have research-proven benefits for patients with certain physical and mental health problems, according to a report in the July Journal of Psychiatric Practice. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

"An extensive review of therapies that include meditation as a key component—referred to as mindfulness-based practices—shows convincing evidence that such interventions are effective in the treatment of psychiatric symptoms and pain, when used in combination with more conventional therapies," according to Dr William R. Marchand of the George E. Wahlen Veterans Affairs Medical Center and the University of Utah in Salt Lake City.

Mindfulness Techniques Show Health Benefits_Dr Marchand reviewed published studies evaluating the health benefits of mindfulness-based practices. Mindfulness has been described as "the practice of learning to focus attention on moment-by-moment experience with an attitude of curiosity, openness, and acceptance." Put another way, "Practicing mindfulness is simply experiencing the present moment, without trying to change anything."

The review focused on three techniques:_• Zen meditation, a Buddhist spiritual practice that involves the practice of developing mindfulness by meditation, typically focusing on awareness of breathing patterns._• Mindfulness-based stress reduction (MBSR), a secular method of using Buddhist mindfulness, combining meditation with elements of yoga and education about stress and coping strategies._• Mindfulness-based cognitive therapy (MBCT), which combines MBSR with principles of cognitive therapy (for example, recognizing and disengaging from negative thoughts) to prevent relapse of depression.

Dr Marchand found evidence that MBSR and MBCT have "broad-spectrum" effects against depression and anxiety and can also decrease general psychological distress. Based on the evidence, MBCT can be "strongly recommended" as an addition to conventional treatments (adjunctive treatment) for unipolar depression. Both MBSR and MBCT were effective adjunctive treatments for anxiety.

Research data also supported the effectiveness of MBSR to help reduce stress and promote general psychological health in patients with various medical and/or psychiatric illnesses. On its own, MBSR was helpful in managing stress and promoting general psychological health in healthy people. There was also evidence that Zen meditation and MBSR were useful adjunctive treatments for pain management.

How do these practices work to affect mental and physical health? Dr Marchand discusses recent research showing the impact of mindfulness practices on brain function and structure, which may in part account for their psychological benefits. "These mindfulness practices show considerable promise and the available evidence indicates their use is currently warranted in a variety of clinical situations," he concludes.

The article includes some proposed evidence-based guidelines for incorporating mindfulness-based practices into health care. So far there's little evidence on which patients are most likely to benefit, but Dr Marchand suggests that patient preferences and enthusiasm are a good guide. He comments, "The most important considerations may be desire to try a mindfulness-based practice and willingness to engage in the regular practice of seated meditation."

Finding right meditation technique key to user satisfaction

A new study published online July 7 in EXPLORE: The Journal of Science and Healing highlights the importance of ensuring that new meditators select methods with which they are most comfortable, rather than those that are most popular.

If they do, they are likely to stick with it, says Adam Burke, the author of the study. If not, there is a higher chance they may abandon meditation altogether, losing out on its myriad personal and medical benefits. Burke is a professor of Health Education at SF State and the director of SF State's Institute for Holistic Health Studies.

"Because of the increase in both general and clinical use of meditation, you want to make sure you're finding the right method for each person," he said. Although meditation has become significantly more popular in the U.S., Burke said, there have been very few studies comparing multiple methods head to head to examine individual preference or specific clinical benefits.

To better understand user preference, Burke compared four popular meditation methods -- Mantra, Mindfulness, Zen and Qigong Visualization -- to see if novice meditation practitioners favored one over the others. The study's 247 participants were taught each method and asked to practice at home and, at the end of the study, evaluate which they preferred. The two simpler methods, Mantra and Mindfulness, were preferred by 31 percent of study participants. Zen and Qigong had smaller but still sizable contingents of adherents, with 22 percent and 14.8 percent of participants preferring them, respectively.

The results show the value of providing new practitioners a simpler, more accessible method of meditation. But they also emphasize that no one technique is best for everyone, and even less common methods are preferred by certain people. Older participants, who grew up when Zen was becoming one of the first meditation techniques to gain attention in the U.S., in particular were more likely to prefer that method.

"It was interesting that Mantra and Mindfulness were found to be equally compelling by participants despite the fact that they are fundamentally different techniques," Burke said. Mindfulness is the most recent meditation technique to gain widespread popularity, he added, and is often the only one with which a novice practitioner or health professional is familiar. Not surprisingly, Mindfulness was the method most preferred by the youngest participants.

"If someone is exposed to a particular technique through the media or a healthcare provider, they might assume because it's popular it's the best for everyone," Burke said. "But that's like saying because a pink dress or a blue sport coat is popular this year, it's going to look good on everybody. In truth, different people like different things. One size does not fit all."

If an individual is not comfortable with a specific method for any reason, he said, they may be less likely to continue meditating and would lose out on such benefits as reduced stress, lower blood pressure or even treatment for addiction.

Burke hopes to see more comparative meditation studies, especially to determine if particular methods are better at addressing specific health issues, such as addiction. If that's the case, he said, healthcare professionals would be able to guide patients toward techniques that will be most effective for them. Additional studies are also needed to determine if there is a way to predict which method will be best suited for any particular individual, he said.

Touch Therapy Helps Reduce Pain, Nausea in Cancer Patients

A new study by the University of Kentucky Markey Cancer Center shows that patients reported significant improvement in side effects of cancer treatment following just one Jin Shin Jyutsu session. Jin Shin Jyutsu is an ancient form of touch therapy similar to acupuncture in philosophy.

Presented at the 2012 Markey Cancer Center Research Day by Jennifer Bradley who is the Jin Shin Jyutsu integrative practitioner at Markey, the study included 159 current cancer patients. Before and after each Jin Shin Jyutsu session, Bradley asked patients to assess their symptoms of pain, stress and nausea on a scale of 0-10, with 0 representing no symptoms.

The study found that in each session patients experienced significant improvement in the areas of pain, stress, and nausea with the first visit and in subsequent visits as well. The mean decreases experienced were three points for stress and two points for both pain and nausea.

"I was pleased to see quantitatively the improvements that patients noted in these primary areas of discomfort," said Bradley. "It was interesting to note that regardless of age, sex or diagnosis, cancer patients received a statistically significant improvement in the side effects from treatment. It is encouraging to note that Jin Shin Jyutsu made improvements in these areas without adding additional unwanted effects that so often occur with medication interventions."

Funded by a grant from the Lexington Cancer Foundation, Jin Shin Jyutsu is considered part of an integrative treatment plan available at the UK Markey Cancer Center. Bradley offers Jin Shin Jyutsu to all cancer patients at no charge. Patients may self-refer, though half are referred by their physician or Markey staff.

During a Jin Shin Jyutsu session, patients receive light touches on 52 specific energetic points called Safety Energy Locks as well as fingers, toes, and midpoints on the upper arm, upper calf and lower leg in predetermined orders known as "flows." Patients remained clothed except for shoes and all hand placements are done over clothing.

Sessions were performed in the Jin Shin Jyutsu Treatment Room, Chemotherapy Outpatient Clinic, or in the patient's hospital room. The study also noted that the greatest overall improvement came from sessions held in the Jin Shin Jyutsu Treatment Room, where sessions are generally of a longer duration.

The study did not include controls for several parameters including the time between sessions or location and duration of service. Bradley's next study will control more of these variables, and her team will access patients' medical records over the time period of their participation to evaluate changes in patients’ medication usage for cancer and symptom management of pain, stress and nausea.

"The American Cancer Society has noted that quality of life is an issue for all cancer patients; those undergoing treatment, late stage patients, and cancer survivors," Bradley said. "There is a need for additional research to develop evidence-based interventions that have a positive impact on the quality of life for all of these individuals without adding to their burden. From what I have seen in my office and the results shown in the study, I believe that Jin Shin Jyutsu has great promise in this area.”

Should Spinal Manipulation for Neck Pain Be Abandoned?

The effectiveness of spinal manipulation divides medical opinion. On the British Medical Journal website, experts debate whether spinal manipulation for neck pain should be abandoned.

Spinal manipulation is a technique that involves the application of various types of thrusts to the lumbar spine (lower back) or cervical spine (neck) to reduce back pain, neck pain and other musculoskeletal conditions.

Neil O'Connell and colleagues argue that cervical spine manipulation "may carry the potential for serious neurovascular complications" and that the technique is "unnecessary and inadvisable."

They say that studies "provide consistent evidence of an association between neurovascular injury and recent exposure to cervical manipulation." Such injuries include vertebral artery dissection (a tear to the lining of the vertebral artery, which is located in the neck and supplies blood to the brain) and stroke.

They point to a Cochrane review of randomised trials of neck manipulation or mobilisation which concluded that as a stand-alone treatment, manipulation provides only moderate short term pain relief versus controls, sham manipulation, or muscle relaxants, and is unlikely to offer meaningful long term benefit for people with neck pain.

Other recent large, high quality trials reinforce this message, suggesting that manipulation is not superior when directly compared with other physical interventions such as exercise, they add.

They argue that, given the equivalence in outcome with other forms of therapy, manipulation seems to be clinically unnecessary. "The potential for catastrophic events and the clear absence of unique benefit lead to the inevitable conclusion that manipulation of the cervical spine should be abandoned as part of conservative care for neck pain," they conclude.

But David Cassidy and colleagues argue that cervical spine manipulation is a valuable addition to patient care and should not be abandoned.

They point to high quality evidence that "clearly suggests that manipulation benefits patients with neck pain" and raises doubt about any causal (direct) relation between manipulation and stroke.

When combined with recent randomised trial results, "this evidence supports including manipulation as a treatment option for neck pain, along with other interventions such as advice to stay active and exercise," they say.

However, they acknowledge that, when risk, benefit, and patient preference are considered, "there is currently no preferred first line therapy, and no evidence that mobilisation is safer or more effective than manipulation. Thus the identification of safe and effective interventions for neck pain remains a high priority."

They conclude: "We say no to abandoning manipulation and yes to more rigorous research on the benefits and harms of this and other common interventions for neck pain."

Meditation practice may decrease risk for cardiovascular disease in teens

Regular meditation could decrease the risk of developing cardiovascular disease in teens who are most at risk, according to Georgia Health Sciences University researchers.

In a study of 62 black teens with high blood pressure, those who meditated twice a day for 15 minutes had lower left ventricular mass, an indicator of future cardiovascular disease, than a control group, said Dr. Vernon Barnes, a physiologist in the Medical College of Georgia and the Georgia Health Sciences University Institute of Public and Preventive Health.

Barnes, Dr. Gaston Kapuku, a cardiovascular researcher in the institute, and Dr. Frank Treiber, a psychologist and former GHSU Vice President for Research, co-authored the study published in Evidence-Based Complementary and Alternative Medicine.

Half of the group was trained in transcendental meditation and asked to meditate for 15 minutes with a class and 15 minutes at home for a four-month period. The other half was exposed to health education on how to lower blood pressure and risk for cardiovascular disease, but no meditation. Left ventricular mass was measured with two-dimensional echocardiograms before and after the study and the group that meditated showed a significant decrease.

"Increased mass of the heart muscle's left ventricle is caused by the extra workload on the heart with higher blood pressure," Barnes explained. "Some of these teens already had higher measures of left ventricular mass because of their elevated blood pressure, which they are likely to maintain into adulthood."

During meditation, which Barnes likens to a period of deep rest, the activity of the sympathetic nervous system decreases and the body releases fewer-than-normal stress hormones. "As a result, the vasculature relaxes, blood pressure drops and the heart works less," he said.

School records also showed behavioral improvements.

"Transcendental meditation results in a rest for the body that is often deeper than sleep," Barnes said. "Statistics indicate that one in every 10 black youths have high blood pressure. If practiced over time, the meditation may reduce the risk of these teens developing cardiovascular disease, in addition to other added health benefits. "