Walking with controlled breathing improves exercise tolerance, anxiety, and quality of life in heart failure patients: A randomized controlled trial

The role of interoception in lifestyle factors: A systematic review

BACKGROUND

Interoception, the perception of the internal state of the body, offers an underrepresented and intriguing potential avenue for altering lifestyle-related behaviors. Interoception is intrinsically related to maintaining homeostasis and the flexible allostatic regulation of complex demands. Internal bodily states may also be influenced by lifestyle factors and related problems. This systematic review aimed to provide insight into the current state of evidence about the role of interoception in lifestyle factors.

METHODS

Studies from three databases (PubMed, Embase, and Web of Science) were screened for eligibility based on two inclusion criteria: 1) at least one measure of interoception (e.g., interoceptive accuracy, attention, or awareness), and 2) at least one measure of a lifestyle factor (i.e., alcohol consumption, cognitive leisure and relaxation activities, eating behavior, exercise, sleep, or smoking). Risk of bias was assessed using an adjusted quality score checklist, consisting of five items related to study design, population size, exposure measurement, outcome measurement, and adjustment for confounders.

RESULTS

The review included 73 studies. Out of the included studies, 51 measured interoceptive accuracy and 36 measured interoceptive attention. Six studies quantified interoceptive awareness. In terms of lifestyle factors, 26 studies on cognitive leisure and relaxation activities, 19 studies on eating behavior, 12 studies focused on alcohol consumption, 10 studies on exercise, five studies on smoking, and four studies on sleep were identified. Findings show positive relations between interoceptive domains and cognitive leisure and relaxation activities, eating behavior, and exercise. Conversely, the consumption of alcohol is negatively related to interoceptive domains. Studies in the smoking and sleep lifestyle factors were sparse and of varying methodological quality.

DISCUSSION

The findings of this review show that interoceptive domains are associated with various lifestyle factors, but the quality of the evidence is limited. Future longitudinal studies with more objective measures of interoception are needed in order to better understand the interrelations between interoception and lifestyle factors.

Comparison of diaphragmatic breathing exercises and incentive spirometry on the functional status of heart failure patients: a randomized controlled trial

BACKGROUND

Respiratory muscle weakness in heart failure (HF) can deteriorate its symptoms such as fatigue, dyspnea, and impaired functional status. Pulmonary rehabilitation can strengthen these muscles. This study aimed to determine the impact of breathing exercises on fatigue severity, dyspnea, and functional classification in HF patients.

METHODS

A three-arm single-blind randomized controlled trial was conducted on 90 hospitalized HF patients in three 30-participant groups including diaphragmatic breathing group (DG), incentive spirometry group (SG), and control group (CG). The interventions were performed thrice daily for 10 days in DG and SG. The Fatigue Severity Scale (FSS), Borg dyspnea scale, and New York Heart Association (NYHA) functional classification were used before and after the intervention. Data were analyzed using SPSS-20 software.

RESULTS

After the intervention, the patients' frequency with severe fatigue decreased by 30% in both DG and SG (p < 0.001); the mean dyspnea score in DG and SG respectively reduced by 0.7 and 0.9 units at rest (p < 0.001) and reduced by 2.93 and 2.73 units during activity (p < 0.001); the total patients' frequency in functional class III and IV was significantly decreased by 30% in DG and 33.3% in SG (p < 0.001). The intervention groups were not significantly different regarding fatigue severity, dyspnea, and functional classification. While in CG these outcomes had no significant reduction after the intervention.

CONCLUSION

In this study breathing exercises could reduce fatigue and dyspnea, and improve NYHA functional classification of HF patients which can be included in nursing care plans for respiratory rehabilitation in HF.

TRIAL REGISTRATION

This study was prospectively registered by the Iranian Registry of Clinical Trials ( https://irct.behdasht.gov.ir/ ) on 14/04/2024 with registration ID: IRCT20240306061197N.

Exercise and health-related quality of life and work-related outcomes in primary care patients with anxiety disorders - A randomized controlled study

BACKGROUND

Exercise interventions show promise in the treatment of anxiety disorders, but effects on health-related quality of life (HR-QoL), work ability, and sick leave are little studied. We investigated these outcomes in a 12-week randomized controlled trial with a 1-year follow-up.

METHODS

Patients aged 18-65 (n = 222) with anxiety disorders from primary care centers in Gothenburg were randomized to a control group or one of two 12-week exercise intervention groups (low-intensity, [LI] and moderate/high-intensity, [HI]); 148 were evaluated at 12-weeks and 113 completed the 1-year follow-up. The EuroQol 5D (EQ5D; index and the visual analogue scale [VAS]), work ability score (WAS), presenteeism, and self-reported sick leave were assessed at baseline, 12 weeks, and 1 year. Improvements were defined by binary cut-offs for each scale. Binary logistic regression with odds ratios (OR) and 95 % confidence intervals (CI) were reported.

RESULTS

There were improved scores for EQ5D and WAS in the HI group compared to controls after 12 weeks (EQ5D index: 4.74 [1.91-11.7], EQ5D-VAS 4.00, [1.65-9.72], WAS 3.41 [1.24-7.37]) and 1 year (EQ5D index: 3.05 [1.05-8.81], EQ5D-VAS 3.20 [1.16-8.84], WAS 5.50 [1.85-16.3]). Post-hoc analysis showed higher ORs in participants on antidepressants (n = 75) (12-week EQ5D index: OR 9.95 [2.85-34.8]) and significant improvements in EQ5D scores for both intervention groups after 1 year. There were no between-group differences for presenteeism or sick leave.

LIMITATIONS

Discontinuation was high, mostly early after randomization (n = 74), as is common for anxiety interventions.

CONCLUSIONS

HI Exercise improves HR-QoL and work ability in anxiety patients, especially when combined with antidepressants.

The Effect of Walking on Depressive and Anxiety Symptoms: Systematic Review and Meta-Analysis

Background

Previous literature lacks summative information on the mental health benefits achieved from different forms of walking.

Objective

The aim of this study was to assess the effectiveness of different forms of walking in reducing symptoms of depression and anxiety.

Methods

This was a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effects of walking on depressive and anxiety symptoms. MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, Allied and Complementary Medicine Database (AMED), CINAHL, and Web of Science were searched on April 5, 2022. Two authors independently screened the studies and extracted the data. Random-effects meta-analysis was used to synthesize the data. Results were summarized as standardized mean differences (SMDs) with 95% CIs in forest plots. The risk of bias was assessed by using the Cochrane Risk of Bias tool.

Results

This review included 75 RCTs with 8636 participants; 68 studies reported depressive symptoms, 39 reported anxiety symptoms, and 32 reported both as the outcomes. One study reported the results for adolescents and was not included in the meta-analysis. The pooled results for adults indicated that walking could significantly reduce depressive symptoms (RCTs: n=44; SMD -0.591, 95% CI -0.778 to -0.403; I2=84.8%; τ2=0.3008; P<.001) and anxiety symptoms (RCTs: n=26; SMD -0.446, 95% CI -0.628 to -0.265; I2=81.1%; τ2=0.1530; P<.001) when compared with the inactive controls. Walking could significantly reduce depressive or anxiety symptoms in most subgroups, including different walking frequency, duration, location (indoor or outdoor), and format (group or individual) subgroups (all P values were <.05). Adult participants who were depressed (RCTs: n=5; SMD -1.863, 95% CI -2.764 to -0.962; I2=86.4%; τ2=0.8929) and those who were not depressed (RCTs: n=39; SMD -0.442, 95% CI -0.604 to -0.280; I2=77.5%; τ2=0.1742) could benefit from walking effects on their depressive symptoms, and participants who were depressed could benefit more (P=.002). In addition, there was no significant difference between walking and active controls in reducing depressive symptoms (RCTs: n=17; SMD -0.126, 95% CI -0.343 to 0.092; I2=58%; τ2=0.1058; P=.26) and anxiety symptoms (14 RCTs, SMD -0.053, 95% CI -0.311 to 0.206, I2=67.7%, τ2=0.1421; P=.69).

Conclusions

Various forms of walking can be effective in reducing symptoms of depression and anxiety, and the effects of walking are comparable to active controls. Walking can be adopted as an evidence-based intervention for reducing depression and anxiety. More evidence on the effect of low-intensity walking is needed in the future.

Bayesian Meta-Analysis of Health State Utility Values: A Tutorial with a Practical Application in Heart Failure

Researchers incorporate health state utility values as inputs to inform economic models. However, for a particular health state or condition, multiple utility values derived from different studies typically exist and a single study is often insufficient to represent the best available source of utility needed to inform policy decisions. The purpose of this paper is to provide an introductory guidance for conducting Bayesian meta-analysis of health state utility values to generate a single parameter input for economic evaluation, using R. The tutorial is illustrated using data from a systematic review of health state utilities of patients with heart failure, with 21 studies that reported utilities measured using the EuroQol-5D (EQ-5D). Explanations, key considerations and suggested readings are provided for each step of the tutorial, adhering to a clear workflow for conducting Bayesian meta-analysis: (1) setting-up the data; (2) employing methods to impute missing standard deviations; (3) defining the priors; (4) fitting the model; (5) diagnosing model convergence; (6) interpreting the results; and (7) performing sensitivity analyses. The posterior distributions for the pooled effect size (i.e. mean health state utility) and between-study heterogeneity are discussed and interpreted in light of the data, priors and models used. We hope that this tutorial will foster interest in Bayesian methods and their applications in the meta-analysis of utilities.

Physical activity improves health-related quality of life, 6MWT, and VO2 peak before and during COVID-19 in patients with heart failure: A meta-analysis

OBJECTIVE

To compare the effects of physical activity on improving health-related quality of life (HRQOL), six minutes walking test (6MWT), and oxygen consumption (VO2) peak before and during Coronavirus disease (COVID-19) in patients with heart failure.

METHODS

Following PRISMA guidelines, we searched for relevant articles from five databases, including Embase, MEDLINE, CINAHL, PEDro, Cochrane, and additional resources. Study quality was assessed using Joanna Briggs Institution (JBI). RevMan 5.3 software was used to perform the meta-analysis.

RESULT

Fifteen randomized controlled trial studies met the criteria. Analysis of the subgroup before COVID-19 showed that PA had a significant effect on HRQOL, as measured by MLHFQ (SDM: -0.27, 95% CI: -0.47 to -0.07, n=590), KCCQ (SDM: 2.10, 95% CI: 0.74 to 3.46, n=53), 6MWT (SMD: 1.63, 95% CI: 0.80 to 2.46, n=284), and VO2 peak (SMD: 0.97, 95% CI: 0.00 to 1.93, n=106). Analysis of the subgroup during COVID-19 showed that PA resulted in a significant effect on HRQOL, MLHFQ (SDM: -0.62, 95% CI: -1.32 to 0.09, n=221), KCCQ (SDM: 0.33, 95% CI: 0.15 to 0.50, n=486), 6MWT (SMD: 0.47, 95% CI: 0.22 to 0.73, n=493), and VO2 peak (SMD: 0.35, 95% CI: 0.10 to 0.60, n=325).

CONCLUSION

The PA could increase HRQOL, 6MWT, and VO2 peak before and during COVID-19, and therefore should be considered as part of daily activities for patients with HF.

Chan-Chuang qigong with breathing meditation improves quality of life and interoceptive awareness in patients with breast cancer: a randomised controlled trial

PURPOSE

To evaluate the effect of Chan-Chuang qigong with breathing meditation on quality of life (QoL) and interoceptive awareness in patients with breast cancer during chemotherapy.

METHODS

This was a randomised controlled trial. Participants were randomly assigned to a qigong group (n = 30), which practised Chan-Chuang qigong with breathing meditation for 15 weeks, and a control group (n = 30), which received routine care. Outcomes were measured by using the European Organization for Research and Treatment of Cancer QoL Questionnaire (EORTC QLQ-C30) and Multidimensional Assessment of Interoceptive Awareness (MAIA-C).

RESULTS

The qigong group, when compared with the control group and baseline, exhibited significantly improved emotional function (p = 0.01) and decreased role function (p = 0.04) at week 15. The MAIA-C indicated a significant difference between groups in self-regulation at week 15 (p = 0.04). Within the qigong group, changes were found in attention regulation (p = 0.03), emotional awareness (p = 0.04), self-regulation (p = 0.01), and body listening (p = 0.002).

CONCLUSIONS

A 15-week programme of Chan-Chuang qigong with breathing meditation is a simple and safe intervention for patients with breast cancer to improve their emotional function and adjust to their role identity. Participants who practised qigong achieved increased awareness of their own bodies and were able to better regulate their emotion and attention.

TRIAL REGISTER

ClinicalTrials.gov Identifier: NCT05385146.

Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials

Deliberate control of the breath (breathwork) has recently received an unprecedented surge in public interest and breathing techniques have therapeutic potential to improve mental health. Our meta-analysis primarily aimed to evaluate the efficacy of breathwork through examining whether, and to what extent, breathwork interventions were associated with lower levels of self-reported/subjective stress compared to non-breathwork controls. We searched PsycInfo, PubMed, ProQuest, Scopus, Web of Science, ClinicalTrials.gov and ISRCTN up to February 2022, initially identifying 1325 results. The primary outcome self-reported/subjective stress included 12 randomised-controlled trials (k = 12) with a total of 785 adult participants. Most studies were deemed as being at moderate risk of bias. The random-effects analysis yielded a significant small-to-medium mean effect size, g = - 0.35 [95% CI - 0.55, - 0.14], z = 3.32, p = 0.0009, showing breathwork was associated with lower levels of stress than control conditions. Heterogeneity was intermediate and approaching significance, χ211 = 19, p = 0.06, I2 = 42%. Meta-analyses for secondary outcomes of self-reported/subjective anxiety (k = 20) and depressive symptoms (k = 18) showed similar significant effect sizes: g = - 0.32, p < 0.0001, and g = - 0.40, p < 0.0001, respectively. Heterogeneity was moderate and significant for both. Overall, results showed that breathwork may be effective for improving stress and mental health. However, we urge caution and advocate for nuanced research approaches with low risk-of-bias study designs to avoid a miscalibration between hype and evidence.

The association of general practitioners' awareness of depression and anxiety with change in quality of life in heart failure patients: results of the prospective observational RECODE-HF cohort study

BACKGROUND

Depression and anxiety are more prevalent in patients with heart failure (HF) than in the general population and reduce quality of life (QoL); therefore, clinical guidelines recommend screening HF patients for depression/anxiety.

OBJECTIVE

We investigated, whether the general practitioners' (GPs) awareness of patients' symptoms of depression and/or anxiety (psychosocial distress) was associated with a change in QoL.

METHODS

In this prospective observational study, we recruited 3,129 primary care HF patients in Germany. Patients completed baseline and 12-month follow-up questionnaires. Their GPs were interviewed. We identified 666 patients with psychosocial distress and compared 2 groups by analysis of covariance: 235 patients with psychosocial distress whose GP was aware of the psychosocial distress and 431 patients with psychosocial distress whose GP was unaware of such distress. Primary outcome was the change in QoL, assessed by the EQ-5D visual analogue scale.

RESULTS

Patients with psychosocial distress showed lower baseline QoL than those without (45.9 vs 64.1; P < 0.001). Within the patients with psychosocial distress, the GPs' awareness of psychosocial distress was not associated with improvement of QoL (F = 1.285; P = 0.258) or remission of psychosocial distress (odds ratio = 0.887; P = 0.608).

CONCLUSION

We found no association between the GPs' awareness of psychosocial distress and change in QoL. Although data for effective treatments of depression in HF are currently insufficient, psychosocial distress strongly impairs the QoL in HF patients. These findings might influence the development of clinical practice guidelines in HF.

The impact of atopic dermatitis on health-related quality of life in Taiwan

BACKGROUND/PURPOSE

Atopic dermatitis (AD) is a common skin disease. At present, there is little evidence regarding its impact on patients' health-related quality of life (HRQoL) in Taiwan. Therefore, this study investigated the relationship between AD severity and patients' HRQoL in Taiwan.

METHODS

Patients with AD were recruited from three hospitals in Taiwan from April 2018 to April 2019. AD severity was measured using the Scoring of AD (SCORAD) scale, and HRQoL was assessed using the Dermatology Life Quality Index (DLQI) and the five-level version of EuroQol five-dimension questionnaire (EQ-5D-5L).

RESULTS

A total of 200 patients (mean age: 34.4 years) were recruited, including 103 males and 97 females. They were further classified as 79 mild, 72 moderate, and 58 severe AD patients according to their SCORAD scores. There was a positive correlation between their SCORAD and DLQI scores (Spearman's r = 0.77, p < 0.001). Patients with severe AD had higher scores in all the DLQI questions, particularly the symptoms, feelings, and work/school. In addition, both the EQ-5D visual analogue scale (VAS) scores and utility index values were negatively correlated with the SCORAD scores (Spearman's r = -0.46 and -0.60, respectively, both p < 0.001). Patients with higher AD severity had more problems with mobility, usual activity, pain/discomfort, and anxiety/depression, while demographic characteristics did not significantly affect HRQoL.

CONCLUSION

Higher AD severity is associated with poorer HRQoL in Taiwanese AD patients, with AD's effects on symptoms, feelings, and work/school being the most troublesome. Meanwhile, demographic factors did not affect HRQoL significantly.

Cardiorespiratory Functioning in Youth with Persistent Post-Concussion Symptoms: A Pilot Study

Dysregulation of the autonomic nervous system (ANS) may play an important role in the development and maintenance of persistent post-concussive symptoms (PPCS). Post-injury breathing dysfunction, which is influenced by the ANS, has not been well-studied in youth. This study evaluated cardiorespiratory functioning at baseline in youth patients with PPCS and examined the relationship of cardiorespiratory variables with neurobehavioral outcomes. Participants were between the ages of 13-25 in two groups: (1) Patients with PPCS (concussion within the past 2-16 months; n = 13) and (2) non-injured controls (n = 12). Capnometry was used to obtain end-tidal CO2 (EtCO2), oxygen saturation (SaO2), respiration rate (RR), and pulse rate (PR) at seated rest. PPCS participants exhibited a reduced mean value of EtCO2 in exhaled breath (M = 36.3 mmHg, SD = 2.86 mmHg) and an altered inter-correlation between EtCO2 and RR compared to controls. Neurobehavioral outcomes including depression, severity of self-reported concussion symptoms, cognitive catastrophizing, and psychomotor processing speed were correlated with cardiorespiratory variables when the groups were combined. Overall, results from this study suggest that breathing dynamics may be altered in youth with PPCS and that cardiorespiratory outcomes could be related to a dimension of neurobehavioral outcomes associated with poorer recovery from concussion.

An evidence-based structured one-year programme to sustain physical activity in patients with heart failure in primary care: A non-randomized longitudinal feasibility study

Aim

The primary objective of this non-randomized feasibility study was to test a 1-year model programme for sustaining/increasing patients' motivation to perform daily physical activity.

Design

Non-randomized longitudinal feasibility study with a one-group repeated measures design.

Methods

The study took place at a primary care centre in mid-Sweden in 2017-2018. The model programme included individual and group-based support, individualized physical activity prescriptions, a wrist-worn activity tracker and an activity diary. The main outcomes were the participants' perceptions of programme feasibility and scores on the Exercise Self-Efficacy Scale.

Results

Seven patients were recruited. Six patients completed the programme that was perceived to imply learning, motivation and support. Compared with baseline, the median score of the Exercise Self-Efficacy Scale improved 3 months after participants completed the programme.

Benefits of Tai Chi Exercise Among Adults With Chronic Heart Failure: A Systematic Review and Meta-Analysis

BACKGROUND

Exercise-based cardiac rehabilitation is safe and effective for adults with chronic heart failure (CHF), yet services are greatly underutilized. However, tai chi is a popular and safe form of exercise among older adults with chronic health conditions.

OBJECTIVE

A systematic review and meta-analysis was conducted to examine the benefits of tai chi exercise among persons with CHF.

METHODS

An electronic literature search of 10 databases (Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Embase, OpenGrey, PsycARTICLES, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science) was conducted from January 1, 2004, to August 1, 2019. Clinical trials that examined tai chi exercise, were published in English or German languages, and conducted among participants with CHF were included. Comprehensive Meta-Analysis version 2.0 software (Biostat, Inc) was used to calculate effect sizes (ie, Hedges g) and 95% confidence intervals using random effects models.

RESULTS

A total of 6 studies met the inclusion criteria, enrolling 229 participants (mean age, 68 years; 28% women; mean ejection fraction = 37%). At least 3 studies reported outcomes for exercise capacity (n = 5 studies), quality of life (n = 5 studies), depression (n = 4 studies), and b-type natriuretic peptide (n = 4 studies), allowing for meta-analysis. Compared with controls, tai chi participants had significantly better exercise capacity (g = 0.353; P = .026, I = 32.72%), improved quality of life (g = 0.617; P = .000, I = 0%), with less depression (g = 0.627; P = .000, I = 0%), and decreased b-type natriuretic peptide expression (g = 0.333; P = .016, I = 0%).

CONCLUSION

Tai chi can be easily integrated into existing cardiac rehabilitation programs. Further research is needed with rigorous study designs and larger samples before widespread recommendations can be made.

Exercise as a prescription for patients with various diseases

A growing understanding of the benefits of exercise over the past few decades has prompted researchers to take an interest in the possibilities of exercise therapy. Because each sport has its own set of characteristics and physiological complications that tend to occur during exercise training, the effects and underlying mechanisms of exercise remain unclear. Thus, the first step in probing the effects of exercise on different diseases is the selection of an optimal exercise protocol. This review summarizes the latest exercise prescription treatments for 26 different diseases: musculoskeletal system diseases (low back pain, tendon injury, osteoporosis, osteoarthritis, and hip fracture), metabolic system diseases (obesity, type 2 diabetes, type 1 diabetes, and nonalcoholic fatty liver disease), cardio-cerebral vascular system diseases (coronary artery disease, stroke, and chronic heart failure), nervous system diseases (Parkinson's disease, Huntington's disease, Alzheimer's disease, depression, and anxiety disorders), respiratory system diseases (chronic obstructive pulmonary disease, interstitial lung disease, and after lung transplantation), urinary system diseases (chronic kidney disease and after kidney transplantation), and cancers (breast cancer, colon cancer, prostate cancer, and lung cancer). Each exercise prescription is displayed in a corresponding table. The recommended type, intensity, and frequency of exercise prescriptions are summarized, and the effects of exercise therapy on the prevention and rehabilitation of different diseases are discussed.