Decrease in serum cortisol during yoga exercise is correlated with alpha wave activation

The therapeutic effects of yoga in people with Parkinson's disease: a mini-review

Parkinson's disease (PD) is one of the most common neurodegenerative diseases, second only to Alzheimer's disease. Drugs and deep brain stimulation (DBS) are the main treatments for PD. However, the long-term side effects of drugs and the risks of surgery cannot be ignored. It is therefore important to research safe and effective complementary and alternative therapies for PD. Yoga, an ancient mind-body exercise, has been widely used in health promotion. Although, yoga can address a range of health problems, little is known about its role in people with PD. This article reviews the evidence that yoga improves PD symptoms, including movement disorders, balance function and emotional disturbance. The authors analyze the role and shortcomings of the yoga intervention process, with the aim of providing a scientific basis for the application of yoga training to people with PD.

A two-week exercise intervention improves cold symptoms and sleep condition in cold-sensitive women

BACKGROUND

We examined whether an aerobic exercise intervention in young women with cold sensitivity symptoms improves sleep quality and decreases cold complaints. Furthermore, we examined the association with increased foot skin temperature (Tsk) before falling asleep and decrease in sensitivity to cold in the brain.

METHODS

We recruited 16 female adult volunteers who had cold sensitivity and were not engaged in daily exercise training, and they were divided into an exercise group (EXE) and a control group (CON). EXE was given a 2-week exercise intervention that consisted mainly of walking and jogging. Before and after the intervention, temperature sensation and body temperature parameters were measured just before bedtime; electroencephalogram measurements were taken during sleep; and subjective sleep surveys, including Oguri-Shirakawa-Azumi (OSA) sleep inventory (middle-aged and aged version) and visual analogue scale (VAS), were conducted immediately after waking up. All experiments were performed in the winter season.

RESULTS

In EXE, overall and foot warmth and comfort increased (p < 0.05) after the 2-week exercise intervention. The exercise intervention also decreased (p < 0.05) the scores for cold feeling in the fingertips, feet, and toes. In the OSA sleep inventory, factor IV (refreshing) and factor V (sleep length) were increased (p < 0.05) by the exercise intervention. Subjective sleep quality evaluated by VAS increased (p < 0.05) with exercise intervention. The exercise intervention in EXE shortened middle awake time after sleep onset (p < 0.05) and prolonged deep sleep length (p < 0.05). The exercise intervention increased (p < 0.05) alpha-wave power before sleep. In CON, all variables remained unchanged throughout the 2-week control period.

CONCLUSION

Short-term aerobic exercise alleviated peripheral extremity cold sensitivity symptoms and improved subjective sleep quality. Our findings suggest that these improvements were not due to increased Tsk at rest before bedtime but to decreased sensitivity to cold in the brain that was expressed as increased alpha activity.

Role of yoga in stress management and implications in major depression disorder

Major Depressive Disorder (MDD) is one of the leading causes of disability affecting more than 340 million people and second largest contributor to global burden of disease. Chronic stress is a common risk factor and important contributor for MDD. Stress could be defined as the "perceived inability to cope". Stressful life events are shown to provoke a sequence of psychological and physiological adjustments including nervous, endocrine and immune mechanisms. Stress can lead to elevation of a variety of inflammatory cytokines and stress hormones, can cause autonomic dysfunction and imbalance in neurotransmitters. Yoga can reduce depressive symptoms by alleviating stress. Studies have shown that yoga can reduce inflammation, maintain autonomic balance and also has a role in maintaining the neurotransmitters. It has role on hypothalamic-pituitary-adrenal (HPA) axis, the peripheral nervous system including GABA, limbic system activity, inflammatory and endocrine responses. Yoga along with antidepressants can help in reducing the depressive symptoms in patient with MDD. Yoga is an ideal complementary and alternative therapy for mental health disorders.

Yoga Meets Intelligent Internet of Things: Recent Challenges and Future Directions

The physical and mental health of people can be enhanced through yoga, an excellent form of exercise. As part of the breathing procedure, yoga involves stretching the body organs. The guidance and monitoring of yoga are crucial to ripe the full benefits of it, as wrong postures possess multiple antagonistic effects, including physical hazards and stroke. The detection and monitoring of the yoga postures are possible with the Intelligent Internet of Things (IIoT), which is the integration of intelligent approaches (machine learning) and the Internet of Things (IoT). Considering the increment in yoga practitioners in recent years, the integration of IIoT and yoga has led to the successful implementation of IIoT-based yoga training systems. This paper provides a comprehensive survey on integrating yoga with IIoT. The paper also discusses the multiple types of yoga and the procedure for the detection of yoga using IIoT. Additionally, this paper highlights various applications of yoga, safety measures, various challenges, and future directions. This survey provides the latest developments and findings on yoga and its integration with IIoT.

Complementary and Integrative Medicine for Anxiety in Children, Adolescents, and Young Adults

An integrative approach to treating anxiety in children and adolescents takes a biopsychosocial-spiritual approach. Early life stress may translate into anxiety via epigenetic mechanisms, the adoption of maladaptive coping tendencies (poor eating, sedentary lifestyle, substance use), and dysregulation of central autonomic nervous system function. Each of these mechanisms may increase inflammatory markers. This article will explore the efficacy of CIM interventions that work on these mechanisms through mind-body-medicine, acupuncture, nutrition, and supplements.

Integration of yoga within exercise and sports science as a preventive and management strategy for musculoskeletal injuries/disorders and mental disorders - A review of the literature

OBJECTIVES

Exercise-induced musculoskeletal injuries/disorders and associated mental disorders are prevalent among athletes. The main objective of this review is to analyze the prospects of Yoga practices as a preventive and management strategy for musculoskeletal injuries/disorders and associated mental disorders often encountered in exercise and sports activities.

METHODS

A review of the literature was performed using electronic databases such as MEDLINE/PubMed and google scholar published between January 1991 and December 2021 which yielded 88 research articles. The keywords used were yoga OR exercise AND musculoskeletal injuries OR disorders, yoga OR exercise AND mental disorders, yoga AND sports injuries, yoga AND stress, yoga OR exercise AND oxidative stress, yoga OR exercise AND inflammation, yoga OR exercise AND diet.

RESULTS

The moderate and regular exercises are beneficial to health. However, high intensity and overtraining physical activities lead to immune suppression, oxidative stress, muscle damage/fatigue, coronary risk, psychiatric disorders and so on due to enormous strain on various physiological functions. Yoga seems to undermine these adverse activities through up-regulating the functions of the parasympathetic nervous system (PNS) and down-regulating the activities of hypothalamohypophysial axis (HPA) which are conducive to healing, recovery, regeneration, reduction in stress, relaxation of mind, better cognitive functions, promotion of mental health, reduction in inflammation and oxidative stress, and so on.

CONCLUSION

Literature suggests that Yoga should be integrated within exercise and sports sciences mainly to prevent & manage musculoskeletal injuries/disorders and associated mental disorders.

Mechanisms Underlying Anti-Inflammatory and Anti-Cancer Properties of Stretching-A Review

Stretching is one of the popular elements in physiotherapy and rehabilitation. When correctly guided, it can help minimize or slow down the disabling effects of chronic health conditions. Most likely, the benefits are associated with reducing inflammation; recent studies demonstrate that this effect from stretching is not just systemic but also local. In this review, we present the current body of knowledge on the anti-inflammatory properties of stretching at a molecular level. A total of 22 papers, focusing on anti-inflammatory and anti-cancer properties of stretching, have been selected and reviewed. We show the regulation of oxidative stress, the expression of pro- and anti-inflammatory genes and mediators, and remodeling of the extracellular matrix, expressed by changes in collagen and matrix metalloproteinases levels, in tissues subjected to stretching. We point out that a better understanding of the anti-inflammatory properties of stretching may result in increasing its importance in treatment and recovery from diseases such as osteoarthritis, systemic sclerosis, and cancer.

Design and implementation of a highly efficacious new yoga breathing and relaxation protocol for asthma: A discussion and summary

Asthma presents a global problem to health of high prevalence; often life-long, typical onset in late teenage years, and no hope of reversal. Also, problems of long-term management with drugs present patients with endless suffering: poor quality of life due to reduced pulmonary function and associated psychological problems. There is thus great need for more effective management, and identification of any possible route to cure. Yoga therapy offers a promising alternative. Studies of specially designed yoga protocols over the past 40 years have shown benefits for all the above problem areas. However, challenges have led to high dropout levels. Some postures may have been too difficult for all to perform, while overall yoga modules may have required too much time for all patients to practice regularly. Despite patients with asthma feeling that Yoga brings benefits, few have practiced it with enough persistence to gain control of their condition. This short communication summarizes two recent papers describing, (a) the development of a short, easy to practise yoga module, and (b) assessment of its efficacy in all three areas by a 90-day randomized control trial. The module's five carefully selected components include four breathing practices and a relaxation exercise, which could be done by anyone, even those new to yoga. Popularity with participants led to zero dropouts, while its efficacy proved extremely high in all areas assessed. These results also offer insights into developing further easily-practised yoga adjuvant therapy modules for chronic conditions other than asthma.

A Randomized, Triple-Blind, Placebo-Controlled, Crossover Study to Investigate the Efficacy of a Single Dose of AlphaWave® L-Theanine on Stress in a Healthy Adult Population

Introduction

Stress is a complex life occurrence essential for survival and goal achievement but can be damaging in excess. Because of the high prevalence of stress in North America, a safe supplement that effectively reduces stress is in demand. The objective of this study was to investigate the efficacy and safety of AlphaWave^®l-Theanine on whole-scalp and frontal alpha power, midline theta power, and salivary cortisol in healthy, moderately stressed adults.

Methods

This was a randomized, triple-blind, placebo-controlled, crossover study that consisted of two study periods with a 7-day washout. A single dose of AlphaWave^®l-Theanine (200 mg) or placebo was administered. To induce stress, a mental arithmetic test (MAT) was administered before and after the dose. Electroencephalogram, salivary cortisol, blood pressure, heart rate, self-reported stress, adverse events, clinical chemistry, and hematology were assessed to evaluate efficacy and safety.

Results

Increases in heart rate, blood pressure, and self-reported stress and state anxiety indicated that participants experienced stress during the MAT. AlphaWave^®l-Theanine led to a greater increase in frontal region and whole-scalp alpha power 3 h post-dose compared to placebo (p ≤ 0.050). Within groups, there were increases in alpha power, at 3 h with AlphaWave^®l-Theanine, over the whole recording and during the eyes-open portions (p ≤ 0.048) of the alpha task. The changes in alpha wave activity are supported by greater decreases in salivary cortisol 1 h post-dose (p < 0.001) with AlphaWave^®l-Theanine compared to placebo.

Conclusion

This study was conducted during the SARS-CoV-2 pandemic, which has had a rapid and significant effect on both physical and mental health around the world. A single dose of AlphaWave^®l-Theanine significantly increased frontal region alpha power compared to placebo in response to an acute stress challenge. These changes are indicative of relaxation in the brain and suggest a calming response. AlphaWave^®l-Theanine was found to be safe and well tolerated by participants.

Trial Registration

ClinicalTrials.gov identifier NCT04706494.

Stress is a complex part of life that is essential for survival and achieving goals. Too much stress, however, can be damaging. There is a high prevalence of stress in North America, creating a demand for a safe and effective supplement to reduce it. This study investigated the effectiveness and safety of AlphaWave^®l-Theanine on brainwaves and salivary cortisol in healthy, moderately stressed adults facing an acute stressor. This was a randomized, triple-blind, placebo-controlled, crossover study that consisted of two study periods with a 7-day washout. A single dose of 200 mg of AlphaWave^®l-Theanine or placebo was administered before and after a mental arithmetic test to elicit acute stress. Electroencephalogram, salivary cortisol, blood pressure, heart rate, self-reported stress, and safety were assessed to evaluate efficacy and safety. This study was conducted during the coronavirus pandemic, which has had a rapid and significant effect on both physical and mental health around the world. A single dose of AlphaWave^®l-Theanine had significant positive effects on brainwaves, salivary cortisol, and self-reported state anxiety compared to the placebo in response to an acute stress challenge. These changes are indicative of relaxation in the brain and suggest a calming response in a moderately stressed but otherwise healthy population. AlphaWave^®l-Theanine was found to be safe and well tolerated by participants.

Slow Breathing Exercise with Multimodal Virtual Reality: A Feasibility Study

Many studies have shown that slow breathing training is beneficial for human health. However, several factors might discourage beginners from continuing their training. For example, a long training period is generally required for benefit realization, and there is no real-time feedback to trainees to adjust their breathing control strategy. To raise the user’s interest in breathing exercise training, a virtual reality system with multimodal biofeedback is proposed in this work. In our system, a realistic human model of the trainee is provided in virtual reality (VR). At the same time, abdominal movements are sensed, and the breathing rate can be visualized. Being aware of the breathing rate, the trainee can regulate his or her breathing to achieve a slower breathing rate. An additional source of tactile feedback is combined with visual feedback to provide a more immersive experience for the trainees. Finally, the user’s satisfaction with the proposed system is reported through questionnaires. Most of the users find it enjoyable to use such a system for mediation training.

The Effects of Yoga on Patients with Parkinson's Disease: A Meta-Analysis of Randomized Controlled Trials

Methods

A meta-analysis was conducted by systematically searching PubMed, Embase, and Cochrane Library databases till August 2020 for studies published in English. The reference lists of eligible studies were also searched. The motor symptoms (UPDRS-Part III), balance function (BBS and BESTest), functional mobility (TUG), anxiety (HADS and BAI), depression (HADS and BDI), and the quality of life (PDQ-39 and PDQ-8) were the primary evaluation indexes.

Results

Ten studies including 359 participants were included in this meta-analysis. The pooled results showed significant difference between the yoga training group and the control group. Patients in the yoga training group had better functional outcomes in terms of motor status (MD = −5.64; 95% CI, -8.57 to -2.7), balance function (SMD = 0.42; 95% CI, 0.08 to 0.77), functional mobility (MD = −1.71; 95% CI, -2.58 to -0.84), anxiety scale scores (SMD = −0.72; 95% CI, -1.01 to -0.43), depression scale scores (SMD = −0.92; 95% CI, -1.22 to -0.62), and QoL (SMD = −0.54; 95% CI, -0.97 to -0.11).

Conclusion

Our pooled results showed the benefits of yoga in improving motor function, balance, functional mobility, reducing anxiety and depression, and increasing QoL in PD patients.

A Complementary Intervention to Promote Wellbeing and Stress Management for Early Career Teachers

The educational climate and culture in our schools present a variety of environmental (contextual) factors that influence teacher wellbeing, job satisfaction, and work-related stress. The magnitude of contextual factors cannot be ignored, and directing attention towards the environment teachers face daily is essential. Primary (organisational)-level interventions are documented in organisational health and wellbeing literature; however, to provide teachers with stress management strategies for promoting wellbeing, attention must also be directed towards secondary (individual)-level interventions. The present study addressed the issue of stress management techniques for early career teachers (n = 24) and aimed to contribute to the research surrounding complementary interventions (CIs) for educators. The intervention was designed to include strategies that operated through cognitive and physiological mechanisms that regulated the stress response and increased awareness of behaviours, emotions, and reactivity. The self-report measures included perceived stress, attention awareness, subjective wellbeing, burnout, and job-related affective wellbeing. The results indicated a statistically significant decrease in perceived stress and increases in attention awareness and subjective wellbeing. The salivary cortisol levels (waking and resting) decreased from baseline to week 6, and the pre- and post-session salivary cortisol levels indicated an immediate decrease in cortisol for weeks 4 to 6.

Resistance training as an acute stressor in healthy young men: associations with heart rate variability, alpha-amylase, and cortisol levels

Regular resistance training has been shown to have many physiological and psychological health benefits. However, the underlying physiological processes are not yet fully understood. One explanation is that resistance training acts like an acute stressor and modulates physiological pathways that are associated with the stress response such as the sympathetic nervous system (SNS), the parasympathetic nervous system (PNS), and the hypothalamic-pituitary-adrenal (HPA) axis. This was systematically investigated in our study. Participants were 45 healthy men who had been doing resistance training regularly for at least nine months. Salivary α-amylase and heart rate that were used as markers for SNS activity increased during the training and decreased afterwards. PNS activity that was assessed by means of heart rate variability parameters decreased during the training and increased after it. Salivary cortisol that was used as marker for HPA axis activity decreased throughout the session. Furthermore, an improvement of positive affect was found after the training. However, additional analyses indicated that the physiological response patterns were found for participants who chose upper-body exercises (in contrast to lower-body exercises) only. Therefore, we were able to show that an upper-body resistance training acts partially like an acute stressor which leads to the typical SNS and PNS - but not HPA axis - stress responses. We conclude that resistance trainings might be an alternative to classical relaxation programs which would have the additional advantage that it is a physical training at the same time. However, more research is needed to develop specific trainings which entirely fulfill this goal.

[Pathophysiological mechanisms of autism in children]

Based on the analysis of literature, the authors describe the neuropathophysiological mechanism of the formation of synapses, synaptic transmission and plasticity, which may underlie the pathogenesis of autism. The results of some studies confirm the involvement of aberrant expression of genes and proteins of synaptic contacts, cell adhesion molecules p120ctn, CNTN5, CNTN6, activation of NMDA glutamate, TrkB, p75 receptors, Ca²⁺-input, BDNF, serotonin and testosterone. This leads to an imbalance in the exciting, inhibitory synaptic transmission and forms of synaptic plasticity, including long-term potentiation (LTP) and long-term depression (LTD) at the level of individual neurons and their chains due to suppression of GABA synthesis, expression of its ionotropic and metabotropic receptors, G proteins, NGF, TrkA receptors, a reduction in the number of GABAergic neurons, their contacts and disruption of differentiation. The pathology of the nuclei of the thalamus, especially the reticular nucleus (RN), is associated with a disturbance of the expression of the subunits of metabotropic GABAβ receptors, Ca²⁺ channels, GABA excretion and the work of chlorine transmitters. These failures do not ensure the inhibitory effect of OC on the exciting associative and ventral nuclei of the thalamus, nor modify the incoming information to the cerebral cortex (CC) from these thalamus nuclei, the dentate gyrus of the hippocampus and the nuclei of the reticular formation. Information propagating into the somatosensory and associative regions of CC is not modified by mirror neurons (MN) when performing arbitrary actions, which prevents the formation of an adequate image in the neural networks of the associative cortex and promotes the development of hyperexcitability, irritability, increased visual and auditory sensitivity, anxiety, and the ability to form a holistic image based on the actions of other people.

A Comparison of the Acute Effects of Different Forms of Yoga on Physiological and Psychological Stress: A Pilot Study

Yoga is a frequently recommended stress management strategy; however, the acute stress response to varying types of yoga are not fully clear. Thus, the purpose of this study was to compare the acute effects of meditative and power yoga on indices of physiological and psychological stress. In a crossover counterbalanced design, physically active females (n = 13; age = 20.8 yrs ± 0.8, height = 164.5 cm ± 6.1, body mass = 65.0 kg ± 13.8) who did not regularly participate in yoga or mindful training enrolled in this study. Participants completed two visits each, with a standardized instructional-video 30-min yoga session with either A) meditative (Hatha style) yoga or B) power (Vinyasa style) yoga. Prior to and immediately after each yoga bout, psychological stress was assessed using the State–Trait Anxiety Inventory (STAI) questionnaire, and salivary cortisol samples were obtained to measure indices of physiological stress. State anxiety scores were significantly lower following meditative yoga (p = 0.047) but were not different following power yoga (p = 0.625). Salivary cortisol levels were significantly lower following meditative yoga (p = 0.020) but not following power yoga (p = 0.242). Results indicate that acute engagement in meditative yoga decreases markers of psychological and physiological stress, while power yoga does not impart a significant stress-relieving benefit. Findings indicate that differing types of yoga may have various stress-relieving capabilities and should be considered by individuals seeking anxiolytic benefits.

Role of Yoga and Meditation as Complimentary Therapeutic Regime for Stress-Related Neuropsychiatric Disorders: Utilization of Brain Waves Activity as Novel Tool

During recent decades, stress-related neuropsychiatric disorders such as anxiety, depression, chronic tension headache, and migraine have established their stronghold in the lives of a vast number of people worldwide. In order to address this global phenomenon, intensive studies have been carried out leading to the advancement of drugs like anti-depressants, anxiolytics, and analgesics which although help in combating the symptoms of such disorders but also create long-term side effects. Thus, as an alternative to such clinical practices, various complementary therapies such as yoga and meditation have been proved to be effective in alleviating the causes and symptoms of different neuropsychiatric disorders. The role of altered brain waves in this context has been recognized and needs to be pursued at the highest level. Thus, the current study provides a review focused on describing the effects of yoga and meditation on anxiety and depression as well as exploring brain waves as a tool for assessing the potential of these complementary therapies for such disorders.

Hypothesis: Pulmonary Afferent Activity Patterns During Slow, Deep Breathing Contribute to the Neural Induction of Physiological Relaxation

Control of respiration provides a powerful voluntary portal to entrain and modulate central autonomic networks. Slowing and deepening breathing as a relaxation technique has shown promise in a variety of cardiorespiratory and stress-related disorders, but few studies have investigated the physiological mechanisms conferring its benefits. Recent evidence suggests that breathing at a frequency near 0.1 Hz (6 breaths per minute) promotes behavioral relaxation and baroreflex resonance effects that maximize heart rate variability. Breathing around this frequency appears to elicit resonant and coherent features in neuro-mechanical interactions that optimize physiological function. Here we explore the neurophysiology of slow, deep breathing and propose that coincident features of respiratory and baroreceptor afferent activity cycling at 0.1 Hz entrain central autonomic networks. An important role is assigned to the preferential recruitment of slowly-adapting pulmonary afferents (SARs) during prolonged inhalations. These afferents project to discrete areas in the brainstem within the nucleus of the solitary tract (NTS) and initiate inhibitory actions on downstream targets. Conversely, deep exhalations terminate SAR activity and activate arterial baroreceptors via increases in blood pressure to stimulate, through NTS projections, parasympathetic outflow to the heart. Reciprocal SAR and baroreceptor afferent-evoked actions combine to enhance sympathetic activity during inhalation and parasympathetic activity during exhalation, respectively. This leads to pronounced heart rate variability in phase with the respiratory cycle (respiratory sinus arrhythmia) and improved ventilation-perfusion matching. NTS relay neurons project extensively to areas of the central autonomic network to encode important features of the breathing pattern that may modulate anxiety, arousal, and attention. In our model, pronounced respiratory rhythms during slow, deep breathing also support expression of slow cortical rhythms to induce a functional state of alert relaxation, and, via nasal respiration-based actions on olfactory signaling, recruit hippocampal pathways to boost memory consolidation. Collectively, we assert that the neurophysiological processes recruited during slow, deep breathing enhance the cognitive and behavioral therapeutic outcomes obtained through various mind-body practices. Future studies are required to better understand the physio-behavioral processes involved, including in animal models that control for confounding factors such as expectancy biases.

Creating an Internal Environment of Cognitive and Psycho-Emotional Well-Being through an External Movement-Based Environment: An Overview of Quadrato Motor Training

In this overview, we discuss the internal and external environmental factors associated with cognitive and psycho-emotional well-being in the context of physical activity and Mindful Movement. Our key argument is that improved cognitive and emotional functions associated with mental well-being can be achieved by an external, Mindful Movement-based environment training called Quadrato Motor Training (QMT). QMT is a structured sensorimotor training program aimed at improving coordination, attention, and emotional well-being through behavioral, electrophysiological, neuroanatomical, and molecular changes. In accordance with this argument, we first describe the general neurobiological mechanisms underpinning emotional states and emotion regulation. Next, we review the relationships between QMT, positive emotional state, and increased emotion regulation, and discuss the neurobiological mechanisms underlying these relationships. We consider the relationships between motion, emotion, and cognition, and highlight the need for integrated training paradigms involving these three trajectories. Such training paradigms provide cognitively engaging exercises to improve emotion regulation, which in turn affects adaptive behaviors. Finally, we address the broader implications of improving cognitive and emotional functioning through Mindful Movement training for environmental research and public health.

Effects of an Online Mind-Body Training Program on the Default Mode Network: An EEG Functional Connectivity Study

Online mind-body training (MBT) programs can improve the psychological capabilities of practitioners. Although there has been a lot of effort to understand the neural mechanisms underlying the therapeutic effects of meditation, little is known about changes in electroencephalographic (EEG) functional connectivity that accompany mind-body training. The present study aimed to investigate how an online MBT program alters EEG functional connectivity in the default mode network (DMN). We assessed a group of healthcare providers, including 14 females who participated in the 4-week MBT program and 15 females who underwent a 4-week of waiting period. EEG data and information about psychological states were obtained at baseline and 4 weeks. The result was that the intervention group showed significant reductions in anxiety and trait anger that were accompanied by increased global DMN network strengths in the theta and alpha (but not beta and delta) frequency bands; these changes were not observed in the control group. Other variables including state anger, positive and negative affect, and self-esteem have not been changed over time in both groups. These findings suggest that practicing the mind-body training could have a relevance to the functional differences in network related to stress and anxiety reaction.

For Body and Mind: Practicing Yoga and Emotion Regulation

The purpose of the present study was to examine if the length of yoga training may influence the use of cognitive reappraisal and expressive suppression (as emotion regulation strategies) and whether this relationship may be moderated by personality traits. Based on previous studies, we hypothesized that the link between the length of yoga practice and emotion regulation can rely most heavily on participants’ conscientiousness and extraversion levels. Ninety women in two groups participated in the study: those who have been practicing yoga for over a year and those who have been practicing for a shorter period of time. An Emotion Regulation Questionnaire was applied to measure the use the strategies of cognitive reappraisal and expressive suppression. Moreover, personality traits, based on the Big Five model were assessed. The results of the study provided support for our prediction: participants who engaged in yoga practice for a longer period of time (as compared to participants who practiced yoga for a shorter duration), reported using cognitive reappraisal more often. Furthermore, longer yoga practice was more beneficial than shorter practice especially for individuals with low levels of conscientiousness and extraversion. Thus, extraversion and conscientiousness seem to facilitate the process of drawing benefits from practicing yoga.

Slow Breathing Can Be Operantly Conditioned in the Rat and May Reduce Sensitivity to Experimental Stressors

In humans, exercises involving slowed respiratory rate (SRR) counter autonomic sympathetic bias and reduce responses to stressors, including in individuals with various degrees of autonomic dysfunction. In the rat, we examined whether operant conditioning could lead to reductions in respiratory rate (RR) and performed preliminary studies to assess whether conditioned SRR was sufficient to decrease physiological and behavioral responsiveness to stressors. RR was continuously monitored during 20 2-h sessions using whole body plethysmography. SRR conditioned, but not yoked control rats, were able to turn off aversive visual stimulation (intermittent bright light) by slowing their breathing below a preset target of 80 breaths/min. SRR conditioned rats greatly increased the incidence of breaths below the target RR over training, with average resting RR decreasing from 92 to 81 breaths/min. These effects were significant as a group and vs. yoked controls. Preliminary studies in a subset of conditioned rats revealed behavioral changes suggestive of reduced reactivity to stressful and nociceptive stimuli. In these same rats, intermittent sessions without visual reinforcement and a post-training priming stressor (acute restraint) demonstrated that conditioned rats retained reduced RR vs. controls in the absence of conditioning. In conclusion, we present the first successful attempt to operantly condition reduced RR in an animal model. Although further studies are needed to clarify the physio-behavioral concomitants of slowed breathing, the developed model may aid subsequent neurophysiological inquiries on the role of slow breathing in stress reduction.

Teaching a Series of Mind-Body Techniques to Address the Risk of Work-Related Musculoskeletal Disorders Among Sonography Students: A Pilot Study

Sonographers have been the focus of documenting work-related musculoskeletal disorders. The literature has focused on self-reported survey data, which point to more than 80% of sonographers performing their jobs in pain. However, few intervention studies have been designed to address these risks. A pre-post pre-experimental design was employed, and longitudinal data were collected from a cohort of first-year sonography students (n = 12). Three groups of participants (n = 4 each) were exposed to a combination of ergonomics education and mind-body techniques. Analysis of survey data did not demonstrate statistically significant changes across any of the groups. However, participants who specifically practiced mindful sonography yoga and cueing indicated an improvement in mental health, stress level, and right upper extremity pain. Posture was improved with biofeedback training, while participants who used both biofeedback training and mindful sonography yoga and cueing demonstrated even greater improvement in posture.

Yoga stretching for improving salivary immune function and mental stress in middle-aged and older adults

Protection against age-related immune suppression is important in elderly individuals. This study determined the effect of yoga on mucosal immune function and mental stress. Saliva samples were collected from 23 adult women (age: 60.4 ± 10.4 years) before and after 90 minutes of yoga stretching or rest to measure secretory immunoglobulin A (SIgA), cortisol, and testosterone. The SIgA concentration and secretion rate were significantly higher after yoga than before (p < .05). The cortisol concentration and secretion rate were lower and testosterone secretion rate higher after yoga (p < .05). Yoga stretching can reduce stress and enhance mucosal immune function in elderly women.

Influence of Binasal and Uninasal Inhalations of Essential Oil of Abies koreana Twigs on Electroencephalographic Activity of Human

Objectives. The present work investigates the effect of essential oil from the twigs of Abies koreana on electroencephalographic (EEG) activity of human brain in order to understand the influence of binasal and uninasal inhalations. Methods. To accomplish this study, the essential oil from the twigs of A. koreana (AEO) was isolated by steam distillation and the EEG readings were recorded using QEEG-8 system from 8 grounding electrodes according to the International 10-20 System. Results. D-Limonene (25.29%), bornyl acetate (19.31%), camphene (12.48%), α-pinene (11.88%), β-pinene (6.45%), and eudesm-7(11)-en-ol (5.38%) were the major components in the essential oil. In the EEG study, the absolute alpha (left frontal and right parietal) and absolute fast alpha (right parietal) values significantly increased during the binasal inhalation of AEO. In the uninasal inhalation, absolute beta and theta values decreased significantly, especially in the right frontal and left and right parietal regions. The results revealed that the AEO produced different EEG power spectrum changes according to the nostril difference. Conclusion. The changes in EEG values due to the inhalation of AEO may contribute to the enhancement of relaxation (binasal inhalation) and alertness/attention (right uninasal inhalation) states of brain which could be used in aromatherapy treatments.

The effect of yoga training on enhancement of Adrenocorticotropic hormone (ACTH) and cortisol levels in female patients with multiple sclerosis

The effect of 8 weeks yoga training on cortisol and Adrenocorticotropic hormone (ACTH) levels in female patients with Multiple Sclerosis (MS) is examined. Twenty four MS female patients with Expanded Disability Status Scale (EDSS) 1 to 5.5 participated in this study as the subject. The participants were divided into control (n = 10) or training group (n = 14) randomly. Training group performed 90 min yoga training per session, 3 days a week for 8 weeks. Assessments include body composition measurement and blood sampling 48 h before first session and 48 h after the intervention. The results demonstrated that ACTH increased and cortisol decreased compared to the control group (P < 0.05); In conclusion, it seems that yoga training modulates ACTH level in concomitant with reduction in cortisol level in female patients with MS.

Yoga practice improves executive function by attenuating stress levels

BACKGROUND

Prolonged activation of the hypothalamus-pituitary-adrenal system is thought to have deleterious effects on brain function. Neuroendocrine studies suggest that brain exposure to higher cortisol concentrations contribute to cognitive deficits as we age. Mind-body techniques such as yoga have shown to improve stress levels by restoring the body's sympathetic-parasympathetic balance. The objective of this study was to determine whether yoga practice moderated the stress response resulting in improved executive function.

METHODS

Sedentary community dwelling older adults (N=118, Mean age=62.02) were randomized to an 8-week yoga intervention or a stretching control group. At baseline and following 8 weeks, all participants completed measures of executive function, self-reported stress and anxiety and provided saliva samples before and after cognitive testing to assess cortisol.

RESULTS

Yoga participants showed improved accuracy on executive function measures and an attenuated cortisol response compared to their stretching counterparts who showed increased cortisol levels and poor cognitive performance at follow up. The change in cortisol levels as well as self-reported stress and anxiety levels predicted performance on the running span task, n-back working memory and task switching paradigm (β's=0.27-0.38, p's≤0.05 for yoga and β's=-0.37-0.47, p's≤0.01 for stretching control).

CONCLUSION

Eight weeks of regular yoga practice resulted in improved working memory performance that was mediated by an attenuated response to stress as measured by self-report stress and objective salivary cortisol measurements. This trial offers evidence for non-traditional physical activity interventions such as yoga that may be helpful in restoring HPA balance in older adults, thereby preventing cognitive decline.

Association of yoga practice and serum cortisol levels in chronic periodontitis patients with stress-related anxiety and depression

AIM

Reducing the psychosocial stress by various methods can improve overall health, and yoga is now considered as an easily available alternative method. The present cross-sectional pilot study was conducted mainly to find the association of yoga practice with periodontal disease by measuring serum cortisol levels.

MATERIALS AND METHODS

A total of 70 subjects with age range of 35-60 years suffering with chronic periodontitis were divided into group I (with stress), group II (without stress), and group III (practicing yoga). Psychological evaluation was carried out using Hamilton Anxiety Rating Scale (HAM-A) and Zung Self-rating Depression Scale (ZSDS). Periodontal parameters like plaque index (PI), probing pocket depth (PPD), and clinical attachment level (CAL) at 5-8 mm and >8 mm were recorded. Blood samples were collected and serum cortisol levels were measured.

RESULTS

Mean age, plaque scores, and number of teeth with PPD and CAL at 5-8 mm and >8 mm were similar in all the groups, except between group I and group III where a multiple comparison with Tukey's post-hoc test showed significant difference in plaque index (P < 0.038) and the number of teeth with CAL 5-8 mm (P < 0.016). Serum cortisol levels and HAM-A scale and ZSDS scores showed highly significant value (P < 0.001) in group I subjects when compared with group II and group III subjects.

CONCLUSION

Cross-sectional observation done among three groups showed that individuals practicing yoga regularly had low serum cortisol levels, HAM-A scale and ZSDS scores, and better periodontal health.

Yoga Training in Junior Primary School-Aged Children Has an Impact on Physical Self-Perceptions and Problem-Related Behavior

The present pilot study investigated the effects of yoga training, as compared to physical skill training, on motor and executive function, physical self-concept, and anxiety-related behavior in junior primary school-aged children. Twenty-four participants with a mean age of 8.4 (±1.4) years completed either yoga or physical skill training twice a week for 6 weeks outside of regular school class time. Both forms of training were delivered in an individualized and child-oriented manner. The type of training did not result in any significant differences in movement and executive function outcomes. In terms of physical self-concept, significant group differences were revealed only for perceived movement speed such that yoga training resulted in perceptions of being slower while physical skill training resulted in perceptions of moving faster. Analysis of anxiety related outcomes revealed significant group effects only for avoidance behavior and coping strategies. Avoidance behavior increased following yoga training, but decreased following physical skill training. In addition, following yoga training, children showed an increased use of divergent coping strategies when facing problematic situations while after physical skill training children demonstrated a decrease in use of divergent coping strategies. Changes in overall physical self-concept scores were not significantly correlated with changes in avoidance behavior following yoga training. In contrast, following physical skill training increased physical self-concept was significantly correlated with decreases in avoidance behavior. In sum, exposure to yoga or physical skill training appears to result in distinct effects for specific domains of physical self-concept and anxiety-related behavior. Further studies with larger samples and more rigorous methodologies are required to further investigate the effects reported here. With respect to future studies, we address potential research questions and specific features associated with the investigation of the effects of yoga in a sample of school-aged children.

Randomized controlled trial of Qigong/Tai Chi Easy on cancer-related fatigue in breast cancer survivors

BACKGROUND

Many breast cancer survivors experience fatigue, mood, and sleep disturbances.

PURPOSE

This study aims to compare a meditative movement practice, Qigong/Tai Chi Easy (QG/TCE) with sham Qigong (SQG), testing effects of meditation/breath aspects of QG/TCE on breast cancer survivors' persistent fatigue and other symptoms.

METHODS

This double-blind, randomized controlled trial tested 12 weeks of QG/TCE versus SQG on fatigue, depression, and sleep among 87 postmenopausal, fatigued breast cancer survivors, stages 0-III, age 40-75.

RESULTS

Fatigue decreased significantly in the QG/TCE group compared to control at post-intervention (p = 0.005) and 3 months follow-up (p = 0.024), but not depression and sleep quality. Improvement occurred over time for both interventions in depression and sleep quality (all p < 0.05).

CONCLUSIONS

QG/TCE showed significant improvement over time compared to SQG for fatigue, but not depression or sleep. Both QG/TCE and SQG showed improvement for two prevalent symptoms among breast cancer survivors, depression and sleep dysfunction.

Acute and Chronic Effects of Tantric Yoga Practice on Distress Index

OBJECTIVES

To evaluate the acute and chronic effects of yoga practice.

DESIGN

Quantitative study using a one-group pre-posttest design.

SETTING

Visão Futuro Institute, Porangaba, São Paulo, Brazil.

PARTICIPANTS

22 volunteers (7 men and 15 women).

INTERVENTION

Six weeks of a tantric yoga program (TYP), 50 minutes per session, held twice a week from 8 a.m. to 9 a.m. The local ethics committee approved the protocol.

OUTCOME MEASURES

Data were collected in the first week and at the end of the sixth week of TYP. Salivary cortisol concentration (SCC) was used to measure physiology of distress and to analyze the short- and long-term effects of TYP. Psychological distress was evaluated by applying a specific perceived stress questionnaire (PSQ). Results (mean±standard deviation) were analyzed by Wilcoxon test (p<0.05).

RESULTS

SCC decreased 24% after the first (0.66±0.20 μg/dL versus 0.50±0.13 μg/dL) and last (1.01±0.37 versus 0.76±0.31 μg/dL) sessions, showing the short-term effect of yoga. Long-term effects were analyzed by daily rhythm of cortisol production. In the beginning, volunteers showed altered SCC during the day, with nighttime values (0.42±0.28) higher than those at noon (0.30±0.06). After the TYP, SCC was higher in the morning (1.01±0.37) and decreased during the day, with lower values before sleep (0.30±0.13). The TYP was also efficient to reduce PSQ scores (0.45±0.13 versus 0.39±0.07). Specifically, the irritability, tension, and fatigue domains on the PSQ decreased (0.60±0.20 versus 0.46±0.13), as did the fear and anxiety domains (0.54±0.30 versus 0.30±0.20).

CONCLUSION

Over the short term, TYP led to the decrease of cortisol production. Over the long term, TYP induced higher cortisol production in the morning and lower production in the evening. Those effects contributed to the physical and mental well-being of the participants.

Neurophysiological and neurocognitive mechanisms underlying the effects of yoga-based practices: towards a comprehensive theoretical framework

During recent decades numerous yoga-based practices (YBP) have emerged in the West, with their aims ranging from fitness gains to therapeutic benefits and spiritual development. Yoga is also beginning to spark growing interest within the scientific community, and yoga-based interventions have been associated with measureable changes in physiological parameters, perceived emotional states, and cognitive functioning. YBP typically involve a combination of postures or movement sequences, conscious regulation of the breath, and various techniques to improve attentional focus. However, so far little if any research has attempted to deconstruct the role of these different component parts in order to better understand their respective contribution to the effects of YBP. A clear operational definition of yoga-based therapeutic interventions for scientific purposes, as well as a comprehensive theoretical framework from which testable hypotheses can be formulated, is therefore needed. Here we propose such a framework, and outline the bottom-up neurophysiological and top-down neurocognitive mechanisms hypothesized to be at play in YBP.

EEG-guided meditation: A personalized approach

The therapeutic potential of meditation for physical and mental well-being is well documented, however the possibility of adverse effects warrants further discussion of the suitability of any particular meditation practice for every given participant. This concern highlights the need for a personalized approach in the meditation practice adjusted for a concrete individual. This can be done by using an objective screening procedure that detects the weak and strong cognitive skills in brain function, thus helping design a tailored meditation training protocol. Quantitative electroencephalogram (qEEG) is a suitable tool that allows identification of individual neurophysiological types. Using qEEG screening can aid developing a meditation training program that maximizes results and minimizes risk of potential negative effects. This brief theoretical-conceptual review provides a discussion of the problem and presents some illustrative results on the usage of qEEG screening for the guidance of mediation personalization.

Isometric yoga improves the fatigue and pain of patients with chronic fatigue syndrome who are resistant to conventional therapy: a randomized, controlled trial

Background

Patients with chronic fatigue syndrome (CFS) often complain of persistent fatigue even after conventional therapies such as pharmacotherapy, cognitive behavioral therapy, or graded exercise therapy. The aim of this study was to investigate in a randomized, controlled trial the feasibility and efficacy of isometric yoga in patients with CFS who are resistant to conventional treatments.

Methods

This trial enrolled 30 patients with CFS who did not have satisfactory improvement after receiving conventional therapy for at least six months. They were randomly divided into two groups and were treated with either conventional pharmacotherapy (control group, n = 15) or conventional therapy together with isometric yoga practice that consisted of biweekly, 20-minute sessions with a yoga instructor and daily in-home sessions (yoga group, n = 15) for approximately two months. The short-term effect of isometric yoga on fatigue was assessed by administration of the Profile of Mood Status (POMS) questionnaire immediately before and after the final 20-minute session with the instructor. The long-term effect of isometric yoga on fatigue was assessed by administration of the Chalder’s Fatigue Scale (FS) questionnaire to both groups before and after the intervention. Adverse events and changes in subjective symptoms were recorded for subjects in the yoga group.

Results

All subjects completed the intervention. The mean POMS fatigue score decreased significantly (from 21.9 ± 7.7 to 13.8 ± 6.7, P < 0.001) after a yoga session. The Chalder’s FS score decreased significantly (from 25.9 ± 6.1 to 19.2 ± 7.5, P = 0.002) in the yoga group, but not in the control group. In addition to the improvement of fatigue, two patients with CFS and fibromyalgia syndrome in the yoga group also reported pain relief. Furthermore, many subjects reported that their bodies became warmer and lighter after practicing isometric yoga. Although there were no serious adverse events in the yoga group, two patients complained of tiredness and one of dizziness after the first yoga session with the instructor.

Conclusions

Isometric yoga as an add-on therapy is both feasible and successful at relieving the fatigue and pain of a subset of therapy-resistant patients with CFS.

Trial registration

University Hospital Medical Information Network (UMIN CTR) UMIN000009646.

Yoga based cardiac rehabilitation after coronary artery bypass surgery: one-year results on LVEF, lipid profile and psychological states--a randomized controlled study

OBJECTIVE

To compare the long term effects of yoga based cardiac rehabilitation program with only physiotherapy based program as an add-on to conventional rehabilitation after coronary artery bypass grafting (CABG) on risk factors.

METHODS

In this single blind prospective randomized parallel two armed active control study, 1026 patients posted for CABG at Narayana Hrudayalaya Institute of Cardiac Sciences, Bengaluru (India) were screened. Of these, 250 male participants (35-65 years) who satisfied the selection criteria and consented were randomized into two groups. Within and between group comparisons were done at three points of follow up (i.e. 6th week, 6th month, and 12th month) by using Wilcoxon's signed ranks test and Mann Whitney U test respectively.

RESULTS

Yoga group had significantly (p = 0.001, Mann Whitney) better improvement in LVEF than control group in those with abnormal baseline EF (<53%) after 1 year. There was a better reduction in BMI in the yoga group (p = 0.038, between groups) in those with high baseline BMI (≥23) after 12 months. Yoga group showed significant (p = 0.008, Wilcoxon's) reduction in blood glucose at one year in those with high baseline FBS ≥110 mg/dl. There was significantly better improvement in yoga than the control group in HDL (p = 0.003), LDL (p = 0.01) and VLDL (p = 0.03) in those with abnormal baseline values. There was significantly better improvement (p = 0.02, between groups) in positive affect in yoga group. Within Yoga group, there was significant decrease in perceived stress (p = 0.001), anxiety (p = 0.001), depression (p = 0.001), and negative affect (p = 0.03) while in the control group there was reduction (p = 0.003) only in scores on anxiety.

CONCLUSION

Addition of yoga based relaxation to conventional post-CABG cardiac rehabilitation helps in better management of risk factors in those with abnormal baseline values and may help in preventing recurrence.

A holistic antenatal model based on yoga, Ayurveda, and Vedic guidelines

The prevalence of pregnancy complications are on the rise globally with severe consequences. According to the World Health Organization (WHO, 2009), every minute, at least one woman dies and 20 are affected by the complications related to pregnancy or childbirth. While the root cause of pregnancy complications is unclear, it likely has physical, psychological, social, and spiritual aspects. The Vedas are a rich source of antenatal health care guidelines in all these aspects. The primary objective of the authors was to compile the scriptural and scientific evidence for a holistic antenatal model of yoga with emphasis on sociocultural Indian practices.

A biobehavioral model of weight loss associated with meditative movement practice among breast cancer survivors

Women with breast cancer often experience weight gain during and after treatment, significantly increasing risk for recurrence as well as all-cause mortality. Based on a growing body of evidence, meditative movement practices may be effective for weight management. First, we describe the effects of stress on factors associated with weight gain for breast cancer survivors. Then, a model is proposed that utilizes existing evidence to suggest how meditative movement supports behavioral, psychological, and neurohormonal changes that may explain weight loss. Application of the model suggests how a novel "mindful-body-wisdom" approach may work to help reduce weight for this at-risk group.

The effect of prenatal Hatha yoga on affect, cortisol and depressive symptoms

Perinatal depression impacts maternal and child health, and little is known about effective interventions. The effects of prenatal Hatha yoga on cortisol, affect and depressive symptoms were investigated in 51 women. Twice during pregnancy, yoga group participants reported on affect and provided a saliva sample before and after a 90-min prenatal Hatha yoga session. Corresponding measures were obtained from yoga and control group participants on days of usual activity. Depressive symptoms were assessed in pregnancy and post partum. Cortisol was lower (p < .01) and positive affect higher (p < .001) on yoga compared to usual activity days. Negative affect and contentment (p < .05) improved more in response to the yoga session. Yoga group participants showed fewer postpartum (p < .05) but not antepartum depressive symptoms than control group participants. Findings indicate that prenatal Hatha yoga may improve current mood and may be effective in reducing postpartum depressive symptoms.

Current evidence regarding the management of mood and anxiety disorders using complementary and alternative medicine

This article is an updated review on the potential uses of complementary and alternative medicine (CAM) approaches for the management of patients with mood and anxiety disorders. We have focused this current paper on the different types of disorders and the CAM intervention which might be useful. This is in distinction to the prior paper which focused on the CAM interventions. In addition, we have provided a discussion of more recent studies that help to further inform practitioners about CAM interventions in these disorders. Mood and anxiety disorders are among the most prevalent mental health issues affecting people today and there are many approaches towards their management. CAM interventions can include supplements, botanical remedies, meditation and spiritual practices, acupuncture, and dietary practices. There are a growing number of research studies on the effectiveness of CAM interventions in mood and anxiety disorders, and this review evaluates and critiques such data.

A methodological review of meditation research

Despite over 50 years of research into the states of consciousness induced by various meditation practices, no clear neurophysiological signatures of these states have been found. Much of this failure can be attributed to the narrow range of variables examined in most meditation studies, with the focus being restricted to a search for correlations between neurophysiological measures and particular practices, without documenting the content and context of these practices. We contend that more meaningful results can be obtained by expanding the methodological paradigm to include multiple domains including: the cultural setting ("the place"), the life situation of the meditator ("the person"), details of the particular meditation practice ('the practice'), and the state of consciousness of the meditator ("the phenomenology"). Inclusion of variables from all these domains will improve the ability to predict the psychophysiological variables ("the psychophysiology") associated with specific meditation states and thus explore the mysteries of human consciousness.

Effect of "SOHAM" meditation on the human brain: an fMRI study

The effect of "SOHAM" meditation has been investigated using functional magnetic resonance imaging (fMRI) in long-term meditators while they were meditating and not meditating. The results have revealed activation in left middle prefrontal cortex (MPFC) (Brodmann's area, BA 46), left inferior frontal gyrus (LIFG) (BA 44), left supplementary motor area (SMA) (BA 6) and left precuneus (BA 5) during the meditation period compared to the control period (no-meditation period). The results have been interpreted in terms of regulation of the emotional state, attention and working memory of the meditators.

Effects of mind-body therapies on symptom clusters during the menopausal transition

AIMS

Although most women experience symptom clusters during the menopausal transition and early postmenopause, investigators reporting clinical trial effects for hot flushes often omit co-occurring symptoms. Our aim was to review controlled clinical trials of mind-body therapies for hot flushes and at least one other co-occurring symptom from these groups: sleep, cognitive function, mood, and pain.

METHODS

An experienced reference librarian performed an extensive search of PubMed/Medline, CINAHL Plus, PsycInfo, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, EMBASE, AMED, and Alt-Health Watch for randomized controlled trials reported in English between 2004 and July 2011. Of 1193 abstracts identified, 58 trials examining effectiveness of therapies for hot flushes and at least one additional co-occurring symptom of interest were identified.

RESULTS

Eight trials (ten publications) examined relaxation, yoga, or exercise. Physical activity/exercise trials (six) yielded mixed results; only one significantly reduced hot flushes and mood symptoms. Of two relaxation therapy trials, only mindfulness-based stress reduction training reduced sleep and mood symptoms and had within-group treatment effects on hot flushes. Yoga (one trial) significantly reduced hot flushes and improved cognitive symptoms more than exercise, and also had within-group effects on sleep and pain symptoms.

CONCLUSIONS

Studies of mind-body therapies for hot flushes increasingly measure multiple symptom outcomes, but few report treatment effects in ways that allow clinicians to consider symptom clusters when prescribing therapies. Future studies need to measure and report results for individual symptoms or group like symptoms together into subscales rather than use subscales with mixed dimensions. Trials with larger numbers of participants are essential to allow evaluation of these therapies on multiple co-occurring symptoms.

The role of stress as a trigger for epileptic seizures: a narrative review of evidence from human and animal studies

Stress is one of the most frequently self-identified seizure triggers in patients with epilepsy; however, most previous publications on stress and epilepsy have focused on the role of stress in the initial development of epilepsy. This narrative review explores the causal role of stress in triggering seizures in patients with existing epilepsy. Findings from human studies of psychological stress, as well as of physiologic stress responses in humans and animals, and evidence from nonpharmacologic interventions for epilepsy are considered. The evidence from human studies for stress as a trigger of epileptic seizures is inconclusive. Although retrospective self-report studies show that stress is the most common patient-perceived seizure precipitant, prospective studies have yielded mixed results and studies of life events suggest that stressful experiences only trigger seizures in certain individuals. There is limited evidence suggesting that autonomic arousal can precede seizures. Interventions designed to improve coping with stress reduce seizures in some individuals. Studies of physiologic stress using animal epilepsy models provide more convincing evidence. Exposure to exogenous and endogenous stress mediators has been found to increase epileptic activity in the brain and trigger overt seizures, especially after repeated exposure. In conclusion, stress is likely to exacerbate the susceptibility to epileptic seizures in a subgroup of individuals with epilepsy and may play a role in triggering "spontaneous" seizures. However, there is currently no strong evidence for a close link between stress and seizures in the majority of people with epilepsy, although animal research suggests that such links are likely. Further research is needed into the relationship between stress and seizures and into interventions designed to reduce perceived stress and improve quality of life with epilepsy.