Gloria Y. Yeh

Use of Complementary and Alternative Medicine Among Persons With Diabetes Mellitus: Results of a National Survey

OBJECTIVES This study sought to characterize the use of complementary and alternative medicine (CAM) among persons with diabetes mellitus residing in the United States. METHODS Data from a 1997-1998 national survey (n = 2055) on CAM use were examined. RESULTS Ninety-five respondents reported having diabetes, of whom 57% reported CAM use in the past year; fewer respondents (35%) reported use specifically for diabetes. Therapies used for diabetes included solitary prayer/spiritual practices (28%), herbal remedies (7%), commercial diets (6%), and folk remedies (3%). Excluding solitary prayer, only 20% of respondents used CAM to treat diabetes. CONCLUSIONS The prevalence of CAM therapy use among persons with diabetes is comparable to that among the general population. Use of CAM therapies specifically to treat diabetes, however, is much less common.

Tai Chi Exercise in Patients With Chronic Heart Failure: A Randomized Clinical Trial

BACKGROUND Preliminary evidence suggests that meditative exercise may have benefits for patients with chronic systolic heart failure (HF); this has not been rigorously tested in a large clinical sample. We sought to investigate whether tai chi, as an adjunct to standard care, improves functional capacity and quality of life in patients with HF. METHODS A single-blind, multisite, parallel-group, randomized controlled trial evaluated 100 outpatients with systolic HF (New York Heart Association class I-III, left ventricular ejection fraction ≤40%) who were recruited between May 1, 2005, and September 30, 2008. A group-based 12-week tai chi exercise program (n = 50) or time-matched education (n = 50, control group) was conducted. Outcome measures included exercise capacity (6- minute walk test and peak oxygen uptake) and disease-specific quality of life (Minnesota Living With Heart Failure Questionnaire). RESULTS Mean (SD) age of patients was 67 (11) years; baseline values were left ventricular ejection fraction, 29% (8%) and peak oxygen uptake, 13.5 mL/kg/min; the median New York Heart Association class of HF was class II. At completion of the study, there were no significant differences in change in 6-minute walk distance and peak oxygen uptake (median change [first quartile, third quartile], 35 [-2, 51] vs 2 [-7, 54] meters, P = .95; and 1.1 [-1.1, 1.5] vs -0.5 [-1.2, 1.8] mL/kg/min, P = .81) when comparing tai chi and control groups; however, patients in the tai chi group had greater improvements in quality of life (Minnesota Living With Heart Failure Questionnaire, -19 [-23, -3] vs 1 [-16, 3], P = .02). Improvements with tai chi were also seen in exercise self-efficacy (Cardiac Exercise Self-efficacy Instrument, 0.1 [0.1, 0.6] vs -0.3 [-0.5, 0.2], P < .001) and mood (Profile of Mood States total mood disturbance, -6 [-17, 1] vs -1 [-13, 10], P = .01). CONCLUSION Tai chi exercise may improve quality of life, mood, and exercise self-efficacy in patients with HF. Trial Registration clinicaltrials.gov Identifier: NCT00110227.

Clinical Applications of Yoga for the Pediatric Population: A Systematic Review

OBJECTIVE The aim of this study was to evaluate the evidence for clinical applications of yoga among the pediatric population. METHODS We conducted an electronic literature search including CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Medline, PsycINFO, and manual search of retrieved articles from inception of each database until December 2008. Randomized controlled trials (RCTs) and nonrandomized controlled trials (NRCTs) were selected that included yoga or yoga-based interventions for individuals aged 0 to 21 years. Data were extracted and articles critically reviewed using a modified Jadad score and descriptive methodological criteria, with summarization in tables. RESULTS Thirty-four controlled studies published from 1979 to 2008 were identified, with 19 RCTS and 15 NRCTs. Many studies were of low methodological quality. Clinical areas for which yoga has been studied include physical fitness, cardiorespiratory effects, motor skills/strength, mental health and psychological disorders, behavior and development, irritable bowel syndrome, and birth outcomes following prenatal yoga. No adverse events were reported in trials reviewed. Although a large majority of studies were positive, methodological limitations such as randomization methods, withdrawal/dropouts, and details of yoga intervention preclude conclusive evidence. CONCLUSIONS There are limited data on the clinical applications of yoga among the pediatric population. Most published controlled trials were suggestive of benefit, but results are preliminary based on low quantity and quality of trials. Further research of yoga for children by using a higher standard of methodology and reporting is warranted.

Effect of Tai Chi on Cognitive Performance in Older Adults: Systematic Review and Meta‐Analysis

To summarize and critically evaluate research on the effects of Tai Chi on cognitive function in older adults.

Tai chi exercise for patients with cardiovascular conditions and risk factors: a systematic review

PURPOSE To conduct a systematic review of the literature evaluating tai chi exercise as an intervention for patients with cardiovascular disease (CVD) or with CVD risk factors (CVDRF). METHODS We searched (1) MEDLINE, CAB Alt HealthWatch, BIOSIS previews, Science Citation Index, EMBASE, and Social Science Citation Index from inception through October 2007; (2) Chinese Medical Database, China Hospital Knowledge, China National Knowledge Infrastructure, and China Traditional Chinese Medicine Database from inception through June 2005; and (3) the medical libraries of Beijing and Nanjing Universities. Clinical studies published in English and Chinese including participants with established CVD or CVDRF were included. Data were extracted in a standardized manner; 2 independent investigators assessed methodological quality, including the Jadad score for randomized controlled trials (RCTs). RESULTS Twenty-nine studies met inclusion criteria: 9 RCTs, 14 nonrandomized studies, and 6 observational trials. Three studies examined subjects with coronary heart disease, 5 in subjects with heart failure, and 10 in heterogeneous populations that included those with CVD. Eleven studies examined subjects with CVDRF (hypertension, dyslipidemia, impaired glucose metabolism). Study duration ranged from 8 weeks to 3 years. Most studies included fewer than 100 subjects (range, 5–207). Six of 9 RCTs were of adequate quality (Jadad ≥ 3). Most studies reported improvements with tai chi, including blood pressure reductions and increases in exercise capacity. No adverse effects were reported. CONCLUSION Preliminary evidence suggests that tai chi exercise may be a beneficial adjunctive therapy for some patients with CVD and CVDRF. Further research is needed.

Systematic Review of the Effects of Ginseng on Cardiovascular Risk Factors

Objective: To examine the evidence for the efficacy of ginseng (Panax spp.) on cardiovascular risk factors, including blood pressure, lipid profiles, and blood glucose, and to summarize reported cardiovascular adverse events. Data Sources: We searched MEDLINE, AMED, BIOSIS, CAB, EMBASE, and the Cochrane Controlled Trials databases through July 2005 and performed hand searches of bibliographies. Study Selection and Data Extraction: Short- or long-term, randomized, controlled trials and nonrandomized studies published in English were included. Data were extracted in a standardized manner, and 2 independent investigators assessed methodologic quality of the studies. Thirty-four studies were identified with results for blood pressure, lipids, and/or blood glucose. Due to heterogeneity of the studies, we were unable to perform a meta-analysis. Data on cardiovascular adverse events were extracted from events reported in identified studies and from case reports. Data Synthesis: The majority of studies were short term. Ginseng may slightly decrease blood pressure compared with placebo (range 0–4%). We found mixed results for an effect on lipids, with 5 of 9 studies showing improvement in one or more lipid parameters compared with baseline (range 7–44%). We identified several studies showing that ginseng lowers blood glucose, but overall studies were inconsistent. Conclusions: Current evidence does not support the use of ginseng to treat cardiovascular risk factors. Some studies suggest a small reduction in blood pressure. Despite some evidence showing that ginseng lowers blood glucose and improves lipid profiles, well-designed, randomized, controlled trials evaluating its effects are lacking.

Impact of Tai Chi exercise on multiple fracture-related risk factors in post-menopausal osteopenic women: a pilot pragmatic, randomized trial

BackgroundTai Chi (TC) is a mind-body exercise that shows potential as an effective and safe intervention for preventing fall-related fractures in the elderly. Few randomized trials have simultaneously evaluated TCs potential to reduce bone loss and improve fall-predictive balance parameters in osteopenic women.MethodsIn a pragmatic randomized trial, 86 post-menopausal osteopenic women, aged 45-70, were recruited from community clinics. Women were assigned to either nine months of TC training plus usual care (UC) vs. UC alone. Primary outcomes were changes between baseline and nine months of bone mineral density (BMD) of the proximal femur and lumbar spine (dual-energy X-ray absorptiometry) and serum markers of bone resorption and formation. Secondary outcomes included quality of life. In a subsample (n = 16), quiet standing fall-predictive sway parameters and clinical balance tests were also assessed. Both intent-to-treat and per-protocol analyses were employed.ResultsFor BMD, no intent-to-treat analyses were statistically significant; however, per protocol analyses (i.e., only including TC participants who completed ≥ 75% training requirements) of femoral neck BMD changes were significantly different between TC and UC (+0.04 vs. -0.98%; P = 0.05). Changes in bone formation markers and physical domains of quality of life were also more favorable in per protocol TC vs. UC (P = 0.05). Changes in sway parameters were significantly improved by TC vs. UC (average sway velocity, P = 0.027; anterior-posterior sway range, P = 0.014). Clinical measures of balance and function showed non-significant trends in favor of TC.ConclusionsTC training offered through existing community-based programs is a safe, feasible, and promising intervention for reducing multiple fracture risks. Our results affirm the value of a more definitive, longer-term trial of TC for osteopenic women, adequately powered to detect clinically relevant effects of TC on attenuation of BMD loss and reduction of fall risk in this population.Trial RegistrationClinicalTrials.gov: NCT01039012

The effectiveness of yoga in modifying risk factors for cardiovascular disease and metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials:

Background Yoga, a popular mind-body practice, may produce changes in cardiovascular disease (CVD) and metabolic syndrome risk factors. Design This was a systematic review and random-effects meta-analysis of randomized controlled trials (RCTs). Methods Electronic searches of MEDLINE, EMBASE, CINAHL, PsycINFO, and The Cochrane Central Register of Controlled Trials were performed for systematic reviews and RCTs through December 2013. Studies were included if they were English, peer-reviewed, focused on asana-based yoga in adults, and reported relevant outcomes. Two reviewers independently selected articles and assessed quality using Cochrane’s Risk of Bias tool. Results Out of 1404 records, 37 RCTs were included in the systematic review and 32 in the meta-analysis. Compared to non-exercise controls, yoga showed significant improvement for body mass index (−0.77 kg/m2 (95% confidence interval −1.09 to −0.44)), systolic blood pressure (−5.21 mmHg (−8.01 to −2.42)), low-density lipoprotein cholesterol (−12.14 mg/dl (−21.80 to −2.48)), and high-density lipoprotein cholesterol (3.20 mg/dl (1.86 to 4.54)). Significant changes were seen in body weight (−2.32 kg (−4.33 to −0.37)), diastolic blood pressure (−4.98 mmHg (−7.17 to −2.80)), total cholesterol (−18.48 mg/dl (−29.16 to −7.80)), triglycerides (−25.89 mg/dl (−36.19 to −15.60), and heart rate (−5.27 beats/min (−9.55 to −1.00)), but not fasting blood glucose (−5.91 mg/dl (−16.32 to 4.50)) nor glycosylated hemoglobin (−0.06% Hb (−0.24 to 0.11)). No significant difference was found between yoga and exercise. One study found an impact on smoking abstinence. Conclusions There is promising evidence of yoga on improving cardio-metabolic health. Findings are limited by small trial sample sizes, heterogeneity, and moderate quality of RCTs.

What do we really know about the safety of tai chi?: A systematic review of adverse event reports in randomized trials.

OBJECTIVE To systematically review the frequency and quality of adverse event (AE) reports in randomized controlled trials (RCTs) of tai chi (TC). DATA SOURCES Electronic searches of PubMed/MEDLINE and additional databases from inception through March 2013 of English-language RCTs. Search terms included tai chi, taiji, and tai chi chuan. Data were independently extracted by 2 investigators. STUDY SELECTION We included all available RCTs that were published in English and used TC as an intervention. Inclusion and exclusion criteria of studies were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA EXTRACTION Eligible RCTs were categorized with respect to AE reporting: no mention of protocol for monitoring AEs or reports of AEs, and reports of AEs either with or without explicit protocol for monitoring AEs. DATA SYNTHESIS There were 153 eligible RCTs identified; most targeted older adults. Only 50 eligible trials (33%) included reporting of AEs; of these, only 18 trials (12% overall) also reported an explicit AE monitoring protocol. Protocols varied with respect to the rigor of systematic monitoring in both the TC and comparison groups. Reported AEs were typically minor and expected and primarily musculoskeletal related (eg, knee and back pain); no intervention-related serious AEs were reported. CONCLUSIONS TC is unlikely to result in serious AEs, but it may be associated with minor musculoskeletal aches and pains. However, poor and inconsistent reporting of AEs greatly limits the conclusions that can be drawn regarding the safety of TC.

Complementary and alternative medicine use by US adults with gastrointestinal conditions: Results from the 2012 National Health Interview Survey.

OBJECTIVES:Use of complementary and alternative medicine (CAM) has increased over the past two decades, and a growing body of evidence suggests that some CAM modalities may be useful in addressing gastrointestinal (GI) conditions. However, the overall pattern of CAM use for GI conditions remains unknown. We sought to elucidate the prevalence and patterns of CAM use among US adults with GI conditions.METHODS:We used the 2012 National Health Interview Survey (n=34,525), a nationally representative survey of the civilian, noninstitutionalized US population, to estimate the prevalence of CAM use among adults with GI conditions (abdominal pain, acid reflux/heartburn, digestive allergy, liver condition, nausea and/or vomiting, stomach or intestinal illness, and ulcer). We also examined the reasons for CAM use, perceived helpfulness, and disclosure of use to health-care providers among individuals who specifically used CAM to address a GI condition. Prevalence estimates were weighted to reflect the complex sampling design of the survey.RESULTS:Of the 13,505 respondents with a GI condition in the past year, 42% (n=5629) used CAM in the past year and 3% (n=407) used at least one CAM modality to address a GI condition. The top three modalities among those using CAM to address GI conditions were herbs and supplements, mind body therapies, and manipulative therapies. Of those using CAM to address a GI condition, 47% used three or more CAM therapies, and over 80% felt that it was helpful in addressing a GI condition and was important in maintaining health and well-being. Respondents told their health-care providers about use of these therapies 70% of the time.CONCLUSIONS:CAM was used by 42% of respondents with a GI condition in the past year. A small proportion use CAM specifically to address their GI condition, but the majority who do find it helpful. The most commonly used modalities in this group are herbs and supplements, and mind body and manipulative therapies.