Mindfulness-based interventions in multiple sclerosis: beneficial effects of Tai Chi on balance, coordination, fatigue and depression

Janina M Burschka, Philipp M Keune, Ulrich Hofstadt-van Oy, Patrick Oschmann, Peter Kuhn, Janina M Burschka, Philipp M Keune, Ulrich Hofstadt-van Oy, Patrick Oschmann, Peter Kuhn

Abstract

Background: Patients suffering from Multiple Sclerosis (MS) experience a wide array of symptoms, including balance problems, mobility impairment, fatigue and depression. Physical exercise has recently been acknowledged as a treatment option complementary to medication. However, information regarding putative effects of structured exercise programs on neurological symptoms is sparse. Tai Chi, a Chinese martial art incorporating physical exercise and mindfulness training, has been shown to yield health benefits in various neurological groups. It seems particularly suitable for patients with motoric deficits as it challenges coordination and balance. The purpose of the current study was to explore the therapeutic value of structured Tai Chi training for coordination, balance, fatigue and depression in mildly disabled MS patients.

Methods: A sample of 32 MS patients (Expanded Disability Status Scale, EDSS < 5) was examined. A structured Tai Chi course was devised and a Tai Chi group participated in two weekly sessions of 90 minutes duration for six months, while a comparison group received treatment as usual (TAU). Both groups were examined prior to and following the six-months interval with regards to balance and coordination performance as well as measures of fatigue, depression and life satisfaction.

Results: Following the intervention, the Tai Chi group showed significant, consistent improvements in balance, coordination, and depression, relative to the TAU group (range of effect-sizes: partial η2 = 0.16 - 0.20). Additionally, life satisfaction improved (partial η2 = 0.31). Fatigue deteriorated in the comparison group, whereas it remained relatively stable in the Tai Chi group (partial η2 = 0.24).

Conclusions: The consistent pattern of results confirms that Tai Chi holds therapeutic potential for MS patients. Further research is needed to determine underlying working mechanisms, and to verify the results in a larger sample and different MS subgroups.

Figures

Figure 1
Figure 1
Conceptual outline of the two-component model of mindfulness,adapted from Bishop et al. (2004) and its relevance for Tai Chi practice.
Figure 2
Figure 2
Mean scores on outcome parameters compared between the Tai Chi and the TAU group. Error bars represent standard errors. See Methods section for a detailed description and references of each test.

References

    1. Murray TJ. Diagnosis and treatment of multiple sclerosis. BMJ. 2006;332:525–527. doi: 10.1136/bmj.332.7540.525.
    1. Compston A, McAlpine D. McAlpine's multiple sclerosis. 4. Aufl. Churchill Livingstone Elsevier, London; 2006.
    1. Compston A, Coles A. Multiple sclerosis. Lancet. 2008;372:1502–1517. doi: 10.1016/S0140-6736(08)61620-7.
    1. Döring A, Pfueller CF, Paul F, Dörr J. Exercise in multiple sclerosis – an integral component of disease management. EPMA J. 2012;3:1–13. doi: 10.1007/s13167-011-0136-4.
    1. Latimer-Cheung AE, Martin Ginis KA, Hicks AL, Motl RW, Pilutti LA, Duggan M, Wheeler G, Persad R, Smith KM. Development of Evidence-Informed Physical Activity Guidelines for Adults With Multiple Sclerosis. Arch Phys Med Rehabil. 2013;94:1829–1836.e7. doi: 10.1016/j.apmr.2013.05.015.
    1. McAlpine D. Multiple sclerosis: a plea for a fresh outlook. Br Med J. 1957;1:475–480. doi: 10.1136/bmj.1.5017.475.
    1. Rietberg MB, Brooks D, Uitdehaag BMJ, Kwakkel G: Exercise therapy for multiple sclerosis.Cochrane Db Syst Rev 2004, (3): Art. No.: CD003980.
    1. Snook EM, Motl RW. Effect of exercise training on walking mobility in multiple sclerosis: a meta-analysis. Neurorehab Neural Re. 2008;23:108–116. doi: 10.1177/1545968308320641.
    1. Latimer-Cheung AE, Pilutti LA, Hicks AL, Martin Ginis KA, Fenuta AM, MacKibbon KA, Motl RW. Effects of exercise training on fitness, mobility, fatigue, and health-related quality of life among adults with multiple sclerosis: a systematic review to inform guideline development. Arch Phys Med Rehabil. 2013;94:1800–1828.e3. doi: 10.1016/j.apmr.2013.04.020.
    1. Sá MJ: Exercise therapy and multiple sclerosis: a systematic review.J Neurol 2013, Epub ahead of print 2013 Nov 22 doi:10.1007/s00415-013-7183-9.
    1. Dalgas U, Stenager E. Exercise and disease progression in multiple sclerosis: can exercise slow down the progression of multiple sclerosis? Ther Adv Neurol Disord. 2012;5:81–95. doi: 10.1177/1756285611430719.
    1. Mayo NE, Bayley M, Duquette P, Lapierre Y, Anderson R, Bartlett S. The role of exercise in modifying outcomes for people with multiple sclerosis: a randomized trial. BMC Neurol. 2013;13:1–11. doi: 10.1186/1471-2377-13-69.
    1. Knaepen K, Goekint M, Heyman EM, Meeusen R. Neuroplasticity – exercise-induced response of peripheral brain-derived neurotrophic factor. Sports Med. 2010;40:765–801. doi: 10.2165/11534530-000000000-00000.
    1. Ellis T, Motl RW. Physical activity behavior change in persons with neurologic disorders. J Neurol Phys Ther. 2013;37:85–90. doi: 10.1097/NPT.0b013e31829157c0.
    1. Motl RW, McAuley E, Wynn D, Vollmer T. Lifestyle physical activity and walking impairment over time in relapsing-remitting multiple sclerosis. Am J Phys Med Rehabil. 2011;90:372–379. doi: 10.1097/PHM.0b013e31820f95e1.
    1. Simpson R, Booth J, Lawrence M, Byrne S, Mair F, Mercer S. Mindfulness based interventions in multiple sclerosis - a systematic review. BMC Neurol. 2014;14:15. doi: 10.1186/1471-2377-14-15.
    1. Nhất H, Ho M, Vo DM. The miracle of mindfulness: An introduction to the practice of meditation. Beacon Press, Boston; 1999.
    1. Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84:822–848. doi: 10.1037/0022-3514.84.4.822.
    1. Brown KW, Ryan RM, Creswell JD. Addressing fundamental questions about mindfulness. Psychol Inq. 2007;18:272–281. doi: 10.1080/10478400701703344.
    1. Rosenzweig S, Greeson JM, Reibel DK, Green JS, Jasser SA, Beasley D. Mindfulness-based stress reduction for chronic pain conditions: Variation in treatment outcomes and role of home meditation practice. J Psychosom Res. 2010;68:29–36. doi: 10.1016/j.jpsychores.2009.03.010.
    1. Grossman P, Tiefenthaler-Gilmer U, Raysz A, Kesper U. Mindfulness training as an intervention for fibromyalgia: evidence of postintervention and 3-year follow-up benefits in well-being. Psychother Psychosom. 2007;76:226–233. doi: 10.1159/000101501.
    1. Kabat-Zinn J, Wheeler E, Light T, Skillings A, Scharf MJ, Cropley TG, Hosmer D, Bernhard JD. Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA) Psychosom Med. 1998;60:625–632. doi: 10.1097/00006842-199809000-00020.
    1. Segal ZV, Williams JM, Teasdale JD. A new approach to preventing relapse. Guilford Press, New York; 2002. Mindfulness-based cognitive therapy for depression.
    1. Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol. 2010;78:169–183. doi: 10.1037/a0018555.
    1. Keune PM, Bostanov V, Kotchoubey B, Hautzinger M. Mindfulness versus rumination and behavioral inhibition: A perspective from research on frontal brain asymmetry. Pers Individ Differ. 2012;53:323–328. doi: 10.1016/j.paid.2012.03.034.
    1. Keune PM, Forintos P. Mindfulness meditation: a preliminary study on meditation practice during everyday life activities and its association with well-being. Psychol Top. 2010;19:373–386.
    1. Keune PM, Bostanov V, Hautzinger M, Kotchoubey B. Mindfulness-based cognitive therapy (MBCT), cognitive style, and the temporal dynamics of frontal EEG alpha asymmetry in recurrently depressed patients. Biol Psychol. 2011;88:243–252. doi: 10.1016/j.biopsycho.2011.08.008.
    1. Davidson RJ, Kabat-Zinn J, Schumacher J, Rosenkranz M, Muller D, Santorelli SF, Urbanowski F, Harrington A, Bonus K, Sheridan JF. Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med. 2003;65:564–570. doi: 10.1097/01.PSY.0000077505.67574.E3.
    1. Keune PM, Bostanov V, Hautzinger M, Kotchoubey B. Approaching dysphoric mood: state-effects of mindfulness meditation on frontal brain asymmetry. Biol Psychol. 2013;93:105–113. doi: 10.1016/j.biopsycho.2013.01.016.
    1. Bishop SR, Lau M, Shapiro S, Carlson L, Anderson ND, Carmody J, Segal ZV, Abbey S, Speca M, Velting D, Devins G. Mindfulness: a proposed operational definition. Clin Psychol: Sci Pract. 2004;11:230–241.
    1. Bostanov V, Keune PM, Kotchoubey B, Hautzinger M. Event-related brain potentials reflect increased concentration ability after mindfulness-based cognitive therapy for depression: a randomized clinical trial. Psychiatry Res. 2012;199:174–180. doi: 10.1016/j.psychres.2012.05.031.
    1. Grossman P, Kappos L, Gensicke H, D'Souza M, Mohr DC, Penner IK, Steiner C. MS quality of life, depression, and fatigue improve after mindfulness training: a randomized trial. Neurology. 2010;75:1141–1149. doi: 10.1212/WNL.0b013e3181f4d80d.
    1. Wayne PM, Kaptchuk TJ. Challenges inherent to t'ai chi research: part I–t'ai chi as a complex multicomponent intervention. J Altern Complement Med. 2008;14:95–102. doi: 10.1089/acm.2007.7170A.
    1. Burschka J, Kuhn P, Menge U, Oschmann P. Research on Tai Chi as a sport in health care. Sportwiss. 2013;43:181–196. doi: 10.1007/s12662-013-0300-1.
    1. Li F, Harmer P, Fitzgerald K, Eckstrom E, Stock R, Galver J, Maddalozzo G, Batya SS. Tai chi and postural stability in patients with Parkinson's disease. N. Engl. J. Med. 2012;366:511–519. doi: 10.1056/NEJMoa1107911.
    1. Wang C, Schmid C, Rones R, Kalish R, Yinh J, Goldenberg D, Lee Y, McAlindon T. A randomized trial of tai chi for fibromyalgia. N Engl J Med. 2010;363:743–754. doi: 10.1056/NEJMoa0912611.
    1. Au-Yeung SSY, Hui-Chan CWY, Tang JCS. Short-form Tai Chi improves standing balance of people with chronic stroke. Neurorehabil Neural Repair. 2009;23:515–522. doi: 10.1177/1545968308326425.
    1. Li L, Manor B. Long term Tai Chi exercise improves physical performance among people with peripheral neuropathy. Am. J. Chin. Med. 2010;38:449–459. doi: 10.1142/S0192415X1000797X.
    1. Husted C, Pham L, Hekking A, Niederman R. Improving quality of life for people with chronic conditions: the example of t'ai chi and multiple sclerosis. Altern Ther Health Med. 1999;5:70–74.
    1. Mills N, Allen J. Mindfulness of movement as a coping strategy in multiple sclerosis. A pilot study. Gen Hosp Psychiatry. 2000;22:425–431. doi: 10.1016/S0163-8343(00)00100-6.
    1. Mills N, Allen J, Carey-Morgan S. Does Tai Chi/Qi Gong help patients with Multiple Sclerosis? J Bodyw Mov Ther. 2000;4:39–48. doi: 10.1054/jbmt.1999.0139.
    1. Tavee J, Rensel M, Planchon SM, Butler RS, Stone L. Effects of meditation on pain and quality of life in multiple sclerosis and peripheral neuropathy. Int J MS Care. 2011;13:163–168. doi: 10.7224/1537-2073-13.4.163.
    1. Wayne PM, Kaptchuk TJ. Challenges inherent to t'ai chi research: part II-defining the intervention and optimal study design. J Altern Complement Med. 2008;14:191–197. doi: 10.1089/acm.2007.7170B.
    1. Allen M, Dietz M, Blair KS, Van Beek M, Rees G, Vestergaard-Poulsen P, Lutz A, Roepstorff A. Cognitive-affective neural plasticity following active-controlled mindfulness intervention. J. 2012;32:15601–15610. doi: 10.1523/JNEUROSCI.2957-12.2012.
    1. Bös K, Wydra G, Karisch G. Ziele und Methoden des Gesundheitssports in der Klinik. perimed-Fachbuch-Verl.-Ges. (Beiträge zur Sportmedizin, Bd. 38), Erlangen; 1992. Gesundheitsförderung durch Bewegung, Spiel und Sport.
    1. Hautzinger M, Bailer M. ADS - Allgemeine Depressionsskala. Beltz (Beltz Test), Göttingen; 2003.
    1. Penner IK, Raselli C, Stöcklin M, Opwis K, Kappos L, Calabrese P. The Fatigue Scale for Motor and Cognitive Functions (FSMC): validation of a new instrument to assess multiple sclerosis-related fatigue. Mult. 2009;15:1509–1517. doi: 10.1177/1352458509348519.
    1. Fahrenberg J. Fragebogen zur Lebenszufriedenheit: (FLZ); Handanweisung. Hogrefe, Verl. für Psychologie, Göttingen, Bern, Toronto, Seattle; 2000.
    1. Robert C, MartinTai Chi 10 Form. Tai Chi 10 Form, with English Titles. 2008. Available online: , [accessed on 01.07.2014]
    1. Ian S. Tai Chi 10 Form. Complete Routine with narration. 2013. Available online: , [accessed on 01.07.2014]
    1. Keune PM, Wiedemann E, Schneidt A, Schönenberg M: Frontal brain asymmetry in adult attention-deficit/hyperactivity disorder (ADHD) with extending the motivational dysfunction hypothesis.Clin Neurophysiol 2014, Epub ahead of print 2014 Jul 18 doi: 10.1016/j.clinph.2014.07.008.
    1. Hofstadt-van Oy U, Keune P, Muenssinger J, Hagenburger D, Oschmann P: Normative data and long-term test-retest reliability of the triple stimulation technique (TST) in multiple sclerosis.Clin Neurophysiol 2014, Epub ahead of print 2014 Jun 21 doi: 10.1016/j.clinph.2014.05.032.
    1. McCracken LM, Gauntlett-Gilbert J, Vowles KE. The role of mindfulness in a contextual cognitive-behavioral analysis of chronic pain-related suffering and disability. Pain. 2007;131:63–69. doi: 10.1016/j.pain.2006.12.013.
    1. Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits. A meta-analysis. J Psychosom Res. 2004;57:35–43. doi: 10.1016/S0022-3999(03)00573-7.
    1. Pilutti LA, Greenlee TA, Motl RW, Nickrent MS, Petruzzello SJ. Effects of exercise training on fatigue in multiple sclerosis: a meta-analysis. Psychosom Med. 2013;75:575–580. doi: 10.1097/PSY.0b013e31829b4525.
    1. Sandoval AE. Exercise in multiple sclerosis. Phys Med Rehabil Clin N Am. 2013;24:605–618. doi: 10.1016/j.pmr.2013.06.010.
    1. Meyer-Moock S, Feng Y, Maeurer M, Dippel F, Kohlmann T. Systematic literature review and validity evaluation of the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Functional Composite (MSFC) in patients with multiple sclerosis. BMC Neurol. 2014;14:58. doi: 10.1186/1471-2377-14-58.
    1. Farb NAS, Segal ZV, Anderson AK. Mindfulness meditation training alters cortical representations of interoceptive attention. Soc Cogn Affect Neurosci. 2013;8:15–26. doi: 10.1093/scan/nss066.
    1. Streeter C, Gerbarg P, Saper R, Ciraulo D, Brown R. Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Med Hypotheses. 2012;78:571–579. doi: 10.1016/j.mehy.2012.01.021.
    1. Lovera J, Reza T. Stress in multiple sclerosis: review of new developments and future directions. Curr Neurol Neurosci Rep. 2013;13:398. doi: 10.1007/s11910-013-0398-4.

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