Randomized controlled trial of mindfulness meditation and exercise for the prevention of acute respiratory infection: possible mechanisms of action

Abstract

Background. A randomized trial suggests that meditation and exercise may prevent acute respiratory infection (ARI). This paper explores potential mediating mechanisms. Methods. Community-recruited adults were randomly assigned to three nonblinded arms: 8-week mindfulness-based stress reduction (N = 51), moderate-intensity exercise (N = 51), or wait-list control (N = 52). Primary outcomes were ARI illness burden (validated Wisconsin Upper Respiratory Symptom Survey). Potential mediators included self-reported psychophysical health and exercise intensity (baseline, 9 weeks, and 3 months). A Baron and Kenny approach-based mediational analysis model, adjusted for group status, age, and gender, evaluated the relationship between the primary outcome and a potential mediator using zero-inflated modeling and Sobel testing. Results. Of 154 randomized, 149 completed the trial (51, 47, and 51 in meditation, exercise, and control groups) and were analyzed (82% female, 94% Caucasian, 59.3 ± SD 6.6 years old). Mediational analyses suggested that improved mindfulness (Mindful Attention Awareness Scale) at 3 months may mediate intervention effects on ARI severity and duration (P < 0.05); 1 point increase in the mindfulness score corresponded to a shortened ARI duration by 7.2-9.6 hours. Conclusions. Meditation and exercise may decrease the ARI illness burden through increased mindfulness. These preliminary findings need confirmation, if confirmed, they would have important policy and clinical implications. This trial registration was Clinicaltrials.gov: NCT01057771.

Figures

Figure 1

Participant Flow Diagram.

Figure 2

Mediational analysis models: the relationship between the “dependent variable” (primary outcomes: acute respiratory infection (ARI) severity and duration), “independent variables” (group status) and possible “mediators” (health indicators); separate models were created for each health indicator. Stage 1 models illustrate single-mediation, while Stage 2 models illustrate compound-mediation (change in the mindfulness score as Mediator 1, and change in the health indicator score as Mediator 2). Abbreviations/Explanations: AUC: area under the curve global ARI severity; “Mediator” is a proposed mediating variable; D1 refers to the “mediator” score change at 9 week, and D2 to the “mediator” score change at 3 month followup; γ1 pathways represent a direct relationship between group status and the primary outcome; γ2 through γ5 pathways represent relationships between group status and the potential mediator; β1 pathways represent relationships between the potential mediator and the primary outcome; and β2 and β3 pathways represent relationships between the two potential mediators.