Effectiveness of a Novel Qigong Meditative Movement Practice for Impaired Health in Flight Attendants Exposed to Second-Hand Cigarette Smoke

Abstract

This single-arm non-randomized pilot study explores an intervention to improve the health of flight attendants (FA) exposed to second-hand cigarette smoke prior to the smoking ban on commercial airlines. This group exhibits an unusual pattern of long-term pulmonary dysfunction. We report on Phase I of a two-phase clinical trial; the second Phase will be a randomized controlled trial testing digital delivery of the intervention. Subjects were recruited in the Northeastern US; testing and intervention were administered in 4 major cities. The intervention involved 12 h of training in Meditative Movement practices. Based on recent research on the effects of nicotine on fear learning, and the influence of the autonomic nervous system on immune function, our hypothesis was that this training would improve autonomic function and thus benefit a range of health measures. Primary outcomes were the 6-min walk test and blood levels of C-reactive protein. Pulmonary, cardiovascular, autonomic, and affective measures were also taken. Fourteen participants completed the training and post-testing. There was a 53% decrease in high sensitivity C-Reactive Protein (p ≤ 0.05), a 7% reduction in systolic blood pressure (p ≤ 0.05), a 13% increase in the 6-min walk test (p ≤ 0.005), and significant positive changes in several other outcomes. These results tend to confirm the hypothesized benefits of MM training for this population, and indicate that autonomic function may be important in the etiology and treatment of their symptoms. No adverse effects were reported. This trial is registered at ClinicalTrials.gov (https://ichgcp.net/clinical-trials-registry/NCT02612389), and is supported by a grant from the Flight Attendant Medical Research Institute (FAMRI).

Keywords: Qigong; autonomic nervous system; flight attendants; nicotine and fear learning; resilience; second-hand cigarette smoke; somatics; stress in first responders.

Figures

Figure 1

Timeline Chart. Timeline structure of study.

Figure 2

Example of intervention practice. One of the authors (PP) demonstrates sitting in balanced alignment, one of the practices taught in the MM intervention.

Figure 3

Participant flow diagram. 47 potential participants were approached, 26 were recruited. 10 discontinued the study and 2 were disqualified. 14 completed the study.

Figure 4

Thirteen Percent Increase in 6MWT Distance. Increased distance walked in the 6MWT in meters, from prior to the intervention to after the 4-month Qigong training. Average distance walked increased by 67 m (13%). Significant at a p ≤ 0.01 level using Students t-test. There was no correlation between improvement in distance walked and pre-intervention scores.

Figure 5

Fifty-three Percent Drop in Blood hs-CRP Levels. Decreases in blood levels of hs-CRP, from prior to the intervention to after the 4-month MM training. There was a 53% decrease in average hs-CRP levels (p ≤ 0.05 using Students t-test), with 10 out of 14 decreasing and 2 remaining at sub-clinical levels. Dashed red line marks the 3 mg/l clinical threshold.

Figure 6

Seven Percent Decrease in Resting Systolic Blood Pressure. Decrease in resting systolic blood pressure from prior to the intervention to after the 4-month MM training. There was a 7% decrease after the intervention (p ≤ 0.05 using Students t-test). 11 out of 14 participants showed reduced systolic blood pressure, and the number of participants above the clinical level declined from 4 to 1. 140 mmHg is regarded as the level above which hypertension occurs, and is indicated by the red dashed line.