Shingles Immunity and Health Functioning in the Elderly: Tai Chi Chih as a Behavioral Treatment

Michael Irwin, Jennifer Pike, Michael Oxman, Michael Irwin, Jennifer Pike, Michael Oxman

Abstract

Both the incidence and severity of herpes zoster (HZ) or shingles increase markedly with increasing age in association with a decline in varicella zoster virus (VZV)-specific immunity. Considerable evidence shows that behavioral stressors, prevalent in older adults, correlate with impairments of cellular immunity. Moreover, the presence of depressive symptoms in older adults is associated with declines in VZV-responder cell frequency (VZV-RCF), an immunological marker of shingles risk. In this review, we discuss recent findings that administration of a relaxation response-based intervention, tai chi chih (TCC), results in improvements in health functioning and immunity to VZV in older adults as compared with a control group. TCC is a slow moving meditation consisting of 20 separate standardized movements which can be readily used in elderly and medically compromised individuals. TCC offers standardized training and practice schedules, lending an important advantage over prior relaxation response-based therapies. Focus on older adults at increased risk for HZ and assay of VZV-specific immunity have implications for understanding the impact of behavioral factors and a behavioral intervention on a clinically relevant end-point and on the response of the immune system to infectious pathogens.

Figures

Figure 1
Figure 1
Varicella zoster virus specific cellular immunity and age. The relationship between human age, level of lymphocyte proliferative response to varicella zoster virus antigen and phytohemagglutinin (PHA), and delayed-type hypersensitivity response to varicella zoster virus antigen skin challenge. There is a marked attenuation of varicella zoster-specific cellular immunity in persons over the age of 60 years. Reprinted from Burke et al. (13).
Figure 2
Figure 2
Pathogenesis of herpes zoster. Reprinted with permission from Oxman (111).
Figure 3
Figure 3
Relationship between depression, life stress, sleep and the autonomic, neuroendocrine and immune systems. The evidence for the relationship between life stress and depression and varicella zoster-specific immunity and herpes zoster risk is the subject of this review. Possible mechanisms for these effects including alterations in behavioral responses such as disordered sleep or abnormal activation of the sympathetic nervous system are also considered.
Figure 4
Figure 4
VZV-specific CMI (VZV-RCF) at baseline and at 1 week post-intervention in the intent-to-treat sample. VZV-RCF increased from baseline to 1 week post-intervention in the TCC group [F(1,31) = 4.4, P < 0.05] but not in the control group. Data are mean ± SEM values. Reprinted with permission from Irwin et al. (70).
Figure 5
Figure 5
SF-36 scale score role-physical at baseline, during the itnervention at weeks 5, 10 and 15, and 1 week post-intervention in the completer sample, TCC (n = 14) and control group (n = 17). SF-36 role-physical scores were higher in the TCC group compared with controls [F(1,2) = 5.1] at post-intervention. Data are mean = SEM scores. Reprinted with permission from Irwin et al. (70).
Figure 6
Figure 6
Hypothesized mediators of the effects of tai chi chih on varicella zoster virus memory T-cell responses. The evidence for the pathway components of exercise and relaxation or meditation with changes of sympathovagal balance are considered.

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