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Mindful exercise and mental health

By Helen Lavretsky, MD, MS

There is currently extensive use of complementary and alternative medicine (CAM) — also known as integrative or mind-body medicine — in the United States to sustain well-being in both aging baby boomers and in children and adolescents. The National Center for Complementary and Alternative Medicine (NCCAM) defines CAM therapies as “a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine,” with “conventional” medicine being defined as the approaches used by clinicians in the routine daily practice of Western or allopathic medicine that are within the currently accepted standard of care.

The most recent comprehensive assessment of CAM use in the United States found that roughly 40% of US adults had used at least one CAM therapy within the past year. In addition, Americans make more visits to CAM providers each year than to primary care physicians and spend at least as much money on out-of-pocket expenses for CAM services as they do for all conventional physician services combined. Patients with mental disorders turn to CAM for relief of symptoms of anxiety, mood, insomnia, impaired cognition, and perceived stress. The most commonly used CAM techniques include prayer for health and the use of multivitamin supplementation. Given widespread use of CAM services among patients, there is an urgent need for greater awareness and familiarity with its applications and outcomes.

As baby boomers age and increase use of CAM, mental health professionals require a working knowledge of CAM techniques intended to address late life mood disorders. An estimated 33-88% of older adults will use CAM therapies, including those with late-life depression and bipolar disorder. CAM treatments of mood and anxiety disorders include acupuncture, deep breathing exercises, massage therapy, meditation, naturopathy, and yoga.

Complementary and alternative medicine encompasses a number of techniques collectively known as mindful exercise (e.g. yoga, Qigong, and Tai Chi), or meditation. This ‘physical exercise executed with a profound inwardly directed contemplative focus’ is increasingly utilized for improving psychological well-being. In general, mindful physical exercise contains the following key elements:

  1. a non-competitive, non-judgmental meditative component,
  2. mental focus on muscular movement and movement awareness combined with a low to moderate level of muscular activity,
  3. centered breathing,
  4. a focus on anatomic alignment (i.e., spine, trunk, and pelvis) and proper physical form,
  5. energy centric awareness of individual flow of intrinsic body energy, otherwise known as prana, life force, qi, or Kundalini.

Mindful exercise has been shown to provide an immediate source of relaxation and mental quiescence. Scientific evidence has shown that medical conditions such as hypertension, cardiovascular disease, insulin resistance, depression, and anxiety disorders respond favorably to mindful exercises.

There is a growing database of the physiological effects of mindful exercise and meditation. Tai Chi and Qi Gong have been shown to promote relaxation and decrease sympathetic output, and to benefit anxiety, depression, blood pressure, and recovery from immune-mediated diseases. Tai Chi and Qi Gong have been shown to improve immune function and vaccine-response. These practices have also been shown to increase blood levels of endorphins and baroreflex sensitivity, and to reduce levels of inflammatory markers (CRP), adrenocorticotrophic hormone (ACTH), and cortisol, implicating the hypothalamic-pituitary-adrenal (HPA) axis as a mediator of stress and anxiety reduction. Brain wave or electroencephalopathy (EEG) studies of participants undergoing Tai Chi and Qi Gong exercise have found increased frontal EEG alpha, beta, and theta wave activity, suggesting increased relaxation and attentiveness. These changes have not been found in aerobic exercise controls.

Yogic meditation (Kirtan Kriya) for stressed family dementia caregivers resulted in lower levels of depressive symptoms, and improvements in mental health and cognitive functioning. Participants in the yogic meditation group showed a 43% improvement in telomerase activity after 12 minutes of daily practice for 8 weeks, compared with 3.7% in relaxation music control participants. This suggests that brief daily meditation practices can benefit stress-induced cellular aging. Kirtan Kriya reversed the pattern of increased NF-κB-related transcription of pro-inflammatory cytokines, and decreased IRF1-related transcription of innate antiviral response genes in distressed dementia caregivers. This reinforces the relationship between stress reduction and beneficial immune response. In the same study, nine caregivers received brain FDG-PET scans at baseline and post-intervention. When comparing the regional cerebral metabolism between groups, significant differences over time were found in different patterns of regional cerebral metabolism suggesting brain-fitness effect different from passive relaxation.

Studies of meditation also report decreased sympathetic nervous activity and increased parasympathetic activity associated with decreased heart rate and blood pressure, decreased respiratory rate, and decreased oxygen metabolism. Functional neuroimaging studies have been able to corroborate these subjective experiences by demonstrating the up-regulation in brain regions of internalized attention and emotion processing with meditation.

In a recent systematic review of neurobiological and clinical features of mindfulness meditations, Chiesa and Serretti (2010) provided evidence on the neurobiological changes related to Mindfulness Meditation (MM) practice in psychiatric disorders. Meditation practices that focus on concentration of an object or mantra seem to elicit the activation of fronto-parietal networks of internalized attention; meditation techniques that focus on breathing may elicit additional activation of paralimbic regions of insula and anterior cingulate; and meditation techniques that focus on emotion may elicit fronto-limbic activation. Future studies will be needed to disentangle the brain activation patterns related to different meditation traditions.

Given the noninvasive nature of mindful exercise and meditation, these exercises are an appropriate option for consumers and clinicians, particularly for conditions that have been examined in controlled studies. Significant evidence supports the assertion that Tai Chi and Qi Gong and yoga and meditation can improve physical and mental health, and quality of life. Ethical considerations should be taken into account when practicing or recommending spiritual interventions by healthcare professionals to respect patients’ beliefs in choosing mind-body interventions.

Dr. Helen Lavretsky is a Professor of Psychiatry at the Semel Institute for Neuroscience and Human Behavior at UCLA, a geriatric psychiatrist with the research interest in geriatric depression and caregiver stress, as well as complementary and alternative medicine and mind-body approaches to treatment and prevention of disorders in older adults. She is co-editor of Late-Life Mood Disorders with Martha Sajatovic and Charles Reynolds. She is a recipient of the two Career Development awards from NIMH and other prestigious research awards. Her current research include clinical and translational studies of geriatric depression and caregiver stress, as well as complementary and alternative interventions for stress reduction in older adults.

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Recent Comments

  1. Moti Lal Dhiman

    I read ” Dose exercise really boost your mood”. The article is well explained. It may be noted that all the activities are controlled by/through the brain. When any function of the body does not work properly, the brain gets tensed which results in spoiling the mood. All the suitable exercises help improvement of body functions and so making the brain feel easy. Resultantly, the brain waves tend to stay in Alpha state which is the best state of brain. States of Mind also depend upon states of brain waves which are directly related i. e. slower the brain waves happier the mind. Therefore optimum level of exercises certainly boost our mood.
    As regards mindful exercises, it may be understood that while doing mindful exercises, the brain has to direct energy towards those parts of the body which are used in the related related exercise.This action works two ways;

    1. The parts so receiving the energy get relaxed as the energy is the ultimate product of all the foods and it is free from all the impurities which has best power of curing.

    2. When the brain diverts energy from it, it gets relieved from excessive load of the same and therefore its waves get calmed down. So the brain becomes able to regulate the body functions easily and therefore one feels happy.

    The same principle works in many methods of meditation.

  2. Luca Samson

    Very comprehensive post!

    This is some really great scientific and statistical information! I may have to use some on my blog :)

    Anyway, great scientific info that is really useful for proving the scientific basis of meditation.

    Cheers, Luca Samson

  3. […] Dr. Dilip Jeste, defined mindful exercise as “physical exercise executed with a profound inwardly directed contemplative focus.” Mindful exercise combines the core principles mindfulness with mild to moderate physical exercise. Helen Lavretsky expanded this definition stating that mindful exercise consists of five elements: […]

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