Global population is aging rapidly. Over the next four decades the number of individuals aged 60 years and older will nearly triple to more than 2 billion in 2050 (UN, 2013). With the aging of the population, the burden and cost of chronic disease will escalate worldwide. In order to ensure healthy and successful aging and reduce the cost of care for this huge increase, building resilience and wellbeing among the aging becomes a top priority for individuals, families, and society at large. Complementary and integrative medicine (CIM) is well positioned to offer interventions leading to prevention of major mental and physical diseases of aging and improve the quality of life for aging individuals and their families.
CIM therapies are defined by the National Center for Complementary and Integrative Health (NCCIH) as “a group of diverse medical and health care systems, practices, and products that are not generally considered a part of conventional medicine” (NCCIH-NIH, 2015). The most recent comprehensive assessment of CIM use in the United States found that roughly 40% of US adults had used at least one CIM therapy within the past year (2007), spending billions of dollars out-of-pocket on these therapies. The use of CIM for treatment of mood and anxiety disorders includes acupuncture, deep breathing exercises, massage therapy, meditation, naturopathy, and yoga. The most commonly used CIM health techniques in general population include prayer for health and the use of multivitamin supplementation. Given widespread use of integrative or mind-body medicine among our patients, there is an urgent need for greater awareness of the applications and outcomes of the commonly used mind-body interventions.
Mind-body medicine encompasses a number of techniques collectively known as mindful exercise (e.g. yoga, Qigong and Tai Chi), or meditation. Mindful physical exercise has become an increasingly utilized approach for improving psychological well-being and is defined as “physical exercise executed with a profound inwardly directed contemplative focus.” 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 life force, prana, Chi, or Kundalini. The 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 the 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. Both 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.
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. In our recently published study of Kundalini yoga compared to memory training in older adults with subjective memory complaints, we found that the yoga group demonstrated a significant improvement in depression and visuospatial memory compared to the memory training group. Both interventions improved verbal memory performance. Improved verbal memory performance was associated with increased connectivity between the language processing brain network. These findings point at the potential of using yoga to offset and delay cognitive decline, improve mood and coping with stress, and enhance brain plasticity.
Given the noninvasive nature of mindful exercise and meditation, recommending these exercises to all those interested in stress reduction and to patients with mental disorders generally seems an appropriate option for consumers and clinicians, particularly for conditions that have been studied in controlled studies. Some of these preventive techniques will include stress reduction that will enhance resilience to stress, and can improve cognition. Many of these techniques can be learned outside of the medical system and include exercise, lifestyle changes, mindfulness and mindful exercise, and the use of any joyful activities that can enhance the quality of life of older adults and their families. 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.
Featured image credit: Group of people practicing yoga, by Eli Christman. CC BY-2.0 via Wikimedia Commons.