Mind Body Medicine
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XXIII Relaxation

Effect of relaxation therapy on cardiac events after myocardial infarction: a 5-year follow-up study.
Authors van Dixhoorn JJ. Duivenvoorden HJ.
Institution Kennemer Hospital, Haarlem, The Netherlands.
Source Journal of Cardiopulmonary Rehabilitation. 19(3):178-85, 1999 May-Jun.
Abstract BACKGROUND: Evidence suggests that breathing and relaxation therapy may influence cardiac events in persons after acute myocardial infarction (MI). The authors studied the effects of breathing and relaxation therapy on rates of cardiac events and cost effectiveness in past MI patients. METHODS: Patients (n = 156) were chosen randomly to receive either exercise training plus relaxation therapy (relaxation group; n = 76) or exercise training only (control group; n = 80). The occurrence of major cardiac events and cardiac rehospitalizations in the two treatment groups was compared. RESULTS: At 5-year follow-up, 12 cardiac deaths had occurred, 5 in the relaxation group and 7 in the control group, reinfarction occurred in 10 and 12 patients, and cardiac surgery was performed in 2 and 11, respectively. In total, 15 (20%) and 26 (33%) patients, respectively, experienced at least one cardiac event (odds ratio [OR] for the relaxation group: 0.55, 95% confidence interval [CI] 0.29-1.05; adjusted for risk factors OR 0.52, 95% CI 0.28-0.99). Regarding all cardiac rehospitalizations, in the relaxation group, 30 patients (39%) had experienced 52 cardiac events, for which the patients were hospitalized for a total of 476 days. In the control group, 38 patients (48%) had experienced 78 cardiac events (OR 0.72; 95% CI 0.38-1.36), comprising 719 days of hospitalization. The total number of hospitalizations was reduced by 31% as a result of relaxation instruction. CONCLUSIONS: In the long-term, the disease course after myocardial infarction is influenced favorably by giving relaxation therapy in addition to cardiac rehabilitation. The extra costs of the therapy are compensated by a decrease in hospitalization for cardiac problems.

Psychological, clinical and pathological effects of relaxation training and guided imagery during primary chemotherapy.
Authors Walker LG. Walker MB. Ogston K. Heys SD. Ah-See AK. Miller ID. Hutcheon AW. Sarkar TK. Eremin O.
Institution Behavioural Oncology Unit, University of Aberdeen, Medical School, Foresterhill, UK.
Source British Journal of Cancer. 80(1-2):262-8, 1999 Apr.
Abstract The diagnosis and treatment of breast cancer are stressful, and stress may be associated with a poorer response to chemotherapy. There is a need, therefore, to develop and evaluate interventions that might enhance quality of life and, possibly, improve treatment response. The effects of relaxation combined with guided imagery (visualizing host defences destroying tumour cells) on quality of life and response to primary chemotherapy, to date, have not been adequately evaluated. Ninety-six women with newly diagnosed large or locally advanced breast cancer (T2 > 4 cm, T3, T4, or TxN2 and M0) took part in a prospective, randomized controlled trial. Patients were randomized following diagnosis to a control condition (standard care) or to the experimental condition (standard care plus relaxation training and imagery). Psychometric tests to evaluate mood and quality of life were carried out before each of the six cycles of chemotherapy and 3 weeks after cycle 6: tests of personality and coping strategy were carried out prior to cycles one and six. Clinical response to chemotherapy was evaluated after six cycles of chemotherapy using standard UICC criteria and pathological response was assessed from the tissue removed at surgery. As hypothesized, patients in the experimental group were more relaxed and easy going during the study (Mood Rating Scale). Quality of life was better in the experimental group (Global Self-assessment and Rotterdam Symptom Checklist). The intervention also reduced emotional suppression (Courtauld Emotional Control Scale). The incidence of clinically significant mood disturbance was very low and the incidence in the two groups was similar. Finally, although the groups did not differ for clinical or pathological response to chemotherapy, imagery ratings were correlated with clinical response. These simple, inexpensive and beneficial interventions should be offered to patients wishing to improve quality of life during primary chemotherapy.

Guided imagery and relaxation therapy can modify host defences in women
Authors Walker, L.G. Walker, M.B. Simpson, E. Fielden, S. Ogston, K. Segar, A. Heys, S.D. Ah-See, A.K. Hutcheon, A.W. Eremin, O.
Institution Behavioural Oncology Unit, Department of Surgery, and Department of Medicine and Therapeutics, University of Aberdeen Medical School, Aberdeen.
receiving treatment for locally advanced breast cancer Sources The British Journal of Surgery. Volume 84(1S) Supplement 1.May 1997.31
Abstract Background: The aim of this study was to evaluate the psychoneuroimmunological effects of relaxation training and guided imagery.
Method: Eighty women with locally advanced breast cancer took part in a randomized, parallel group clinical trial to evaluate the psychoneuroimmunological effects of relaxation therapy and guided imagery. Women randomized to the experimental treatment were asked to practise relaxation and visualization at least daily during chemotherapy and to keep detailed records of practice, image intensity, etc. Patients assigned to the control treatment received a high level of support and a similar amount of staff contact in the unit. All women were given six cycles of CHOP neoadjuvant chemotherapy every 3 weeks followed by surgery (lumpectomy or mastectomy) and 20 fractions of radiotherapy. Sixty ml peripheral blood were removed at trial entry, prior to the 1st, 2nd, 4th and 6th cycles of radiotherapy, before and after surgery, and 4 weeks and 12 weeks after radiotherapy. The primary outcome measures were natural killer (NK) and lymphokine-activated killer (LAK) cell activity. Interleukins 1, 2, 4 and 6, tumour necrosis factor-alpha (TNF-alpha), gamma-interferon and CD profiles were also assayed using standard techniques.
Results: At the final follow-up (12 weeks after radiotherapy), women in the experimental group had higher LAK cell activity than those in the control group. Although the two groups did not differ in NK cell activity, within the experimental group, relaxation frequency and self-rated imagery quality were positively correlated with NK cell activity at final follow-up (partial correlation coefficients = 0.365 (P < 0.05) and 0.521 (P < 0.05), respectively). In addition, those who practised more than once daily during chemotherapy had higher NK cell activity during chemotherapy. Repeated measures (ANCOVAs and ANOVAs) showed that, compared with control patients, women in the experimental group had higher absolute numbers and percentages of CD 25 (activated T cells), a higher percentage of CD 2 and lower levels of circulating TNF-alpha.
Conclusion: Even in patients receiving immunosuppressive treatments for large or locally advanced tumours (chemotherapy, surgery, radiotherapy), relaxation and imagery can produce immunological changes which may have clinical relevance.