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NCCIH Clinical Digest

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Mind and Body Practices for Older Adults:
What the Science Says

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August 2019
older yoga

   

Clinical Guidelines, Scientific Literature, Info for Patients: 

Osteoarthritis

In 2012, the American College of Rheumatology issued recommendations for using pharmacologic and nonpharmacologic approaches for OA of the hand, hip, and knee:

The guidelines conditionally recommend tai chi, along with other non-drug approaches such as manual and thermal therapies, self-management programs, and walking aids, for managing knee OA.

Acupuncture is also conditionally recommended for those who have chronic moderate-to-severe knee pain and are candidates for total knee replacement but are unwilling or unable to undergo surgical repair.

What Does the Research Show?

  • A 2016 comparative effectiveness randomized controlled trial involving 204 participants with symptomatic knee arthritis found that tai chi produced beneficial effects similar to those participants who received a standard course of physical therapy. A 2016 systematic review and meta-analysis of 18 randomized controlled trials involving a total of 1,260 participants found that tai chi showed positive evidence on relief of chronic pain from osteoarthritis. A 2013 meta-analysis of seven randomized controlled trials involving 348 participants with osteoarthritis found that 12-week tai chi is beneficial for improving arthritis symptoms and physical function.
  • A 2009 NCCIH-funded review of meta-analyses and systematic reviews on acupuncture for chronic back pain, OA, and headache found that acupuncture generally appears better than standard care or wait list controls for people with OA but may not provide additional benefit for people with OA who are receiving advice and exercise. A 2010 systematic review of 16 trials of 3,498 patients examined the effects of acupuncture in OA in peripheral joints and found that although acupuncture, when compared to a sham treatment, showed statistically significant, short-term improvements in osteoarthritis pain, the benefits were small and not clinically relevant. In contrast, acupuncture, when compared to a waiting list control, showed statistically significant and clinically relevant benefits in people with peripheral joint OA.

Safety

  • Tai chi appears to be a safe practice. Complaints of musculoskeletal pain after starting tai chi may occur but have been found to improve with continued practice.
  • There are few complications associated with acupuncture, but adverse effects such as minor bruising or bleeding can occur; infections can result from the use of nonsterile needles or poor technique from an inexperienced practitioner.

Sleep Disorders

Current clinical practice guidelines from the American Academy of Sleep Medicine recommend psychological and behavioral interventions, such as stimulus control therapy or relaxation therapy, or cognitive behavioral therapy for insomnia (CBT-I), in the treatment of chronic primary and secondary insomnia for adults of all ages, including older adults.

What Does the Research Show?

  • 2008 clinical practice guidelines issued by the American Academy of Sleep Medicine recommend psychological and behavioral interventions in the treatment of chronic primary and secondary insomnia. The guidelines state: “Initial approaches to treatment should include at least one behavioral intervention such as stimulus control therapy or relaxation therapy, or the combination of cognitive therapy, stimulus control therapy, sleep restriction therapy with or without relaxation therapy—otherwise known as cognitive behavioral therapy for insomnia (CBT-I).”
  • Results from a 2015 randomized controlled trial involving 60 adults aged 75 years and over with chronic insomnia suggest that mindfulness-based stress reduction is an efficient therapy for chronic insomnia. 
  • A 2014 randomized controlled trial examined the comparative efficacy of cognitive behavioral therapy, tai chi, and sleep seminar education control in 123 older adults with chronic and primary insomnia. The study found that cognitive behavioral therapy performed better than tai chi and sleep seminar education in remission of clinical insomnia, and also showed greater improvement in sleep quality, sleep parameters, fatigue, and depressive symptoms than the tai chi and sleep seminar education groups. Compared with the sleep seminar education control, tai chi was associated with improvements in sleep quality, fatigue, and depressive symptoms, but not insomnia remission.
  • A 2011 systematic review of 20 studies involving eight complementary health approaches for insomnia found evidentiary support in the treatment of chronic insomnia for tai chi.

Safety

  • Relaxation therapies and cognitive behavioral therapy for insomnia are considered safe.

Menopausal Symptoms

Overall, research suggests that some mind and body approaches, such as yoga, tai chi, and meditation-based programs may provide some benefit in reducing common menopausal symptoms.

What Does the Research Show?

  • A 2019 systematic review and meta-analysis of 12 randomized controlled trials involving a total of 1,016 women found that psychological interventions, including cognitive behavioral therapy, mindfulness-based therapy, and behavioral therapy reduced hot flashes in the short and medium-term and other menopausal symptoms in the short-term. 
  • A 2010 review of 21 papers assessed mind and body therapies for menopausal symptoms. The researchers found that yoga, tai chi, and meditation-based programs may be helpful in reducing common menopausal symptoms including the frequency and intensity of hot flashes, sleep and mood disturbances, stress, and muscle and joint pain.
  • A 2013 Cochrane review of 16 randomized controlled trials involving 1,155 women found that when acupuncture was compared with sham acupuncture, there was no evidence of difference in their effect on hot flashes. However, when acupuncture was compared with no treatment, there appeared to be some benefit from acupuncture. Acupuncture was less effective than hormone therapy. The low quality of evidence and lack of control with sham acupuncture for some of the studies led the reviewers to conclude that there is insufficient evidence to determine whether acupuncture is effective for controlling menopausal vasomotor symptoms.

Safety

  • Meditation is considered to be safe for healthy people. There have been rare reports that meditation could cause or worsen symptoms in people who have certain psychiatric problems, but this question has not been fully researched. People with physical limitations may not be able to participate in certain meditative practices involving physical movement. Individuals with existing mental or physical health conditions should speak with their health care providers prior to starting a meditative practice and make their meditation instructor aware of their condition.
  • Overall, clinical trial data suggest yoga as taught and practiced in these research studies under the guidance of skilled teacher has a low rate of minor side effects. However, injuries from yoga, some of them serious, have been reported in the popular press. People with health conditions should work with an experienced teacher who can help modify or avoid some yoga poses to prevent side effects.
  • Tai chi is considered to be a safe practice. Complaints of musculoskeletal pain after starting tai chi may occur but have been found to improve with continued practice.
  • There are few complications associated with acupuncture, but adverse effects such as minor bruising or bleeding can occur; infections can result from the use of nonsterile needles or poor technique from an inexperienced practitioner.

Herpes Zoster (Shingles)

There have only been a few studies on the effects of tai chi on cell-mediated immunity to varicella zoster virus following vaccination, but the results of these studies have shown some benefit. Other interventions such as acupuncture, cupping, neural therapy, and intravenous vitamin C (ascorbic acid) have been studied for their effects on duration of neuropathic pain and post-herpetic neuralgia due to herpes zoster, but these studies have been small.

What Does the Research Show?

  • A 2007 randomized controlled trial in more than 100 healthy older adults found that those people who participated in a 16-week tai chi program had higher levels of cell-mediated immunity to varicella zoster virus following shingles vaccination than those who received the same vaccine but participated in a health education program instead of tai chi.
  • Findings from a 2017 systematic review and meta-analysis of nine randomized controlled trials involving a total of 945 participants suggest a potential benefit from acupuncture and moxibustion in reducing pain intensity from shingles; however, overall there is insufficient evidence from high quality studies.  

Safety

  • Tai chi is considered to be a safe practice. Complaints of musculoskeletal pain after starting tai chi may occur but have been found to improve with continued practice.
  • There are few complications associated with acupuncture, but adverse effects such as minor bruising or bleeding can occur; infections can result from the use of nonsterile needles or poor technique from an inexperienced practitioner.

Poor Balance/Risk of Fall

There is evidence that tai chi may reduce the risk of falling in older adults. There is also some evidence that tai chi may improve balance and stability with normal aging and in people with neuro-degenerative conditions, including mild-to-moderate Parkinson’s disease and stroke.

What Does the Research Show?

  • A 2019 Cochrane review of 108 randomized controlled trials involving 23,407 community-living participants aged 60 years and older found that exercise programs reduce the rate of falls and the number of people experiencing falls in older people living in community settings. The review also found that tai chi may reduce the rate of falls by 19 percent (low-certainty evidence) and may reduce the number of people who experience falls by 20 percent (high-certainty evidence).
  • A 2017 meta-analysis of 10 studies found that for at-risk adults and older adults, tai chi may reduce the rate of falls and injury-related falls over the short term (less than 12 months) by approximately 43 percent and 50 percent, respectively.
  • A 2014 Cochrane review of 30 studies involving 2,878 older adults assessed the effects of exercise interventions, which included tai chi, for reducing fear of falling in community-dwelling older people. Reviewers concluded that exercise interventions had low quality evidence that they reduce the fear of falling immediately following the intervention and insufficient evidence to determine whether these interventions reduce fear of falling after the intervention has ended. The review also examined whether exercise interventions reduced the number of falls in participants as a secondary outcome but was considered incomplete because only a portion of the studies in the analysis evaluated this outcome..

Safety

  • Tai chi is considered to be a safe practice. Complaints of musculoskeletal pain after starting tai chi may occur but have been found to improve with continued practice.

Cognitive Decline

There is some evidence that suggests mind-and-body exercise programs such as tai chi and yoga may have the potential to provide modest enhancements of cognitive function in older adults without cognitive impairment.

What Does the Research Show?

  • A 2018 systematic review and meta-analysis of 19 randomized controlled trials involving a total of 2,539 older adults found that compared to a control group, mind-and-body exercise (such as tai chi and yoga) showed significant benefits on cognitive performance, global cognition, executive functions, learning and memory, and language. All of these programs involved actions and breathing techniques associated with mind-and-body exercise (e.g., stretching and abdominal breathing).  However, more high-quality studies are needed before definitive conclusions can be drawn.
  • However, another 2018 systematic review of 16 randomized controlled trials found evidence was insufficient to draw conclusions about the effectiveness of tai chi for improving cognition.

Safety

  • Tai chi is considered to be a safe practice. Complaints of musculoskeletal pain after starting tai chi may occur, but have been found to improve with continued practice.

 

References

NCCIH Clinical Digest is a service of the National Center for Complementary and Integrative Health, NIH, DHHS. NCCIH Clinical Digest, a monthly e-newsletter, offers evidence-based information on complementary health approaches, including scientific literature searches, summaries of NCCIH-funded research, fact sheets for patients, and more.

The National Center for Complementary and Integrative Health is dedicated to exploring complementary health products and practices in the context of rigorous science, training complementary health researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCIH's Clearinghouse toll-free at 1-888-644-6226, or visit the NCCIH Web site at nccih.nih.gov. NCCIH is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.

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This page last modified August 13, 2019