Stretching, meditation ‘one of the arrows in a quiver’ to reduce muscle cramps in cirrhosis
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Key takeaways:
- Both stretching and meditation significantly reduced cramp severity from baseline, with similar results between the two interventions.
- More patients recommended stretching over meditation (79.5% vs. 55.3%).
Both stretching and meditation reduced cramp severity and improved quality of life among patients with cirrhosis and may be considered as nonpharmacologic interventions when treating nocturnal muscle cramps, according to researchers.
“We found that muscle cramps were a key determinant of quality of life for people with chronic liver disease,” Elliot B. Tapper, MD, associate professor and academic chief of hepatology at Michigan Medicine, told Healio. “[Prior research] showed that sips of pickle juice were highly effective at improving cramp severity, but they did not improve sleep or overall health-related quality of life.”
Tapper continued: “Stretching had been proven to prevent cramps in older adults and meditation is a common intervention that we employ in our research group. We were interested in enrolling not just people with cirrhosis but people with any form of chronic disease who are bothered by cramps, so we could have a claim towards a generalizable intervention.”
In the RELAX trial, Tapper and colleagues enrolled 98 adult patients (median age, 63 years; 67% women) with a history of more than four muscle cramps in the previous month, of whom 48% had cirrhosis and 40% had diabetes. More than 95% of patients reported being awakened by cramping. Patients were randomly assigned 1:1 to stretching (n = 53) or meditation (n = 45) for 35 days.
The primary outcome was change in cramp severity, measured by the visual analogue scale. Secondary outcomes included patient global impression of change and changes in sleep quality and health-related quality of life (HRQoL), measured via the EQ-5D and visual analogue scale-global HRQoL.
According to results published in Liver International, both stretching and meditation reduced cramp severity by a median of 1.44 points and 1.97 points, respectively —changes that were significant from baseline but similar between groups. In addition, both groups experienced positive patient global impression of change, as well as improved sleep quality.
“What we ended up finding is that cramps and quality of life both got better with stretching and meditation,” Tapper said.
In the meditation group, global HRQoL did not change according to EQ-5D measures, but was “numerically higher” based on the visual analogue scale, a finding that was not observed in the stretching group. Still, more patients recommended stretching over meditation (79.2% vs. 55.3%).
“The key takeaway from this is that we have two cheap, safe, potentially effective interventions for a vexing symptom,” Tapper told Healio. “We are now interested in deploying these interventions in broader programs aimed at addressing the multitude of symptoms that bother people with chronic liver disease. We see this as one of the arrows in a quiver that a clinician can use when addressing a patient with chronic liver disease holistically.”
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