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Mind-body Practices Benefit Patients With Rheumatic Conditions
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While the mechanisms of mind-body practice to improve rheumatic disease are not fully understood, these practices have been found to improve balance and movement, relieve pain, lower blood pressure and reduce falls in patients with various rheumatic conditions. Practices such as tai chi, qi gong, Feldenkrais, yoga and meditation may also provide ancillary benefits to these patients, such as increased mindfulness, relaxation and an improved sense of well-being.
“I think that for rheumatic conditions and also for overall health, patients should do something they enjoy,” Mary L. Jurisson, MD, physiatrist and rheumatologist at the Mayo Clinic’s department of physical medicine and rehabilitation, told Healio Rheumatology. “Bringing some of these principles of mind-body practice into recreational activities makes a lot of sense to me as a way to promote health. That’s where I think we should be.”
Healio Rheumatology spoke with Jurisson about the different mind-body practices, the history of these practices and their benefits to rheumatic and general health.
Healio Rheumatology: What is the role of the mind-body connection in rheumatic disease?
Mary L. Jurisson, MD: That’s a tricky question. The most accurate answer is that I don’t think it is well explored. There are several mind-body practices that are popular with people who feel it improves their health. Among those would be tai chi, other internal martial arts, yoga and some meditation practices. As there’s a belief out there that it’s good for health, scientist clinicians have done studies to try to show that is the case. The first studies along those lines, that I know of, were studies done in people with rheumatic conditions, such as arthritis, osteoarthritis and rheumatoid arthritis. The first ones I know of were probably done in the 1980s. They did seem to show improvements in people’s sense of well-being, confidence and ability to move comfortably, but there haven’t been large prospective studies to definitely prove that is the case or find out how these improvements are achieved. It’s hard to do studies in a reasonable amount of time with a reasonable amount of money with a group large enough to definitely prove it helps or why.
Healio Rheumatology: Are there theories as to why it might help?
Jurisson: People hypothesize about how it might help. For example, people have suggested that perhaps the meditative aspects of mind-body practices reduce your sympathetic nervous system tone — that’s your flight-or-fight response. Often, inflammatory molecules in your bloodstream might go up when you’re more stressed or more aroused and if the stress goes down, maybe it will also calm the inflammation of your rheumatic condition. That’s one possibility.
Another is that maybe if you can calm down your autonomic nervous system, regardless of what it does for inflammation, maybe it will reduce how much pain you have or how much the pain bothers you. Mind-body [practices] typically involve movement and so perhaps it can improve your movement if you apply that to other kinds of movement. There’s mindful walking or tai chi walking, or meditative walking, which may help in reducing pain while walking.
Another potential mechanism is that, for joint health, it’s not just a matter of inflammation, but also of how accurately the surfaces of the joint oppose each other during weight bearing and movement. That’s a function of how the muscles work together to load the joints and also how the nervous system interprets whatever information it has received. One could hypothesize that if you haven’t had self-awareness and you practice comfortably loading your joints, it could be a more congruent loading and put less stress on your joint and contribute to healing. No one has ever studied that. In fact, it’s a hard thing to study. There are people who are trying research that, but I don’t know when we will have answers about that.
Healio Rheumatology: What effects do mind-body practices have on balance?
Jurisson: Some studies were done in the 1990s on the effect of tai chi on balance. At that time, the NIH recognized that one of the major expenses and health threats in elderly people is injury from falls and asked for researchers to propose [ideas] to prevent falls and broken bones related to falls. One group that answered the request for proposals was a group from Emory University that was evaluating tai chi to prevent falls, the FICSIT study. They were able to show that it did prevent falls and also incidentally, people’s blood pressure also went down. That generated interest among researchers in cardiology as well. There were a number of studies with different types of cardiac conditions, but many of the studies involved blood pressure, resting heart rate, that type of thing. People with different kinds of arthritis can have impaired balance and certainly everyone needs good blood pressure control, so that’s another mechanism of tai chi helping people with arthritis.
Healio Rheumatology: What recent or current research is being done on mind-body practices and rheumatic conditions?
Jurisson: One of the most committed researchers on tai chi for rheumatic conditions right now is Chenchen Wang, MD. She is in Boston and has been doing some elegant studies of tai chi for osteoarthritis of the knee. She has begun to use some paper and pencil outcome tools to see if self-awareness and mindfulness is increased by practicing tai chi in patients with osteoarthritis of the knee and whether that correlates with improvements in outcome with osteoarthritis of the knee. I think some of those studies are currently in progress.
Another group in Boston, led by Gloria Y. Yeh, MD, is evaluating the extent to which practicing tai chi might improve certain related behaviors, like complexity of movement and postural sway. It is certainly possible that various kinds of mind-body practices help with that, because these help you pay attention to how you feel. Most mind-body practices include a an exercise called a “body scan” where you sequentially direct your attention to different areas of your body.
Mind-body practices also pay attention to somatic movement and also autonomic functions, like breathing. How exactly is it you are breathing? How long you breathe in, how long you breathe out, what it feels like and how those things interact with movement.
Healio Rheumatology: What is qi gong and how might it help rheumatic conditions?
Jurisson: Qi gong is a Chinese energy practice. People who practice qigong will explain it in different ways, but I think ‘qi’ refers to energy and ‘gong’ refers to practicing with skill to achieve skill. “Energy practice” is a reasonable way to understand that. You could think of tai chi as a particular type of qi gong. There are several ways that it is used. There is medical qi gong, in which you go to a traditional doctor of Chinese medicine for something like arthritis or pain in your joints, muscle or skeleton. They might recommend a series of qi gong exercises tailored to your condition or might recommend that you practice tai chi.
Healio Rheumatology: Can you talk about Feldenkrais and its possible benefits?
Jurisson: I am trained in Feldenkrais as a teacher as well. Moshé Feldenkrais was a scientist, engineer and also practiced Asian martial arts. When he injured his knee, he combined his knowledge of mindful movement from the martial arts with his knowledge of physics and mechanics and learned through systematic self experimentation to improve his knee problem. Over time, colleagues and others learned about his approach to self healing and requested his instruction. Eventually he developed his method that consists of 2 general strategies. Awareness Through Movement (ATM) lessons are verbally guided sequences of movements that help the student improve the quality of movement. Functional Integration(FI) usually involves the teacher gently moving the student through movements in such a way that the student becomes kinesthetically aware of their movement patterns and can shift to more effective, more comfortable patterns.
Feldenkrais method has been helpful in chronic pain, radiculopathies and in some neurological disorders. Others have practiced the method to improve creativity or to improve athletic performance. Studies of effectiveness have been small and limited so far. However, Feldenkrais lessons often are fun to perform and feel good.
Healio Rheumatology: How do you help a patient decide which of these practices might benefit them most?
Jurisson: As a physician, I have patients ask me if they should exercise for their arthritis or whether they should avoid it. I would say everyone should exercise, but I think a patient should find a form of recreational exercise that they enjoy. Maybe a patient doesn’t like walking and they want to know what else they can do. Contact sports might not be your best first choice, but I think a patient could do a lot worse than practicing tai chi. People need to socialize, they need sport, they need physical activity. It helps them become fit and stay fit. Tai chi and Feldenkrais can serve that role. Because tai chi and Feldenkrais are usually practiced in a group, participants can develop feelings of social connection in the group which motivates people to stay with it the practice. Personally, for recreation, I prefer dancing. I think you can bring some of the mind-body spirit to dancing or other activities once you learn how.
Healio Rheumatology: Do you think insurance should cover mind-body practices?
Jurisson: Most of the time, when we talk about tai chi or other mind-body practices for health, these questions come from health care providers and when they learn more about tai chi, yoga or Feldenkrais, they realize it takes a while to learn it, involves practice, and requires skilled teachers. The medical outcomes are modest, so as a medical treatment these practices seem expensive and slow. I would submit that the benefits are realized similarly over time as those gained from walking or biking or other recreational activities and possibly have additional health benefits over longer time periods.
I think the problem lies in the question, “Should the health care system be responsible for everything that promotes health?” Or is this something a community is responsible for? I personally think that in the way we currently talk about health, we turn to physicians and other providers working in the health care system for this kind of advice. That sort of thing could be funded by an insurance company. Alternativelyit could be funded by health clubs that are in turn funded by communities or insurance companies and supported by evidence-based data. Insurance companies would be more likely to fund activities at health clubs if there is some evidence that these practices support health and reduce health care costs. We are beginning to see this more and more. As evidence accumulates that an activity promotes health it is likely that they will be included in health budgets.
By the same token, eating habits can make or break your health, just as whether you smoke or drink to excess, whether you get a good night’s sleep. There are a number of health habits that are strongly associated with better health, less disease and less disability. Overall, I find that people who practice healthy living principles have less disease, less disability and less pain. – by Jennifer Byrne
For more information:
Mary L. Jurisson, MD, can be reached at 200 1st St., Rochester, NY 55905; email: mjurisson@mayo.edu.
Disclosure: Jurisson reports no relevant disclosures.