Effects of Mind-Body Therapy on Quality of Life and Neuroendocrine and Cellular Immune Functions in Patients with Ulcerative Colitis

Abstract

Background: The aim of this study was to investigate the effects of mind-body therapy on neuroendocrine and cellular immune measures, health-related quality of life and disease activity in patients with ulcerative colitis (UC) in remission. Methods: Thirty UC patients in remission or with low disease activity were randomly assigned to an intervention group (n = 15) or a usual-care waiting control group (n = 15). Intervention consisted of a structured 60-hour training program over 10 weeks which included stress management training, moderate exercise, Mediterranean diet, behavioral techniques and self-care strategies. Quality of life, perceived stress and disease activity were assessed with standardized questionnaires (IBDQ, SF-36, PSS, CAI). In addition, the distribution of circulating lymphocytes and lymphocyte subsets as well as the β-adrenergic modulation of TNF-α production in vitro were analyzed. Urine catecholamines and plasma cortisol, prolactin and growth hormone were measured pre- and postinterventionally, and were compared with a healthy control group (n = 10). Results: In response to therapy, patients in the intervention group showed significantly greater improvement in the SF-36 scale Mental Health and the Psychological Health Sum score compared with changes observed in the usual-care waiting control group. Patients in the intervention group showed significantly greater improvement on the IBDQ scale Bowel Symptoms compared with the control group. However, no significant group differences in circulating lymphocyte subsets or endocrine parameters were observed in response to therapy. In addition, no significant effects of intervention on either the basal levels of TNF-α or the suppressive action of the β-adrenergic agonist isoproterenol on TNF-α production were observed. Conclusion: Mind-body therapy may improve quality of life in patients with UC in remission, while no effects of therapy on clinical or physiological parameters were found, which may at least in part be related to selective patient recruitment.

Effect of psychological therapy on disease activity, psychological comorbidity, and quality of life in inflammatory bowel disease: a systematic review and meta-analysis

“…Several of the studies included in the 2011 Cochrane review 22 addressing this issue did not fulfil our inclusion criteria for various reasons. These included a lack of randomisation, 43,44 recruitment of patients with both active and quiescent disease, with no reporting of data separately for these distinct groups of patients, 45 being conducted in an adolescent population, 46 redundant publication, 47 or providing no extractable data. 48 In addition, we made every effort to contact the authors of potentially eligible studies, where dichotomous or continuous data of interest were not available in the published manuscript.…”

"Role of Psychosocial Factors on the Course of Inflammatory Bowel Disease and Associated Psychotherapeutic Approaches. A Fresh Perspective and Review"

“…The conventional medical control group did not show any significant changes. One year later, mindbody therapy, which includes stress management and relaxation techniques, self-care strategies, cognitive behavioral techniques, and integration of health-promoting behaviors (moderate exercise and healthy diet), showed improvements in health perception measures and psychosocial well-being in CU patients after 60 hours of treatment over 10 weeks compared to waitlist controls [56]. No effects on objective disease measures were found perhaps due to the fact that the patients were in remission.…”

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“…All 11 investigations have reported benefit in terms of reduced disease activity, although in some cases the experimental designs were not very satisfactory. Only 5 of the 11 studies were controlled [19,21,30,34,48], the exercise intervention was often poorly defined [21,23], and sometimes included other lifestyle elements, and the largest of the 5 randomized studies referred to patients with irritable bowel syndrome rather than CD or UC [30]. Most studies were based upon moderate aerobic activity, but one specifically used resistance training [9].…”

“…Most studies were based upon moderate aerobic activity, but one specifically used resistance training [9]. Focusing upon the 4 controlled trials of CIBD, it is clear that the condition was not worsened by exercise, but positive changes were fewer: a lessening of constipation, but not pain or diarrhoea [19], a reduction of disease activity on the IBDQ scale, but no decrease of TNF-α [21], no change of Crohn's disease indices despite an improved reported quality of life [34], and improved scores on the IBDQ and Harvey Bradshaw index [48]. Animal experiments have allowed a comparison between moderate and much more vigorous exercise programmes.…”

“…Another potential effect is that exercise may induce an autophagy of the cells responsible for inflammation [26]. In practice, 1 uncontrolled and 3 controlled human studies [17,18,21,37,67] have shown little exercise-induced change of endocrine or immune function other than possible increases of TBARS and expired NO under resting conditions. However, several investigators have studied exercise responses in animals, some with colitis induced by irritant chemicals, and here benefit has generally been noted.…”