Studie zur Wirksamkeit von Yoga gegenüber der Low-FODMAP Ernährung in der Behandlung des Reizdarmsyndroms
Patienten mit Reizdarmsyndrom erleiden häufig erhebliche Einschränkungen ihrer Lebensqualität, die durch Stress und psychosoziale Symptome mitbedingt werden. Yoga hat sich bei verschiedenen Erkrankungen als wirksam in der Förderung der Lebensqualität und Stressreduktion gezeigt. Die Low-FODMAP Diät zeigte ebenfalls bereits in einigen Studien Wirksamkeit bei Darmbeschwerden.
Ziel dieser Studie war es, den Einfluss einer 12-wöchigen Hatha-Yogapraxis im Vergleich zu einer Ernährungsberatung nach dem Low-FODMAP-Prinzip auf Darmbeschwerden und psychische Symptome, Lebensqualität, Stressempfinden sowie die Zusammensetzung der Darmflora von Patienten mit Reizdarmsyndrom zu untersuchen.
59 Patienten in die Studie aufgenommen und per Zufall einer der beiden Gruppen zugeteilt. Die Häufigkeit und Intensität von körperlichen und psychischen Symptomen wurde mittels Fragebögen und die Darmbakterien mittels 16S rRNA Analyse bestimmt. Der Hauptzielparameter waren die anhand eines spezifischen Fragebogens berichteten krankheitsspezifischen Symptome. Untersuchte Nebenzielparameter waren Stress, Ängstlichkeit und Depressivität, Lebensqualität, Körperbewusstsein und der Einfluss der jeweiligen Intervention auf das Darmmikrobiom.
Zum Abschluss der Intervention waren im Hauptzielparameter keine signifikanten Unterschiede zwischen den Gruppen zu sehen. Es zeigte sich aber ein signifikanter Gruppenunterschied zugunsten von Yoga hinsichtlich der Verbindung von Körper und Geist nach 12 Wochen und nach 24 Wochen im Körperbewusstsein und der physischen Lebensqualität im Vergleich zur Low-FODMAP Gruppe. Ein signifikanter Gruppenunterschied zugunsten der Yogagruppe zeigte sich auch bei der Ängstlichkeit nach 12 Wochen. Innerhalb der Gruppen berichteten die Patienten in beiden Gruppen außerdem eine signifikante Verminderung ihrer Darmbeschwerden zu Woche 12 und 24.
Die Low-FODMAP Ernährung führte in der Darmflora zu einer Verminderung der allgemeinen relativen Häufigkeit der Spezies Firmicutes, insbesondere der Gattung Blautia. Begleitet wurde dies von einem Anstieg der relativen Häufigkeit der Spezies Bacteroidetes. Der gleiche Trend ließ sich in schwächerer Form in der Yoga Gruppe beobachten, jedoch nicht mit statistischer Signifikanz.
Diese Studie liefert erste Hinweise für eine positive Wirkung von Yoga sowie einer Low-FODMAP Diät auf das Reizdarmsyndrom. Dennoch bedarf es weiterer Forschung um die Behandlungen langfristig und uneingeschränkt empfehlen zu können.
Ergebnisse einiger am Lehrstuhl durchgeführter Studien
Kohlwickel bei Kniearthrose
Clin J Pain. 2016 Feb 17. [Epub ahead of print]
Efficacy of Cabbage Leaf Wraps in the Treatment of Symptomatic Osteoarthritis of the Knee: A Randomized Controlled Trial.
Lauche R, Romeikat N, Cramer H, Al-Abtah J, Dobos G, Saha FJ.
Osteoarthritis of the knee is one of the most common chronic diseases among older adults. This study aimed to test the effects of cabbage leaf wraps (CLWs) in the treatment of symptomatic osteoarthritis.
Patients with osteoarthritis of the knee at stages II to III (Kellgren-Lawrence) were randomly assigned to 4 weeks of treatment with CLWs (daily 2 h min), topical pain gel (TPG) (10 mg diclofenac/g, once daily min), or usual care (UC). The primary outcome measure was pain intensity (VAS) after 4 weeks. Secondary outcomes included functional disability (WOMAC), quality of life (SF-36), self-efficacy (ASES-D), physical function (30 s CST), pressure pain sensitivity (PPT), satisfaction, and safety after 4 and 12 weeks.
In total, 81 patients were included in this study (42 women, 65.9±10.3 y). After 4 weeks patients in the CLW group reported significantly less pain compared with those in the UC group (difference, -12.1; 95% [confidence interval] CI, -23.1, -1.0; P=0.033) but not when compared with the TPG group (difference, -8.6; 95% CI, -21.5, 4.4; P=0.190). Significant effects were also found in WOMAC, SF-36, 30-second CST, and PPT scores in the CLW group compared with the UC group. Compared with TPG, effects from CLW were found for WOMAC after 4 weeks and for quality of life after 12 weeks. Patients were satisfied with both active interventions, and except for 2 adverse events in both groups the applications were well tolerated.
CLWs are more effective for knee osteoarthritis than UC, but not compared with diclofenac gel. Therefore, they might be recommended for patients with osteoarthritis of the knee. Further research is warranted.
- [PubMed - as supplied by publisher]
Yoga bei Brustkrebs
Cancer. 2015 Jul 1;121(13):2175-84. doi: 10.1002/cncr.29330. Epub 2015 Mar 4.
Yoga and meditation for menopausal symptoms in breast cancer survivors-A randomized controlled trial.
Cramer H, Rabsilber S, Lauche R, Kümmel S, Dobos G.
Breast cancer survivors have only very limited treatment options for menopausal symptoms. The objective of this trial was to evaluate the effects of a 12-week traditional Hatha yoga and meditation intervention on menopausal symptoms in breast cancer survivors.
Patients were randomly assigned either to a 12-week yoga and meditation intervention or to usual care. The primary outcome measure was total menopausal symptoms (Menopause Rating Scale [MRS] total score). Secondary outcome measures included MRS subscales, quality of life (Functional Assessment of Cancer Therapy-Breast), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue), depression, and anxiety (Hospital Anxiety and Depression Scale). Outcomes were assessed at week 12 and week 24 after randomization.
In total, 40 women (mean age ± standard deviation, 49.2 ± 5.9 years) were randomized to yoga (n = 19) or to usual care (n = 21). Women in the yoga group reported significantly lower total menopausal symptoms compared with the usual care group at week 12 (mean difference, -5.6; 95% confidence interval, -9.2 to -1.9; P = .004) and at week 24 (mean difference, -4.5; 95% confidence interval, -8.3 to -0.7; P = .023). At week 12, the yoga group reported less somatovegetative, psychological, and urogenital menopausal symptoms; less fatigue; and improved quality of life (all P < .05). At week 24, all effects persisted except for psychological menopausal symptoms. Short-term effects on menopausal symptoms remained significant when only women who were receiving antiestrogen medication (n = 36) were analyzed. Six minor adverse events occurred in each group.
Yoga combined with meditation can be considered a safe and effective complementary intervention for menopausal symptoms in breast cancer survivors. The effects seem to persist for at least 3 months. Cancer 2015;121:2175-2184. © 2015 American Cancer Society.
© 2015 American Cancer Society.
breast neoplasm; meditation; menopause; randomized controlled trial; yoga
- [PubMed - in process]
Yoga bei Darmkrebs
Psychooncology. 2015 Jul 29. doi: 10.1002/pon.3927. [Epub ahead of print]
A randomized controlled bicenter trial of yoga for patients with colorectal cancer.
Cramer H, Pokhrel B, Fester C, Meier B, Gass F, Lauche R, Eggleston B,Walz M, Michalsen A, Kunz R, Dobos G, Langhorst J.
The aim of this trial was to evaluate the effects of yoga on health-related quality of life in patients with colorectal cancer.
Patients with non-metastatic colorectal cancer were randomly assigned to a 10-week yoga intervention (90 min once weekly) or a waitlist control group. Primary outcome measure was disease-specific quality of life (Functional Assessment of Cancer Therapy - Colorectal [FACT-C]) at week 10. Secondary outcome measures included FACT-C subscales: spiritual well-being (FACT - Spirituality); fatigue (FACT - Fatigue); sleep disturbances (Pittsburgh Sleep Quality Inventory); depression and anxiety (Hospital Anxiety and Depression Scale); body awareness (Scale of Body Connection); and body-efficacy expectations (Body-Efficacy Expectations Scale). Outcomes were assessed at week 10 and week 22 after randomization.
Fifty-four patients (mean age 68.3 ± 9.7 years) were randomized to yoga (n = 27; attrition rate 22.2%) and control group (n = 27; attrition rate 18.5%). Patients in the yoga group attended a mean of 5.3 ± 4.0 yoga classes. No significant group differences for the FACT-C total score were found. Group differences were found for emotional well-being at week 22 (∆ = 1.59; 95% CI = 0.27,2.90; p = 0.019), sleep disturbances at week 22 (∆ = -1.08; 95% CI = -2.13, -0.03; p = 0.043), anxiety at week 10 (∆ = -1.14; 95% CI = -2.20, -0.09; p = 0.043), and depression at week 10 (∆ = -1.34; 95% CI = -2.61, -0.8; p = 0.038). No serious adverse events occurred in the yoga group, while liver metastases were diagnosed in one patient in the control group.
This randomized trial found no effects of yoga on health-related quality of life in patients with colorectal cancer. Given the high attrition rate and low intervention adherence, no definite conclusions can be drawn from this trial. Copyright © 2015 John Wiley & Sons, Ltd.
Copyright © 2015 John Wiley & Sons, Ltd.
- [PubMed - as supplied by publisher]
Craniosacrale Therapie zur Behandlung Chronischer Nackenschmerzen
Clin J Pain. 2015 Sep 3. [Epub ahead of print]
Craniosacral Therapy for the Treatment of Chronic Neck Pain: A Randomized Sham-controlled Trial.
Haller H, Lauche R, Cramer H, Rampp T, Saha FJ, Ostermann T, Dobos G.
With growing evidence for Craniosacral Therapy (CST) effectiveness for pain management, the question about CST efficacy remained unclear. This study therefore aimed at investigating CST in comparison to sham treatment in chronic non-specific neck pain patients.
54 blinded patients were randomized to either 8 weekly units of CST or light touch sham treatment. Outcomes were assessed before and after treatment (week 8) and a further 3 months later (week 20). The primary outcome was pain intensity on a visual analogue scale; secondary outcomes included pain on movement, pressure pain sensitivity, functional disability, health-related quality of life, well-being, anxiety, depression, stress perception, pain acceptance, body awareness, patients' global impression of improvement and safety.
In comparison to sham, CST patients reported significant and clinically relevant effects on pain intensity at week 8 (-21▒mm; 95%-CI: [-32.6|-9.4]; P=0.001; d=1.02) as well as at week 20 (-16.8▒mm; 95%-CI: [-27.5|-6.1]; P=0.003; d=0.88). Minimal clinically important differences in pain intensity at week 20 were reported by 78% of the CST patients, while 48% even had substantial clinical benefit. Significant differences at week 8 and 20 were also found for pain on movement, functional disability, physical quality of life and patients' global improvement. Pressure pain sensitivity and body awareness were significantly improved only at week 8; anxiety only at week 20. No serious adverse events were reported.
CST was both specifically effective and safe in reducing neck pain intensity and may improve functional disability and quality of life up to 3 months post intervention.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0.
- [PubMed - as supplied by publisher]
Alexandertechnik bei Nackenschmerzen
Clin Rehabil. 2016 Mar;30(3):247-58. doi: 10.1177/0269215515578699. Epub 2015 Mar 31.
Efficacy of the Alexander Technique in treating chronic non-specific neck pain: a randomized controlled trial.
Lauche R, Schuth M, Schwickert M, Lüdtke R, Musial F, Michalsen A, Dobos G, Choi KE.
To test the efficacy of the Alexander Technique, local heat and guided imagery on pain and quality of life in patients with chronic non-specific neck pain.
A randomized controlled trial with 3 parallel groups was conducted.
Outpatient clinic, Department of Internal and Integrative Medicine.
A total of 72 patients (65 females, 40.7±7.9 years) with chronic non-specific neck pain.
Patients received 5 sessions of the Alexander Technique - an educational method which aims to modify dysfunctional posture, movement and thinking patterns associated with musculoskeletal disorders. Control groups were treated with local heat application or guided imagery. All interventions were conducted once a week for 45 minutes each.
The primary outcome measure at week 5 was neck pain intensity on a 100-mm visual analogue scale; secondary outcomes included neck disability, quality of life, satisfaction and safety.
Analyses of covariance were applied; testing ordered hypotheses.
No group difference was found for pain intensity for the Alexander Technique compared to local heat (difference 4.5mm; 95%CI:-8.1;17.1;p=0.48), but exploratory analysis revealed the superiority of the Alexander Technique over guided imagery (difference -12.9mm; 95%CI:-22.6;-3.1,p=0.01). Significant group differences in favor of the Alexander Technique were also found for physical quality of life (P<0.05). Adverse events mainly included slightly increased pain and muscle soreness.
The Alexander Technique was not superior to local heat application in treating chronic non-specific neck pain. It cannot be recommended as routine intervention at this time. Further trials are warranted for conclusive judgment.
© The Author(s) 2015.
Alexander Technique; Neck pain; chronic pain; clinical trial; guided imagery; kinesthetic control; local heat; randomized controlled trial; sensory awareness
- [PubMed - in process]
Kümmelleibauflage bei Reizdarm
Digestion. 2015;92(1):22-31. doi: 10.1159/000398790. Epub 2015 Jun 5.
Efficacy of Caraway Oil Poultices in Treating Irritable Bowel Syndrome--A Randomized Controlled Cross-Over Trial.
Lauche R, Janzen A, Lüdtke R, Cramer H, Dobos G, Langhorst J.
Irritable bowel syndrome (IBS) is a frequent gastrointestinal disorder, with only limited evidence regarding self-management approaches. This study tested the efficacy of caraway oil poultices (CarO) for treating IBS.
This randomized controlled open-label cross-over trial included three treatment periods with hot CarO and hot olive oil poultice (OlivH) or nonheated poultices (OlivC) with olive oil as control interventions. Patients applied each intervention daily for 3 weeks. The primary outcome was symptom severity (IBS-SSS); secondary outcomes included responder rates (improvement ≥ 50 IBS-SSS), quality of life (EQ-5D, IBS-QOL), psychological distress (HADS), adequate relief, and safety.
48 patients with IBS were included (40 females, 53.9 ± 14.4 years). A significant difference was found for symptom severity in favor of CarO compared to OlivC (difference -38.4, 95% CI -73.6, -3.1, p = 0.033), but not compared to OlivH (difference -24.3, 95% CI -56.5, 7.9, p = 0.139). Responder rates were highest for CarO compared to OlivH and OlivC (43.9, 20.0, 18.9%, respectively). Within the CarO, 51.8% reported adequate relief compared to 23.5% (OlivH) and 25.8% (OlivC). One adverse event (gastrointestinal infection) was reported during CarO.
Hot caraway oil poultices appear effective and safe, although their effects may be a result of the heat application. Patients reported highest levels of subjective benefit from caraway oil poultices, making their use appropriate in the self-management of IBS.
© 2015 S. Karger AG, Basel.
- [PubMed - in process]
Tagesklinik für Onkologische Patienten
Support Care Cancer. 2015 Oct;23(10):2945-55. doi: 10.1007/s00520-015-2660-6. Epub 2015 Feb 26.
Integrating mindfulness in supportive cancer care: a cohort study on a mindfulness-based day care clinic for cancer survivors.
Dobos G, Overhamm T, Büssing A, Ostermann T, Langhorst J, Kümmel S, Paul A, Cramer H.
The aim of this study was to investigate the effects of a mindfulness-based day care clinic group program for cancer survivors on health-related quality of life and mental health; and to investigate which psychological variables are associated with changes in health variables.
One hundred seventeen cancer survivors (91.0 % female; mean age 53.9 ± 10.7 years; 65.0 % breast cancer; mean time since diagnosis 27.2 ± 46.5 months) participated in an 11-week mindfulness-based day care clinic group program, 6 h per week. The intervention incorporated mindfulness-based meditation, yoga, cognitive-behavioral techniques, and lifestyle modification. Outcome measures including health-related quality of life (EORTC QLQ-C30), depression and anxiety (HADS); and psychological variables including life satisfaction (BMLSS), mindfulness (FMI), adaptive coping styles (AKU), spiritual/religious attitudes in dealing with illness (SpREUK), and interpretation of illness (IIQ) were assessed before, after, and 3 months after the intervention.
Using mixed linear models, significant improvements in global health status, physical functioning, role functioning, emotional functioning, cognitive functioning, and social functioning were found. Cancer-related symptoms, including fatigue, pain, insomnia, constipation, anxiety, and depression, also improved significantly. Mindfulness, life satisfaction, health satisfaction, all coping styles, all spiritual/religious attitudes, and interpretation of illness as something of value increased; interpretation of illness as punishment decreased significantly (all p < 0.05). Improved outcomes were associated with increases in psychological variables, mainly life satisfaction, health satisfaction, and trust in medical help