Bruce Barrett, MD, PhD, Mary S. Hayney, PharmD, Daniel
Muller, MD, PhD, David Rakel, MD, Ann Ward, PhD, Chidi N. Obasi, MD,
Roger Brown, PhD, Zhengjun Zhang, PhD, Aleksandra Zgierska, MD, PhD,
James Gern, MD, Rebecca West, PhD, APRN, Tola Ewers, MS, Shari
Barlow, BA, Michele Gassman, MA, Christopher L. Coe, PhD
Ann Fam Med. 2012;10(4):337-346.
Abstract and Introduction
Abstract
Purpose This study was designed to
evaluate potential preventive effects of meditation or exercise on
incidence, duration, and severity of acute respiratory infection (ARI)
illness.
Methods Community-recruited adults
aged 50 years and older were randomized to 1 of 3 study groups: 8-week
training in mindfulness meditation, matched 8-week training in
moderate-intensity sustained exercise, or observational control. The
primary outcome was area-under-the-curve global illness severity during a
single cold and influenza season, using the Wisconsin Upper Respiratory
Symptom Survey (WURSS-24) to assess severity. Health care visits and
days of missed work were counted. Nasal wash collected during ARI
illness was assayed for neutrophils, interleukin-8, and viral nucleic
acid.
Results Of 154 adults randomized into
the study, 149 completed the trial (82% female, 94% white, mean age
59.3 ± 6.6 years). There were 27 ARI episodes and 257 days of ARI
illness in the meditation group (n = 51), 26 episodes and 241 illness
days in the exercise group (n = 47), and 40 episodes and 453 days in the
control group (n = 51). Mean global severity was 144 for meditation,
248 for exercise, and 358 for control. Compared with control, global
severity was significantly lower for meditation (
P = .004). Both global severity and total days of illness (duration) trended toward being lower for the exercise group (
P=.16 and
P=.032, respectively), as did illness duration for the meditation group (
P=.034).
Adjusting for covariates using zero-inflated multivariate regression
models gave similar results. There were 67 ARI-related days of-work
missed in the control group, 32 in the exercise group (
P = .041), and 16 in the meditation group (
P
<.001). Health care visits did not differ significantly. Viruses
were identified in 54% of samples from meditation, 42% from exercise,
and 54% from control groups. Neutrophil count and interleukin-8 levels
were similar among intervention groups.
Conclusions Training in meditation or exercise may be effective in reducing ARI illness burden.
Introduction
Acute respiratory infection (ARI) is
extremely common, often debilitating, and among the most costly of human
illnesses. Influenza, the most serious of the viral ARIs, is associated
with approximately 36,000 deaths and more than 500,000 hospitalizations
in the United States yearly.
[1] Nevertheless, symptoms of influenza infection are usually indistinguishable from those produced by other viruses.
[2,3]
In the United States each year, noninfluenza ARI accounts for more than
20 million doctor visits and 40 million lost school and work days, with
an economic impact of more than $40 billion, making noninfluenza ARI
rank first in the top 10 most expensive illnesses.
[4] Reducing this burden even modestly could lead to substantial economic and quality-of-life benefits.
Available treatments are not very effective. If started early enough, antiviral medications have limited efficacy for influenza,
[5]
but not for other viral ARIs. Symptomatic treatments may reduce
severity slightly but have never been shown to reduce illness duration
or overall severity. Influenza vaccination is accepted as effective for
prevention,
[6] but it is imperfect, with sero-protection
rates ranging from 60% to 80% in healthy younger adults and 40% to 60%
in the elderly.
[7] For noninfluenza ARI, immunization strategies are impractical, and preventive strategies are limited to not smoking,
[8] hand washing,
[9] and avoiding sick contacts.
There is some evidence that enhancing general
physical and mental health may reduce ARI burden. In a series of
observational and viral inoculation studies, perceived stress,
[10] negative emotion,
[11] and lack of social support
[12]
predicted not only self-reported illness, but also such biomarkers as
viral shedding and inflammatory cytokine activity. Evidence suggests
that mindfulness meditation can reduce experienced stress and negative
emotions.
[13,14] Similarly, both epidemiological and
experimental studies have suggested that regular exercise may protect
people from ARI illness.
[15,16] A recent observational cohort
study (n = 1,002 adults) reported 32% to 46% lower incidence, duration,
and severity of ARI illness among the most active vs least active
participants.
[17] Thus, sufficient evidence exists to justify
testing the hypothesis that training in meditation or exercise can
reduce susceptibility to ARI illness.
