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This randomized controlled trial was conducted to evaluate the effects of a 3‐month‐long Chan‐Chuang qigong program on patients' physical performance and quality of life while excluding the influence caused by the progression of their cognitive impairment. Patients with mild to moderate cognitive impairment were recruited from two dementia daycare centers in Taiwan. The control group (n = 41) received the standardized plan of treatment, and the qigong group (n = 39) received the standardized plan of treatment plus the Chan‐Chuang qigong program. The outcomes were muscle strength, muscle endurance, exercise capacity, and quality of life. After controlling for the progression of cognitive impairment, the qigong group showed significant improvements over the control group and baseline in muscle strength and exercise capacity at Months 2 and 3 (p < 0.05) and in muscle endurance at Months 1, 2, and 3 (p < 0.05). The Cognitron test scores were significantly associated with muscle strength (p = 0.03), whereas the Corsi block‐tapping test scores were significantly associated with exercise capacity (p = 0.001). Furthermore, a significant between‐group difference was detected in the physical (p = 0.01), not mental (p = 0.83), component of quality of life. The 3‐month Chan‐Chuang qigong program can be applied for patients with mild to moderate cognitive impairment as complementary therapy to improve their muscle strength, muscle endurance, exercise capacity, and physical quality of life. This program should be practiced for at least 2 months to achieve satisfactory results. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of mindful walking practice on the exercise capacity of patients with chronic obstructive pulmonary disease (COPD). Design: A randomised controlled trial with four repeated measurements. Setting: Outpatient departments of a medical centre in northern Taiwan. Participants: Patients with mild to severe COPD. Intervention: The control group received usual care, whereas the mindful walking group received usual care plus undertook a mindful walking practice. Outcome measures: The main outcome was the six-minute walk distance. And the Global Initiative for Chronic Obstructive Lung Disease classification, dyspnoea, heart rate variability and interoceptive awareness were control factors. Results: Compared with the control group (n = 40), the mindful walking group (n = 38) achieved a significantly longer six-minute walk distance (longer by 45.57 m; P = 0.04). The interaction effect of the six-minute walk distance significantly increased on Week 4 (P = 0.01), Week 8 (P = 0.002) and Week 12 (P = 0.02). Participants in Global Initiative for Chronic Obstructive Lung Disease class A exhibited significantly improved six-minute walk distance compared with those in class D (P = 0.001). Moreover, scores on the emotional awareness scale of interoceptive awareness were significantly associated with the six-minute walk distance (P = 0.02). Conclusion: The eight-week mindful walking practice improved the exercise capacity of patients with COPD, and its effect was sustained for at least four weeks after the end of the practice. This study suggest that this practice improved COPD symptoms, reduced COPD risk and increased the interoceptive awareness of this population. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of a 12-week breathing-based leg exercises program on quality of life under stabilizing heart rate variability and reducing fatigue in regular hemodialysis patients. Design: Randomized controlled trial. Setting: A 94-bed hemodialysis department at a medical center in northern Taiwan. Participants: Eighty-six patients with end-stage renal disease undergoing hemodialysis were recruited and randomly assigned to the ExBr or control groups. Interventions: The breathing-based leg exercises program comprised abdominal breathing and low-intensity leg exercise, including leg lifts, quadriceps femoris contraction and knee flexion, and lasted for 15 minutes at one time, three times a week for 12 weeks. Main measure: Data was collected by using the World Health Organization quality of life assessment-brief, physiological signal recorder for heart rate variability and hemodialysis-related fatigue scale at baseline and on Week 4, Week 8, and Week 12. Results: Average (standard deviation) age was 53.70 (10.04) years in the ExBr group and 61.19 (10.19) years in the control group. The linear mixed model with adjusted age, creatinine, heart rate variability and fatigue revealed that the ExBr group had significantly higher quality of life than did the control group (P = 0.01), especially on Week 12 (P = 0.04). Fatigue was significantly correlated with quality of life (P < 0.001). Conclusion: This study supported the benefits of the continued breathing-based leg exercises during hemodialysis for at least 12 weeks, which improved the quality of life of patients with end-stage renal disease and did not affect the stability of their vital signs. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of intradialytic cycling exercise on physical functional performance with gain in muscle strength and endurance in end-stage renal disease patients with haemodialysis. Design: Randomized controlled trial, with repeated measurements at baseline and after 4, 8, and 12 weeks of intradialytic cycling exercise. Setting: A 50-bed haemodialysis centre in a regional hospital in Taiwan. Subjects: Seventy-six regular haemodialysis patients, recruited and equally and randomly assigned to exercise and control groups. Intervention: The intradialytic cycling exercise was performed for 12 weeks and comprised warm-up, main, and cool-down exercise phases. A stationary cycling equipment was used, which involved aerobic and resistance modalities. The intensity was maintained at somewhat hard exertion. Each intradialytic cycling exercise was implemented for 30 minutes, starting at the second hour of treatment. Main measure: Measured outcomes were 6-minute walk distance, time taken to complete 10 sit-to-stand-to-sit cycles and number of sit-to-stand-to-sit cycles in 60 seconds. Results: Average (standard deviation) participant age was 55.47 (13.00) years. Therefore, the 6-minute walk distance was significantly different at weeks 8 (P = 0.01) and 12 (P < 0.001) in the exercise group compared with that in the control group at baseline. Notably, sit-to-stand-to-sit outcomes (P = 0.01) significantly influenced the 6-minute walk distance. Sit-to-stand-to-sit outcomes significantly improved in the exercise group (P < 0.05). Conclusion: Twelve-week intradialytic exercise for patients on haemodialysis can improve physical functional performance with gain muscle strength and endurance. This is a safe and effective method for improving health. [ABSTRACT FROM AUTHOR]

Background: Stroke, a medical condition that causes physical disability and mental health problems, impacts negatively on quality of life. Post-stroke rehabilitation is critical to restoring quality of life in these patients. Objectives: This study was designed to evaluate the effect of a mind–body interactive qigong intervention on the physical and mental aspects of quality of life, considering bio-physiological and mental covariates in subacute stroke inpatients. Methods: A randomized controlled trial with repeated measures design was used. A total of 68 participants were recruited from the medical and rehabilitation wards at a teaching hospital in northern Taiwan and then randomly assigned either to the Chan-Chuang qigong group, which received standard care plus a 10-day mind–body interactive exercise program, or to the control group, which received standard care only. Data were collected using the National Institutes of Health Stroke Scale, Hospital Anxiety and Depression Scale, Short Form-12, stroke-related neurologic deficit, muscular strength, heart rate variability and fatigue at three time points: pre-intervention, halfway through the intervention (day 5) and on the final day of the intervention (day 10). Results: The results of the mixed-effect model analysis showed that the qigong group had a significantly higher quality of life score at day 10 (p <0.05) than the control group. Among the covariates, neurologic deficit (p =0.04), muscle strength (p =0.04), low frequency to high frequency ratio (p =0.02) and anxiety (p =0.04) were significantly associated with changes in quality of life. Conversely, heart rate, heart rate variability (standard deviation of normal-to-normal intervals, low frequency and high frequency), fatigue and depression were not significantly associated with change in quality of life (p >0.05). Conclusions: This study supports the potential benefits of a 10-day mind–body interactive exercise (Chan-Chuang qigong) program for subacute stroke inpatients and provides information that may be useful in planning adjunctive rehabilitative care for stroke inpatients. [ABSTRACT FROM AUTHOR]

Hemorrhoidectomy is the current best treatment for severe hemorrhoids, but it causes significant postoperative pain and anxiety, which is associated with heart rate variability (HRV). Transcutaneous acupoint electrical stimulation (TAES) was assumed to alleviate pain and anxiety, and modify the autonomic nervous system. This study aimed to examine the effects of TAES intervention on postoperative pain, anxiety, and HRV in patients who received a hemorrhoidectomy. A randomized-controlled trial with five repeated measures was conducted. The TAES group (n = 39) received four 20-min sessions of electrical stimulation at chengshan (BL57) and erbai (EX-UE2) after hemorrhoidectomy, whereas the control group (n = 41) did not. Data were collected using Visual Analogue Scale (VAS), State Anxiety Inventory (STAI), and HRV physiological signal monitor. TAES resulted in a significant group difference in pain scores, anxiety levels, and some HRV parameters. The findings indicate that TAES can help reduce pain and anxiety associated with hemorrhoidectomy. TAES is a noninvasive, simple, and convenient modality for post-hemorrhoidectomy-associated pain control and anxiety reduction. [ABSTRACT FROM AUTHOR]

Background: Numerous studies have demonstrated autonomic abnormalities in various pain conditions. However, few have investigated heart rate variability (HRV) in young women with primary dysmenorrhea, and the conclusions have been inconsistent. More evidence is required to confirm the reported trend for consistent fluctuation of HRV parameters in dysmenorrhea. Purpose: The study’s aim was to determine whether significant differences exist between young women with and without dysmenorrhea for heart rate (HR), blood pressure (BP), and HRV parameters during menses. Design: A prospective comparison design with repeated measures was used. Setting and participants: Sixty-six women aged 18–25 with dysmenorrhea and 54 eumenorrheic women were recruited from a university in northern Taiwan. Methods: High-frequency and low-frequency HRV parameters (HF and LF), LF/HF ratio, BP, and HR were measured daily between 8 p.m. and 10 p.m. from Day 1 to Day 6 during menses. The generalized estimating equation was used to analyze the effects of group, time, and Group × Time interaction on these variables. Results: HF values were significantly lower in the dysmenorrhea than in the eumenorrhea group, but there were no differences in BP, HR, LF, or LF/HF ratio. Conclusion: Reduced HF values reflect reduced parasympathetic activity and autonomic instability in young women with dysmenorrhea. Future longitudinal studies are warranted to examine autonomic regulation in menstrual pain of varying intensities associated with dysmenorrhea-related symptoms and to clarify the causal relationship between dysmenorrhea and HRV fluctuations. [ABSTRACT FROM AUTHOR]

Auricular acupoint stimulation has become a popular weight loss method. However, its efficacy for obesity treatment has not been fully studied. This study aimed to investigate the effect of a 10-week intervention of auricular electrical stimulation combined with auricular acupressure on weight reduction in obese outpatients. In this single-blind randomized sham-controlled study, 134 participants were randomly assigned to an experimental group receiving stimulation at true acupoints, or a sham group receiving stimulation delivered in the same manner but at sham acupoints. Each participant received nutrition counseling by a nutritionist weekly. The results showed significant differences in body mass index, blood pressure, total cholesterol, triglyceride, and leptin or adiponectin over time within the group, but not between the groups. This study could not exclude the effect of placebo and dietary consultation. Further study that adds a control group receiving no treatment is therefore needed to confirm the effects of auricular acupressure. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this study was to investigate the effects of a cognitive behavioural intervention combined with a breathing relaxation exercise on sleep quality and heart rate variability in patients with major depression. Background Depression is a long-lasting illness with significant effects not only in individuals themselves, but on their family, work and social relationships as well. Cognitive behavioural therapy is considered to be an effective treatment for major depression. Breathing relaxation may improve heart rate variability, but few studies have comprehensively examined the effect of a cognitive behavioural intervention combined with relaxing breathing on patients with major depression. Design An experimental research design with a repeated measure was used. Methods Eighty-nine participants completed this study and entered data analysed. The experimental group ( n = 43) received the cognitive behavioural intervention combined with a breathing relaxation exercise for four weeks, whereas the control group ( n = 46) did not. Sleep quality and heart rate variability were measured at baseline, posttest1, posttest2 and follow-up. Data were examined by chi-square tests, t-tests and generalised estimating equations. Results After adjusting for age, socioeconomic status, severity of disease and psychiatric history, the quality of sleep of the experimental group improved, with the results at posttest achieving significance. Heart rate variability parameters were also significantly improved. Conclusions This study supported the hypothesis that the cognitive behavioural intervention combined with a breathing relaxation exercise could improve sleep quality and heart rate variability in patients with major depression, and the effectiveness was lasting. Relevance to clinical practice The cognitive behavioural intervention combined with a breathing relaxation exercise that included muscle relaxation, deep breathing and sleep hygiene could be provided with major depression during hospitalisation. Through group practice and experience sharing, participants could modulate their heart rate variability and share feeling about good sleep as well relaxation. [ABSTRACT FROM AUTHOR]

Abstract: Background: Critical thinking (CT) is essential to the exercise of professional judgment. As nurses face increasingly complex health-care situations, critical thinking can promote appropriate clinical decision-making and improve the quality of nursing care. Objectives: This study aimed to evaluate the effects of a program of case studies, alone (CS) or combined with concept maps (CSCM), on improving CT in clinical nurses. Design: The study was a randomized controlled trial. The experimental group participated in a 16-week CSCM program, whereas the control group participated in a CS program of equal duration. Methods: A randomized-controlled trial with a multistage randomization process was used to select and to assign participants, ultimately resulting in 67 nurses in each group. Data were collected before and after the program using the California Critical Thinking Skill Test (CCTST) and the California Critical Thinking Disposition Inventory (CCTDI). Results: After the programs, there were significant differences between the two groups in the critical thinking skills of analysis, evaluation, inference, deduction, and induction. There was also an overall significant difference, and a significant difference in the specific disposition of open-mindedness. Conclusions: This study supports the application of case studies combined with concept maps as a hospital-based teaching strategy to promote development of critical thinking skills and encourage dispositions for nurses. The CSCM resulted in greater improvements in all critical thinking skills of as well as the overall and open-minded affective dispositions toward critical thinking, compared with the case studies alone. An obvious improvement in the CSCM participants was the analytic skill and disposition. Further longitudinal studies and data collection from multisite evaluations in a range of geographic locales are warranted. [Copyright &y& Elsevier]

Abstract: Background: Smoking plays a disease-related risk factor and is however the principal cause of preventable death. Many studies support the use of combined rather than single interventions to stop smoking. Objective: This study aimed to evaluate the effects of auricular acupressure combined with multimedia instruction in comparison with auricular acupressure alone on smoking cessation in young adults. Method: A quasi-experimental research design was used and participants were assigned to experimental groups according to their preference. Group 1 received the 10-week program with auricular acupressure plus multimedia instruction; Group 2 received auricular acupressure alone. Thirty-two participants were in each group were recruited from universities in Taiwan. The physical and psychological data were collected right before and after the program. Results: This study demonstrated the effects of smoking cessation on physical and psychological factors in each group. Statistical between-group differences existed in psychological factors of smoking cessation self-efficacy and nicotine dependence, but not in physical factors of carbon monoxide and cotinine. Conclusions: This study adds to the body of research on the benefits of using auricular acupressure combined with or without multimedia instruction for smoking cessation in adolescents. The combined intervention was more effective especially in increasing smoking cessation self-efficacy and decreasing nicotine dependence. Further study is suggested adding control groups such as placebo in order to understand a single effect of smoking cessation. [Copyright &y& Elsevier]