Lifestyle Related Research from Pubmed

Lifestyle counseling in primary care: opportunities and challenges for changing practice.

Med Teach. 2008;30(2):185-191

Authors: Sargeant J, Valli M, Ferrier S, Macleod H

Background: Many patients today have health concerns related to lifestyle factors. This has created a situation where physicians are regularly confronted with the challenge of how to conduct lifestyle counseling with patients. Specific strategies can enable physicians to more effectively navigate this complex area of communication with patients, improving patient response in adopting healthy behaviours and increasing physician satisfaction with this task. Aim: To evaluate the impact of a lifestyle counseling workshop incorporating the motivational enhancement and transtheoretical models upon primary care clinicians' counseling practice patterns, especially communication and counseling skills, and attitudes toward lifestyle counseling. Method: This study used a mixed method research design. Forty-three clinicians completed a post-workshop evaluation and identified intended changes to practice following the workshop. Twelve participated in interviews several months later to explore the kinds of changes made and influences upon them. Results: Forty-one (95.3%) questionnaire respondents reported an intention to change their practice. Main changes reported were: asking more questions, listening more, assessing patients' readiness to change, tailoring counseling to patients' readiness to change. They seemed to have acquired and retained new knowledge and most were able to apply the new skills in their practices. Many reported feeling more comfortable and/or confident when interacting with patients in need of lifestyle change. But, time constraints, comfort with current skills, lack of self-efficacy, and fears of missing opportunities to influence patients, moderated participants' ability to adopt and maintain new approaches. Conclusions: While primary care clinicians can successfully learn specific lifestyle counseling skills and incorporate them into their practice following a two-hour evidence-based workshop, individual, educational and system factors can interfere.

PMID: 18464145 [PubMed - as supplied by publisher]

[Alternative and complementary therapies in fibromyalgia syndrome.]

Schmerz. 2008 May 9;

Authors: Langhorst J, Häuser W, Irnich D, Speeck N, Felde E, Winkelmann A, Lucius H, Michalsen A, Musial F

INTRODUCTION: Interdisciplinary S3 level guidelines were devised in cooperation with 8 medical, 2 psychological and 2 patient support groups. Results were elaborated in a multilevel group process. METHODS: On the bases of the "Cochrane Library" (1993-2006), "Medline" (1980-2006), "PsychInfo" (2006) and "Scopus" (2006) controlled studies and meta-analyses of controlled studies were analyzed. RESULTS: Only few controlled studies were found supporting in part the effectiveness of CAM therapies in the treatment of fibromyalgia syndrome. Due to the lack of information on long term efficacy and cost-effectiveness, only limited recommendations for CAM therapies can be given. CONCLUSION: Within a multicomponent therapy setting, selective CAM therapies (acupuncture, vegetarian diet, homeopathy, Tai Chi, Qi Gong, music-oriented and body-oriented therapies) can be recommended for a limited period of time.

PMID: 18463899 [PubMed - as supplied by publisher]

Treating the climacteric symptoms in Indian women with an integrated approach to yoga therapy: a randomized control study.

Menopause. 2008 May 6;

Authors: Chattha R, Raghuram N, Venkatram P, Hongasandra NR

OBJECTIVE:: To study the effect of yoga on the climacteric symptoms, perceived stress, and personality in perimenopausal women. DESIGN:: One hundred twenty participants (ages 40-55 y) were randomly divided into two study arms, ie, yoga and control. The yoga group practiced an integrated approach to yoga therapy comprising surya namaskara (sun salutation) with 12 postures, pranayama (breathing practices), and avartan dhyan (cyclic meditation), whereas the control group practiced a set of simple physical exercises under supervision of trained teachers for 8 weeks (1 h daily, 5 days per week). The assessments were made by Greene Climacteric Scale, Perceived Stress Scale, and Eysenck's Personality Inventory before and after the intervention. RESULTS:: Of the three factors of the Greene Climacteric Scale, the Mann-Whitney test showed a significant difference between groups (P < 0.05) in the vasomotor symptoms, a marginally significant difference (P = 0.06) in psychological factors but not in the somatic component. Effect sizes were higher in the yoga group for all factors. There was a significantly greater degree of decrease in Perceived Stress Scale scores (P < 0.001, independent samples t test) in the yoga group compared with controls (between-group analysis) with a higher effect size in the yoga group (1.10) than the control (0.27). On the Eysenck's Personality Inventory, the decrease in neuroticism was greater (P < 0.05) in the yoga group (effect size = 0.43) than the control group (effect size = 0.21) with no change in extroversion in either the yoga or control group. CONCLUSIONS:: Eight weeks of an integrated approach to yoga therapy decreases climacteric symptoms, perceived stress, and neuroticism in perimenopausal women better than physical exercise.

PMID: 18463543 [PubMed - as supplied by publisher]

Pilot of 'Families for Health': community-based family intervention for obesity.

Arch Dis Child. 2008 May 7;

Authors: Robertson W, Friede T, Blissett J, Rudolf MC, Wallis MA, Stewart-Brown S

OBJECTIVE: To develop and evaluate 'Families for Health' - a new community based family intervention for childhood obesity. DESIGN: Programme development, pilot study and evaluation using intention-to-treat analysis. SETTING: Coventry, England PARTICIPANTS: 27 overweight or obese children aged 7-13 years (18 girls, 9 boys) and their parents, from 21 families. INTERVENTION: 'Families for Health' is a 12 week programme with parallel groups for parents and children, addressing parenting, lifestyle change and social & emotional development. MAIN OUTCOME MEASURES: Primary: change in baseline BMI z-score at end of programme (3 months) and 9 month follow-up. Attendance, drop-out, parents' perception of programme, child's quality of life and self esteem, parental mental health, parent-child relationships and lifestyle changes were also measured. RESULTS: Attendance rate was 62%, with 18 of the 27 (67%) children completing the programme. For the 22 children with follow-up data (including 4 drop-outs), BMI z-score was reduced by -0.18 (95%CI -0.30 to -0.05) at end of programme and by -0.21 (-0.35 to -0.07) at 9 months. Statistically significant improvements were observed in children's quality of life and lifestyle (reduced sedentary behaviour, increased steps and reduced exposure to unhealthy foods), child-parent relationships and parents' mental health. Fruit and vegetable consumption, participation in moderate/vigorous exercise and children's self-esteem did not change significantly. Topics on parenting skills, activity and food were rated as helpful and were used with confidence by the majority of parents. CONCLUSIONS: Families for Health is a promising new childhood obesity intervention. Definitive evaluation of its clinical effectiveness by randomised controlled trial is now required.

PMID: 18463121 [PubMed - as supplied by publisher]

A randomised trial of a 5 week, manual based, self-management programme for hypertension delivered in a cardiac patient club in Shanghai.

BMC Cardiovasc Disord. 2008 May 6;8(1):10

Authors: Xue F, Yao W, Lewin RJ

ABSTRACT: BACKGROUND: In Shanghai there are 1.2 million people with hypertension, many of whom have difficulty in affording medical treatment. Community based, anti-hypertensive clubs have been created to provide health education but education alone is often ineffective. Lifestyle change programmes have shown some potential for reducing blood pressure but in previous trials have required specialist staff and extensive contact. We have previously demonstrated that self-management programmes delivered by health professionals, such as a nurse who has had short training in self-management techniques can change health behaviour and reduce symptoms. This study was designed to evaluate the benefits of a simple, cognitive-behavioural, self-management programme for hypertension based around a hypertension manual and delivered in the setting of a community anti-hypertensive club in Shanghai. METHOD: The method was a pragmatic randomised controlled trial with an intention-to-treat analysis. Adult patients with mild-to-moderate primary hypertension, waiting to join a neighbourhood anti-hypertension club, were randomised to the self-management programme or to an information only control procedure. They attended the group treatment sessions on 4 occasions over 5 weeks for education combined with goal setting for lifestyle change and an introduction to exercise. The main outcome measures were: changes in blood pressure; blood total cholesterol; diet; activity level and health related quality of life 1 month and 4 months after the end of treatment. RESULTS: A total of 140 adults with mild-to-moderate primary hypertension took part. All of the main outcomes showed beneficial changes. Four months after the end of treatment the mean blood pressure differences between groups were systolic 10.15 mm Hg (P<0.001, 95% CI 7.25-13.05), and diastolic 8.29 mmHg (P<0.001, 95% CI 6.71-9.88). Patients in the intervention group also had significantly reduced weight, lowered blood total cholesterol, increased physical activity and improved quality of life. CONCLUSIONS: Patients with mild-to-moderate primary hypertension attending a 5 week, group and manual based, cognitive-behavioural self-management programme, delivered through a voluntary club in Shanghai experienced a significant reduction in blood pressure.

PMID: 18460201 [PubMed - as supplied by publisher]

[Educational approach to patients with cardiovascular risk factors]

Rev Med Suisse. 2008 Mar 12;4(148):657-60

Authors: Auer R, Morin D, Darioli R, Cornuz J, Rodondi N

In the outpatient setting, the long-term management of cardiovascular risk factors is essential to prevent recurrent cardiovascular disease. Recent studies have shown an additional benefit of beginning cardiovascular secondary prevention during the hospital stay. Early, in-hospital initiation of proven beneficial medications, such as aspirin or blood lipid lowering drugs and therapeutic lifestyle change counseling, improves patients' long-term outcome, as long as there is continuity of care in the outpatient setting. A recent hospitalization may be a teachable moment, when patients are more likely to modify their health behaviors. The continuity of care between in-hospital medicine and the outpatient setting helps patients in the long-term management of their cardiovascular disease.

PMID: 18459661 [PubMed - in process]

Meditation with yoga, group therapy with hypnosis, and psychoeducation for long-term depressed mood: a randomized pilot trial.

J Clin Psychol. 2008 May 5;

Authors: Butler LD, Waelde LC, Hastings TA, Chen XH, Symons B, Marshall J, Kaufman A, Nagy TF, Blasey CM, Seibert EO, Spiegel D

This randomized pilot study investigated the effects of meditation with yoga (and psychoeducation) versus group therapy with hypnosis (and psychoeducation) versus psychoeducation alone on diagnostic status and symptom levels among 46 individuals with long-term depressive disorders. Results indicate that significantly more meditation group participants experienced a remission than did controls at 9-month follow-up. Eight hypnosis group participants also experienced a remission, but the difference from controls was not statistically significant. Three control participants, but no meditation or hypnosis participants, developed a new depressive episode during the study, though this difference did not reach statistical significance in any case. Although all groups reported some reduction in symptom levels, they did not differ significantly in that outcome. Overall, these results suggest that these two interventions show promise for treating low- to moderate-level depression. (c) 2008 Wiley Periodicals, Inc. J Clin Psychol 64(7): 1-15, 2008.

PMID: 18459121 [PubMed - as supplied by publisher]

Effects of tai chi on gait kinematics, physical function, and pain in elderly with knee osteoarthritis - a pilot study.

Am J Chin Med. 2008;36(2):219-32

Authors: Shen CL, James CR, Chyu MC, Bixby WR, Brismée JM, Zumwalt MA, Poklikuha G

Our previous study has demonstrated that 6 weeks of Tai Chi exercise significantly improves knee pain and stiffness in elderly with knee osteoarthritis. This study also examine the effects of Tai Chi exercise on gait kinematics, physical function, pain, and pain self-efficacy in elderly with knee osteoarthritis. In this prospective, pretest-posttest clinical trial, 40 men and women (64.4 +/- 8.3 years) diagnosed with knee osteoarthritis participated in 6 weeks of instructed Tai Chi training, 1 hour/session, 2 sessions/week. The following measures were taken at baseline and the conclusion of the intervention: (a) gait kinematics including stride length, stride frequency, and gait speed quantified using video analysis, (b) physical function, (c) knee pain, and (d) pain self-efficacy. Data were analyzed using repeated MANCOVA, MANOVA, ANOVA and Wilcoxon tests. After 6 weeks of Tai Chi exercise, stride length (p = 0.023; 1.17 +/- 0.17 vs. 1.20 +/- 0.14 m), stride frequency (p = 0.014; 0.91 +/- 0.08 vs. 0.93 +/- 0.08 strides/s), and consequently gait speed (p < 0.025; 1.06 +/- 0.19 vs. 1.12 +/- 0.15 m/s) increased in the participants. Physical function was significantly improved (p < 0.001) and knee pain was significantly decreased (p = 0.002), while no change was observed in pain self-efficacy. In conclusion, these findings support that Tai Chi is beneficial for gait kinematics in elderly with knee osteoarthritis, and a longer term application is needed to substantiate the effect of Tai Chi as an alternative exercise in management of knee osteoarthritis.

PMID: 18457357 [PubMed - in process]

Dietary Triggers of Abdominal Symptoms in Patients With Irritable Bowel Syndrome: Randomized Placebo-Controlled Evidence.

Clin Gastroenterol Hepatol. 2008 May 2;

Authors: Shepherd SJ, Parker FC, Muir JG, Gibson PR

BACKGROUND & AIMS: Observational studies suggest dietary fructose restriction might lead to sustained symptomatic response in patients with irritable bowel syndrome (IBS) and fructose malabsorption. The aims of this study were first to determine whether the efficacy of this dietary change is due to dietary fructose restriction and second to define whether symptom relief was specific to free fructose or to poorly absorbed short-chain carbohydrates in general. METHODS: The double-blinded, randomized, quadruple arm, placebo-controlled rechallenge trial took place in the general community. The 25 patients who had responded to dietary change were provided all food, low in free fructose and fructans, for the duration of the study. Patients were randomly challenged by graded dose introduction of fructose, fructans, alone or in combination, or glucose taken as drinks with meals for maximum test period of 2 weeks, with at least 10-day washout period between. For the main outcome measures, symptoms were monitored by daily diary entries and responses to a global symptom question. RESULTS: Seventy percent of patients receiving fructose, 77% receiving fructans, and 79% receiving a mixture reported symptoms were not adequately controlled, compared with 14% receiving glucose (P </= 0.002, McNemar test). Similarly, the severity of overall and individual symptoms was significantly and markedly less for glucose than other substances. Symptoms were induced in a dose-dependent manner and mimicked previous IBS symptoms. CONCLUSIONS: In patients with IBS and fructose malabsorption, dietary restriction of fructose and/or fructans is likely to be responsible for symptomatic improvement, suggesting efficacy is due to restriction of poorly absorbed short-chain carbohydrates in general.

PMID: 18456565 [PubMed - as supplied by publisher]

Type 2 diabetes mellitus is associated with multiple cardiometabolic risk factors.

Clin Cornerstone. 2007;8(3):53-68

Authors: Gerich JE

The risk for cardiovascular disease (CVD) is multifactorial and includes such risk factors as diabetes, hypertension, smoking, and dyslipidemia. Thus, targeting the hyperglycemia in type 2 diabetes mellitus (DM) alone will not eliminate all of the excess cardiovascular risk; rather aggressive treatment is needed for all of the modifiable cardiometabolic risk factors. Therapeutic lifestyle change is considered primary therapy for hyperglycemia in type 2 DM. Currently, however, the focus in treatment is on preventing CVD rather than controlling glucose, lipid, or blood pressure (BP) levels. The American Diabetes Association guidelines identify low-density lipoprotein cholesterol as the first priority of lipid lowering, with optimal level set at <100 mg/dL (2.6 mmol/L). To reach the target BP level of <130/85 mm Hg, >65% of patients with DM and hypertension will require 2 or more different antihypertensive drugs. Strategies that combine thiazolidinediones and statins may have complementary effects on cardiovascular risk-factor profiles in type 2 DM, in addition to controlling glycemia. Despite the range of treatment options available, therapeutic agents that target new steps in the progression of CVD are needed, as patients with type 2 DM remain at increased risk and many do not achieve therapeutic targets with the drugs available.

PMID: 18452842 [PubMed - in process]

Self-reported prevalence and awareness of metabolic syndrome: findings from SHIELD.

Int J Clin Pract. 2008 Apr 29;

Authors: Lewis SJ, Rodbard HW, Fox KM, Grandy S,

Purpose: This study assessed awareness of metabolic syndrome and evaluated health knowledge, attitudes and behaviours of respondents at risk. Methods: Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD), a longitudinal US population-based survey initiated in 2004, included respondents, >/= 18 years of age, reporting a diagnosis of metabolic syndrome. Prevalence of metabolic syndrome was compared in SHIELD and National Health and Nutrition Examination Survey (NHANES) 1999-2002 survey. The proportion of SHIELD respondents who had heard of and/or understood metabolic syndrome was estimated. Respondents at high risk for metabolic syndrome were stratified into attitude-behaviour categories of 'Already Doing It', 'I Know I Should' and 'Don't Bother Me' and differences in attitudes and behaviours were evaluated with chi-square tests. Results: Prevalence of reported metabolic syndrome was 0.6% in SHIELD screening questionnaire respondents (n = 211,097) vs. 25.9% in NHANES (n = 10,780). Less than 15% of SHIELD baseline questionnaire respondents (n = 22,001) had heard of or understood metabolic syndrome. Attitudes toward health status were more favourable in the 'Doing' group (27% reported fair/poor health) compared with those in the 'Should' (38%) and 'Don't' (54%) groups (p < 0.0001). The 'Don't' group was most likely to prefer medications to lifestyle change (13% vs. 2-4%) compared with 'Should' and 'Doing' groups (p < 0.0001). More 'Doing' respondents (79%) than 'Should' (59%) and 'Don't' (48%) respondents reported exercising regularly (p < 0.0001). Conclusions: The lack of knowledge about metabolic syndrome reported in SHIELD indicates limited penetration of this concept into public awareness. With behaviour categories, respondents who report healthy attitudes are more likely to embrace lifestyle changes, while respondents who do not care may be more difficult to treat.

PMID: 18452535 [PubMed - as supplied by publisher]

Use of Complementary and Alternative Therapies by Overweight and Obese Adults.

Obesity (Silver Spring). 2008 May 1;

Authors: Bertisch SM, Wee CC, McCarthy EP

Objective:Obesity is associated with higher health-care costs due, in part, to higher use of traditional health care. Few data are available on the relationship between obesity and the use of complementary and alternative medicine (CAM).Methods and Procedures:We analyzed data on CAM use from the 2002 National Health Interview Survey (NHIS) Alternative Medicine Supplement (n = 31,044). We compared the use of CAM overall, within the past 12 months, between normal weight (BMI from 18 to <25), overweight (from 25 to <30), mildly obese (from 30 to <35), moderately obese (from 35 to <40), and extremely obese (>40) adults. For the primary analysis, our multivariable model was adjusted for sociodemographic factors, insurance status, medical conditions, and health behaviors. We performed additional analyses to explore the association of BMI and the use of seven CAM modalities.Results:We found that adults with obesity have lower prevalence of use of yoga therapy, and similar prevalence of use of several CAM modalities, including relaxation techniques, natural herbs, massage, chiropractic medicine, tai chi, and acupuncture, compared to normal-weight individuals. After adjustment for sociodemographic factors, insurance status, medical conditions, and health behaviors, adults with obesity were generally less likely to use most individual CAM modalities, although the magnitude of these differences were quite modest in many cases.Discussion:Even though adults with obesity have a greater illness burden and higher utilization of traditional medical care, adults with higher BMIs were no more likely to use each of the individual CAM therapies studied. Additional research is needed to improve our understanding of CAM use by adults with obesity.Obesity (2008) doi:10.1038/oby.2008.239.

PMID: 18451783 [PubMed - as supplied by publisher]

Trying to Lose or Maintain Weight During Pregnancy-United States, 2003.

Matern Child Health J. 2008 May 1;

Authors: Bish CL, Chu SY, Shapiro-Mendoza CK, Sharma AJ, Blanck HM

Objectives Current pregnancy weight gain recommendations are for women to gain between 15 and 40 pounds; weight loss or weight maintenance is not recommended. However, for many women, overweight and obesity are chronic conditions, and commitment to weight loss or maintenance could override advice to gain weight during pregnancy. Our objective was to determine the prevalence of trying to lose or maintain weight among U.S. women during pregnancy. Methods The Behavioral Risk Factor Surveillance System is a state-based, random-digit-dialed telephone survey of noninstitutionalized, U.S. civilians aged >/=18 years. We identified women aged 18-44 years who reported being pregnant during 2003 (n = 2,464), assessed the prevalence of trying to lose or maintain weight and assessed independent associations with selected demographic, clinical, and behavioral factors using multinomial logistic regression. Results Among women who reported being pregnant, 7.5% (confidence interval [CI] = 5.7-9.8%) and 34.3% (CI = 31.0-37.7%) were trying to lose or maintain weight, respectively. Among women who reported trying to lose or maintain weight, exercise was a more prevalent weight control strategy than dietary change. After adjustment, women who drank alcohol during the past 30 days (Odds ratio [OR] = 8.86, CI: 4.51-17.42) or women who received advice in the past year to lose weight (OR = 9.10, CI: 3.20-25.87) were more likely to report trying to lose weight; women advised to maintain (OR = 0.20, CI: 0.07-0.60) or gain (OR = 0.04, CI: 0.01-0.23) weight were less likely to report trying to lose weight. Conclusions Despite guidelines to gain weight during pregnancy, about 8% and 34% of U.S. pregnant women reported trying to lose or maintain weight, respectively. Providers may encounter an increasing number of pregnant women whose weight control intentions conflict with current guidelines for pregnancy weight gain. Further research in this area is warranted.

PMID: 18449630 [PubMed - as supplied by publisher]

Impact of breathing awareness meditation on ambulatory blood pressure and sodium handling in prehypertensive African American adolescents.

Ethn Dis. 2008;18(1):1-5

Authors: Barnes VA, Pendergrast RA, Harshfield GA, Treiber FA

OBJECTIVES: This study evaluated the impact of a breathing awareness meditation (BAM) program on ambulatory blood pressure and sodium handling in African American adolescents with high-normal systolic blood pressure (SBP) levels. DESIGN AND METHODS: Following three consecutive days of SBP screenings, 66 eligible ninth graders were randomly assigned by school to either BAM (n = 20) or health education control (n = 46) groups. The BAM group engaged in 10-minute BAM sessions at school and at home each day for three months. Teachers conducted sessions at school during health classes. Before and after the intervention, overnight urine samples were collected, and ambulatory SBP, diastolic blood pressure, and heart rate were recorded periodically for 24 hours. RESULTS: Significant changes before and after the intervention were observed between BAM and control groups for SBP during school hours (-4.7 vs .9 mm Hg, P < .05), SBP at night (-4.8 vs -.6 mm Hg, P < .01), and heart rate during school hours (-6.7 vs -2.3 bpm, P < .02), adjusted for their respective preintervention levels. The overnight urinary sodium excretion rate decreased in the BAM group but increased in the control group (-.3 +/- 4.9 vs 1.1 +/- 4.0 mEq/hour, P < .03). CONCLUSIONS: These findings demonstrate the potential beneficial impact of BAM taught by school health teachers on blood pressure control in the natural environment in African American youth at risk for development of hypertension.

PMID: 18447091 [PubMed - in process]

Potential role of mind-body therapies in cancer survivorship.

Cancer. 2008 Apr 21;

Authors: Monti DA, Sufian M, Peterson C

The use of complementary and alternative medicine (CAM) by cancer survivors is high, particularly among those with psychosocial distress, poor quality of life, culturally based health beliefs, and those who experience health disparities in the mainstream healthcare system. As the number of cancer survivors continues to increase, so does the diversity of the survivorship population, making it increasingly important to understand and address the CAM culture in different survivor groups. Given the known communication barriers between cancer patients and their physicians regarding CAM, it would be useful for oncology providers to have a platform from which to discuss CAM-related issues. It is proposed that mind-body therapies with some basis in evidence could provide such a platform and also serve as a possible means of connecting cancer survivors to psychosocial supportive services. This article reviews a few mind-body therapies that may have particular relevance to cancer survivors, such as hypnosis and meditation practices. A theoretical foundation by which such therapies provide benefit is presented, with particular emphasis on self-regulation. Cancer 2008. (c) 2008 American Cancer Society.

PMID: 18428193 [PubMed - as supplied by publisher]

Menopause, the metabolic syndrome, and mind-body therapies.

Menopause. 2008 Apr 17;

Authors: Innes KE, Selfe TK, Taylor AG

Cardiovascular disease risk rises sharply with menopause, likely due to the coincident increase in insulin resistance and related atherogenic changes that together comprise the metabolic or insulin resistance syndrome, a cluster of metabolic and hemodynamic abnormalities strongly implicated in the pathogenesis and progression of cardiovascular disease. A growing body of research suggests that traditional mind-body practices such as yoga, tai chi, and qigong may offer safe and cost-effective strategies for reducing insulin resistance syndrome-related risk factors for cardiovascular disease in older populations, including postmenopausal women. Current evidence suggests that these practices may reduce insulin resistance and related physiological risk factors for cardiovascular disease; improve mood, well-being, and sleep; decrease sympathetic activation; and enhance cardiovagal function. However, additional rigorous studies are needed to confirm existing findings and to examine long-term effects on cardiovascular health.

PMID: 18427353 [PubMed - as supplied by publisher]