Blood pressure, salivary cortisol, and inflammatory cytokine outcomes in senior female cancer survivors enrolled in a tai chi chih randomized controlled trial
- 621 Downloads
Older cancer survivors are a vulnerable population due to an increased risk for chronic diseases (e.g., cardiovascular disease) compounded with treatment late-effects and declines in physical functioning. Therefore, interventions that reduce chronic disease risk factors (i.e., blood pressure, chronic inflammation, and cortisol) are important in this population. Tai chi chih (TCC) is a mind-body exercise associated with reductions in chronic disease risk factors, but has not been examined with older cancer survivors. In a feasibility randomized controlled trial of TCC, we examined secondary outcomes of blood pressure, salivary cortisol, and inflammatory cytokines (interleukin (IL)-6, IL-12, tumor necrosis factor-α, IL-10, IL-4) due to their implications in chronic diseases.
Sixty-three senior female cancer survivors (M age = 67 years, SD = 7.15) with physical functioning limitations (SF-12 physical functioning ≤80 or role-physical ≤72) were randomized to 12-weeks (60-min, three times a week) of TCC or Health Education control (HEC) classes. Resting blood pressure, 1-day salivary cortisol samples, and fasting plasma samples for cytokine multiplex assays were collected at baseline and 1-week post-intervention.
Controlling for baseline values, the TCC group had significantly lower systolic blood pressure (SBP, p = 0.002) and cortisol area-under-curve (AUC, p = 0.02) at post-intervention than the HEC group. There was no intervention effect on inflammatory cytokines (p’s > 0.05).
This TCC feasibility trial was associated with significant reductions in SBP and cortisol AUC in senior female cancer survivors. Larger, definitive trials are needed to confirm these findings.
Implications for Cancer Survivors
Senior survivors’ have an increased risk for chronic diseases; however, TCC interventions may help reduce associated risk factors.
KeywordsSenior cancer survivors Tai Chi Chih Randomized controlled trial Blood pressure Cortisol Inflammatory cytokines
Preparation of this manuscript was funded by a National Institutes of Health National Center for Complementary and Alternative Medicine Research Fellowship in Complementary and Alternative Medicine (T-32 AT00378) at the University of North Carolina for the first author (R.A. Campo). The Health Education and Active Living in Surviving Seniors (HEALS) Project was funded by a grant from the National Cancer Institute (R21CA135250) awarded to Dr. Anita Kinney and by the Huntsman Cancer Foundation. Additional support was provided by the Shared Resources (P30 CA042014) for use of the Research Informatics Shared Resource and the Study Design and Biostatistics Center. Additionally, the Linda B. and Robert B. Wiggins Wellness-Survivorship Center at Huntsman Cancer Institute provided support for the study physical assessments. This content is solely the responsibility of the authors and does not necessarily represent the official views of the funding and supporting agencies. We thank the Associated Regional and University Pathologists’ Institute for Clinical and Experimental Pathology at the University of Utah and the Kirschbaum Biopsychology Laboratory at Technical University of Dresden, Germany for assays of the inflammatory cytokines and cortisol samples, respectively.
Conflict of interest
All authors declare that they have no conflict of interest.
- 2.ACS. Cancer treatment and survivorship facts & Figs. 2012–2013. Atlanta: American Cancer Society; 2012.Google Scholar
- 10.Patnaik JL, Byers T, DiGuiseppi C, Dabelea D, Denberg TD. Cardiovascular disease competes with breast cancer as the leading cause of death for older females diagnosed with breast cancer: a retrospective cohort study. Breast Cancer Res. 2011;13(3):R64. doi: 10.1186/bcr2901.PubMedCentralCrossRefPubMedGoogle Scholar
- 12.Weaver KE, Foraker RE, Alfano CM, Rowland JH, Arora NK, Bellizzi KM, et al. Cardiovascular risk factors among long-term survivors of breast, prostate, colorectal, and gynecologic cancers: a gap in survivorship care? J Cancer Surviv. 2013;7(2):253–61. doi: 10.1007/s11764-013-0267-9.PubMedCentralCrossRefPubMedGoogle Scholar
- 17.Irwin ML, Smith AW, McTiernan A, Ballard-Barbash R, Cronin K, Gilliland FD, et al. Influence of pre- and postdiagnosis physical activity on mortality in breast cancer survivors: the health, eating, activity, and lifestyle study. J Clin Oncol. 2008;26(24):3958–64. doi: 10.1200/JCO.2007.15.9822.PubMedCentralCrossRefPubMedGoogle Scholar
- 22.Hui SS, Woo J, Kwok T. Evaluation of energy expenditure and cardiovascular health effects from tai chi and walking exercise. Hong Kong Med J Xianggang Hong Kong Acad Med. 2009;15 Suppl 2:4–7.Google Scholar
- 28.Janelsins MC, Davis PG, Wideman L, Katula JA, Sprod LK, Peppone LJ, et al. Effects of tai chi chuan on insulin and cytokine levels in a randomized controlled pilot study on breast cancer survivors. Clin Breast Cancer. 2011;11(3):161–70. doi: 10.1016/j.clbc.2011.03.013.PubMedCentralCrossRefPubMedGoogle Scholar
- 29.Lavretsky H, Alstein LL, Olmstead RE, Ercoli LM, Riparetti-Brown M, Cyr NS, et al. Complementary use of Tai Chi chih augments escitalopram treatment of geriatric depression: a randomized controlled trial. Am J Geriatr Psychiatr. 2011;19(10):839–50. doi: 10.1097/JGP.0b013e31820ee9ef.CrossRefGoogle Scholar
- 35.Peppone LJ, Mustian KM, Janelsins MC, Palesh OG, Rosier RN, Piazza KM, et al. Effects of a structured weight-bearing exercise program on bone metabolism among breast cancer survivors: a feasibility trial. Clin Breast Cancer. 2010;10(3):224–9. doi: 10.3816/CBC.2010.n.030.PubMedCentralCrossRefPubMedGoogle Scholar
- 45.Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon 3rd RO, Criqui M, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003;107(3):499–511.CrossRefPubMedGoogle Scholar
- 49.Daher IN, Daigle TR, Bhatia N, Durand JB. The prevention of cardiovascular disease in cancer survivors. Tex Heart Inst J, St Luke’s Episcopal Hosp, Tex Child Hosp. 2012;39(2):190–8.Google Scholar
- 62.Aardal E, Holm AC. Cortisol in saliva—reference ranges and relation to cortisol in serum. Eur J Clin Chem Clin Biochem: J Forum Eur Clin Chem Soc. 1995;33(12):927–32.Google Scholar
- 69.Christian LM, Deichert NT, Gouin J-P, Graham JE, Kiecolt-Glaser JK. Psychological influences on neuroendocrine and immune outcomes. In: Berntson JTCGG, editor. Handbook of neuroscience for the behavioral sciences. Hoboken: Wiley; 2009. p. 1260–79.Google Scholar
- 70.Carlson LE, Speca M, Faris P, Patel KD. One year pre-post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients. Brain Behav Immun. 2007;21(8):1038–49. doi: 10.1016/j.bbi.2007.04.002.CrossRefPubMedGoogle Scholar