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Menopause. Author manuscript; available in PMC 2010 January 25.
Published in final edited form as:
PMCID: PMC2810543
NIHMSID: NIHMS151542

Menopause, the metabolic syndrome, and mind-body therapies

Kim E. Innes, MSPH, PhD, Terry Kit Selfe, DC, PhD, and Ann Gill Taylor, MS, EdD

Abstract

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.

Keywords: Menopause, Metabolic syndrome, Cardiovascular disease, Yoga, Tai chi, Qigong, Mind-body, Insulin resistance

Menopause represents a period of accelerated physical, physiological, and neuroendocrine aging in women. The constellation of adverse changes that occurs in response to the altered hormonal environment characterizing menopause, especially the sharp decline in estrogens that marks this transition, results in a dramatic rise in the risk of cardiovascular disease (CVD),1,2 currently the leading cause of death in US women.35 This precipitous increase in CVD risk likely reflects the coincident rise in the prevalence of specific metabolic and hemodynamic abnormalities related to insulin resistance and strongly predictive of CVD, collectively termed metabolic or insulin resistance syndrome (IRS).3,610 Insulin resistance (ie, resistance to insulin-stimulated glucose uptake) is generally considered the primary defect underlying IRS and is a cardinal feature linking IRS with the development of atherosclerosis and CVD.11,20 Insulin resistance is a strong independent risk factor for CVD in both diabetic21 and nondiabetic individuals2127 and has been causally linked to elevated blood pressure,13,28,30 dyslipidemia,13,31,32 inflammation,19,33 impaired fibrinolysis, 13,19 endothelial dysfunction,13,19,32,34 sympathetic activation, 13,29,34 and other indices of CVD risk.13,18,19 Insulin resistance increases dramatically with menopause,1,6,7,35,36 and is considered to be a key factor underlying the abrupt increase in CVD risk among women after menopause.6,36,37

Other related changes associated with menopause include increases in blood pressure,1,7,38,40 visceral adiposity,1,7,36 proinflammatory cytokines,2,7,36 and oxidative stress;41,42 reductions in glucose tolerance1 and heart rate variability;4345 atherogenic changes in lipid and coagulation profiles;1,68,46,47 and impairment of endothelial function.1,6 Postmenopausal women also demonstrate reduced insulin-like growth factor-1 bioavailability,48 a factor that may contribute to insulin resistance, impaired lipid metabolism, and other IRS-related abnormalities12,4953 and play an important role in the pathogenesis of CVD5456 and other IRS-associated disorders.57 In addition, menopause has been independently associated with increased arterial stiffness (measured as brachial-ankle pulse-wave velocity),58,59 a factor that has been strongly linked to insulin resistance6063 and the IRS.60,64

Menopause has also been associated with an increase in plasma catecholamines,65 resting heart rate44,66 and other markers of sympathetic activity,44,66 a rise in neuroendocrine and cardiovascular reactivity,44,6769 and a reduction in parasympathetic tone,44,45 factors strongly implicated in the pathogenesis of both IRS and CVD.7075 In addition, the menopause transition is often accompanied by depressive symptoms, including tension, anger, anxiety, and irritability,7679 which have been attributed in part to neuroendocrine dysregulation.76 Such negative affective states are strongly associated with insulin resistance and other components of the IRS in a bidirectional manner80 and are powerful predictors of CVD.73,8186 Sleep disturbance in women also rises dramatically during the midlife years87 and is likewise thought to reflect sympathetic hyperactivity.70 Sleep deprivation has been experimentally shown to promote insulin resistance and other features of IRS70,88,89 and has been indirectly linked to CVD morbidity and mortality.90,91 Figure 1 summarizes the key IRS-related changes that characterize menopause and are linked to increased risk of atherosclerosis and CVD.

FIG. 1
Change in cardiovascular risk profiles with menopause. HRV, heart rate variability; IGF-1, insulin-like growth factor 1; IRS, insulin resistance syndrome.

Given that IRS-related abnormalities increase so strikingly with menopause and that the association between IRS and risk of CVD is particularly strong among middle-aged women,3 identifying potential cost-effective strategies for reducing IRS-related risk factors for CVD in postmenopausal women is clearly warranted. Given the importance of neuroendocrine changes, sympathetic activation, and psychosocial factors in the development of insulin-resistant states and the synergistic, mutually exacerbating effects of these and other IRS-related risk factors, mind-body therapies may have promise for the prevention of CVD and other insulin resistance conditions in women post-menopause. One mind-body therapy that merits further investigation as a health promotion and therapeutic measure for older women is yoga. Yoga is an ancient discipline that is fast gaining popularity among women of all ages in Western industrialized countries as a means of reducing stress, improving emotional well-being, and enhancing health and fitness.9295 Widely used in India to help prevent and manage a variety of chronic insulin resistance conditions,9698 yoga may also offer a cost-effective intervention for at-risk Western populations. A growing body of research suggests that yoga-based interventions can improve cardiovascular risk profiles and aid in the management of CVD and other IRS-related conditions in a wide range of populations, including older women.96,97 Similarly, recent studies indicate that certain other traditional mind-body practices such as tai chi chuan and qigong may also reduce risk for CVD and related disorders.96,99102 In the following sections, we review the evidence regarding the potential beneficial effects of these traditional active mind-body modalities on CVD risk profiles.

EFFECTS OF YOGA ON CVD RISK

Originating in India at least 4000 years ago, yoga is a traditional mind-body discipline that has been successfully used in India for the prevention and management of hypertension, diabetes, and related chronic insulin resistance conditions associated with aging.94,96,97 There is increasing evidence, reviewed in detail elsewhere,96,97 suggesting that even the short-term practice of yoga can decrease both psychological and physiological risk factors for CVD and may attenuate signs, reduce complications, and improve the prognosis of those with clinical or underlying disease.94,96,97 For example, controlled studies of both healthy and chronically ill adults in India, the United States, Europe, and Thailand indicate that yoga may improve glucose tolerance and serum lipid profiles96,97 reduce blood pressure and body weight,96,97,103,104 decrease oxidative stress,96,97,105 and lower sympathetic reactivity.96,97 Limited data on healthy Indian and German adults also suggest that yoga practice may improve coagulation profiles.96,97 In addition, recent studies in Indian and European populations suggest that the practice of yoga and yoga-based meditation can improve heart rate variability and baroreflex sensitivity in both healthy and hypertensive adults.96,97

Similarly, there is a growing body of research suggesting that yoga therapy may also be effective in reducing psychosocial risk factors for CVD in both healthy adults and those with chronic disorders.96,97 For example, recent controlled investigations in India,106116 the United States,117121 Europe,122124 Thailand,104 Israel,125 and Turkey126 have reported decreased perceived stress104,106,107,113,124 and reactivity to stressors,123 enhanced stress-related coping,107,117 reduced symptoms of depression108113,115,120,124,127 and anxiety,108,112,113,117,119,120,124,125,128 and decreased anger114,120,122 and fatigue116,120122,124,126,129 following yoga-based interventions. Likewise, recent studies in India,116,128,130,131 Turkey,126 and the United States132134 have indicated that yoga practice may improve sleep in both healthy116,128,130,133,134 and chronically ill populations.116,126,131,132

Yoga’s rapidly increasing popularity among older women in the Western industrialized world, coupled with the numerous recent studies suggesting that yoga-based programs may improve CVD risk profiles in older adults, indicate that yoga may represent a promising intervention for postmenopausal women at risk for CVD and related chronic disorders.

OTHER TRADITIONAL ACTIVE MIND-BODY THERAPIES TO DECREASE CVD RISK: TAI CHI CHUAN AND QIGONG

Although yoga remains perhaps the most extensively studied mind-body therapy with respect to effects on IRS-related indices of cardiovascular risk, findings from recent clinical trials suggest that other traditional active mind-body modalities, such as tai chi chuan (tai chi) and qigong, may also have promise for the prevention of CVD in postmenopausal women and other at-risk populations.

Internal qigong is a major branch of traditional Chinese medicine135 that originated in China more than 2,500 years ago. Like yoga, qigong has many forms, blending meditation and controlled breathing techniques with precise gentle movements and postures.102,135,136 Qigong has been practiced for hundreds of years by emperors to achieve health and longevity, by monks to attain peace and inner clarity, and by martial artists to increase inner strength and power.135137 Tai chi is an ancient Chinese martial art derived from qigong that traces its origins back to at least the seventh century AD.138 Tai chi is thought to have originated as a formal discipline in the 13th century with the teachings of the legendary Taoist monk Zhang San Feng.138,139 Although there are multiple styles of tai chi (Chen, Yang, Old Wu, Wu, and Sun), all combine deep diaphragmatic breathing with specific postures that are performed in a coordinated, dancelike sequence of slow, graceful movements.101,138,140143 Due to the typically slow pace, gentle nature, and low impact movements characterizing tai chi and qigong, these practices are particularly appropriate for older individuals.144 Qigong and tai chi are practiced widely in China to promote physical, mental, and spiritual health; to improve balance and flexibility; and to enhance memory and concentration.99,102 Like yoga, these ancient practices are also gaining favor in Western industrialized nations as alleged means of reducing stress, enhancing psychological well-being, and improving health and fitness.101,140142,145 The growing popularity of these practices among older adults in the United States and other Western industrialized countries,144146 coupled with recent research involving both healthy141,146152 and chronically ill older women141,153 in Western146,148155 and non-Western populations150 suggest that tai chi and qigong may represent acceptable and attractive interventions for postmenopausal women at risk of CVD.

QIGONG AND CVD RISK

Recent studies from China, Korea, Japan, Sweden, and the United States suggest that qigong may also help to reduce CVD risk in both healthy and chronically ill populations.102,137,156158 For example, recent controlled trials in Chinese and Korean adults with hypertension or CVD suggest that qigong practice may decrease blood pressure,100,135,137,159163 lower fasting cholesterol162 and triglyceride levels159,160 and increase high-density lipoprotein concentrations relative to usual care or waitlist controls135,159161 and baseline values.159,162 In a recent randomized, controlled trial of diabetic adults in Japan, Tsujiuchi et al164 reported significant reductions in glycated hemoglobin and C-peptide in the qigong versus the usual care group. Likewise, uncontrolled studies conducted in China156,159 and Korea165 have demonstrated significant improvements in blood pressure,165 lipid profiles,156 and markers of insulin resistance and glucose tolerance.156,159 Similarly, a recent Hong Kong randomized, controlled trial of qigong in community-dwelling adults with mild hypertension demonstrated significant declines in body mass index, weight, and waist circumference that were comparable to those following a conventional exercise program. 162 Controlled studies investigating the effects of qigong programs in both healthy adults166 and those with hypertension135,161,162 have also reported significant decreases in resting heart rate,162 urinary catecholamine,135,161,166 cortisol levels,161 and other measures of sympathetic activation166 relative to baseline135,161,162 or controls.166

Evidence from recent research suggests that qigong may reduce certain psychosocial risk factors for CVD as well. For example, controlled trials of both healthy adults and adults with chronic conditions162164,167,168 have reported qigong to decrease anxiety163,164 and depression,162,167,168 and to improve mood163,164 and psychological well-being.163,167,168 Similarly, more limited data suggest that qigong may lower perceived stress.158,161,166,169,170

TAI CHI AND CVD RISK

A growing body of research from both Western and Eastern countries offers evidence that the practice of tai chi may also lower CVD risk in older adults.143,145,171 For example, several recent randomized, controlled trials of British and American adults with myocardial infarction;172 healthy American,173 Korean,174 and Taiwanese175 adults with mild to moderate hypertension; and community-dwelling176,177 and frail American elderly178 have reported significant reductions in blood pressure in participants completing a supervised tai chi program relative to baseline,172,173,175 wellness education controls,176,178 or usual care controls.174,177 Likewise, nonrandomized, controlled investigations of healthy middle-aged American women179 and older Chinese adults180 have documented significant declines in blood pressure in those assigned to tai chi versus waitlist179 or no intervention180 control groups. More limited data from both controlled151,175,178,181,182 and uncontrolled studies183 in older American151,178 and Asian populations175,181,183,184 suggest that tai chi practice may also improve lipid profiles,175,183 reduce body mass index,178 enhance endothelial function,181 lower heart rate175,178 and other markers of sympathetic activation,151,182,184 and improve cardiovagal function.151,184 Findings from a recent pre-post investigation in Taiwan suggest that tai chi may also decrease glycated hemoglobin and fasting glucose levels in adults with type 2 diabetes.185

In addition, there is increasing evidence that tai chi may help reduce psychological indices of CVD risk in both Western and non-Western populations.99,145,186 For example, recent controlled studies regarding the effects of tai chi in both healthy and chronically ill older adults have reported tai chi to decrease anxiety101,147,175,180 and depression,174,187,188 to improve mood101,147,174 and psychological well-being,101 and to reduce anger, tension,147,189 and confusion147 relative to exercise,147 education,174 wellness program,188 attention, 189 or waitlist/usual care controls.175,180,187 Similarly, several controlled investigations offer evidence that tai chi may lower perceived stress,101,177 enhance stress-related coping,190 and improve sleep191 relative to exercise191 or usual care/no treatment controls.177,190

LOGISTICAL ADVANTAGES OF TRADITIONAL MIND-BODY THERAPIES AND CURRENT LIMITATIONS IN THE LITERATURE

In addition to the numerous reported health benefits, yoga and other traditional mind-body disciplines have many practical advantages as therapeutic intervention and health promotion measures. These practices are relatively simple to learn and are economical, noninvasive therapies with few side effects and multiple collateral lifestyle benefits.92,94,140,150,192194 Group practice of these ancient disciplines can offer a source of social support, a factor strongly associated with decreased CVD risk.73,195 Group and individual practice may also help to improve lifestyle choices and health-related attitudes, in part by enhancing psychological well-being,195 and thereby contribute significantly to CVD prevention and health promotion.195 In addition, stress reduction programs based on mind-body therapies have been shown to be cost-saving relative to usual treatment for the management of CVD and related conditions. 196 For example, Blumenthal and colleagues196 showed significant reductions in coronary events for patients randomized to a yoga-based stress management intervention and found significant cost savings associated with the program relative to exercise or usual medical care.

Mind-body therapies may also provide an attractive alternative to conventional exercise for many older women. There are mounting data to suggest that older adults, especially older women, may experience greater barriers to initiating and continuing conventional exercise programs than young adults.197,198 Although the Centers for Disease Control and Prevention, the National Institute on Aging, the American College of Sports Medicine, and other national organizations strongly encourage physical activity to enhance health and prevent cardiovascular and other chronic disease, most older women do not engage in regular physical activity.198 In 1998, only 10% of Americans aged 65 to 74 years reported participating in strength or endurance exercise 2 or more days per week, and this figure may be even lower in women.198,199 Among older adults engaged in physical activity, adherence rates indicate only 15% of older women (vs 30% of older men) actually participate in regular sustained activity.200 Moreover, an estimated 50% or more of older adults who begin an exercise program are reported to drop out within the first 6 months,197 with adherence rates much lower in certain populations.197,201,202 Standard exercise programs often require travel, a considerable time commitment, and special clothes, facilities, and/or equipment. 198 Initiation and maintenance of an exercise routine may also be compromised by safety, monetary, hygiene, weather, discomfiture, injury, and other concerns that are particularly important among older women.197,198,203,204 The perceived benefits of standard physical exercise are typically delayed, further discouraging continued practice.197

A growing body of research suggests that yoga, tai chi, qigong, and other active mind-body interventions are readily accepted by older women in both Western and non-Western countries,96,146,150,152,205 and, as documented above, may improve a range of physical, physiological, and mental health outcomes related to cardiovascular risk in older populations. These traditional mind-body therapies are all typically low speed, low impact, and noncompetitive in nature and can be safely practiced even by elderly, ill, unfit, and overweight individuals,92,94,96,99,101,102,140,160,167,206 rendering each appropriate for older sedentary women. These ancient practices can be performed virtually anywhere and for any length of time, an important consideration given that perceived inconvenience and lack of time have been cited as major factors underlying the high attrition often associated with physical activity programs.197,198,204,207,208 In contrast to most conventional Western exercise programs, the practice of yoga and other similar mind-body therapies typically brings immediate positive benefits, including feelings of relaxation and tranquility,123,125,209211 helping to encourage continued adherence. Moreover, even short-term (2–12 weeks) yoga and other active mind-body interventions have been shown to result in significant gains in cardiovascular and psychological health, as well as in flexibility, endurance, and strength,151,161,163,212217 offering powerful incentives for continued practice. Several studies have, in fact, documented excellent adherence and long-term maintenance of benefits among older adults.218222 Thus, a yoga, tai chi, or other traditional active mind-body program, especially one that is specifically designed for older adults and easily performed in the home, may offer an excellent alternative to conventional exercise programs for women post-menopause.

In summary, yoga, tai chi, and qigong may offer acceptable and cost-effective interventions for postmenopausal women and other populations at risk of CVD, IRS, and related insulin resistance conditions, demonstrating promise for the improvement of both psychological and physical health and ultimately for the prevention and management of CVD and associated chronic disorders. However, despite the growing popularity and apparent therapeutic potential of yoga, tai chi, qigong, and other mind-body therapies, rigorous, controlled studies investigating the effects of these practices on CVD risk factors or related clinical endpoints remain relatively few, especially in Western populations. 94,96,100167 Interpretation of many existing studies is also hampered by design and other methodological limitations, including selection bias, small sample sizes, lack of appropriate control groups, lack of randomization, exposure to multiple interventions, failure to adjust for lifestyle characteristics and other potential confounders, inadequacies in statistical analysis and presentation, or other methodological problems.96,97,100102,141,174 In addition, the large variation in the duration, intensity, nature, and delivery methods of the interventions used renders comparisons among studies difficult. Publication bias may also influence the selective reporting of positive results,223 especially in non-Western countries where these disciplines are more widely accepted and more likely to be integrated into healthcare. Few studies have examined the long-term effects of yoga and other mind-body therapies, and the mechanisms underlying the reported benefits associated with these disciplines remain poorly understood. Clearly, additional high-quality research is warranted to confirm and further explore the putative beneficial effects of yoga, tai chi, qigong, and other promising mind-body therapies on CVD risk and to further investigate the potential long-term benefits of and adherence to these therapies, especially in older women in Western countries.

CONCLUSIONS

CVD risk rises sharply with menopause, likely due to the coincident increase in insulin resistance and related atherogenic changes that together comprise IRS, a cluster of metabolic and hemodynamic abnormalities strongly implicated in the pathogenesis and progression of CVD. There is growing evidence that traditional mind-body practices such as yoga, tai chi, and qigong may offer safe and cost-effective strategies for reducing IRS-related risk factors for CVD in older populations, including postmenopausal women. However, additional rigorous studies are needed to confirm existing findings and to examine long-term effects on cardiovascular health.

Acknowledgments

Funding/support: This work was made possible by the University of Virginia Institute on Aging, the National Center for Complementary and Alternative Medicine and Office of Women’s Health (grant R21AT002982 and K01AT004108) and the National Center for Research Resources (grant M01 RR 00030-32). The contents are solely the responsibility of the authors and do not represent the official views of the University of Virginia or the National Institutes of Health.

Footnotes

Financial disclosure: None reported.

REFERENCES

1. Gohlke-Barwolf C. Coronary artery disease-is menopause a risk factor? Basic Res Cardiol. 2000;95 Suppl 1:177–183. [PubMed]
2. Baker L, Meldrum KK, Wang M, et al. The role of estrogen in cardiovascular disease. J Surg Res. 2003;115:325–344. [PubMed]
3. Knopp R. Risk factors for coronary artery disease in women. Am J Cardiol. 2002;89(12 Suppl):28E–35E. [PubMed]
4. Walcott-McQuiggWalcott-McQuigg JA. Psychological factors influencing cardiovascular risk reduction behavior in low and middle income African-American women. J Natl Black Nurses Assoc. 2000;11:27–35. [PubMed]
5. Lewis SJ. Cardiovascular disease in postmenopausal women: myths and reality. Am J Cardiol. 2002;89:5E–11E. [PubMed]
6. Spencer CP, Godsland IF, Stevenson JC. Is there a menopausal metabolic syndrome? Gynecol Endocrinol. 1997;11:341–355. [PubMed]
7. Carr MC. The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab. 2003;88:2404–2411. [PubMed]
8. Simkin-Silverman L, Wing RR, Hansen DH, et al. Prevention of cardiovascular risk factor elevations in healthy premenopausal women. Prev Med. 1995;24:509–517. [PubMed]
9. Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB. The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988–1994. Arch Intern Med. 2003;163:427–436. [PMC free article] [PubMed]
10. Rossi R, Grimaldi T, Origliani G, Fantini G, Coppi F, Modena MG. Menopause and cardiovascular risk. Pathophysiol Haemost Thromb. 2002;32:325–328. [PubMed]
11. Fernandez-Real JM, Ricart W. Insulin resistance and chronic cardiovascular inflammatory syndrome. Endocr Rev. 2003;24:278–301. [PubMed]
12. Byrne CD. Programming other hormones that affect insulin. Br Med Bull. 2001;60:153–171. [PubMed]
13. Innes K, Wimsatt J. Pregnancy-induced hypertension and insulin resistance: evidence for a connection. Acta Obstet Gynecol Scand. 1999;78:263–284. [PubMed]
14. Wheatcroft SB, Williams IL, Shah AM, Kearney MT. Pathophysiological implications of insulin resistance on vascular endothelial function. Diabet Med. 2003;20:255–268. [PubMed]
15. Natali A, Ferrannini E. Hypertension, insulin resistance, and the metabolic syndrome. Endocrinol Metab Clin North Am. 2004;33:417–429. [PubMed]
16. Mallinckrodt CH, Sanger TM, Dube S, et al. Assessing and interpreting treatment effects in longitudinal clinical trials with missing data. Biol Psychiatry. 2003;53:754–760. [PubMed]
17. Leonetti F, Iacobellis G, Zappaterreno A, Di Mario U. Clinical, physiopathological and dietetic aspects of metabolic syndrome. Dig Liver Dis. 2002;34 Suppl 2:S134–S139. [PubMed]
18. Festa A, D’Agostino R, Jr, Mykkanen L, et al. LDL particle size in relation to insulin, proinsulin, and insulin sensitivity. The Insulin Resistance Atherosclerosis Study. Diabetes Care. 1999;22:1688–1693. [PubMed]
19. Steinbaum SR. The metabolic syndrome: an emerging health epidemic in women. Prog Cardiovasc Dis. 2004;46:321–336. [PubMed]
20. Reaven GM. Pathophysiology of insulin resistance in human disease. Physiol Rev. 1995;75:473–486. [PubMed]
21. Kendall DM, Harmel AP. The metabolic syndrome, type 2 diabetes, and cardiovascular disease: understanding the role of insulin resistance. Am J Managed Care. 2002;8(20 Suppl):S635–S657. [PubMed]
22. Reaven GM. Insulin resistance/compensatory hyperinsulinemia, essential hypertension, and cardiovascular disease. J Clin Endocrinol Metab. 2003;88:2399–2403. [PubMed]
23. Hanley AJ, Williams K, Stern MP, Haffner SM. Homeostasis model assessment of insulin resistance in relation to the incidence of cardiovascular disease: the San Antonio Heart Study. Diabetes Care. 2002;25:1177–1184. [PubMed]
24. Snell-Bergeon JK, Hokanson JE, Kinney GL, et al. Measurement of abdominal fat by CT compared to waist circumference and BMI in explaining the presence of coronary calcium. Int J Obes Relat Metab Disord. 2004;28:1594–1599. [PubMed]
25. McLaughlin T, Allison G, Abbasi F, Lamendola C, Reaven G. Prevalence of insulin resistance and associated cardiovascular disease risk factors among normal weight, overweight, and obese individuals. Metabolism. 2004;53:495–499. [PubMed]
26. Facchini FS, Stoohs RA, Reaven GM. Enhanced sympathetic nervous system activity: the linchpin between insulin resistance, hyperinsulinemia, and heart rate. Am J Hypertens. 1996;9:1013–1017. [PubMed]
27. Bonora E, Zavaroni I, Alpi O, et al. Influence of the menstrual cycle on glucose tolerance and insulin secretion. Am J Obstet Gynecol. 1987;157:140–141. [PubMed]
28. Busija DW, Miller AW, Katakam P, Simandle S, Erdos B. Mechanisms of vascular dysfunction in insulin resistance. Curr Opin Invest Drugs. 2004;5:929–935. [PubMed]
29. Imazu M. Hypertension and insulin disorders. Curr Hypertens Rep. 2002;4:477–482. [PubMed]
30. Sowers JR, Frohlich ED. Insulin and insulin resistance: impact on blood ressure and cardiovascular disease. Med Clin North Am. 2004;88:63–82. [PubMed]
31. Grundy S. Hypertriglyceridemia, insulin resistance, and the metabolic yndrome. Am J Cardiol. 1999;83 Suppl 9B:25F–29F. [PubMed]
32. Eschwège E. The dysmetabolic syndrome, insulin resistance and increased cardiovascular (CV) morbidity and mortality in type 2 diabetes: aetiological factors in the development of CV complications. Diabetes Metab. 2003;29(4 Pt 2):6S18–6S27. [PubMed]
33. Caballero AE. Endothelial dysfunction in obesity and insulin resistance: a road to diabetes and heart disease. Obes Res. 2003;11:1278–1289. [PubMed]
34. Ramos F, Baglivo HP, Ramirez AJ, Sanchez R. The metabolic syndrome and related cardiovascular risk. Curr Hypertens Rep. 2001;3:100–106. [PubMed]
35. Mercuro G, Zoncu S, Dragoni F. Gender differences in cardiovascular risk factors. Ital Heart J. 2003;4:363–366. [PubMed]
36. Sites CK, Toth MJ, Cushman M, et al. Menopause-related differences in inflammation markers and their relationship to body fat distribution and insulin-stimulated glucose disposal. Fertil Steril. 2002;77:128–135. [PubMed]
37. Signorelli SS, Neri S, Sciacchitano S, et al. Duration of menopause and behavior of malondialdehyde, lipids, lipoproteins and carotid wall artery intima-media thickness. Maturitas. 2001;39:39–42. [PubMed]
38. August P, Oparil S. Hypertension in women. J Clin Endocrinol Metab. 1999;84:1862–1866. [PubMed]
39. Scuteri A, Ferrucci L. Blood pressure, arterial function, structure, and aging: the role of hormonal replacement therapy in postmenopausal women. J Clin Hypertens. 2003;5:219–225. [PubMed]
40. Wyss JM, Carlson SH. Effects of hormone replacement thrapy on the sympathetic nervous system and blood pressure. Curr Hypertens Rep. 2003;5:241–246. [PubMed]
41. Kawano H, Yasue H, Hirai N, et al. Effects of transdermal and oral estrogen supplementation on endothelial function, inflammation and cellular redox state. Int J Clin Pharmacol Ther. 2003;41:346–353. [PubMed]
42. Wassmann S, Baumer AT, Strehlow K, et al. Endothelial dysfunction and oxidative stress during estrogen deficiency in spontaneously hypertensive rats. Circulation. 2001;103:435–441. [PubMed]
43. Brockbank CL, Chatterjee F, Bruce SA, Woledge RC. Heart rate and its variability change after the menopause. Exp Physiol. 2000;85:327–330. [PubMed]
44. Farag NH, Bardwell WA, Nelesen RA, Dimsdale JE, Mills PJ. Autonomic responses to psychological stress: the influence of menopausal status. Ann Behav Med. 2003;26:134–138. [PubMed]
45. Rosano GM, Patrizi R, Leonardo F, et al. Effect of estrogen replacement therapy on heart rate variability and heart rate in healthy postmenopausal women. Am J Cardiol. 1997;80:815–817. [PubMed]
46. Evans EM, Van Pelt RE, Binder EF, Williams DB, Ehsani AA, Kohrt WM. Effects of HRT and exercise training on insulin action, glucose tolerance, and body composition in older women. J Appl Physiol. 2001;90:2033–2040. [PubMed]
47. Kuller LH, Simkin-Silverman LR, Wing RR, Meilahn EN, Ives DG. Women’s Healthy Lifestyle Project: a randomized clinical trial–results at 54 months. Circulation. 2001;103:32–37. [PubMed]
48. Landin-Wilhelmsen K, Wilhelmsen L, Bengtsson BA. Postmenopausal osteoporosis is more related to hormonal aberrations than to lifestyle factors. Clinical Endocrinology. 1999;51(4):387–394. [PubMed]
49. Vickers M, Ikensaio B, Breier B. IGF-1 treatment reduces hyperphagia, obesity, and hypertension in metabolic disorders induced by fetal programming. Endocrinology. 2001;142:3964–3973. [PubMed]
50. Ren J, Samson WK, Sowers JR. Insulin-like growth factor I as a cardiac hormone: physiological and pathophysiological implications in heart disease. J Mol Cell Cardiol. 1999;31:2049–2061. [PubMed]
51. Wold LE, Muralikrishnan D, Albano CB, Norby FL, Ebadi M, Ren J. Insulin-like growth factor I (IGF-1) supplementation prevents diabetes-induced alterations in coenzymes Q9 and Q10. Acta Diabetol. 2003;40:85–90. [PubMed]
52. Clemmons DR. The relative roles of growth hormone and IGF-1 in controlling insulin sensitivity. J Clin Invest. 2004;113:25–27. [PMC free article] [PubMed]
53. Kolaczynski JW, Caro JF. Insulin-like growth factor-1 therapy in diabetes: physiologic basis, clinical benefits, and risks. Ann Intern Med. 1994;120:47–55. [PubMed]
54. Juul A, Scheike T, Davidsen M, Gyllenborg J, Jorgensen T. Low serum insulin-like growth factor I is associated with increased risk of ischemic heart disease: a population-based case-control study. Circulation. 2002;106:939–944. [PubMed]
55. Khan AS, Sane DC, Wannenburg T, Sonntag WE. Growth hormone, insulin-like growth factor-1 and the aging cardiovascular system. Cardiovasc Res. 2002;54:25–35. [PubMed]
56. Innes K, Weitzel L, Laudenslager M. Altered metabolic profiles among older mothers with a history of preeclampsia. Gynecol Obstet Invest. 2005;59:192–201. [PubMed]
57. McEwen B, Magarinos A, Reagan L. Studies of hormone action in the hippocampal formation: possible relevance to depression and diabetes. J Psychosom Res. 2002;53:883–890. [PubMed]
58. Zaydun G, Tomiyama H, Hashimoto H, et al. Menopause is an independent factor augmenting the age-related increase in arterial stiffness in the early postmenopausal phase. Atherosclerosis. 2006;184:137–142. [PubMed]
59. Takahashi K, Miura S, Mori-Abe A, et al. Impact of menopause on the augmentation of arterial stiffness with aging. Gynecol Obstet Invest. 2005;60:162–166. [PubMed]
60. Sipila K, Koivistoinen T, Moilanen L, et al. Metabolic syndrome and arterial stiffness: the Health 2000 Survey. Metabolism. 2007;56:320–326. [PubMed]
61. Seo HS, Kang TS, Park S, et al. Insulin resistance is associated with arterial stiffness in nondiabetic hypertensives independent of metabolic status. Hypertens Res. 2005;28:945–951. [PubMed]
62. Kasayama S, Saito H, Mukai M, Koga M. Insulin sensitivity independently influences brachial-ankle pulse-wave velocity in non-diabetic subjects. Diabet Med. 2005;22:1701–1706. [PubMed]
63. Nestel P. Relationship between arterial stiffness and glucose metabolism in women with metabolic syndrome. Clin Exp Pharmacol Physiol. 2006;33:883–886. [PubMed]
64. Kim YK. Impact of the metabolic syndrome and its components on pulse wave velocity. Korean J Intern Med. 2006;21:109–115. [PubMed]
65. Menozzi R, Cagnacci A, Zanni AL, Bondi M, Volpe A, Del Rio G. Sympathoadrenal response of postmenopausal women prior and during prolonged administration of estradiol. Maturitas. 2000;34:275–281. [PubMed]
66. Rosano GM, Rillo M, Leonardo F, Pappone C, Chierchia SL. Palpitations: what is the mechanism, and when should we treat them? Int J Fertil Womens Med. 1997;42:94–100. [PubMed]
67. Saab PG, Matthews KA, Stoney CM, McDonald RH. Premenopausal and postmenopausal women differ in their cardiovascular and neuro-endocrine responses to behavioral stressors. Psychophysiology. 1989;26:270–280. [PubMed]
68. Lindheim SR, Legro RS, Bernstein L, et al. Behavioral stress responses in premenopausal and postmenopausal women and the effects of estrogen. Am J Obstet Gynecol. 1992;167:1831–1836. [PubMed]
69. Owens JF, Stoney CM, Matthews KA. Menopausal status influences ambulatory blood pressure levels and blood pressure changes during mental stress. Circulation. 1993;88:2794–2802. [PubMed]
70. Egan BM. Insulin resistance and the sympathetic nervous system. Curr Hypertens Rep. 2003;5:247–254. [PubMed]
71. Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation. 1999;99:2192–2217. [PubMed]
72. Singh RB, Kartik C, Otsuka K, Pella D, Pella J. Brain-heart connection and the risk of heart attack. Biomed Pharmacother. 2002;56 Suppl 2:257s–265s. [PubMed]
73. Bunker SJ, Colquhoun DM, Esler MD, et al. “Stress” and coronary heart disease: psychosocial risk factors. Med J Aust. 2003;178:272–276. [PubMed]
74. Bjorntorp P, Holm G, Rosmond R, Folkow B. Hypertension and the metabolic syndrome: closely related central origin? Blood Press. 2000;9:71–82. [PubMed]
75. Hjemdahl P. Stress and the metabolic syndrome: an interesting but enigmatic association. Circulation. 2002;106:2634–2636. [PubMed]
76. Rajewska J, Rybakowski JK. Depression in premenopausal women: gonadal hormones and serotonergic system assessed by D-fenfluramine challenge test. Prog Neuropsychopharmacol Biol Psychiatry. 2003;27:705–709. [PubMed]
77. Joffe H, Soares CN, Cohen LS. Assessment and treatment of hot flushes and menopausal mood disturbance. Psychiatr Clin North Am. 2003;26:563–580. [PubMed]
78. Cramer EH, Jones P, Keenan NL, Thompson BL. Is naturopathy as effective as conventional therapy for treatment of menopausal symptoms? J Altern Complement Med. 2003;9:529–538. [PubMed]
79. Carrasco GA, Van de Kar LD. Neuroendocrine pharmacology of stress. Eur J Pharmacol. 2003;463:235–272. [PubMed]
80. Raikkonen K, Matthews KA, Kuller LH. The relationship between psychological risk attributes and the metabolic syndrome in healthy women: antecedent or consequence? Metabolism. 2002;51:1573–1577. [PubMed]
81. Ariyo A, Haan M, Tangen C, et al. Depressive symptoms and risks of coronary heart disease and mortality in elderly Americans. Cardiovascular Health Study Collaborative Research Group. Circulation. 2000;102:1773–1791. [PubMed]
82. Kop WJ. The integration of cardiovascular behavioral medicine and psychoneuroimmunology: new developments based on converging research fields. Brain Behav Immunity. 2003;17:233–237. [PubMed]
83. Pickering T, Clemow L, Davidson K, Gerin W. Behavioral cardiology: has its time finally arrived? Mt Sinai J Med. 2003;70:101–112. [PubMed]
84. Everson SA, Kaplan GA, Goldberg DE, Salonen R, Salonen JT. Hopelessness and 4-year progression of carotid atherosclerosis. The Kuopio Ischemic Heart Disease Risk Factor Study. Arterioscler Thromb Vasc Biol. 1997;17:1490–1495. [PubMed]
85. Todaro JF, Shen BJ, Niaura R, Spiro A, III, Ward KD. Effect of negative emotions on frequency of coronary heart disease (The Normative Aging Study) Am J Cardiol. 2003;92:901–906. [PubMed]
86. Severus W, Littman A, Stoll A. Omega-3 fatty acids, homocysteine, and the increased risk of cardiovascular mortality in major depressive disorder. Harv Rev Psychiatry. 2001;9:280–293. [PubMed]
87. Clark AJ, Flowers J, Boots L, Shettar S. Sleep disturbance in mid-life women. J Adv Nurs. 1995;22:562–568. [PubMed]
88. Boethel CD. Sleep and the endocrine system: new associations to old diseases. Curr Opin Pulm Med. 2002;8:502–505. [PubMed]
89. Akerstedt T, Nilsson PM. Sleep as restitution: an introduction. J Intern Med. 2003;254:6–12. [PubMed]
90. Knutsson A. Shift work and coronary heart disease. Scand J Soc Med Suppl. 1989;44:1–36. [PubMed]
91. Nilsson PM, Nilsson JA, Hedblad B, Berglund G. Sleep disturbance in association with elevated pulse rate for prediction of mortality: consequences of mental strain? J Intern Med. 2001;250:521–529. [PubMed]
92. Garfinkel M, Schumacher HJ. Yoga. Rheum Dis Clin North Am. 2000;26:125–132. [PubMed]
93. Chandler K. The emerging field of yoga therapy. Hawaii Med J. 2001;60:286–287. [PubMed]
94. Raub J. Psychophysiologic effects of hatha yoga on musculoskeletal and cardiopulmonary function: a literature review. J Altern Complement Med. 2002;8:797–812. [PubMed]
95. Saper R, Eisenberg D, Davis R, Culpepper L, Phillips R. Prevalence and patterns of adult yoga use in the United States: results of a national survey. Altern Ther Health Med. 2004;10:44–49. [PubMed]
96. Innes K, Bourguignon C, Taylor A. Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga: a systematic review. J Am Board Fam Pract. 2005;18:491–519. [PubMed]
97. Innes K, Vincent H. The influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus: a systematic review. Evid Based Complement Altern Med. 2007;4:469–486. [PMC free article] [PubMed]
98. Innes K, Vincent H, Taylor A. Chronic stress and insulin-resistance-related indices of cardiovascular disease risk, part II: a potential role for mind-body therapies. [erratum appears in Altern Ther Health Med 2007;13:15] Altern Ther Health Med. 2007;13:44–51. [PubMed]
99. Lan C, Lai JS, Chen SY. Tai chi chuan: an ancient wisdom on exercise and health promotion. Sports Med. 2002;32:217–224. [PubMed]
100. Mayer M. Qigong and hypertension: a critique of research. J Altern Complement Med. 1999;5:371–382. [PubMed]
101. Wang C, Collet JP, Lau J. The effect of tai chi on health outcomes in patients with chronic conditions: a systematic review. Arch Intern Med. 2004;164:493–501. [PubMed]
102. Kemp CA. Qigong as a therapeutic intervention with older adults. J Holistic Nurs. 2004;22:351–373. [PubMed]
103. Gupta N, Khera S, Vempati RP, Sharma R, Bijlani RL. Effect of yoga based lifestyle intervention on state and trait anxiety. Indian J Physiol Pharmacol. 2006;50:41–47. [PubMed]
104. McCaffrey R, Ruknui P, Hatthakit U, Kasetsomboon P. The effects of yoga on hypertensive persons in Thailand. Holistic Nurs Pract. 2005;19:173–180. [PubMed]
105. Yadav RK, Ray RB, Vempati R, Bijlani RL. Effect of a comprehensive yoga-based lifestyle modification program on lipid peroxidation. Indian J Physiol Pharmacol. 2005;49:358–362. [PubMed]
106. Walia IJ, Mehra P, Grover P, Earnest C, Verma SK, Sanjeev Health status of nurses and yoga. IV. Experiment and results. Nurs J India. 1992;83:27–28. [PubMed]
107. Latha D, Kaliappan K. Efficacy of yoga therapy in the management of headaches. J Indian Psychol. 1992;10:41–47.
108. Ray U, Mukhopadhyaya S, Purkayastha S, et al. Effect of yogic exercises on physical and mental health of young fellowship course trainees. Indian J Physiol Pharmacol. 2001;45:37–53. [PubMed]
109. Harinath K, Malhotra AS, Pal K, et al. Effects of hatha yoga and Omkar meditation on cardiorespiratory performance, psychologic profile, and melatonin secretion. J Altern Complement Med. 2004;10:261–268. [PubMed]
110. Krishnamurthy MN, Telles S. Assessing depression following two ancient Indian interventions: effects of yoga and ayurveda on older adults in a residential home. J Gerontol Nurs. 2007;33:17–23. [PubMed]
111. Sharma VK, Das S, Mondal S, Goswampi U, Gandhi A. Effect of Sahaj yoga on depressive disorders. Indian J Physiol Pharmacol. 2005;49:462–468. [PubMed]
112. John PJ, Sharma N, Sharma CM, Kankane A. Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial. Headache. 2007;47:654–661. [PubMed]
113. Banerjee B, Vadiraj HS, Ram A, et al. Effects of an integrated yoga program in modulating psychological stress and radiation-induced genotoxic stress in breast cancer patients undergoing radiotherapy. Integr Cancer Ther. 2007;6:242–250. [PubMed]
114. Bhushan S, Sinha P. Yoganidra and management of anxiety and hostility. J Indian Psychol. 2001;19:44–49.
115. Janakiramaiah N, Gangadhar B, Naga Venkatesha Murthy P, Harish M, Subbakrishna D, Vedamurthachar A. Antidepressant efficacy of Sudarshan Kriya yoga (SKY) in melancholia: a randomized comparison with electroconvulsive therapy (ECT) and imipramine. J Affect Disord. 2000;57:255–259. [PubMed]
116. Manjunath NK, Telles S. Influence of Yoga and Ayurveda on self-rated sleep in a geriatric population. Indian J Med Res. 2005;121:683–690. [PubMed]
117. Shannahoff-Khalsa DS, Ray LE, Levine S, Gallen CC, Schwartz BJ, Sidorowich JJ. Randomized controlled trial of yogic meditation techniques for patients with obsessive compulsive disorders. CNS Spectrums. 1999;4:34–46. [PubMed]
118. Oken B, Kishiyama S, Zajdel D, et al. Randomized controlled trial of yoga and exercise in multiple sclerosis. Neurology. 2004;62:2058–2064. [PubMed]
119. Platania-Solazzo A, Field T, Blank J, et al. Relaxation therapy reduces anxiety in child and adolescent psychiatric patients. Acta Paedopsychiatr. 1992;55:115–120. [PubMed]
120. Berger B, Owen D. Mood alteration with yoga and swimming: aerobic exercise may not be necessary. Percept Mot Skills. 1992;75:1331–1343. [PubMed]
121. Oken BS, Zajdel D, Kishiyama S, et al. Randomized, controlled, six-month trial of yoga in healthy seniors: effects on cognition and quality of life. Altern Ther Health Med. 2006;12:40–47. [PMC free article] [PubMed]
122. Appels A, Bar F, Lasker J, Flamm U, Kop W. The effect of a psychological intervention program on the risk of a new coronary event after angioplasty: a feasibility study. J Psychol Res. 1997;43:209–217. [PubMed]
123. Schell F, Allolio B, Schonecke O. Physiological and psychological effects of hatha-yoga exercise in healthy women. Int J Psychosom. 1994;41:46–52. [PubMed]
124. Michalsen A, Grossman P, Acil A, et al. Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program. Med Sci Monit. 2005;11:CR555–CR561. [PubMed]
125. Netz Y, Lidor R. Mood alterations in mindful versus aerobic exercise modes. J Psychol Res. 2003;137:405–419. [PubMed]
126. Yurtkuran M, Alp A, Dilek K. A modified yoga-based exercise program in hemodialysis patients: a randomized controlled study. Complement Ther Med. 2007;15:164–171. [PubMed]
127. Pilkington K, Kirkwood G, Rampes H, Richardson J. Yoga for depression: the research evidence. J Affect Disord. 2005;89:13–24. [PubMed]
128. Telles S, Naveen K. Yoga for rehabilitation: an overview. Indian J Med Sci. 1997;51:123–127. [PubMed]
129. Oken BS, Kishiyama S, Zajdel D, et al. Randomized controlled trial of yoga and exercise in multiple sclerosis. Neurology. 2004;62:2058–2064. [PubMed]
130. Sahajpal P, Ralte R. Impact of induced yogic relaxation training (IYRT) on stress-level, self-concept and quality of sleep among minority group individuals. J Indian Psychol. 2000;18:66–73.
131. Joseph CD. Psychological supportive therapy for cancer patients. Indian Jo Cancer. 1983;20(5):268–270. [PubMed]
132. Cohen L, Warneke C, Fouladi RT, Rodriguez MA, Chaoul-Reich A. Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer. 2004;100:2253–2260. [PubMed]
133. Booth-LaForce C, Thurston RC, Taylor MR. A pilot study of a hatha yoga treatment for menopausal symptoms. Maturitas. 2007;57:286–295. [PubMed]
134. Khalsa SB. Treatment of chronic insomnia with yoga: a preliminary study with sleep-wake diaries. Appl Psychophysiol Biofeedback. 2004;29:269–278. [PubMed]
135. Lee MS, Choi ES, Chung HT. Effects of Qigong on blood pressure, blood pressure determinants and ventilatory function in middle-aged patients with essential hypertension. Am J Chinese Med. 2003;31:489–497. [PubMed]
136. Jones BM. Changes in cytokine production in healthy subjects practicing Guolin qigong: a pilot study. BMC Complement Altern Med. 2001;1:8. [PMC free article] [PubMed]
137. Sancier KM. Medical applications of qigong. Altern Ther Health Med. 1996;2:40–46. [PubMed]
138. Kit WK. The Complete Book of Tai Chi Chuan: A Comprehensive Guide to the Principles and Practice. Boston: Tuttle Publishing; 2002.
139. Chu DA. Tai chi, qi gong and reiki. Phys Med Rehabil Clin North Am. 2004;15:773–781. [PubMed]
140. Taylor-Piliae RE. Tai chi as an adjunct to cardiac rehabilitation exercise training. J Cardiopulm Rehabil. 2003;23:90–96. [PubMed]
141. Verhagen AP, Immink M, van der Meulen A, Bierma-Zeinstra SM. The efficacy of Tai Chi Chuan in older adults: a systematic review. Fam Pract. 2004;21:107–113. [PubMed]
142. Li JX, Hong Y, Chan KM. Tai chi: physiological characteristics and beneficial effects on health. Br Jo Sports Med. 2001;35(3):148–156. [PMC free article] [PubMed]
143. Kuramoto AM. Therapeutic benefits of tai chi exercise: research review. World Med J. 2006;105:42–46. [PubMed]
144. Park CH, Malavasi LM, Wen HJ, et al. Qi gong and tai chi: strategies for developing and implementing community-based programs for older adults: 2300. Med Sci Sports Exerc. 2007;39(5 Suppl):S420.
145. Hogan M. Physical and cognitive activity and exercise for older adults: a review. Int J Aging Hum Dev. 2005;60:95–126. [PubMed]
146. Jouper J, Hassmen P, Johansson M. Qigong exercise with concentration predicts increased health. Am J Chinese Med. 2006;34:949–957. [PubMed]
147. Brown M, Buddle M. The importance of nonproteinuric hypertension in pregnancy. Hypertens Pregnancy. 1995;14:57–65.
148. Luskin F, Niewell K, Griffith M, et al. A review of mind-body therapies in the treatment of cardiovascular disease. Part I. Implications for the elderly. Altern Ther Health Med. 1998;4:46–61. [PubMed]
149. Kjos V, Etnier JL. Pilot study comparing physical and psychological responses in medical qigong and walking. J Aging Phys Activity. 2006;14:241–253. [PubMed]
150. Wayne PM, Kiel DP, Krebs DE, et al. The effects of tai chi on bone mineral density in postmenopausal women: a systematic review. Arch Phys Med Rehabil. 2007;88:673–680. [PubMed]
151. Audette JF, Jin YS, Newcomer R, Stein L, Duncan G, Frontera WR. Tai chi versus brisk walking in elderly women. Age Ageing. 2006;35:388–393. [PubMed]
152. Taggart HM. Effects of tai chi exercise on balance, functional mobility, and fear of falling among older women. Appl Nurs Res. 2002;15:235–242. [PubMed]
153. Stenlund T, Lindstrom B, Granlund M, Burell G. Cardiac rehabilitation for the elderly: qi gong and group discussions. Eur J Cardiovasc Prev Rehabil. 2005;12:5–11. [PubMed]
154. Brown DR, Wang Y, Ward A, et al. Chronic psychological effects of exercise and exercise plus cognitive strategies. Med Sci Sports Exerc. 1995;27:765–775. [PubMed]
155. Zijlstra GA, van Haastregt JC, van Rossum E, van Eijk JT, Yardley L, Kempen GI. Interventions to reduce fear of falling in community-living older people: a systematic review. J Am Geriatr Soc. 2007;55:603–615. [PubMed]
156. Miller AP, Chen YF, Xing D, Feng W, Oparil S. Hormone replacement therapy and inflammation: interactions in cardiovascular disease. Hypertension. 2003;42:657–663. [PubMed]
157. Sancier KM. Therapeutic benefits of qigong exercises in combination with drugs. J Altern Complement Med. 1999;5:383–389. [PubMed]
158. Sancier KM, Holman D. Commentary: Multifaceted health benefits of medical qigong. J Altern Complement Med. 2004;10:163–165. [PubMed]
159. Kuang A, Wang C, Xu D, Qian Y. Research on “anti-aging” effect of qigong. J Trad Chinese Med. 1991;11:153–158. [PubMed]
160. Lee MS, Kim HJ, Choi ES. Effects of qigong on blood pressure, high-density lipoprotein cholesterol and other lipid levels in essential hypertension patients. Int J Neurosci. 2004;114:777–786. [PubMed]
161. Lee MS, Kim HJ, Moon SR. Qigong reduced blood pressure and catecholamine levels of patients with essential hypertension. Int J Neurosci. 2003;113:1691–1701. [PubMed]
162. Cheung BM, Lo JL, Fong DY, et al. Randomised controlled trial of qigong in the treatment of mild essential hypertension. J Hum Hypertens. 2005;19:697–704. [PubMed]
163. Hui PN, Wan M, Chan WK, Yung PM. An evaluation of two behavioral rehabilitation programs, qigong versus progressive relaxation, in improving the quality of life in cardiac patients. J Altern Complement Med. 2006;12:373–378. [PubMed]
164. Tsujiuchi T, Kumano H, Yoshiuchi K, et al. The effect of qi-gong relaxation exercise on the control of type 2 diabetes mellitus: a randomized controlled trial. Diabetes Care. 2002;25:241–242. [PubMed]
165. Lee MS, Kim BG, Huh HJ, Ryu H, Lee H-S, Chung H-T. Effect of qi-training on blood pressure, heart rate and respiration rate. Clin Physiol. 2000;20:173–176. [PubMed]
166. Skoglund L, Jansson E. Qigong reduces stress in computer operators. Complement Ther Clin Pract. 2007;13:78–84. [PubMed]
167. Tsang HW, Mok CK, Au Yeung YT, Chan SY. The effect of qigong on general and psychosocial health of elderly with chronic physical illnesses: a randomized clinical trial. Int J Geriatr Psychiatry. 2003;18:441–449. [PubMed]
168. Tsang HW, Fung KM, Chan AS, Lee G, Chan F. Effect of a qigong exercise programme on elderly with depression. Int J Geriatr Psychiatry. 2006;21:890–897. [PubMed]
169. Rosenbaum E, Gautier H, Fobair P, et al. Cancer supportive care, improving the quality of life for cancer patients: a program evaluation report. Support Care Cancer. 2004;12:293–301. [PubMed]
170. Lee MS, Jeong SM, Oh SW, Ryu H, Chung HT. Effects of chundosunbup qi-training on psychological adjustments: a cross-sectional study. Am J Chinese Med. 1998;26:223–230. [PubMed]
171. Wang YT, Taylor L, Pearl M, Chang LS. Effects of tai chi exercise on physical and mental health of college students. Am J Chinese Med. 2004;32:453–459. [PubMed]
172. Channer KS, Barrow D, Barrow R, Osborne M, Ives G. Changes in haemodynamic parameters following tai chi chuan and aerobic exercise in patients recovering from acute myocardial infarction. Postgrad Med J. 1996;72:349–351. [PMC free article] [PubMed]
173. Young DR, Appel LJ, Jee S, Miller ER., III The effects of aerobic exercise and t’ai chi on blood pressure in older people: results of a randomized trial. J Am Geriatr Soc. 1999;47:277–284. [PubMed]
174. Logtenberg SJ, Kleefstra N, Houweling ST, Groenier KH, Bilo HJ. Effect of device-guided breathing exercises on blood pressure in hypertensive patients with type 2 diabetes mellitus: a randomized controlled trial. J Hypertens. 2007;25:241–246. [PubMed]
175. Tsai JC, Wang WH, Chan P, et al. The beneficial effects of tai chi chuan on blood pressure and lipid profile and anxiety status in a randomized controlled trial. J Altern Complement Med. 2003;9:747–754. [PubMed]
176. Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T. Reducing frailty and falls in older persons: an investigation of tai chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. J Am Geriatr Soc. 1996;44:489–497. [PubMed]
177. Sun W, Dosch M, Gilmore G, et al. Effects of tai chi chuan program on among American older adults. Educ Gerontol. 1996;22:161–167.
178. Wolf SL, O’Grady M, Easley KA, Guo Y, Kressig RW, Kutner M. The influence of intense Tai Chi training on physical performance and hemodynamic outcomes in transitionally frail, older adults. J Gerontol A Biol Sci Med Sci. 2006;61:184–189. [PubMed]
179. Thornton EW, Sykes KS, Tang WK. Health benefits of tai chi exercise: improved balance and blood pressure in middle-aged women. Health Promot Int. 2004;19:33–38. [PubMed]
180. Chen WW, Sun WY. Tai chi chuan, an alternative form of exercise for health promotion and disease prevention for older adults in the community. Int Q Community Health Educ. 1997;16:333–339. [PubMed]
181. Wang JS, Lan C, Chen SY, Wong MK. Tai chi chuan training is associated with enhanced endothelium-dependent dilation in skin vasculature of healthy older men. J Am Geriatr Soc. 2002;50:1024–1030. [PubMed]
182. Motivala SJ, Sollers J, Thayer J, Irwin MR. Tai chi chih acutely decreases sympathetic nervous system activity in older adults. J Gerontol A Biol Sci Med Sci. 2006;61:1177–1180. [PubMed]
183. Ko GT, Tsang PC, Chan HC. A 10-week tai-chi program improved the blood pressure, lipid profile and SF-36 scores in Hong Kong Chinese women. Med Sci Monit. 2006;12:CR196–CR199. [PubMed]
184. Lu WA, Kuo CD. The effect of tai chi chuan on the autonomic nervous modulation in older persons. Med Sci Sports Exerc. 2003;35:1972–1976. [PubMed]
185. Yeh SH, Chuang H, Lin LW, Hsiao CY, Wang PW, Yang KD. Tai chi chuan exercise decreases A1C levels along with increase of regulatory T-cells and decrease of cytotoxic T-cell population in type 2 diabetic patients. Diabetes Care. 2007;30:716–718. [PubMed]
186. Arthur HM, Patterson C, Stone JA. The role of complementary and alternative therapies in cardiac rehabilitation: a systematic evaluation. Eur J Cardiovasc Prev Rehabil. 2006;13:3–9. [PubMed]
187. Lan C, Chou SW, Chen SY, Lai JS, Wong MK. The aerobic capacity and ventilatory efficiency during exercise in qigong and tai chi chuan practitioners. Am J Chinese Med. 2004;32:141–150. [PubMed]
188. Wang C, Roubenoff R, Lau J, et al. Effect of tai chi in adults with rheumatoid arthritis. Rheumatology. 2005;44:685–687. [PubMed]
189. Hartman CA, Manos TM, Winter C. Effects of t’ai chi training on function and quality of life indicators in older adults with osteoarthritis. J Am Geriatr Soc. 2000;48:1553–1559. [PubMed]
190. Song R, Lee EO, Lam P, Bae SC. Effects of a Sun-style tai chi exercise on arthritic symptoms, motivation and the performance of health behaviors in women with osteoarthritis. Daehan Ganho Haghoeji. 2007;37:249–256. [PubMed]
191. Li F, Fisher KJ, Harmer P, Irbe D, Tearse RG, Weimer C. Tai chi and self-rated quality of sleep and daytime sleepiness in older adults: a randomized controlled trial. J Am Geriatr Soc. 2004;52:892–900. [PubMed]
192. Labarthe D, Ayala C. Nondrug interventions in hypertension prevention and control. Cardiol Clin. 2002;20:249–263. [PubMed]
193. Gimbel M. Yoga, meditation, and imagery: clinical applications. Nurse Pract Forum. 1998;9:243–255. [PubMed]
194. Wayne PM, Krebs DE, Wolf SL, et al. Can Tai Chi improve vestibulopathic postural control? Arch Phys Med Rehabil. 2004;85:142–152. [PubMed]
195. Vitaliano PP, Scanlan JM, Zhang J, Savage MV, Hirsch IB, Siegler IC. A path model of chronic stress, the metabolic syndrome, and coronary heart disease. Psychosom Med. 2002;64:418–435. [PubMed]
196. Blumenthal JA, Babyak M, Wei J, et al. Usefulness of psychosocial treatment of mental stress-induced myocardial ischemia in men. Am J Cardiol. 2002;89:164–168. [PubMed]
197. Chao D, Foy C, Farmer D. Exercise adherence among older adults: challenges and strategies. Control Clin Trials. 2000;21:212S–217S. [PubMed]
198. US Department of Health and Human Services. Healthy People 2010, 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. Washington, DC: US Government Printing Office; 2000.
199. Adams P, Schoenborn C. Health behaviors of adults: United States, 2002–04. National Center for Health Statistics. Vital Health Stat. 2006;10:1–151.
200. U.S. Department of Health and Human Services. Physical Activity and Health; A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services; 1996. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion.
201. Wing RR, Epstein LH, Paternostro-Bayles M, Kriska A, Nowalk MP, Gooding W. Exercise in a behavioural weight control programme for obese patients with type 2 (non-insulin-dependent) diabetes. Diabetologia. 1988;31:902–909. [PubMed]
202. Munro J, Nicholl J, Brazier J, Davey R, Cochrane T. Cost effectiveness of a community based exercise programme in over 65 year olds: cluster randomised trial. J Epidemiol Community Health. 2004;58:1004–1010. [PMC free article] [PubMed]
203. Pollock ML, Carroll JF, Graves JE, et al. Injuries and adherence to walk/jog and resistance training programs in the elderly. Med Sci Sports Exerc. 1991;23:1194–1200. [PubMed]
204. Heesch KC, Brown DR, Blanton CJ. Perceived barriers to exercise and stage of exercise adoption in older women of different racial/ethnic groups. Women Health. 2000;30:61–75. [PubMed]
205. Chen HH, Yeh ML, Lee FY. The effects of baduanjin qigong in the prevention of bone loss for middle-aged women. Am J Chinese Med. 2006;34:741–747. [PubMed]
206. Wu G. Evaluation of the effectiveness of tai chi for improving balance and preventing falls in the older population: a review. J Am Geriatr Soc. 2002;50:746–754. [PubMed]
207. Schmidt JA, Gruman C, King MB, Wolfson LI. Attrition in an exercise intervention: a comparison of early and later dropouts. J Am Geriatr Soc. 2000;48:952–960. [PubMed]
208. Dishman RK, Sallis JF, Orenstein DR. The determinants of physical activity and exercise. Public Health Rep. 1985;100:158–171. [PMC free article] [PubMed]
209. Wood C. Mood change and perceptions of vitality: a comparison of the effects of relaxation, visualization and yoga. J R Soc Med. 1993;86:254–258. [PMC free article] [PubMed]
210. Szabo A, Mesko A, Caputo A, Gill ET. Examination of exercise-induced feeling states in four modes of exercise. Int J Sport Psychol. 1998;29:376–390.
211. Ryu H, Lee HS, Shin YS, et al. Acute effect of qigong training on stress hormonal levels in man. Am J Chinese Med. 1996;24:193–198. [PubMed]
212. Dash M, Telles S. Improvement in hand grip strength in normal volunteers and rheumatoid arthritis patients following yoga training. Indian J Physiol Pharmacol. 2001;45:355–360. [PubMed]
213. Bowman A, Clayton R, Murray A, Reed J, Subhan M, Ford G. Effects of aerobic exercise training and yoga on the baroreflex in healthy elderly persons. Eur J Clin Invest. 1997;27:443–449. [PubMed]
214. Konar D, Latha R, Bhuvaneswaran JS. Cardiovascular responses to head-down-body-up postural exercise (Sarvangasana) Indian J Physiol Pharmacol. 2000;44:392–400. [PubMed]
215. Lakshmikanthan C, Alagesan R, Thanikachalam S, et al. Long term effects of yoga on hypertension and/or coronary artery disease. J Assoc Physicians India. 1979;27:1055–1058. [PubMed]
216. Joshi L, Joshi V, Gokhale L. Effect of short term ‘Pranayam’ practice on breathing rate and ventilatory functions of lung. Indian J Physiol Pharmacol. 1992;36:105–108. [PubMed]
217. Raju PS, Prasad KV, Venkata RY, Murthy KJ, Reddy MV. Influence of intensive yoga training on physiological changes in 6 adult women: a case report. J Altern Complement Med. 1997;3:291–295. [PubMed]
218. Miller J, Fletcher K, Kabat-Zinn J. Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. Gen Hosp Psychiatry. 1995;17:192–200. [PubMed]
219. Manchanda S, Narang R, Reddy K, et al. Retardation of coronary atherosclerosis with yoga lifestyle intervention. J Assoc Physicians India. 48:687–694. [PubMed]
220. Patel C. 12-month follow-up of yoga and bio-feedback in the management of hypertension. Lancet. 1975;1:62–64. [PubMed]
221. Patel C, Marmot M, Terry D, Carruthers M, Hunt B, Patel M. Trial of relaxation in reducing coronary risk: four year follow-up. Br Med J. 1985;290:1103–1106. [PMC free article] [PubMed]
222. Wolfson L, Whipple R, Derby C, et al. Balance and strength training in older adults: intervention gains and tai chi maintenance. J Am Geriatr Soc. 1996;44:498–506. [PubMed]
223. Vickers A, Goyal N, Harland R, Rees R. Do certain countries produce only positive results? A systematic review of controlled trials. Controlled Clin Trials. 1998;19:159–166. [PubMed]