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Answer questions and earn CME/CNE Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. CA Cancer J Clin 2017;67:194-232. (c) 2017 American Cancer Society.

BACKGROUND: The majority of breast cancer patients use complementary and/or integrative therapies during and beyond cancer treatment to manage symptoms, prevent toxicities, and improve quality of life. Practice guidelines are needed to inform clinicians and patients about safe and effective therapies. METHODS: Following the Institute of Medicine's guideline development process, a systematic review identified randomized controlled trials testing the use of integrative therapies for supportive care in patients receiving breast cancer treatment. Trials were included if the majority of participants had breast cancer and/or breast cancer patient results were reported separately, and outcomes were clinically relevant. Recommendations were organized by outcome and graded based upon a modified version of the US Preventive Services Task Force grading system. RESULTS: The search (January 1, 1990-December 31, 2013) identified 4900 articles, of which 203 were eligible for analysis. Meditation, yoga, and relaxation with imagery are recommended for routine use for common conditions, including anxiety and mood disorders (Grade A). Stress management, yoga, massage, music therapy, energy conservation, and meditation are recommended for stress reduction, anxiety, depression, fatigue, and quality of life (Grade B). Many interventions (n = 32) had weaker evidence of benefit (Grade C). Some interventions (n = 7) were deemed unlikely to provide any benefit (Grade D). Notably, only one intervention, acetyl-l-carnitine for the prevention of taxane-induced neuropathy, was identified as likely harmful (Grade H) as it was found to increase neuropathy. The majority of intervention/modality combinations (n = 138) did not have sufficient evidence to form specific recommendations (Grade I). CONCLUSIONS: Specific integrative therapies can be recommended as evidence-based supportive care options during breast cancer treatment. Most integrative therapies require further investigation via well-designed controlled trials with meaningful outcomes.

BACKGROUND: Stress places a metabolic burden on homeostasis and is linked to heightened sympathetic activity, increased energy expenditure and pathology. The yogic state is a hypometabolic state that corresponds with mind-body coherence and reduced stress. This study aimed to investigate metabolic responses to stress and different yoga practices in regular yoga practitioners (YP), non-yoga practitioners (NY) and metabolic syndrome patients (MS). METHODS: YP (n = 16), NY (n = 15) and MS (n = 15) subjects underwent an experimental protocol that comprised of different 5-minute interventions including mental arithmetic stress test (MAST), alternate nostril breathing (ANB), Kapabhati breathing (KB) and meditation (Med) interspersed with 5 minutes of quiet resting (neutral condition (NC)). During the intervention periods continuous body weight adjusted oxygen consumption (VO2ml/min/kg) was measured using open circuit indirect calorimetry with a canopy hood. RESULTS: This is the first study to report oxygen consumption (OC) in yoga practitioners during and after MAST and the first to report both within and between different populations. The results were analysed with SPSS 16 using 3X9 mixed factorial ANOVAs. The single between-subject factor was group (YP, NY and MS), the single within-subject factor was made up of the nine intervention phases (NC1, MAST, NC2, ANB, NC3, KB, NC4, Med, NC5). The results demonstrated that the regular YP group had significantly less OC and greater variability in their OC across all phases compared to the MS group (p = .003) and NY group (p = .01). All groups significantly raised their OC during the mental arithmetic stress, however the MS group had a significantly blunted post-stress recovery whereas the YP group rapidly recovered back to baseline levels with post stress recovery being greater than either the NY group or MS group. CONCLUSIONS: Yoga practitioners have greater metabolic variability compared to non-yoga practitioners and metabolic syndrome patients with reduced oxygen requirements during resting conditions and more rapid post-stress recovery. OC in metabolic syndrome patients displays significantly blunted post-stress recovery demonstrating reduced metabolic resilience. Our results support the findings of previous randomised trials that suggest regular yoga practice may mitigate against the effects of metabolic syndrome. CLINICAL TRIAL NUMBER: ACTRN12614001075673; Date of Registration: 07/10/2014.

BACKGROUND: Stress places a metabolic burden on homeostasis and is linked to heightened sympathetic activity, increased energy expenditure and pathology. The yogic state is a hypometabolic state that corresponds with mind-body coherence and reduced stress. This study aimed to investigate metabolic responses to stress and different yoga practices in regular yoga practitioners (YP), non-yoga practitioners (NY) and metabolic syndrome patients (MS). METHODS: YP (n = 16), NY (n = 15) and MS (n = 15) subjects underwent an experimental protocol that comprised of different 5-minute interventions including mental arithmetic stress test (MAST), alternate nostril breathing (ANB), Kapabhati breathing (KB) and meditation (Med) interspersed with 5 minutes of quiet resting (neutral condition (NC)). During the intervention periods continuous body weight adjusted oxygen consumption (VO2ml/min/kg) was measured using open circuit indirect calorimetry with a canopy hood. RESULTS: This is the first study to report oxygen consumption (OC) in yoga practitioners during and after MAST and the first to report both within and between different populations. The results were analysed with SPSS 16 using 3X9 mixed factorial ANOVAs. The single between-subject factor was group (YP, NY and MS), the single within-subject factor was made up of the nine intervention phases (NC1, MAST, NC2, ANB, NC3, KB, NC4, Med, NC5). The results demonstrated that the regular YP group had significantly less OC and greater variability in their OC across all phases compared to the MS group (p = .003) and NY group (p = .01). All groups significantly raised their OC during the mental arithmetic stress, however the MS group had a significantly blunted post-stress recovery whereas the YP group rapidly recovered back to baseline levels with post stress recovery being greater than either the NY group or MS group. CONCLUSIONS: Yoga practitioners have greater metabolic variability compared to non-yoga practitioners and metabolic syndrome patients with reduced oxygen requirements during resting conditions and more rapid post-stress recovery. OC in metabolic syndrome patients displays significantly blunted post-stress recovery demonstrating reduced metabolic resilience. Our results support the findings of previous randomised trials that suggest regular yoga practice may mitigate against the effects of metabolic syndrome. CLINICAL TRIAL NUMBER: ACTRN12614001075673; Date of Registration: 07/10/2014.

BACKGROUND: Stress places a metabolic burden on homeostasis and is linked to heightened sympathetic activity, increased energy expenditure and pathology. The yogic state is a hypometabolic state that corresponds with mind-body coherence and reduced stress. This study aimed to investigate metabolic responses to stress and different yoga practices in regular yoga practitioners (YP), non-yoga practitioners (NY) and metabolic syndrome patients (MS). METHODS: YP (n = 16), NY (n = 15) and MS (n = 15) subjects underwent an experimental protocol that comprised of different 5-minute interventions including mental arithmetic stress test (MAST), alternate nostril breathing (ANB), Kapabhati breathing (KB) and meditation (Med) interspersed with 5 minutes of quiet resting (neutral condition (NC)). During the intervention periods continuous body weight adjusted oxygen consumption (VO2ml/min/kg) was measured using open circuit indirect calorimetry with a canopy hood. RESULTS: This is the first study to report oxygen consumption (OC) in yoga practitioners during and after MAST and the first to report both within and between different populations. The results were analysed with SPSS 16 using 3X9 mixed factorial ANOVAs. The single between-subject factor was group (YP, NY and MS), the single within-subject factor was made up of the nine intervention phases (NC1, MAST, NC2, ANB, NC3, KB, NC4, Med, NC5). The results demonstrated that the regular YP group had significantly less OC and greater variability in their OC across all phases compared to the MS group (p = .003) and NY group (p = .01). All groups significantly raised their OC during the mental arithmetic stress, however the MS group had a significantly blunted post-stress recovery whereas the YP group rapidly recovered back to baseline levels with post stress recovery being greater than either the NY group or MS group. CONCLUSIONS: Yoga practitioners have greater metabolic variability compared to non-yoga practitioners and metabolic syndrome patients with reduced oxygen requirements during resting conditions and more rapid post-stress recovery. OC in metabolic syndrome patients displays significantly blunted post-stress recovery demonstrating reduced metabolic resilience. Our results support the findings of previous randomised trials that suggest regular yoga practice may mitigate against the effects of metabolic syndrome. CLINICAL TRIAL NUMBER: ACTRN12614001075673; Date of Registration: 07/10/2014.

BACKGROUND: Unhealthy lifestyles are a major factor in the development and exacerbation of many chronic diseases. Improving lifestyles though immersive residential experiences that promote healthy behaviours is a focus of the health retreat industry. This systematic review aims to identify and explore published studies on the health, wellbeing and economic impact of retreat experiences. METHODS: MEDLINE, CINAHL and PsychINFO databases were searched for residential retreat studies in English published prior to February 2017. Studies were included if they were written in English, involved an intervention program in a residential setting of one or more nights, and included before-and-after data related to the health of participants. Studies that did not meet the above criteria or contained only descriptive data from interviews or case studies were excluded. RESULTS: A total of 23 studies including eight randomised controlled trials, six non-randomised controlled trials and nine longitudinal cohort studies met the inclusion criteria. These studies included a total of 2592 participants from diverse geographical and demographic populations and a great heterogeneity of outcome measures, with seven studies examining objective outcomes such as blood pressure or biological makers of disease, and 16 studies examining subjective outcomes that mostly involved self-reported questionnaires on psychological and spiritual measures. All studies reported post-retreat health benefits ranging from immediately after to five-years post-retreat. Study populations varied widely and most studies had small sample sizes, poorly described methodology and little follow-up data, and no studies reported on health economic outcomes or adverse effects, making it difficult to make definite conclusions about specific conditions, safety or return on investment. CONCLUSIONS: Health retreat experiences appear to have health benefits that include benefits for people with chronic diseases such as multiple sclerosis, various cancers, HIV/AIDS, heart conditions and mental health. Future research with larger numbers of subjects and longer follow-up periods are needed to investigate the health impact of different retreat experiences and the clinical populations most likely to benefit. Further studies are also needed to determine the economic benefits of retreat experiences for individuals, as well as for businesses, health insurers and policy makers.

Heart Rate Variability (HRV) and respiratory sinus arrhythmia are directly associated with autonomic flexibility, self-regulation and well-being, and inversely associated with physiological stress, psychological stress and pathology. Yoga enhances autonomic activity, mitigates stress and benefits stress-related clinical conditions, yet the relationship between autonomic activity and psychophysiological responses during yoga practices and stressful stimuli has not been widely explored. This experimental study explored the relationship between HRV, mood states and flow experiences in regular yoga practitioners (YP), non-yoga practitioners (NY) and people with metabolic syndrome (MetS), during Mental Arithmetic Stress Test (MAST) and various yoga practices. The study found that the MAST placed a cardio-autonomic burden in all participants with the YP group showing the greatest reactivity and the most rapid recovery, while the MetS group had significantly blunted recovery. The YP group also reported a heightened experience of flow and positive mood states compared to NY and MetS groups as well as having a higher vagal tone during all resting conditions. These results suggest yoga practitioners have a greater homeostatic capacity and autonomic, metabolic and physiological resilience. Further studies are now needed to determine if regular yoga practice may improve autonomic flexibility in non-yoga practitioners and metabolic syndrome patients. Clinical Trial No 'ACTRN 2614001075673'.

Heart Rate Variability (HRV) and respiratory sinus arrhythmia are directly associated with autonomic flexibility, self-regulation and well-being, and inversely associated with physiological stress, psychological stress and pathology. Yoga enhances autonomic activity, mitigates stress and benefits stress-related clinical conditions, yet the relationship between autonomic activity and psychophysiological responses during yoga practices and stressful stimuli has not been widely explored. This experimental study explored the relationship between HRV, mood states and flow experiences in regular yoga practitioners (YP), non-yoga practitioners (NY) and people with metabolic syndrome (MetS), during Mental Arithmetic Stress Test (MAST) and various yoga practices. The study found that the MAST placed a cardio-autonomic burden in all participants with the YP group showing the greatest reactivity and the most rapid recovery, while the MetS group had significantly blunted recovery. The YP group also reported a heightened experience of flow and positive mood states compared to NY and MetS groups as well as having a higher vagal tone during all resting conditions. These results suggest yoga practitioners have a greater homeostatic capacity and autonomic, metabolic and physiological resilience. Further studies are now needed to determine if regular yoga practice may improve autonomic flexibility in non-yoga practitioners and metabolic syndrome patients. Clinical Trial No 'ACTRN 2614001075673'.

Heart Rate Variability (HRV) and respiratory sinus arrhythmia are directly associated with autonomic flexibility, self-regulation and well-being, and inversely associated with physiological stress, psychological stress and pathology. Yoga enhances autonomic activity, mitigates stress and benefits stress-related clinical conditions, yet the relationship between autonomic activity and psychophysiological responses during yoga practices and stressful stimuli has not been widely explored. This experimental study explored the relationship between HRV, mood states and flow experiences in regular yoga practitioners (YP), non-yoga practitioners (NY) and people with metabolic syndrome (MetS), during Mental Arithmetic Stress Test (MAST) and various yoga practices. The study found that the MAST placed a cardio-autonomic burden in all participants with the YP group showing the greatest reactivity and the most rapid recovery, while the MetS group had significantly blunted recovery. The YP group also reported a heightened experience of flow and positive mood states compared to NY and MetS groups as well as having a higher vagal tone during all resting conditions. These results suggest yoga practitioners have a greater homeostatic capacity and autonomic, metabolic and physiological resilience. Further studies are now needed to determine if regular yoga practice may improve autonomic flexibility in non-yoga practitioners and metabolic syndrome patients. Clinical Trial No 'ACTRN 2614001075673'.

The practice of mindfulness is being used with increased frequency in schools around the world. In the current literature review we outline some of the core concepts and practices associated with mindfulness and discuss studies analysing the process of mindfulness teacher training. Preliminary research in this emerging field suggests that mindfulness has the potential to improve classroom management, teacher-student relationships and instructional strategies. Mindfulness instructors recommend that before teachers can feel comfortable and effectively teach mindfulness in the classroom they need to embody and practice mindfulness in their own lives. It is proposed that in order to improve our knowledge base in this area a critical synthesis and analysis of school-based mindfulness programs is required.

The practice of mindfulness is being used with increased frequency in schools around the world. In the current literature review we outline some of the core concepts and practices associated with mindfulness and discuss studies analysing the process of mindfulness teacher training. Preliminary research in this emerging field suggests that mindfulness has the potential to improve classroom management, teacher-student relationships and instructional strategies. Mindfulness instructors recommend that before teachers can feel comfortable and effectively teach mindfulness in the classroom they need to embody and practice mindfulness in their own lives. It is proposed that in order to improve our knowledge base in this area a critical synthesis and analysis of school-based mindfulness programs is required.

OBJECTIVE:The current study explores relationships between mindfulness, emotional regulation, impulsivity, and stress proneness in a sample of participants recruited in a Diagnostic and Statistical Manual of Mental Disorder Fifth Edition Field Trial for Hypersexual Disorder and healthy controls to assess whether mindfulness attenuates symptoms of hypersexuality. METHOD: Hierarchal regression analysis was used to assess whether significant relationships between mindfulness and hypersexuality exist beyond associations commonly found with emotional dysregulation, impulsivity, and stress proneness in a sample of male hypersexual patients (n = 40) and control subjects (n = 30). RESULTS: Our results show a robust inverse relationship of mindfulness to hypersexuality over and above associations with emotional regulation, impulsivity, and stress proneness. CONCLUSIONS: These results suggest that mindfulness may be a meaningful component of successful therapy among patients seeking help for hypersexual behavior in attenuating hypersexuality, improving affect regulation, stress coping, and increasing tolerance for desires to act on maladaptive sexual urges and impulses.

Over the last decade, the cultivation of mindfulness has become a common part of the curriculum in classrooms around the world. A recent survey indicates that nearly 50% of teachers are sharing mindfulness with children. To date, researchers have predominately used outcome-based trial designs to understand the practice s efficacy for improving wellness in children. Less research has been directed towards understanding how children perceive mindfulness experiences. This gap inspired the research question What are students perspectives of learning mindfulness practices at school? Thematic analysis was employed to understand and interpret 38 elementary school students mindfulness journals. Findings suggest that mindfulness enhances student wellbeing and helps children develop a greater awareness of their body, mind and emotions. Implications of these findings are discussed. Future research is required to determine how mindfulness practices enhance and sustain student wellbeing and learning.

Over the last decade, the cultivation of mindfulness has become a common part of the curriculum in classrooms around the world. A recent survey indicates that nearly 50% of teachers are sharing mindfulness with children. To date, researchers have predominately used outcome-based trial designs to understand the practice’s efficacy for improving wellness in children. Less research has been directed towards understanding how children perceive mindfulness experiences. This gap inspired the research question—What are students’ perspectives of learning mindfulness practices at school? Thematic analysis was employed to understand and interpret 38 elementary school students’ mindfulness journals. Findings suggest that mindfulness enhances student wellbeing and helps children develop a greater awareness of their body, mind and emotions. Implications of these findings are discussed. Future research is required to determine how mindfulness practices enhance and sustain student wellbeing and learning.

Over the last decade, the cultivation of mindfulness has become a common part of the curriculum in classrooms around the world. A recent survey indicates that nearly 50% of teachers are sharing mindfulness with children. To date, researchers have predominately used outcome-based trial designs to understand the practice’s efficacy for improving wellness in children. Less research has been directed towards understanding how children perceive mindfulness experiences. This gap inspired the research question—What are students’ perspectives of learning mindfulness practices at school? Thematic analysis was employed to understand and interpret 38 elementary school students’ mindfulness journals. Findings suggest that mindfulness enhances student wellbeing and helps children develop a greater awareness of their body, mind and emotions. Implications of these findings are discussed. Future research is required to determine how mindfulness practices enhance and sustain student wellbeing and learning.