Efficacy of Virtually-Delivered Qigong/Tai Chi for Depression in Middle- and Older-Age Adults with Bipolar Disorder (QT-BD): A Pilot Randomized Controlled Trial during the COVID-19 Pandemic

Background : Depressive symptoms in middle-aged and older age bipolar disorder (BD) are associated with decreased quality of life and premature mortality. Yet, currently available pharmacological treatments are limited in efficacy. Mind-body interventions have been shown to improve mood, quality of life, and cognition in other adult populations, and may thus provide a promising therapeutic alternative. Here we conduct the first randomized controlled trial (RCT) examining the efficacy of a group Qigong/Tai Chi intervention (QT-BD) for reducing depressive symptoms in middle-aged and older adults with BD. As a further innovation during the COVID pandemic, we used Zoom to deliver the group intervention and active control. Methods : We conducted a virtually-delivered 12-week pilot RCT with 23 patients with BD aged >= 40 comparing a QT-BD intervention versus an active control (light exercise). We assessed depressive symptoms (primary outcome), verbal fluency (secondary outcome), and functioning/quality of life (exploratory outcomes) at baseline and 12-weeks. Results : No statistically significant differences were observed between groups for all outcomes (all p's>0.05). However, non-significant decreases in depressive symptoms were found in the subgroup of participants with baseline MADRS scores ≥10 in the QT-BD intervention only (p=0.07). Limitations : Our sample size was limited and the virtually-delivered format may have limited the positive benefits of face-to-face interventions. Conclusions : This novel pilot study suggests that QT-BD may be a feasible and efficacious intervention for reducing depressive symptoms in middle- and older-aged BD, particularly when baseline MADRS is ≥10, warranting further investigation in larger-scale trials.

Effect of Tai Chi versus Aerobic Training on Improving Hand Grip Strength, Fatigue, and Functional Performance in Older Adults Post-COVID-19: a randomized controlled trial

Background: The recent pandemic of COVID-19 has left a wide range of after-effects on the health of older adults. The effects of the pandemic have been particularly felt in the areas of physical strength, fatigue, and functional performance. Material(s) and Method(s): Fifty-four participants were allocated into three groups: Tai Chi (TC) attended 4 sessions of 60-min TC training per week for consecutive 12 weeks, Aerobic Training (AT) attended 4 sessions of 60-min aerobic training per week for 12 weeks, and Control (CON) instructed to maintain a daily routine. Hand grip strength (HGS) and Fatigue Severity Scale (FSS) were used to evaluate the participants. Functional performance outcomes were determined The functional performance outcome was determined by The 30-second Chair Stand Test (CST), The 30-second Arm Curl Test (ACT), The 8-feet Up-and-Go test (TUG), and The 2 min steps. Pre-post comparisons of all outcomes in each group and comparisons between groups were analyzed using the ANOVA test with SPSS software. Result(s): After the intervention, TC and AT groups both experienced significant improvements in HGS, fatigue levels, CST, ACT, TUG, and 2-minute steps compared to baseline (all P < 0.001). The Tai Chi group also experienced significantly improved hand grip strength (p =0.0435, mean difference of-2.5), and ACT (p =0.0235, mean difference of 1) compared to the AT group. Conclusion(s): Tai Chi is an integrated rehabilitation program that had a positive effect on hand grip strength, fatigue levels, and functional performance compared to aerobic training in the elderly post-COVID-19.Copyright © 2023, Codon Publications. All rights reserved.

A tai chi/qigong intervention for older adults living with HIV: a study protocol of an exploratory clinical trial.

BACKGROUND: Almost half of people living with HIV (PLWH) in the USA are over 50 years of age; this is expected to increase to 70% by 2020. Yet, few interventions exist for older PLWH that address psychological and physical symptoms combined, both prevalent in this population. There is a need to find innovative and accessible interventions that can help older PLWH to manage their symptoms. Mind-body interventions, like tai chi/qigong (TCQ), improve both physical and psychological health. TCQ is a series of slow, low-impact meditative movements that integrates breathwork, meditation, and stances. METHODS: The present study is an exploratory clinical trial that will evaluate the acceptability and feasibility of a 12-week, small group TCQ intervention (n = 24), a sham qigong control condition (n = 24), and a standard of care control condition (n = 24) for older people living with HIV/AIDS. It will also explore any preliminary associations between the TCQ intervention and symptom alleviation. Participants will be recruited from community-based health and social services organizations in Miami, FL, and randomized to one of the 3 conditions. DISCUSSION: We will assess feasibility and acceptability through questionnaires and adherence to TCQ. We will assess preliminary associations with symptoms such as depression, anxiety, social support, chronic HIV-related fatigue, and clinical outcomes. These will be described through proportions, means, and changes over time through graphing techniques. Outcomes will be assessed at baseline, at post-intervention, and at 3 months follow-up. These preliminary analyses also will provide information necessary to estimate effect size and power needed for a larger clinical trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT03840525 . Registered on 16 July 2018.

Pilot studies of recruitment and feasibility of remote Tai Chi in racially diverse older adults with multisite pain.

BACKGROUND: Multisite musculoskeletal pain is highly prevalent among older adults yet undertreated. Studies support the promise of Tai Chi for managing pain and lowering fall risk. Since the COVID-19 pandemic, effective alternatives to classroom-based exercise programming are warranted. AIMS: To recruit 100 racially diverse older adults with multisite pain and increased fall risk, who are interested in participating in a future Tai Chi clinical trial, and to evaluate the feasibility and acceptability of a short-term, remotely delivered home-based Tai Chi program. METHODS: A random sample of adults aged 65 years or older living in diverse Boston neighborhoods were sent mailed invitations to participate in a telephone screening survey. Eligible adults were invited to join a 4-week Tai Chi program offered online via Zoom. Primary outcomes were class attendance, experience, and program safety. RESULTS: Among 334 survey respondents, 105 were eligible for the intervention. Average age of eligible participants was 74 years, 75% were women, and 62% were Black. We assigned 32 participants to 4 Tai Chi or 2 light exercise groups conducted via Zoom; of these, 24 (75%) completed the program and 79% attended ≥6 of 8 classes. There were no adverse events reported. Two-thirds reported it was very easy to join the online classes and 88%, very easy to see the instructor. CONCLUSION: Mailed invitations were effective for recruiting a racially diverse sample. Remote exercise programming delivered online via live Zoom sessions is safe and feasible for diverse older adults who have multisite pain and risk of falls.

Efficacy of traditional Chinese exercise for obesity: A systematic review and meta-analysis.

Background: Obesity is considered one of the biggest public health problems, especially in the background of the coronavirus disease 2019 (COVID-19) lockdown. It is urgent to find interventions to control and improve it. We performed this systematic review and meta-analysis to summarize the effect of traditional Chinese exercise on obesity. Methods: We searched PubMed, Embase, Cochrane Library, the China National Knowledge Infrastructure (CNKI), the Chinese Scientific Journal Database (VIP), the Chinese Biomedical Literature Database (CBM), and WanFang database for updated articles published from the inception of each database to June 2022. Randomized controlled trials (RCTs) on traditional Chinese exercise in weight reduction were included, and related data were extracted. The random-effects model was used to adjust for the heterogeneity of the included studies, and funnel plots were used to examine publication bias. Results: A total of 701 participants were included in the 10 studies. Compared with the control group, the outcome of body weight [mean difference (MD) = -6.10; 95% CI = -8.79, -3.42], body mass index (MD = -2.03; 95% CI = -2.66, -1.41), body fat mass (MD = -3.12; 95% CI = -4.49, -1.75), waist circumference (MD = -3.46; 95% CI = -4.67, -2.24), hip circumference (MD = -2.94; 95% CI = -4.75, -1.30), and waist-to-hip ratio (MD = -0.04; 95% CI = -0.06, -0.03) in the intervention group had significant differences. Egger's test and funnel plots showed that the potential publication bias of the included studies was slight (p = 0.249). Conclusion: Traditional Chinese exercise is an effective treatment for obesity; people under the COVID-19 lockdown could do these exercises to control weight. However, a precise and comprehensive conclusion calls for RCTs on a larger scale with more rigorous designs considering the inferior methodological quality and limited retrieved articles. Systematic review registration: www.crd.york.ac.uk/PROSPERO/, identifier CRD42021270015.

Feasibility, Usability, and Acceptability of Online Mind-Body Exercise Programs for Older Adults: A Scoping Review.

Objectives: Engaging in mind-body exercises (MBEs: e.g., Tai Chi and yoga) can have physical and mental health benefits particularly for older adults. Many MBEs require precise timing and coordination of complex body postures posing challenges for online instruction. Such challenges include difficulty viewing instructors as they demonstrate different movements and lack of feedback to participants. With the shift of exercise programs to online platforms during the COVID-19 pandemic, we conducted a scoping review to examine the feasibility, usability, and acceptability of online MBE classes for older adults. Materials and Methods: We followed the scoping review methodology and adhered to the PRISMA reporting checklist. We searched five databases: Medline, Embase, CINHAL, Web of Science, and ACM digital library. Screening of articles and data extraction was conducted independently by two reviewers. Settings/Location: Online/virtual. Subjects: Older adults ≥55 years of age. Outcome Measures: Feasibility measures. Results: Of 6711 studies retrieved, 18 studies were included (715 participants, mean age 66.9 years). Studies reported moderate to high retention and adherence rates (mean >75%). Older adults reported online MBE classes were easy to use and reported high satisfaction with the online format. We also identified barriers (e.g., lack of space and privacy and unstable internet connection) and facilitators (e.g., convenience and technical support) to the online format. Opinions related to social connectedness were mixed. Conclusion: Online MBE programs for older adults appear to be a feasible and acceptable alternative to in-person programs. It is important to consider the type of exercise (e.g., MBE), diverse teaching styles, and learner needs when designing online exercise classes.

Tai chi or health education for older adults with hypertension: effects on mental health and psychological resilience to COVID-19.

OBJECTIVE: To compare the effectiveness of 12 weeks of community-based, in-person, group Tai Chi (TC) and Health Education (HAP-E) in improving health and wellbeing in older adults with hypertension and in promoting psychological resilience during COVID-19. METHODS: A 12-week randomized controlled trial (RCT) in San Diego County, USA. Self-reported depressive symptoms, anxiety, sleep disturbances, gratitude, resilience, mental and physical health were assessed in-person pre- and post-intervention, and by long-term follow-up surveys during COVID-19. Linear mixed-effects models were used to assess study arm differences over time and logistic regression to identify predictors of positive intervention response. RESULTS: Of 182 randomized participants (72.6 ± 7.9 yrs; 72% female), 131 completed the intervention. Modest improvements in health and wellbeing occurred post-intervention in both arms (Cohen's d: TC = 0.38, 95% CI: 0.25-0.51; HAP-E = 0.24, 0.11-0.37), though positive intervention responses were more than twice as likely in TC (OR = 2.29, 1.07-4.57). Younger age, higher anxiety, and poorer mental health at baseline predicted greater odds of response. Small declines in health and wellbeing were reported at the first COVID-19 follow-up, with smaller declines in the TC arm (Cohen's d: TC = -0.15, -0.31-0.00; HAP-E = -0.34, -0.49 to -0.19). Health and wellbeing stabilized at the second COVID-19 follow-up. Most participants (>70%) reported that the interventions benefitted their health and wellbeing during COVID-19. CONCLUSION: TC and HAP-E improved health and wellbeing, though TC conferred greater odds of an improved mental health response. Declines in health and wellbeing were observed at pandemic follow-up, with smaller declines in the TC arm, suggesting increased resilience.

Evaluation of the effect of drug on physiotherapy methods on cytokines and chemokines of Covid-19 patients

Previous investigations have demonstrated that interleukin-6 (IL-6), C reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), in Coronavirus disease 2019 (COVID-19) patients are considerably increased, and their progressive elevation are clinical threat indicators of disease severity. The purpose of this systematic review is to evaluate the efficacy of physiotherapy, specifically chest physiotherapy, on different cytokines in Covid-19 and non-covid-19 patients. The main complications and symptoms of this virus are as follows;a dry cough, fever, and progressive dyspnea. Quickly, the coronavirus, which is named SARS-CoV-21, has spread worldwide, causing severe lung inflammation, respiratory distress syndrome, cardiac and renal injury, especially in comorbidities patients. Approximately 96% of the cases experience mild respiratory symptoms;some progress to pneumonia, respiratory insufficiency, acute respiratory distress syndrome, and multiorgan failure. The overall mortality rate per number of diagnosed cases is 4.6%;it can range from 0.2% to 15% according to age and health problems. Combination MeSH and text terms were used to perform the search strategy. Interventions in RCTs and clinical trials with or without comparison were assessed. Six studies met the inclusion criteria. Studies demonstrated that physiotherapy could have an effect on TNF-alpha, IL-6, IL-10, IL-1 beta and CRP.

Can Yoga, Qigong, and Tai Chi Breathing Work Support the Psycho-Immune Homeostasis during and after the COVID-19 Pandemic? A Narrative Review.

Breathing is crucial in life; nevertheless, the healthcare community often overlooks the health potential of breathing techniques. Conscious manipulation of breathing to achieve specific health goals is found in yoga, Qigong and Tai Chi. This paper reviews the value of breathing exercises as a foremost mechanism for promoting, recuperating and maintaining health. Practices involving breathing techniques are described, and their prophylactic or therapeutic characteristics are explored. The main goals of this review are: (i) to summarize the evidence supporting the hypothesis that breathing practices have a significant beneficial impact on human health; (ii) to provide a deeper understanding of traditional biofeedback practices, particularly yoga, Qigong and Tai Chi, and outline their focus on breathing techniques; (iii) to outline specific immune-related responses, relevant for COVID-19 disorders; and (iv) to call for committed attention and action from the scientific community and health agencies in promoting the implementation of a practical and costless health program based on breathing techniques. This review shows the health potentials of breathing practices and exercises, which, by having a high benefit-cost ratio, could be selected and implemented as a primary standard routine in public health programs.

Telehealth delivered Tai Chi intervention for managing aromatase inhibitor-induced arthralgia in breast cancer patients: TaiChi4Joint during the COVID-19 pandemic a Pilot study

Background: Estrogen receptor positive breast cancer (BC) is the most common type of breast cancer in postmenopausal women and aromatase inhibitors (AI) are the endocrine therapy of choice recommended for these patients. Up to 50% of those treated with an AI develop Arthralgia often resulting in poor adherence and decreased quality of life. Methods: This is a single arm longitudinal pilot study aiming to evaluate the safety, feasibility, acceptability and potential efficacy of TaiChi4Joint, a remotelydelivered 12-week Tai Chi intervention designed for the relief of AI-induced joint pain. Women diagnosed with stage 0-III BC who have been receiving an AI for at least 2 months and reporting arthralgia with a ≥ 4 score on a 0-10 scale for joint pain were eligible for study enrollment. Participants were encouraged to join Tai Chi classes delivered over ZOOM three times a week for 12 weeks. Program engagement strategies include the use of a private Facebook study group and box.com cloud for archiving live class recordings. The program utilizes Text messaging and emails with periodic positive quotes and evidence based information on Tai Chi for facilitating community bonding and class attendance. Participants were invited to complete the following assessments online at baseline, 1, 2 and 3 months intervals from study enrollment: Brief Pain Inventory (BPI), Western Ontario and McMaster University Osteoarthritis index (WOMAC), The Australian Canadian Osteoarthritis Hand Index (AUSCAN), Fatigue Symptom Inventory (FSI), Hot Flash Related Daily Interference Scale (HFRDIS), Pittsburg Sleep Quality Index (PSQI) and Center for Epidemiological Studies Depression (CES-D). Results: 55 eligible patients were invited to participate and 39 consented and completed the baseline assessments. 61% (median) Participants attended the classes, with no Tai Chi related adverse events reported. 22 of the 39 participants completed the 3-month follow up assessments with a 56% retention rate. Study participants reported improvement from baseline compared to 3 month as follows: For BPI (P = .000), AUSCAN pain subscale (P =.000), AUSCAN function subscale for 35 patients (P = .000), WOMAC (P = .000), CES-D (P = 0.001), FSI (P = 0.00) and PSQI (P = .000). However HFRDIS improved in 11 patients (P = 0.00) for the other 22 patients (P = 0.154). Conclusions: The COVID-19 global pandemic has resulted in the need to rethink how mind-body therapies can be delivered. This study demonstrated the feasibility, acceptability, and potential efficacy of a Telehealth based Tai Chi intervention for reducing AI-induced arthralgia. The intervention decreased patient reported pain, stiffness and improved sleep quality and depressive symptoms. With our promising findings, larger telehealth based trials of Tai Chi for AI-associated arthralgia are needed.

2022 ASCO Annual Meeting I

The proceedings contain 5148 papers. The topics discussed include: baseline GP2 immune response as an independent prognostic factor in a phase IIb study evaluating HER2/neu peptide GP2 (GLSI-100) versus. GM-CSF alone after adjuvant trastuzumab in HER2-positive women with breast cancer;fertility preservation decisions and outcomes of young women with breast cancer;adjuvant trastuzumab and vinorelbine (TV) for early-stage HER2+ breast cancer;Outcomes of neoadjuvant (NA) and adjuvant (A) chemotherapy in geriatric patients with stage I-III triple-negative breast cancer (TNBC): a single institution experience;Telehealth delivered Tai Chi intervention for managing aromatase inhibitor-induced arthralgia in breast cancer patients: TaiChi4Joint during the COVID-19 pandemic a pilot study;a prospective real-world study to assess the effectiveness and safety of trastuzumab biosimilar in the adjuvant treatment of HER2-positive breast cancer: preliminary safety results;effectiveness of chemotherapy on prognosis of elderly breast cancer: a retrospective cohort study based on SEER database;and prognostic role of the stromal tumor-infiltrating lymphocytes (TILs) in women with early ER+/HER2+ breast cancer (BC) in whom adjuvant chemotherapy (ChT) was omitted.

Veterans Health Administration's National Delivery of CIH Therapies, Whole Health Services and Chiropractic Care in 2020 and the Pivot to Telehealth

Methods: Databases were searched using CPT codes (acupuncture, chiropractic, and massage therapy), clinic stop codes (chiropractic care), clinic location names, internal accounting codes, clinic note titles, and structured coding templates (Health Factors) unique to VHA's electronic medical record. Results: A total of 441,891 Veterans used 2,930,700 of these services in FY20, representing a slight decrease from FY19 (3,083,806 total visits). Prior to the COVID19 pandemic, VHA was on track for expanded utilization in FY20. Of these visits, 422,313 (14%) were delivered through telehealth. Over 8.1% of all Veterans receiving VHA care in FY20 received at least oneCIH therapy, Whole Health service, or chiropractic care service. Use was highest among women (14.3%), patients with chronic pain (18.1%), opioid use disorder (15.6%), rheumatoid arthritis (13.3%), obesity (12.9%), or a mental health condition (12.8%). VHA medical centers worked quickly during the pandemic to expand telehealth offerings;comparing against FY19, nearly onethird of the monthly in-person visit volume was provided through telehealth by the end of 2020 for therapies including Core Whole Health services, yoga, Tai Chi/Qigong, meditation, biofeedback, guided imagery, and hypnosis. Background: Given that VHA is the largest healthcare system provider of CIH therapies in the U.S., we examined the VHA's national provision of nine CIH therapies (acupuncture, battlefield acupuncture, biofeedback, clinical hypnosis, guided imagery, massage therapy, meditation, Tai Chi/Qigong, and yoga), chiropractic care, and Whole Health services for fiscal years (FYs) 2017 to 2020 using data from electronic medical records and community-based claims, and assessed utilization as VHA expanded CIH offerings and pivoted to tele-CIH and tele-Whole Health in response to the COVID19 pandemic. Conclusion: Despite the impact of COVID19 on reduced FY20 in-person visits, including group CIH therapies, VHA continued to provide nearly the same number of visits as the prior year, in part due to expansion of telehealth services.

Complementary and Integrative Health in the Community: Expanding Access for Veterans Seeking Care through the Veterans Health Administration

Methods: Data were pulled from an internal administrative dashboard. Referrals include services for Veterans who live a prescribed driving distance from a VAMC, wait times over threshold, services unavailable, or for reasons of the best medical interest. Data was pulled for fiscal years 2020 through 2021 and included: chiropractic care, acupuncture, biofeedback, neuron feedback, clinical hypnosis, massage therapy, meditation (specifically MBSR), Tai Chi/qigong, and yoga. Standardized tracking of referrals began with the implementation of Standard Episodes of Care (SEOC) which define care requested and include number of visits permitted and timeframe. Results: Referrals increased for all approaches from FY20-21 shown as (FY20;FY21): chiropractic (104,197;197,357), acupuncture (59,787;100,908), massage therapy (5,021;17,646), biofeedback (31;69), neuron feedback (27;74), clinical hypnosis (10;40), MBSR (2;8), Tai Chi (2;8) and Yoga (1;2). Background: The Veterans Health Administration (VHA) Directive 1137: Provision of Complementary and Integrative Health (CIH) identifies the inclusion of evidence-based CIH approaches in the VHA's Medical Benefits Package (acupuncture, biofeedback, clinical hypnosis, guided imagery, massage therapy, meditation, Tai Chi/qigong, and yoga). The purpose of this administrative data review is to identify which approaches are being referred to Community Care from VHA medical centers (VAMC), and to identify if COVID-19 has had an impact on referrals to the community. Conclusion: CIH is expanding across the VHA and could be useful in supporting a cultural transformation that includes integrative health approaches within conventional medical systems. While all VAMCs provide some CIH in-house, a substantial amount is provided through Community Care. As the largest integrated healthcare system in the United States, this could impact growth of CIH and the need for more providers in the community. By hiring CIH professionals onstation and expanding the network to the community, VHA could be one of the largest providers and users of CIH.

Implementation and Impact of Tele-Whole Health on Patients: Provider and Patient Perspectives

Methods: Semi-structured interviews were conducted with 51 providers and 30 Veterans across 12 VHA Medical Centers (VAMCs). Interviewees included staff delivering and patients participating in tele WH coaching, tele WH educational classes, and tele-complementary and integrative therapies (e.g., acupuncture, chiropractic, yoga, Tai Chi, mindfulness or meditation). Interviews were transcribed and a content analysis was performed using a rapid approach. Results: Participants described a broad range of benefits associated with Veteran participation in teleWH services. These included: 1) Improved access to services that previously were not widely offered in-person;2) Increased comfort engaging in services, especially for specific Veteran populations (e.g., Veterans with PTSD, LGBTQ, women, and younger Veterans);3) Greater convenience, including less stress related to travel, length of time required to use services, and integration with workday;and 4) Increased engagement in self-care outside of classes or services. Disadvantages included: 1) Decreased socialization and opportunities for group interaction;2) Decreased access to touch-based services (e.g., acupuncture);3) Technological challenges with approved virtual platforms. Facilitator skill and tele health etiquette mattered greatly for satisfaction with tele WH. Background: The Veterans Health Administration (VHA) quickly responded to the COVID-19 pandemic by providing access to care via tele health. This rapid pivot occurred simultaneously with VHA's Whole Health transformation, which includes the integration of complementary and integrative health services, education, and coaching to develop self-care skills. This qualitative study explored providers' and patients' perspectives on the implementation and advantages/ disadvantages of tele-Whole Health services (tele WH). Conclusion: Tele WH is perceived to be a strong complement to in-person services and poses many physical and mental health benefits for patients. Attention to facilitator skills training and ease of virtual platform use is needed to increase engagement and make tele WH a viable patient centered option for care.

Veteran Engagement in Well-being Programming in the VA Whole Health System of Care Prior to and During COVID-19 Operations

Methods: The population included Veterans enrolled in the WHS nationally. Students t-test was used to assess the difference in unique Veterans engaged in WBP the six quarters prior to COVID (pre-COV) and the six quarters during COVID response (resp-COV). The differences in delivery of virtual WBP was assessed, including: (RFLX) Intro to WH Group, (HTAC) Take Charge of My Life & Health Group, (SCHC) EVP WH, (SNVC) EVP Mindful Movement, (HTFC) WH Partner Indiv., (WCHC) WH Coaching Indiv., (WCDC) WH Coaching Group, (CGQC) Qigong, (TAIC) TAI CHI, (YOGA) YOGA, (GIMA) Guided Imagery, (RLXT) Relaxation Techniques, (MANT) Mantram Repetition, (MDTN) Meditation, (MMMT) Mindfulness (non-MBSR), (REIK) REIKI, and (TPHT) Therapeutic/ Healing Touch. Results: Pre-COV, a total of 58,165 unique Veterans were engaged in 14,163 tele-health WBP encounters, compared to 63,648 unique Veterans engaged in 334,472 tele-health WBP encounters resp-COV. A significant increase in average number of tele-health WBP encounters per quarter was observed: 2,593 (95%CI 1537, 3649) telehealth pre-COV compared to 52,548 (95%CI 34169, 70926) during resp-COV, p=0.0008. There were significant increases in the delivery of all virtual WBP offerings (all P <0.05), except for SCHC and TPHT. Background: Well-being programming (WBP) is a core part of delivery of Whole Health (WH). During the COVID response, there was a pronounced decrease in delivery of WBP care, with a shift of delivery from face-to-face to virtual. This study describes the impact of COVID on delivery of WBP within the VA WH System (WHS). Conclusion: These data suggest that the response to COVID had little impact on the number of unique Veterans engaged in WBP overall, but the number of virtual WBP encounters increased significantly, comparing the same time periods. This analysis shows that the VA COVID response to increase delivery of virtual WBP as part of the national offering of the WHS was effective.

A Telehealth-Delivered Tai Chi Intervention (TaiChi4Joint) for Managing Aromatase Inhibitor-Induced Arthralgia in Patients With Breast Cancer During COVID-19: Longitudinal Pilot Study.

BACKGROUND: Estrogen receptor-positive breast cancer is the most common type of breast cancer in postmenopausal women. Aromatase inhibitors (AIs) are the endocrine therapy of choice recommended for these patients. Up to 50% of those treated with an AI develop arthralgia, often resulting in poor adherence and decreased quality of life. OBJECTIVE: The study is a single-arm longitudinal pilot study aiming to evaluate the safety, feasibility, acceptability, and potential efficacy of TaiChi4Joint, a remotely delivered 12-week tai chi intervention designed to relieve AI-induced joint pain. METHODS: Women diagnosed with stage 0-III breast cancer who received an AI for at least 2 months and reported arthralgia with a ≥4 score on a 0 to 10 scale for joint pain were eligible for study enrollment. Participants were encouraged to join tai chi classes delivered over Zoom three times a week for 12 weeks. Program engagement strategies included using a private Facebook study group and a Box cloud for archiving live class recordings. The program uses SMS text messaging and emails with periodic positive quotes and evidence-based information on tai chi for facilitating community bonding and class attendance. Participants were invited to complete the following assessments at baseline and at 1-, 2-, and 3-month intervals from study enrollment: Brief Pain Inventory, Western Ontario and McMaster University Osteoarthritis Index (WOMAC), The Australian Canadian Osteoarthritis Hand Index (AUSCAN), Fatigue Symptom Inventory, Hot Flash Related Daily Interference Scale (HFRDIS), Pittsburgh Sleep Quality Index (PSQI), and Center for Epidemiological Studies-Depression (CES-D). RESULTS: A total of 55 eligible patients were invited to participate, and 39 (71%) consented and completed the baseline assessments. Participants attended 61% (median) of the suggested classes, with no tai chi-related adverse events reported. Of the 39 participants, 22 completed the 3-month follow-up assessment with a 56% retention rate. Study participants reported improvement from baseline compared to 3 months as follows (paired t test): Brief Pain Inventory (P<.001), AUSCAN pain subscale (P=.007), AUSCAN function subscale (P=.004), Fatigue Symptom Inventory (P=.004) and PSQI (P<.001), and HFRDIS (P=.02) and CES-D (P<.001). In particular, for our primary end point of interest, improvements in hip and knee symptoms, measured by WOMAC's three subscales, were clinically meaningful and statistically significant when adjusted for multiple comparisons from baseline to 3 months post intervention. CONCLUSIONS: The COVID-19 global pandemic has resulted in the need to rethink how mind-body therapies can be delivered. This study demonstrated the feasibility, acceptability, and potential efficacy of a telehealth-based tai chi intervention for reducing AI-induced arthralgia. The intervention decreased patient-reported pain and stiffness, and improved sleep quality and depressive symptoms. Fully powered, large, telehealth-based tai chi trials for AI-associated arthralgia are needed considering our promising findings. TRIAL REGISTRATION: ClinicalTrials.gov NCT04716920; https://www.clinicaltrials.gov/ct2/show/NCT04716920.

The Sleep Quality of the Frontline Healthcare Workers and the Improving Effect of Tai Chi.

Background: A number of studies have documented that coronavirus disease 2019 (COVID-19) brought more negative impact on the physical and psychological functioning of frontline healthcare workers. Especially, sleep quality was focused. This study aimed to investigate the sleep quality of frontline healthcare workers, risk factors for sleep quality, and the effect of Tai Chi training. Methods: A total of 98 frontline healthcare workers were recruited, coming from the infection department, fever clinic, laboratory, and medical imaging department in a COVID-19-designated hospital in Shanghai. Of them, 50 participated in a 2-week intervention and were randomized to receive a Tai Chi training or relaxation training. Participants were assessed at baseline, 7 and 14 days after participation. Demographic information, sleep quality, and anxiety were measured by using the demographic questionnaire, Pittsburgh Sleep Quality Index (PSQI) and Beck Anxiety Inventory (BAI). Results: 13.3% participants were above the cut-off score (>10) for the PSQI. Regression analysis showed gender, age, working years, and job category had effect on sleep quality. Compared to the control group, participants in the Tai Chi training group had lower scores on both PSQI (p < 0.05) and BAI (p < 0.01) after the 2-week intervention. Conclusion: It was demonstrated that poor sleep quality existed in the frontline healthcare workers, which was related to gender, age, working years, and job category. Tai Chi training can dramatically improve their sleep quality and reduce anxiety symptoms.

Decreasing Loneliness and Social Isolation during the COVID Pandemic using Cancer Support Services: Case Study of a Geriatric Patient with Diffuse Large B-cell Lymphoma

Background/Purpose: We present a case study demonstrating how cancer support services assisted a patient diagnosed with diffuse large B-cell lymphoma (DLBCL) to cope throughout the COVID-19 pandemic. Perceived social isolation and loneliness were exacerbated for this patient due to the interaction of 1) cancer diagnosis, 2) COVID- 19 social distancing, 3) inability of vaccination to produce immunity to COVID-19, and 4) diminution of her social network due to aging. Methods: We summarize clinical encounters and chart review for an 88-year-old female patient (divorced, living with son) with DLBCL evaluated at a large urban university hospital to illustrate the impact of cancer support service interventions on social isolation and loneliness. Results: Systematic review revealed that interventions such as exercise, mindfulness-based practice, Tai Chi Qigong meditation, and art therapies decrease loneliness and increase perceived social support. The patient consistently observed COVID-19 social distancing precautions throughout the pandemic, receiving Pfizer vaccine immediately once available, and Moderna vaccine thereafter. However, she did not develop antibodies, reinforcing her need to strictly isolate. The patient has participated in a regimen of online cancer support activities: twice-weekly group exercise physiology sessions and gentle chair yoga sessions, twice-monthly individual exercise physiology, weekly music therapy, weekly chaplain meetings, and daily treadmill walking. She recognizes distress and anxiety as temporary feelings and understands how these support activities enhance her repertoire of coping strategies. Despite being restricted to home;she states that regular interaction with her support services team-and attentive care from her son-have decreased feelings of loneliness. Conclusions and Implications: Our patient has demonstrated resilience, overcoming the combined challenges that amplify loneliness and social isolation: DLBCL diagnosis, lack of COVID-19 antibody response, and aging. Although she is unable to socialize in person, her interactions with cancer support services staff and engagement in a suite of activities have mitigated loneliness and isolation.

Mind-Body Therapies From Traditional Chinese Medicine: Evidence Map.

Background: The mind-body therapies of traditional Chinese medicine include several intervention types and combine physical poses with conscious relaxation and breathing techniques. The purpose of this Evidence Map is to describe these different interventions and report related health outcomes. Methods: This evidence map is based on the 3iE Evidence Gap Map methodology. We searched seven electronic databases (BVS, PUBMED, EMBASE, PEDro, ScienceDirect, Web of Sciences, and PschyInfo) from inception to November 2019 and included systematic reviews only. Systematic reviews were analyzed based on AMSTAR 2. We used Tableau to graphically display quality assessment, the number of reviews, outcomes, and effects. Results: The map is based on 116 systematic reviews and 44 meta-analyses. Most of the reviews were published in the last 5 years. The most researched interventions were Tai Chi and Qi Gong. The reviews presented the following quality assessment: 80 high, 43 moderate, 23 low, and 14 critically low. Every 680 distinct outcome effect was classified: 421 as potential positive; 237 as positive; 21 as inconclusive/mixed; one potential negative and none no effect. Positive effects were related to chronic diseases; mental indicators and disorders; vitality, well-being, and quality of life. Potential positive effects were related to balance, mobility, Parkinson's disease, hypertension, joint pain, cognitive performance, and sleep quality. Inconclusive/mixed-effects justify further research, especially in the following areas: Acupressure as Shiatsu and Tuiná for nausea and vomiting; Tai Chi and Qi Gong for acute diseases, prevention of stroke, stroke risk factors, and schizophrenia. Conclusions: The mind-body therapies from traditional Chinese medicine have been applied in different areas and this Evidence Map provides a visualization of valuable information for patients, professionals, and policymakers, to promote evidence-based complementary therapies.

A REMOTE-DELIVERED MIND-BODY INTERVENTION FOR KNEE OSTEOARTHRITIS PATIENTS DURING THE PANDEMIC: A QUALITATIVE STUDY

Purpose: The aims of this study were to explore the feasibility and perceived benefits of a remotely delivered Tai Chi mind-body Intervention compared with a wellness education intervention for Knee OA during the COVID-19 pandemic. Methods: In our randomized controlled trial, patients who met the ACR criteria for Knee OA were randomized to either a Tai Chi or Wellness Education group and attended 12 weeks of biweekly remote sessions. Semi-structured interviews were audio and videotaped via Zoom or telephone and ranged from 15-20 minutes in length. Interview questions were designed to ensure the exploration of key themes and were tailored for each intervention. Eleven key themes, including perceived benefits, social interaction and engagement, remote administration, and COVID-19 related experiences were identified and analyzed. Results: Thirty-two patients completed interviews. The mean participant age was 66 years, with 65% female. Consensus suggested remote delivery of the intervention was a well-adapted remedy for Knee OA. Specifically, the Tai Chi group reported pain reduction, improved walking ability;the Wellness group incorporated improved knowledge of healthy living skills into their daily routines. Both groups found therapeutic value in the interventions, such as direct benefits of Tai Chi, and indirect benefits of social interaction during an isolating time. Participants also reported enhanced ability to manage stress surrounding the pandemic. Most interviewees expressed general satisfaction. Several key barriers to treating Knee OA were identified, such as difficulty tailoring instructions to individual patients and providing direct feedback. Conclusions: This study confirmed the feasibility of a remote-delivered behavioral intervention for Knee OA during the pandemic. Despite the challenges of this novel experience, the perceived intervention benefits are comparable to those found in prior, in-person studies. Non-pharmacological methods of treating Knee OA, including remote delivery of education and mind-body approaches, are effective ways of managing Knee OA symptoms.