practicing mindfulness combined with tai chi for diabetic peripheral neuropathy management

Tai Chi with Mindfulness Training to Manage Diabetic Peripheral Neuropathy

Diabetes Mellitus (DM) is a serious health concern globally, affecting millions of people worldwide1. The International Diabetes Federation (IDF) reveals that the prevalence of DM could increase up to 12.2% by 20452. Type 2 diabetes (T2DM) accounts for about 90% of DM2. Patients with T2DM, particularly those who struggle to control their blood glucose levels, are likely to suffer from adverse complications, including macrovascular disease, microangiopathy, and diabetic peripheral neuropathy (DPN)3. DPN is a prevalent microvascular complication, with at least 50% of DM patients showing DPN signs and symptoms over time4. Unfortunately, DPN is often ignored, and the actual figures of patients suffering are much higher than reported in most cases2.
Patients with poor glycemic control are prone to developing DPN with an insidious onset. The initial symptoms of DPN are often unremarkable, which makes it easy for patients to overlook the condition. When obvious symptoms and functional impairment appear, irreversible neurological damage has been caused5. DPN has a complex clinical presentation. Patients suffer from long-term metabolic disturbances and oxidative stress damage. This can result in symmetrical limb numbness, pain, or paresthesia6,7. As the disease progresses, neurological and vascular injuries are further aggravated, eventually leading to irreversible tissue damage8. The incidence of diabetic foot ulcers and amputations is associated with mortality from DPN9. In addition, as symptoms of DPN often persist, many patients experience depression, sleep disturbances, and activity limitations, leading to a decrease in overall quality of life and even disability10.
Currently, lifestyle interventions (including exercise, diet, psychotherapy, etc.) are well recognized as effective treatments for DPN patients in addition to glycemic control and pharmacotherapy11. According to the American Diabetes Association (ADA), &#34;valuable exercise is beneficial to all patients with DM&#34;. For example, it can improve glycolipid metabolism and insulin resistance1. Studies have shown that exercise can improve metabolic, vascular damage, and neurological function in patients with DPN12,13. However, patients with DPN are reluctant to exercise due to a lack of motility, pain, and fear of foot injury.
The diabetic peripheral neuropathy (DPN) patients&#39; physical discomfort and limitations on daily activities, according to the Fear-Avoidance Model (FAM), can reduce their capacity for social interaction, which in turn can contribute to negative emotional reactions like anxiety and depression14. Conversely, negative emotions can affect glycemic control and increase the rate of complications15,16,17,18. Therefore, mind-body therapy is recommended for DPN, which focuses on the interaction between thoughts, emotions, bodies, and behaviors. The aim is to achieve homeostasis of the body and mind.
Tai Chi is a traditional Chinese mind-body exercise. Tai Chi has received much attention from scholars worldwide because of its unique exercise modes and therapeutic effects on diseases. Multiple high-quality clinical trials published in international journals have confirmed the effectiveness of Tai Chi for the treatment and rehabilitation of chronic diseases such as Parkinson&#39;s disease19, stroke20, metabolic syndrome21, knee arthritis22, and breast cancer23. Tai Chi belongs to a class of moderate-intensity aerobic exercises that uses continuous body spiral exercise and regulated breathing to improve aerobic capacity, muscle strength, balance, and exercise capacity. Traditional Chinese medicine holds that Tai Chi can balance yin and Yang, run Qi and blood, and relax meridians24. It is a suitable form of exercise for patients with DPN. Many studies have found that Tai Chi improves insulin resistance and blood lipids, and reduces the incidence of anxiety and depression25,26. In addition, Tai Chi could improve quality of life and decrease body mass index for patients with T2DM 27.
Mindfulness training is another prominent mind-body intervention that focuses on cultivating an intentional, moment-to-moment, nonjudgmental awareness of experience28. It helps to enhance attention to the present experience, including thoughts, feelings, breathing, and body sensations. Zeidan&#39;s research found that mindfulness training could make patients more objectively evaluate discomfort and improve self-regulation29. Wielgosz&#39;s study showed that the biggest problem of exercise intervention was poor compliance, which could be solved by adding mindfulness training to exercise30. Mindfulness training combined with exercise could effectively improve patients&#39; willingness to move, increase the time and frequency of movement, and promote patients&#39; perceiving body sensations in activity.
Meanwhile, exercise combined with mindfulness training can expand patients&#39; vision and enhance their understanding of themselves. This helps the body to become more flexible, relaxed, and balanced, effectively relieving the negative experience of patients. The concept of mindfulness training is consistent with the idea of &#34;unity of form and spirit&#34; of Tai Chi. Most patients with DPN often receive misinformation from the feet provided by the brain due to impaired sensory function31. Mindfulness training can enhance the effect of movement through psychological regulation and nervous regulation32. Therefore, this study aims to verify the feasibility of mindfulness training combined with Tai Chi and explore its effect on DPN patients.

Author Spotlight: Integrating Tai Chi with Mindfulness Training to Achieve an Effective Mind-Body Exercise 

Effects of Mindfulness Training Combined with Tai Chi in Patients with Diabetic Peripheral Neuropathy

Our research focused on the Chinese traditional sports Tai Chi. We are exploring the possibility and the effectiveness of mindfully training combined with Tai Chi as the mind-body exercise for treating diabetic peripheral neuropathy. Ensuring that subjects complete three intensive training sessions per week is an important challenge in this study.Our research show that Tai Chi can be well-integrated with mindfulness training. Our outline the steps to integrate mindfulness training with Tai Chi. It will pave the way for the future development of Tai Chi, making this traditional sports more engaging and beneficial for practitioner.In the future, we will focus on the application of mindfulness training combined with Tai Chi in other chronic diseases. We will also make efforts to promote mindfulness training combined with Tai Chi.

Watch this Scientific Journal Video about Practicing Mindfulness Combined with Tai Chi for Diabetic Peripheral Neuropathy Management at JoVE.com

Practicing Mindfulness Combined with Tai Chi for Diabetic Peripheral Neuropathy Management

To begin mindfulness training combined with Tai Chi, select an open and tranquil space. Spread the yoga mat and sit on it to perform mindfulness meditation. Slowly and deeply breathe in and out three to four times, focusing on the sensation of air, entering through the nostrils, filling the chest and abdomen, and then exiting the body.Then allow the breathing rhythm to return to normal and do not control the breathing. Next, focus on various elements such as breath, physical sensation, audio cues, thought processes, and emotions, while consciously relaxing the body. Transition into the mindfulness body scan by lying supine on the yoga mat.Legs resting apart at a natural distance, eyes nearly closed, and arms beside the body without making contact with the body. Concentrate on the sensations throughout the body from the toes up to the brain. If falling asleep, choose to sit to avoid dozing off during the mindfulness body scanning exercises.Next, perform Tai chi or mindfulness movement by focusing on every individual movement aiming to maintain a state of deep mindfulness throughout the process. Take note of the alternating stress and relaxation in the leg muscles, as well as the tactile sensation of the feet touching the ground. To end the activity engage in relaxation exercises for both the upper and lower limbs.Also, perform breathing adjustments for a 10 minute duration, which acts as a relaxed balancing conclusion to the activity. Sit in a meditative state, refrain from making judgements about the thoughts that arise and always accept these concepts. After the intervention, there was a statistically significant difference in the TCSS score of MTCG, the group practicing mindfulness training with Tai Chi, TCG, the group practicing only Tai Chi and the control group, or cg.The TCSS score of MTCG was significantly lower than TCG and CG.The MAAS score of the MTCG not only improved after the intervention, but it was also significantly higher than that of the TCG and CG.After the intervention, there was a statistically significant difference in the VAS scores between the three groups. The score of the MTCG was significantly lower than the other groups. A similar trend was observed in the case of the serum necrosis factor alpha or TNF alpha levels.After the intervention, there was a statistically significant difference in the DSQL scores between the three groups. The DSQL score of the MTCG was significantly lower than that of the other groups.

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131 Views.  Hospital of Chengdu University of Traditional Chinese Medicine. To begin mindfulness training combined with Tai Chi, select an open and tranquil space. Spread the yoga mat and sit on it to perform mindfulness meditation. Slowly and deeply breathe in and out three to four times, focusing on the sensation of air, entering through the nostrils, filling the chest and abdomen, and then exiting the body.Then allow the breathing rhythm to return to normal and do not control the breathing. Next, focus on various elements such as breath, physical sensation,...