Barrett B, Hayney MS, Muller D, et al. Meditation or exercise for preventing acute respiratory infection: a randomized controlled trial. Ann Fam Med. 2012 Aug; (10):337-346.
Randomized controlled study
One hundred forty-nine healthy adults aged 50 years and older were randomized to 3 parallel groups (mindfulness meditation, moderate-intensity exercise, or observational control) and studied from September 2009 through May 2010. Participants were included if they reported an average of one of more colds per year and were excluded if they had depression, cancer, autoimmune disease, or immunodeficiency. Additional exclusion criteria included prior training or current practice in meditation or participation in exercise more than once per week.
Forty-seven participants were assigned to an exercise program, led by exercise physiologists at the University of Washington Health Sports Medicine Center. The exercise program consisted of 2.5-hour group sessions each week and 45 minutes of brisk walking or jogging per day at moderate intensity for 8 weeks. Participants used the Borg’s Rating of Perceived Exertion to direct them to moderate-intensity exercise. Fifty-one adults were assigned to a mindfulness meditation program based on Jon Kabat-Zinn’s mindfulness-based stress-reduction program (MBSR), designed to increase self-awareness of how one’s mind and body reacts to stress. Participants in the meditation group attended 2.5-hour group sessions weekly and performed 45 minutes of daily meditation at home. Fifty-one participants served as observational controls.
Primary Outcome Measures
Acute respiratory tract infection (ARTI) incidence, duration, and severity were evaluated using the Wisconsin Upper Respiratory Symptom Survey (WURSS-24), a 7-point scale assessing illness-specific quality of life, completed daily throughout an ARTI. In addition, visits with doctors and days of missed work were counted. Lastly, nasal wash samples were collected during ARTI episodes and evaluated for neutrophils and viral load.
At the conclusion of the study, there were 27 ARTI episodes in the meditation group, 26 ARTI episodes in the exercise group, and 40 ARTI episodes in the control group. Total number of ARTI illness days was 257 (P=0.032), 241 (P=0.032), and 453 in the meditation, exercise and control groups, respectively. Mean global severity using the WURSS-24 questionnaire was 144 (P=0.004), 248 (P=0.16), and 358 for participants in the meditation, exercise, and control groups, respectively; thus participation in mindfulness meditation resulted in a statistically significant reduction in ARTI severity scores. This means that incidence, duration and global severity of ARTIs were 33%, 43%, and 60% lower in the meditation group and 29%, 43%, and 31% lower in the exercise group, compared to the controls.
In addition, in the meditation group, there were 16 days (P<0.001) of missed work attributed to ARTI with 10 ARTI-related healthcare visits. In the exercise group, there were 32 days (P=0.041) of missed worked due to ARTI with 15 ARTI-related healthcare visits. In comparison, in the control group, there were 67 missed work days due to ARTIs and 16 ARTI-related healthcare visits; neither exercise nor meditation conferred a statistically significant reduction in the number of healthcare visits; however, the study demonstrated 76% fewer lost work days in the meditation group and 48% fewer days missed in the exercise group.
The results of this study are consistent with prior studies that correlate high stress level, lack of social support and negative emotions with higher rates of self-reported illness.
The results of this study are consistent with prior studies that correlate high stress level, lack of social support and negative emotions with higher rates of self-reported illness.1–3 Mindful meditation can reduce perceived stress and negative emotions, thereby improving mental health and ARTI burden.4–5 On a similar note, both epidemiological and experimental research has shown that regular exercise confers protection from ARTI.6–8 While ARTIs are common and self-limiting, they are costly, affecting millions of Americans each year. The average adult experiences 2–4 colds per year, and the average child experience 6–10 colds per year.9 In fact, non-influenza ARTIs cause in 20 million healthcare visits and 40 million missed work and school days in the United States each year, resulting in an estimated economic burden of $40 billion each year.10 The staggering annual cost of ARTIs warrant the promotion of lifestyle changes that are congruent with health maintenance and disease prevention. Several activities, such as frequent hand washing,11 smoking cessation,12 and the use of saline nasal irrigation13 have also been shown to help prevent and reduce ARTI incidence, duration, and severity. While this study does not demonstrate statistically significant improvements in all parameters defining ARTI burden, these findings are certainly clinically significant as even mild improvement in disease burden can result in notable economic and health benefits.
- Cohen S, Tyrrell DA, Smith AP. Psychological stress and susceptibility to the common cold. N Engl J Med. 1991;325(9): 606-612.
- Cohen S, Doyle WJ, Skoner DP, Rabin BS, Gwaltney JM Jr. Social ties and susceptibility to the common cold. JAMA. 1997; 277(24):1940-1944.
- Doyle WJ, Gentile DA, Cohen S. Emotional style, nasal cytokines, and illness expression after experimental rhinovirus exposure. Brain Behav Immun. 2006;20(2):175-181.
- Mars TS, Abbey H. Mindfulness meditation practice as a healthcare intervention: A systematic review. Int J Osteopath Med. 2010;13(2): 56-66.
- Carmody J, Baer RA. Relationship between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. J Behav Med. 2008;31(1):23-33.
- Nieman DC, Henson DA, Austin MD, Sha W. Upper respiratory tract infection is reduced in physically fit and active adults. Br J Sports Med. 2012;45(12):987-992.
- Nieman DC. Exercise, upper respiratory tract infection, and the immune system. Med Sci Sports Exerc. 1994;26(2):128-139.
- Chubak J, McTiernan A, Sorensen B, et al. Moderate-intensity exercise reduces the incidence of colds among postmenopausal women. Am J Med. 2006;119(11):937-942.
- Gwaltney JM Jr. Rhinoviruses. In: Viral Infectionf Humans: Epidemiology and Control. 4th ed. Evans AS, Kaslow RA, eds. New York, NY: Plenum Press;1997:815-838.
- Fendrick AM, Monto AS, Nightengale B, Sarnes M. The economic burden of non-influenza-related viral respiratory tract infection in the United States. Arch Intern Med. 2003;163(4):487-494.
- Carter JM. Hand washing decreases risk of colds and flu. J Natl Med Assoc. 2002;9(2):A11.
- Cohen S, Tyrrell DA, Russell MAH, Jarvis MJ, Smith AP. Smoking, alcohol consumption, and susceptibility to the common cold. Am J Public Health. 1993;83(9):1277-1283.
- Rabago D, Zgierska. Saline nasal irrigation for upper respiratory