Iyengar yoga for adolescents and young adults with irritable bowel syndrome

艾扬格瑜伽针对患有肠易激综合症的青少年和年轻人

• 批准号: 8005039
• 负责人: Subhadra Evans
• 金额: $ 14.16万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-01-01 至 2014-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8005039
• 关键词: Abdomen; Adolescence; Adolescent; Adrenal Glands; Affect; Aftercare; American; Arousal; Autonomic nervous system; Biological; California; Child; Childhood; Clinical; Clinical Research; Clinical Treatment; Clinical Trials; Collection; Complementary and alternative medicine; Constipation; Control Groups; Data Analyses; Data Collection; Development; Development Plans; Diarrhea; Direct Costs; Disease; Doctor of Philosophy; Elements; Emotional Stress; Ensure; Environment; Ethics; Facilities and Administrative Costs; Faculty; Family; Fellowship; Functional disorder; Goals; Health system; Home environment; Hormonal; Hour; Housing; Hydrocortisone; Hypothalamic structure; Individual; Intervention; Investigation; Irritable Bowel Syndrome; Laboratories; Lead; Life; London; Los Angeles; Measurement; Measures; Mediating; Mediator of activation protein; Meditation; Mentored Research Scientist Development Award; Mentors; Mind-Body Intervention; Mind-Body Method; Modeling; Moods; Neuroendocrinology; Outcome; Pain; Pain Research; Pain management; Participant; Patient Self-Report; Patients; Physiological; Physiology; Pituitary Gland; Postdoctoral Fellow; Posture; Process; Publications; Quality of life; Randomized; Randomized Controlled Trials; Relative (related person); Relaxation; Research; Research Design; Research Personnel; Research Training; Resources; Role; Safety; Salivary; School-Age Population; Schools; Self Efficacy; Series; Specimen; Stress; Students; Symptoms; System; Testing; Training; Training Programs; Universities; Visceral; Visceral pain; Vulnerable Populations; Waiting Lists; Water; Work; Writing; Yoga; aged; base; biobehavior; biological adaptation to stress; biopsychosocial; body-mind; career; career development; chronic pain; control trial; coping; cost effective; cytokine; daily functioning; design; experience; follow-up; health related quality of life; high school; hypothalamic-pituitary-adrenal axis; improved; innovation; interest; medical schools; mindfulness; pediatric department; primary outcome; programs; protocol development; psychologic; psychosocial; public health relevance; response; restoration; secondary outcome; sound; statistics; teacher; tool; treatment as usual; young adult

DESCRIPTION (provided by applicant): The proposed Mentored Research Scientist Development Award (K01) entitled 'Iyengar yoga for adolescents and young adults with irritable bowel syndrome' is a first resubmission in response to PA-09-040 (previously PA-06-001). The proposed training and research will take place in the Pediatric Pain Program (PPP) within the David Geffen School of Medicine at the University of California, Los Angeles, where I am currently serving as Assistant Researcher in the Faculty series. Immediate goals: After spending my PhD dissertation examining the impact of maternal chronic pain on children's psychosocial and pain development and a post-doctoral research fellowship at Brunel University in West London, my immediate goal is to apply biopsychosocial pain research to the understanding of mind- body medicine. I have a long-standing interest in mind-body techniques such as yoga and meditation, and intend to scientifically examine the benefits I have noted in my personal practice. To this end, I intend to conduct this first, preliminary study of yoga for adolescents and young adults with irritable bowel syndrome (IBS), a common functional neurovisceral disorder. Given that limited research exists regarding the safety, feasibility and efficacy of yoga for young people, I plan to conduct a randomized controlled trial (RCT) of yoga for young IBS patients using a standardized yoga intervention and a wait-list usual care control group, and explore biobehavioral mediator mechanisms. Long-term goals: My long-term goal is to become an independent investigator with expertise in biopsychosocial measures and the conduct of RCTs of mind-body interventions for pain management in children, young adults and families. My ultimate goal is to advance the field of complementary and alternative medicine (CAM) by delineating the physiological and psychospiritual mechanisms in the action of yoga upon clinical outcomes in pain. The training and research plan proposed in this application will enable me to begin a program of research that will implement a series of high quality, methodologically sound clinical trials on yoga to understand both mechanistic processes and key predictors of clinical outcomes to understand what works for whom and why. Training/Research Career Development: My career development plan includes courses in physiology, neuroendocrinology, advanced statistics, mind-body techniques and the responsible conduct of clinical research. My career development will also involve mentoring experiences with Dr Lonnie Zeltzer, an eminent pediatric CAM and pain researcher, Dr Bruce Naliboff, a thought leader in functional pain conditions and Dr Jennie Tsao, who has extensive experience in research design and data analysis for pain research. Environment: The PPP specifically and UCLA in general are both extremely supportive of biopsychosocial research. UCLA houses a number of centers and programs specializing in CAM which will support my development as a mind-body researcher. Moreover, the Department of Pediatrics has been very forthcoming about its support of my training and research plans. Research: IBS affects as many as 14% of high school-aged students. Symptoms include discomfort in the abdomen, along with diarrhea and/or constipation and other gastroenterological symptoms, which can significantly impact quality of life and daily functioning of patients. Emotional stress appears to exacerbate IBS symptoms suggesting that mind-body interventions reducing arousal may prove beneficial. For many sufferers, symptoms can be traced to childhood and adolescence, making the early manifestation of IBS important to understand. The current study will focus on young people aged 16-22 years with IBS. The study will test the potential benefits of Iyengar yoga (IY) on clinical symptoms, psychospiritual functioning and visceral sensitivity. Yoga is thought to bring physical, psychological and spiritual benefits to practitioners and has been associated with reduced stress and pain. Through its focus on restoration and use of props, IY is especially designed to decrease arousal and promote psychospiritual resources in physically compromised individuals. IY is suitable for research, as an extensive and standardized teacher-training program ensure it is replicable and safe. Sixty-four IBS patients aged 16-22 will be randomly assigned to a standardized 8-week biweekly IY group-based program (1.5 hour sessions) or a wait-list usual care control group. The groups will be compared on the primary clinical outcomes of IBS symptoms, quality of life and global improvement at post- treatment and 2 month follow-up. Secondary outcomes will include visceral pain sensitivity assessed with a standardized laboratory task (water load task), and psychospiritual variables including coping, self-efficacy, mood, acceptance and mindfulness. Mechanisms of action involved in the proposed beneficial effects of yoga upon clinical outcomes will be explored, and include the mediating effects of visceral sensitivity, increased psychospiritual resources, regulated autonomic nervous system (ANS) responses (measured in response to the visceral sensitivity task) and regulated hormonal stress response assessed via salivary cortisol. It is hypothesized that IY will be safe and feasible: with less than 20% attrition; and the IY group will demonstrate significantly improved outcomes compared to controls, with physiological and psychospiritual mechanisms contributing to improvements; clinical treatment gains will be maintained at 2 months following yoga. PUBLIC HEALTH RELEVANCE: IBS affects millions of Americans. Despite the apparent role of stress in symptoms, little is known about the effect of mind-body interventions such as yoga on the responses of IBS patients. The proposed work will promote our understanding of an approach to reduce stress and pain and enhance functioning in a particularly vulnerable group of IBS patients - young people. The findings would contribute towards the development of a cost-effective mind-body treatment for IBS.

描述（由申请人提供）：拟议的导师研究科学家发展奖（K01）题为“针对患有肠易激综合症的青少年和年轻人的艾扬格瑜伽”，是针对 PA-09-040（以前的 PA-06-001）的首次重新提交）。拟议的培训和研究将在加州大学洛杉矶分校大卫格芬医学院的儿科疼痛项目 (PPP) 中进行，我目前担任学院系列的助理研究员。 近期目标：在我的博士论文研究了母亲慢性疼痛对儿童心理社会和疼痛发展的影响以及在西伦敦布鲁内尔大学获得博士后研究奖学金后，我的近期目标是将生物心理社会疼痛研究应用于理解心理-身体医学。我长期以来对瑜伽和冥想等身心技巧很感兴趣，并打算科学地检验我在个人练习中注意到的好处。为此，我打算针对患有肠易激综合症（IBS）（一种常见的功能性神经内脏疾病）的青少年和年轻人进行瑜伽的首次初步研究。鉴于关于年轻人瑜伽的安全性、可行性和有效性的研究有限，我计划使用标准化瑜伽干预措施和候补名单常规护理对照组，对年轻 IBS 患者进行一项瑜伽随机对照试验 (RCT)，并探索生物行为调节机制。 长期目标：我的长期目标是成为一名独立研究者，拥有生物心理社会测量方面的专业知识，以及针对儿童、年轻人和家庭疼痛管理进行身心干预随机对照试验。我的最终目标是通过描述瑜伽作用对疼痛临床结果的生理和精神机制来推进补充和替代医学（CAM）领域。本申请中提出的培训和研究计划将使我能够开始一项研究计划，该计划将实施一系列高质量、方法论合理的瑜伽临床试验，以了解机械过程和临床结果的关键预测因素，从而了解什么对谁有效以及为什么。 培训/研究职业发展：我的职业发展计划包括生理学、神经内分泌学、高级统计学、身心技术和负责任的临床研究课程。我的职业发展还将包括与著名儿科 CAM 和疼痛研究员 Lonnie Zeltzer 博士、功能性疼痛病症思想领袖 Bruce Naliboff 博士以及在疼痛研究的研究设计和数据分析方面拥有丰富经验的 Jennie Tsao 博士的指导经历。 环境：PPP（尤其是 PPP）和 UCLA（加州大学洛杉矶分校）总体上都非常支持生物心理社会研究。加州大学洛杉矶分校拥有许多专门从事 CAM 的中心和项目，这将支持我作为身心研究员的发展。此外，儿科非常乐意支持我的培训和研究计划。 研究：IBS 影响多达 14% 的高中生。症状包括腹部不适，以及腹泻和/或便秘和其他胃肠道症状，这会显着影响患者的生活质量和日常功能。情绪压力似乎会加剧肠易激综合征症状，这表明减少觉醒的身心干预可能是有益的。对于许多患者来说，症状可以追溯到童年和青春期，因此了解肠易激综合症的早期表现非常重要。目前的研究将重点关注 16-22 岁患有 IBS 的年轻人。该研究将测试艾扬格瑜伽（IY）对临床症状、心理精神功能和内脏敏感性的潜在益处。瑜伽被认为可以给练习者带来身体、心理和精神上的益处，并且可以减轻压力和疼痛。通过专注于道具的恢复和使用，IY 专门用于减少身体受损个体的唤醒并促进心理精神资源。 IY 适合研究，因为广泛且标准化的教师培训计划确保了它的可复制性和安全性。 64 名 16-22 岁的 IBS 患者将被随机分配到标准化的为期 8 周、每两周一次的 IY 小组计划（1.5 小时课程）或等待名单上的常规护理对照组。将比较各组的 IBS 症状、生活质量以及治疗后和 2 个月随访时的整体改善的主要临床结果。次要结果包括通过标准化实验室任务（水负荷任务）评估的内脏疼痛敏感性，以及心理精神变量，包括应对、自我效能、情绪、接受度和正念。将探讨瑜伽对临床结果的拟议有益影响的作用机制，包括内脏敏感性的中介作用、增加的心理精神资源、调节的自主神经系统（ANS）反应（根据内脏敏感性任务进行测量）和通过唾液皮质醇评估调节的荷尔蒙应激反应。假设 IY 将是安全可行的：人员流失率低于 20%；与对照组相比，IY 组将表现出显着改善的结果，生理和心理精神机制有助于改善；临床治疗效果将在瑜伽结束后 2 个月内保持。 公共卫生相关性：IBS 影响着数百万美国人。尽管压力在症状中发挥着明显的作用，但人们对瑜伽等身心干预措施对 IBS 患者反应的影响知之甚少。拟议的工作将促进我们对减轻压力和疼痛并增强特别脆弱的 IBS 患者群体（年轻人）功能的方法的理解。这些发现将有助于开发一种具有成本效益的肠易激综合征身心治疗方法。