bluerain 2010-6-12 01:07
太極拳可以改善某些ADHD症狀
作者：Caroline Helwick
出處：WebMD醫學新聞
May 26, 2010 (紐澳良) — 根據發表於美國精神科協會(APA)2010年會中的研究，在夏令營中參加太極拳課程6週可以改善心智疾病青少年的行為控制。
紐約布魯克林Maimonides醫學中心精神科住院醫師Peng Pang表示，我們發現，這群診斷有注意力不足/過動障礙症(attention-deficit/hyperactivity disorder，ADHD)的青少年整體在控制過動上有幫助，認知技能也有改善。
Pang醫師表示，隨機控制試驗顯示，太極拳可以改善成人的生活品質與憂鬱症狀，且至少有一個非控制型試驗發現，對於ADHD或焦慮的小孩有幫助，但是少有研究探討太極拳對年輕人可能的心理社會幫助。
因此，目前的這篇控制型研究檢視了太極拳促進青少年(12-18歲)自我控制和減少情緒不穩的效果，這些青少年至少有一種精神疾病診斷與統計手冊第四版內文修正版(Diagnostic and Statistical Manual of Mental Disorders [Fourth Edition, Text Revision])的心智疾病診斷，這些研究對象參加該醫學中心在2009年舉辦的夏日喘息計劃(summer respite program)。
該研究包括了太極拳組的10名青少年以及9名參加該營隊但未學習太極拳的控制組，平均年紀是14歲，約半數為白人、半數為男性。約50%有ADHD診斷，其他診斷包括適應障礙、憂鬱、對立性反抗疾患以及焦慮。
兩組在開始時的人口統計學資料和Conners-Wells自我報告量表(Conners-Wells’ Self-Report Scale，CWSS)的次量表等醫學資訊之間並無顯著差異；主要終點為根據CWSS判斷的過動改善情況。
太極拳組每週有兩次由太極拳師傅指導45分鐘的太極拳課程，為期6週，控制組參加日間營隊，但是只參與標準活動。在開始時、第6週和第12週時反覆進行測量，以得知兩組之間的差異。
研究者發現，在第6週結束時，太極拳改善了過動與ADHD指標次量表分數。Pang醫師報告指出，太極拳組的過動分數從47.11減少到45.22 (P =.03)，但是控制組則是從52.89增加到57.88。太極拳組的ADHD指標次量表分數也從52.00降低到51.89(P = .005)，而控制組則是從52.89增加到57.88。
不過，根據Pang醫師表示，第12週時效果並未持續，這或許是因為這些研究對象未持續自己打太極拳，也恢復服用他們的ADHD藥物，而可能稀釋了(太極拳)的治療效果。
第12週時，太極拳組的過動分數為44.25，控制組則是52.11。兩組的ADHD指標次量表分數分別是54.63和58.33。不論任何時間點，兩組的CWSS品行或認知次量表都沒有差異。
她報告指出，半數有ADHD診斷，而參與太極拳課程者的CWSS認知問題次量表有改善。
Pang醫師建議，因為太極拳沒有副作用也無須特別花費，是一種有經濟效益的替代治療方式，特別是那些無法耐受ADHD藥物的病患或者父母親反對用藥的病患，或者用來作為停藥期間維持相對穩定狀態的一種方法。
馬里蘭的一位精神科醫師、《Messages: Self-Help Through Popular Culture》的作者Mike Brody向Medscape Psychiatry表示，太極拳的效果可能只是透過讓青少年「專注」；Brody醫師是APA和美國小兒科學院的聯絡員。
他表示，太極拳不錯，但是我相信，任何類型的活動都可以用來調節、提供訓練— 例如舞蹈、唱詩歌、空手道、甚至棒球 — 都可改善ADHD。他堅決相信，任何可以幫助小孩專注的訓練活動都對此疾病有所助益，此外，他認為，活動的其他方面，例如孩童接受的額外注意也有所影響。
伯林頓佛蒙特大學精神科臨床教授David Fassler醫師也提出看法，這是個有趣的先驅研究，認為太極拳對於ADHD青少年的整體症狀有正面影響，有關柔道和增加運動的其他研究也提出過類似的結果。
雖然這類活動對於特定病患可能有所幫助，但目前的研究結果並非意味著它們可以取代更具確定性的介入方式，我同意作者們的看法，需要後續研究，以進一步暸解太極拳對於精神異常青少年的可能治療效果。
Pang醫師、Brody醫師與 Fassler醫師皆宣告沒有相關財務關係。
美國精神科協會(APA)2010年會：摘要NR2-77。發表於2010年5月24日。
Tai Chi May Improve Some ADHD Symptoms
By Caroline Helwick
Medscape Medical News
May 26, 2010 (New Orleans, Louisiana) — The practice of tai chi chuan for 6 weeks during a summer camp improved behavior control in adolescents with mental illness, according to a study presented at the American Psychiatric Association (APA) 2010 Annual Meeting.
"We found beneficial effects in controlling hyperactivity in the group as a whole, and adolescents with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) also showed improvements in cognitive skills, "said Peng Pang, MD, a resident in psychiatry at Maimonides Medical Center, Brooklyn, New York.
Randomized controlled trials have shown the benefits of tai chi in improving quality of life and depressive symptoms in adults, and at least 1 noncontrolled trial has found benefits in children with ADHD or anxiety, but there has been little study of the potential psychosocial benefits of tai chi in young people, Dr. Pang said.
The current controlled study, therefore, examined the efficacy of tai chi in enhancing self-control and in reducing mood disturbances in adolescents (aged 12-18 years) with at least 1 Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) diagnosis of mental illness. The subjects were participating in a summer respite program run by the medical center in 2009.
The study included 10 adolescents in the tai chi group and 9 control subjects attending the camp but not taught tai chi. Mean age was 14 years, approximately half the subjects were white, and half were male. ADHD was the diagnosis for approximately 50% of the group, with most other diagnoses being adjustment disorder, depressive disorder, oppositional defiant disorder, and anxiety disorder.
No significant differences were found between the groups in baseline demographic data and medical information, including subscales of the Conners-Wells’ Self-Report Scale (CWSS). Improvement in hyperactivity on the CWSS was the primary endpoint.
The tai chi group received instruction in tai chi from a tai chi chuan master in 45-minute sessions twice a week for 6 weeks. The control group attended the day camp but participated only in the standard activities. A repeated-measures experimental design was used to measure group differences at baseline, week 6, and week 12.
Investigators found that tai chi practice improved hyperactivity and ADHD index subscores at the end of week 6. The hyperactivity score was reduced from 47.11 to 45.22 (P = .03) in the tai chi group, but it increased from 52.89 to 57.88 in the control group. The ADHD index subscore also decreased, from 52.00 to 51.89 in the tai chi group (P = .005), whereas it increased from 52.89 to 57.88 in the control group, Dr. Pang reported.
No lasting effect was shown, however, by week 12, which probably reflects the fact that the subjects did not continue the tai chi practice on their own and also went back to taking their ADHD medication, which could dilute a treatment effect, according to Dr. Pang.
At 12 weeks, the hyperactivity score was 44.25 in the tai chi group and 52.11 in the control group. The ADHD index subscores were 54.63 and 58.33, respectively. No group differences were observed at any time point for the conduct or cognitive subscales of the CWSS.
Half the group had a diagnosis of ADHD, and those who practiced tai chi also had an improvement on the cognitive problem subscale of the CWSS, she reported.
Because tai chi has no adverse effects and no significant costs, it is a potential economic alternative treatment modality, especially for patients intolerant of ADHD medications or those whose parents object to the use of medications, or as a way to maintain a relative steady state during medication vacations, Dr. Pang suggested.
Mike Brody, MD, a Maryland psychiatrist who is author of Messages: Self-Help Through Popular Culture, commented to Medscape Psychiatry that the effect of tai chi chuan may simply be through its ability to "focus" the adolescents. Dr. Brody is an APA liaison with the American Academy of Pediatrics.
"Tai chi is good, but I believe that any type of activity that serves to regulate, that provides discipline — such as dance, chorale, karate, even baseball — should improve ADHD," he said. "I believe strongly that any disciplined activity, if it helps a child focus, will help this disorder." In addition, he suggested that other aspects of the activity, such as the extra attention the children received, could also be influential.
David Fassler, MD, clinical professor of psychiatry at the University of Vermont, Burlington, also commented, "This is an interesting pilot study suggesting that tai chi chuan may have a positive impact on the overall symptoms of ADHD in adolescents. Other studies have reported similar findings for judo and for increased exercise, in general.
"Although such activities may be helpful components of treatment for particular patients, the results of the current study do not imply that they should be used in lieu of more established interventions. I would agree with the authors' suggestion that further research is warranted to better understand?the potential use of tai chi in the treatment of adolescents with psychiatric disorders."
Dr. Pang, Dr. Brody, and Dr. Fassler have disclosed no relevant financial relationships.
American Psychiatric Association (APA) 2010 Annual Meeting: Abstract NR2-77. Presented May 24, 2010.