Loyola nursing school study involves female veterans at risk of heart disease
By RENEE STOVSKY
Veteran Karen Breeze, 66, of Lisle, Ill., left military service 45 years ago, after serving as the first female computer programmer in the Marine Corps from 1966 to 1969, during the escalation of the Vietnam War.
Now retired, she says her life is relatively stress-free compared to the time she spent both in the Corps and afterward in civilian life, where she worked for 40 years as a software developer while juggling the household demands of a single mother with three children.
Marine Corps veteran Karen Breeze does a deep breathing exercise she learned as part of a mindfulness-based stress reduction program. Researchers at Loyola University Chicago Marcella Niehoff School of Nursing and the Edward Hines, Jr. VA Hospital in Hines, Ill., are studying whether meditation and yoga can reduce risk factors for cardiovascular disease.
Still, she suffers from sleep problems and carries several risk factors for cardiovascular disease, including hypertension, obesity and a family history of stroke. So when researchers began recruiting women veterans between 18 and 70 years old and with at least two risk factors for heart disease to participate in a mindfulness-based stress reduction study last fall, she decided to investigate further. The researchers are with Loyola University Chicago Marcella Niehoff School of Nursing and the Edward Hines, Jr. VA Hospital in the west Chicago suburb of Hines, Ill.
"I really didn't anticipate anything significant happening from the experience; I just thought I might learn something that could help me sleep better," she says.
Follow the breath
For eight weeks, Breeze and four other participants, all from different eras of military service, met weekly for two and a half hour sessions with private practice clinical psychologist Chris Chroniak to study meditation and yoga techniques while a control group of peers enrolled in an educational health class. The veterans also agreed to submit to regular blood draws and saliva samples so researchers could collect data such as hemoglobin A17 lipid panels and hemoglobin A1C tests to measure for cholesterol and blood sugar levels respectively. Endothelial dysfunction — a precursor to plaque formation — was monitored as well with the use of blood pressure cuffs to help occlude blood flow to a finger.
"We learned to do full body scans while laying on the floor to get in touch with all parts of our bodies. We also practiced deep breathing to help us focus, and we did 40 minutes of yoga each session to help us relax," says Breeze. "Dr. Chroniak also gave us homework each week to reinforce the techniques he taught us."
Success breeds success
Much to Breeze's surprise, by the end of the eight-week session, her blood pressure had dropped 15 to 20 points and she had lost several pounds. That, she says, "mentally prepared" her to begin an active weight reduction program, and she has since lost 20 pounds and is doing water aerobics regularly at a neighborhood gym.
"It's been a very positive experience. When I wake up at night now, I'm able to get back to sleep by using the breathing techniques I learned," she says. "I'm not nearly as anxious or aggravated as I used to be; mindfulness training has made me feel much happier."
Such anecdotal evidence of the benefits of mindfulness meditation is common, says Chroniak, who began his own meditation practice in 1982, when he briefly joined a Jesuit order. By 1995, he had trained formally with Jon Kabat-Zinn, an MIT-educated scientist and author of the mindfulness-based stress reduction bible, Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. Kabat-Zinn developed the mindfulness-based stress reduction curriculum now taught in nearly every state and more than 30 countries. Today, Chroniak estimates he himself has taught more than 75 groups — including corporate executives, AIDS patients and diabetics — techniques to help quiet their busy minds and give their attention fully to whatever they are actually doing at the present time.
"Mindfulness is moment-to-moment, nonjudgmental attention with compassion and acceptance," says Chroniak. "It's teaching people how to be in the here and now instead of getting caught up in what has happened earlier or what's to come."
Popular science
Mindfulness-based stress reduction has become what Chroniak calls "in the zeitgeist" of our distracted, multi-
tasking world. For example, Kabat-Zinn's book recently reissued as a 15th anniversary edition; there are mindfulness apps; a new monthly magazine, Mindful; and popular books promoting meditation, such as Congressman Tim Ryan's (D-Ohio) A Mindful Nation: How a Simple Practice Can Help Us Reduce Stress, Improve Performance, and Recapture the American Spirit, and ABC newsanchor Dan Harris' 10% Happier: How I Tamed the Voice in My Head, Reduced Stress Without Losing My Edge, and Found Self-Help That Actually Works — A True Story.
"We are entering the golden age of brain research, so this is an exciting time to study mindfulness-based stress reduction," says Chroniak. "Scientists are looking at everything from how mindfulness affects the sympathetic and parasympathetic branches of the autonomic nervous system to how it taps into the neuroplasticity of the brain and gene expressions in the body."
Indeed, according to a recent Time magazine article, the National Institutes of Health has funded some 50 clinical trials in the past five years examining the effects of mindfulness on health, with about half pertaining to Kabat-Zinn's curriculum alone. The trials, according to Time, are studying how mindfulness-based stress reduction affects "everything from social-anxiety disorder to the body's immune response to human papillomavirus to cancer-related fatigue."
Loyola research
Karen Saban spent 20 years as an intensive care unit nurse with a specialty in neuroscience, caring for patients with stroke and brain injuries, before earning a doctorate and becoming an associate professor at Loyola University Chicago's nursing school and a health science researcher at the Hines VA Hospital. Already familiar with studies of cancer patients that linked mindfulness training to a decrease in inflammatory markers, she wondered if mindfulness-based stress reduction could be helpful with reducing inflammation related to cardiovascular disease as well.
With a $1.1 million, four-year grant from the VA Nursing Research Initiative and the support of Dr. Sudha Bhoopalam, medical director of women's health at the Hines VA Hospital, she launched the current randomized clinical trial with women veterans in October and hopes to track three groups of eight to 10 women per year for four years — plus control groups — to see if mindfulness-based stress reduction can improve their health and quality of life as well.
"In addition to studying decreases in inflammation and reduction in heart disease risks, we'll be looking at the women veterans' immune function and psychological well-being, including anxiety and depression, after four weeks, eight weeks and six months of MBSR training," says Saban.
Mind over inflammation
Bhoopalam is particularly interested in studying women veterans, since females now represent 15 percent of active military and 18 percent of the National Guard.
"We know that chronic stress doubles the risk of heart attack and contributes to inflammation linked to artery disease and stroke. Veterans who have experienced combat are at greater risk, as a result," she says. While previous research has focused on males, a large percentage of women vets are believed to have experienced at least one traumatic event leading to stress — including prior life adversity such as sexual assault and physical violence.
In addition, Bhoopalam says, women in combat experience not only the same sleep deprivation, extreme temperatures and toxic agents their male counterparts do, but often suffer from more physical stress — such as back and ankle pain — from carrying heavy equipment. And, of course, they are subject to the same pre- and postnatal stress and menopausal disorders as nonveteran women.
"We, of course, want to study (mindfulness-based stress reduction) as an alternative method to improve the health and quality of life of those who have served," says Saban. "But given that heart disease is a major cause of death, this research also may have broader implications for the general population."
So far, according to both Saban and Bhoopalam, feedback from the participating veterans has been extremely positive.
"They love it; they see it as a way to manage stress, if nothing else," says Bhoopalam.