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Tai Chi, exercise therapy and acupuncture: Effective health care interventions?

July 20, 2004

Welcome to the News Alert newsletter for The Cochrane Library. The Cochrane Library Issue 3 of 2004 is published this week by Wiley, and this newsletter highlights some of the key health care conclusions reached by new Cochrane reviews and their implications for practice.

This newsletter highlights a selection of the most interesting and relevant new reviews in this issue of The Library. If you would like to see these reviews or any other Cochrane reviews, are interested in contacting the authors for comment, or have any other questions about this newsletter, please contact Jaida Harris on +44 (0)1243 770674 or by email jharris@wiley.co.uk.

Highlights of the new Issue:

o Benefits from diet lower in salt not limited to those with high blood pressure
o Medicinal qualities of plants shown to ease symptoms of genetic disease
o Soy formula not a good choice for infants at risk of allergies
o Chemotherapy and supportive care are a winning combination
o Wrist acupuncture point stimulation proves useful in preventing post-op nausea and vomiting
o Chinese martial art helps keep arthritis sufferers on their feet
o Alternative method to 'drilling and filling' dental cavities is found lacking
o Exercise therapy looks promising for alleviating symptoms of fatigue

PLEASE SCROLL DOWN FOR HIGHLIGHTS

Benefits from diet lower in salt not limited to those with high blood pressure
It has long been established that people suffering from high blood pressure can benefit greatly by reducing their salt intake. Until now, it has remained unclear to what extent a salt reduction benefits those with normal blood pressure - if at all. A systematic review of 28 trials with nearly 3000 participants concludes that a modest, longer-term reduction in salt intake leads to a significant decrease in blood pressure, even in people whose blood pressure is normal to start with. Greater the salt reduction, leads to greater lowering in blood pressure. This review's conclusions are important. An overall lowering of blood pressure across the population as a whole, would result in fewer strokes, heart attacks and heart failure.

Authors of the review summed up the results, "Benefits from reducing salt intake not limited to those with high blood pressure. Those with normal blood pressure also benefit. The lower the salt intake, the greater the benefits."

Review title: Effect of longer term modest salt reduction on blood pressure
Reviewers: He FJ and MacGregor GA.

Medicinal qualities of plants shown to ease symptoms of genetic disease
Phytomedicines are medicines derived from plants and often responsible for the healing effects of traditional remedies used. The use of phytomedicines represents an important convergence of traditional and classical medical treatments. One phytomedicine has been used in the treatment of sickle cell disease, and a systematic review of the available data indicates that it reduced the number of crisis periods with severe pain that people experienced over a six-month period. Furthermore, no adverse side symptoms were noted following the use of the phytomedicine.
Review title: Phytmedicines (medicines derived from plants) for sickle cell disease
Reviewers: Cordeiro NJV and Oniyangi O.

Soy formula not a good choice for infants at risk of allergies
Soy-protein based infant formulas have been used to treat infants who have food allergies or intolerances. This raises the possibility that soy formulas might prevent food allergies in children at high-risk, such as an infant with family history of allergy. A recent review of the available literature, however, concludes that there is no evidence to suggest that soy formulas are any more effective in preventing allergies than formula based on cow's milk. In addition, the research showed that there was more risk of developing allergies if a soy formula was used rather than a hydrolysed protein formula. As a result, soy formulas cannot be recommended for preventing allergies in high-risk infants.
Review title: Soy formula for prevention of allergy and food intolerance in infants
Reviewers: Osborn DA and Sinn J.

Chemotherapy and supportive care are a winning combination
Gastrointestinal cancer, including colorectal, is one of the most common groups of cancers to claim Western lives. Research is continuously conducted to determine the most effective ways to treat these cancers, taking into account both survival and quality of life. This includes research into supportive care, which included social, psychological and spiritual care as well as palliative medical treatment. A recent review of the evidence for supportive care in addition to chemotherapy versus chemotherapy alone for gastrointestinal cancer concluded that a combination of certain types of chemotherapyand supportive care, provide the best outcomes in terms of survival and quality of life. Supportive care and palliative care are newly developing fields. Their definition and administration vary significantly from country to country and even within one country. This is apparent in the trials in the review. However, the evidence in this systematic review makes an important contribution towards developing definitive, uniform standards for comprehensive supportive care.

Authors of the review state: "Adding comprehensive supportive care to chemotherapy for gastrointestinal cancer improves patients' outcomes. There is a need for standardising supportive care interventions to enable more patients to benefit. "

Review title: Supportive care for patients with gastrointestinal cancer
Reviewers: Ahmed N, Ahmedzai S, Vora V, Hillam S and Paz S.

Wrist acupuncture point stimulation proves useful in preventing post-op nausea and vomiting
Post-operative nausea and vomiting (PONV) are common complications following surgery and anaesthesia and can add to the stress of hospital stays. Various drugs for preventing PONV are available and are used regularly, but are only partially effective. Stimulation of the wrist acupuncture point is a promising alternative method. Many trials have been done but these have produced conflicting findings. A recent systematic review of 26 trials concludes that acupoint stimulation reduces the risk of both nausea and vomiting. These results, in combination with the fact that only a few, minor side effects were experienced, support the use of wrist acupuncture point stimulation to prevent PONV. There was insufficient evidence to conclude whether wrist acupuncture point stimulation is as good or better than antiemetic drugs. As attention is increasingly focused upon more cost-effective methods for preventing PONV, the results of this review will be of significant importance.

"If you are at high-risk of postoperative nausea and vomiting, techniques such as acupuncture and acupressure wristbands are worth considering in addition to antiemetic drugs," say the authors of the review.
Review title: Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting.
Reviewers: Lee A and Done ML.

Chinese martial art helps keep arthritis sufferers on their feet
The traditional Chinese martial art of Tai Chi has been said to produce a variety of health benefits for older adults. These include stress reduction, improved posture and balance and lower extremity strength. A new review of research, however, suggests another potential benefit of performing Tai Chi. Four comparative studies measured improvements of ambulatory adults suffering from rheumatoid arthritis in 8-10 week Tai Chi programmes. Although, in three studies, no differences were found, in one small study, the most notable results were a significantly increased range of motion in the ankle, hip and knee and increased enjoyment of exercise. No detrimental effects were reported. Preserving range of motion in affected joints is particularly important for rheumatoid arthritis sufferers to maintain functionality.
Review title: Tai Chi for treating rheumatoid arthritis
Reviewers: Han A, Robinson V, Judd M, Taixiang W, Wells G and Tugwell P.

Novel method to 'drilling and filling' dental cavities is found lacking
Innovative methods for preventing the progression of caries in teeth appear regularly. One such method is the application of ozone gas to carious lesions. The idea being that this will reduce the amount of bacteria in the lesion and prevent the need for 'drilling and filling'. A review of the available research, however, concludes that there is no evidence to suggest that the application of ozone to affected teeth has any benefits over no treatment at all. Reviewers determined that the available data were inadequate for a valid evaluation of this alternative technique. It is their belief that a further body of independent research is needed of appropriate rigor without risk of bias before ozone treatment can be validated as an alternative to traditional methods.
Review title: Ozone therapy for the treatment of dental caries.
Reviewers: Rickard GD, Richardson R, Johnson T, McColl D, Hooper L, Glenny A-M and Clarkson J.

Exercise therapy looks promising for alleviating symptoms of fatigue
Chronic Fatigue Syndrome (CFS) is persistent, medically unexplained fatigue lasting more than six months. As many as 3 in a hundred people are estimated to have it. The condition often renders sufferers unable to work or do normal daily activities. Exercise therapy is commonly prescribed for CFS, and a recent review of the evidence cautiously concludes that this is beneficial. A total of five studies were included in the review. The results showed that after three months of therapy, fatigue was generally improved as were health-related quality of life, sleep and functional work capacity. As CFS is an ongoing condition, the possibility that a low-cost therapy, with minimal adverse effects, will be effective is extremely promising.
Review title: Exercise therapy for chronic fatigue syndrome
Reviewers: Edmonds M, McGuire H, Price J.

John Wiley & Sons