Mind/Body/Movement Laboratory

Research Team

Peter Wayne, PhD, Principal Investigator

From left to right: Brian Gow, BS, Senior Research Assistant; Kamila Osypiuk, MS, Senior Research Assistant / Lab Coordinator; Audrey Hernandez, MS, Research Assistant; Charles Coey, PhD, T-32 Post-Doctoral Research Fellow; Ivy Ma, MD, T-32 Post-Doctoral Research Fellow

Research Overview

The Mind-Body-Movement (MBM) laboratory explores the interdependence of movement, posture, cognition and emotion in health, aging and rehabilitation. Our research begins with the assumption that health relies on the complex integration of these and other physiological systems, enabling us to function and adapt to the demands of everyday life. Conversely, age-related decline and disease is thought to result from progressive multi-system impairment, leading to decreased physical and cognitive function and reduced resilience to stress.

Taking advantage of a rich collaborative network of laboratories across the Harvard Medical School, and drawing on conceptual models, quantitative methods, and experimental designs grounded in systems biology, our research has focused on evaluating the clinical impact and physiological basis of multiple integrative medicine (IM) therapies.

Current work centers around the study of Tai Chi, manual therapies, and acupuncture for the prevention, rehabilitation, and symptom management of a broad range of chronic health conditions including age- and Parkinson’s disease-related balance impairments and cognitive decline, back and neck pain, migraine headaches, and cancer.

Research on these, ongoing research studies, and related topics are summarized below.

Current Areas of Research

Tai Chi, neuromusculoskeletal health, and balance

A central and ongoing focus of our research has been evaluating the safety, efficacy and potentially unique biomechanical, physiological and behavioral mechanisms through which Tai Chi may improve chronic neuromuscular and musculoskeletal conditions.

In one early NIH funded study, we developed and evaluated a simplified Tai Chi training protocol for highly impaired patients with vestibulopathy. We found Tai Chi improved dynamic postural control  and impacted neuromuscular mechanisms that complement vestibulo–ocular reflex mechanisms targeted in standard vestibular rehabilitation.1,2

Another NIH funded trial in postmenopausal osteopenic women demonstrated that Tai Chi modifes multiple objective predictors of fracture risk.3,4  Functional and fall risk benefits of Tai Chi were also supported in another pilot RCT of frail elders residing in assisted living facilities.5 Findings from this study published in JAGS informed the recently NIH funded MiWish Study, a 5-year trial evaluating yearlong Tai Chi vs. health promotion programs in subsidized low-income elderly housing facilities to determine the impact of these programs on both functional performance and health care utilization and costs.

Representative publications

  1. McGibbon C, Krebs D, Parker S, Scarborough D, Wayne P, Wolf S. Tai Chi and vestibular rehabilitation improve vestibulopathic gait via different neuromuscular mechanisms: preliminary report. BMC neurology. 2005;5(1):3.
  2. McGibbon C, Krebs D, Wolf S, Wayne P, Scarborough D, Parker S. Tai Chi and vestibular rehabilitation effects on gaze and whole-body stability. Journal of vestibular research : equilibrium & orientation. 2004;14(6):467-478.
  3. Wayne PM, Buring JE, Davis RB, et al. Tai Chi for osteopenic women: design and rationale of a pragmatic randomized controlled trial. BMC Musculoskelet Disord. 2010;11:40.
  4. Wayne PM, Kiel DP, Buring JE, et al. Impact of Tai Chi exercise on multiple fracture-related risk factors in post-menopausal osteopenic women: a pilot pragmatic, randomized trial. BMC complementary and alternative medicine. 2012;12:7.
  5. Manor B, Lough M, Gagnon MM, Cupples A, Wayne PM, Lipsitz LA. Functional benefits of tai chi training in senior housing facilities. Journal of the American Geriatrics Society. 2014;62(8):1484-1489.

Tai Chi and cognitive-motor interdependence

An extensive body of research now supports that fall risk and cognition are highly interdependent, and processes like executive function, gait health and balance are correlated and predictive of one another.  This emerging view supports a particularly unique role for mind-body exercise like Tai Chi, which strategically targets both cognitive and motor processes, as well as their coordination (e.g., through training in attention shifting, multitasking, and goal setting).

Our group led the first meta-analysis supporting a positive effect of Tai Chi on cognitive function.1 With support from an NIH study on healthy aging, our team also evaluated cognitive-motor interactions during gait and balance using a dual task paradigm in Tai Chi experts and Tai Chi naïve older adults. We found that when participants were asked to walk while simultaneously doing a complex mental task, Tai Chi experts exhibited significantly lower stride time variability, a sensitive predictor of falls.2

Current ongoing studies are extending this research by evaluating how Tai Chi impacts cognitive-motor interactions in individuals with Parkinson’s disease (assessed with both clinical and fMRI measures).

Representative publications

  1. Wayne PM, Walsh JN, Taylor-Piliae RE, et al. Effect of tai chi on cognitive performance in older adults: systematic review and meta-analysis. Journal of the American Geriatrics Society. Jan 2014;62(1):25-39.

2. Wayne PM, Hausdorff JM, Lough M, et al. Tai Chi training may reduce dual task gait variability, a potential mediator of fall risk, in healthy older adults: Cross-sectional and randomized trial studies. Frontiers in human neuroscience. 2015;9:332.

Tai Chi and cardiorespiratory health

Working in close collaboration with Dr. Gloria Yeh, the MBM lab has contributed significantly to our understanding of how Tai Chi and related mind-body exercises impact cardiorespiratory health. This work began with a pilot study of Tai Chi for systolic heart failure (HF) patients, which demonstrated safety and benefits to HF-related quality of life (QOL) and exercise capacity.1

A subsequent larger NIH funded trial that reported, when compared to an attention-matched educational control, Tai Chi improved HF-related QOL, exercise self-efficacy and mood.2 A third study in diastolic HF patients evaluated the importance of metabolic intensity, and found that even when compared with a higher intensity aerobic intervention, Tai Chi resulted in greater improvements in exercise capacity and QOL.3

The impact of Tai Chi, isolated mind-body breathing exercises, and group walking in patients with COPD are currently being evaluated in two independent NIH funded studies.4,5  We are also collaborating with Dr. Elena Salmoirago-Blotcher and colleagues at Brown University to evaluate Tai Chi as an alternative exercise for cardiac rehabilitation.6

Representative publications

 

  1. Yeh GY, Wood MJ, Lorell BH, et al. Effects of tai chi mind-body movement therapy on functional status and exercise capacity in patients with chronic heart failure: a randomized controlled trial. The American journal of medicine. 2004;117(8):541-548.
  2. Yeh GY, McCarthy EP, Wayne PM, et al. Tai chi exercise in patients with chronic heart failure: a randomized clinical trial. Arch Intern Med. 2011;171(8):750-757.
  3. Yeh GY, Wood MJ, Wayne PM, et al. Tai chi in patients with heart failure with preserved ejection fraction. Congestive heart failure. 2013;19(2):77-84.
  4. Moy ML, Wayne PM, Litrownik D, et al. Long-term exercise after pulmonary rehabilitation (LEAP): design and rationale of a randomized controlled trial of Tai chi. Contemp clinical trials. 8 2015.
  5. Yeh GY, Wayne PM, et. al. Tai chi mind-body exercise in patients with COPD: study protocol for a randomized controlled trial. Trials. 2014;15:337.
  6. Salmoirago-Blotcher E, Wayne P, Bock BC, et al. Design and methods of the Gentle Cardiac Rehabilitation Study – A behavioral study of tai chi exercise for patients not attending cardiac rehabilitation. Contemp clinical trials. 2015;43:243-251.

Integrative therapies and chronic pain

Another area of focus in the MBM lab is translational research in musculoskeletal pain. In collaboration with Dr. Julie Buring, we are completing an NIH funded observational study based at the Osher Clinical Center for Integrative Therapies. The study evaluates in a real-world setting the effectiveness of our uniquely trained integrative care team1,2 on symptoms and function in chronic low back pain (CLBP) patients, compared with a control group of CLBP patients receiving care elsewhere within BWH.

In another recently completed study of CLBP patients supported by an NIH career development grant awarded to Dr. Eric Jacobson, we found that the manual therapy Structural Integration (SI, aka Rolfing) leads to improvements in disability and pain.3  Our lab also collaborated on a recent trial of Tai Chi for chronic neck pain with researchers at the University of Duisburg-Essen in Germany.  Findings support that Tai Chi is effective in reducing neck pain and disability and point to improved postural awareness as a contributing mechanism.4,5

Research led by Rebecca Wells (a T32 fellow) also found that  mindfulness-based stress reduction reduced the burden of migraine headache pain.6

Two new ongoing trials are evaluating the effectiveness of: 1) A chiropractic care program for reducing frequency and severity of episodic migraines in women; and 2) Qigong for post-mastectomy pain in breast cancer survivors.

Representative publications

 

  1. O’Connor B, Eisenberg DM, Buring JE, Liang C, Osypiuk K, Levy DB, Wayne PM. Within-team Patterns of Communication and Referral in Multimodal Treatment of Chronic Low Back Pain Patients by an Integrative Care Team. Global Adv Health Med 2015;4:36-45.
  2. Eisenberg DE, Kaptchuk T, Post D, Hrbek A, O’Connor B, Osypiuk K, Wayne PM, Buring JE, Levy D. Establishing an Integrative Medicine Program Within an Academic Health Center: Essential Considerations. Academic Medicine, 2016; 91(9):1223-30.
  3. Jacobson E, Meleger A, Bonato P, Wayne PM, Langevin H, Kaptchuk TJ and Davis RB. Structural Integration as an adjunct to outpatient rehabilitation for chronic non-specific low back pain: a randomized pilot clinical trial. Evid-Based Comp and Alt Med 2015: doi.org/10.1155/2015/813418.
  4. Lauche R, Stumpe C, Fehr J, Cramer H, Cheng YC, Wayne PM, Rampp T, Langhorst J, Dobos G. The effects of Tai Chi and neck exercises in the treatment of chronic non-specific neck pain: A randomized controlled trial J. Pain 2016; 17(9):1013-27.
  5. Lauche R, Wayne PM, Fehr J, Stumpe C, Dobos G Cramer H. Does postural awareness contribute to exercise-induced improvements in neck pain intensity? A secondary analysis of a randomized controlled trial evaluating Tai Chi and neck exercises. Spine 2016: In Press.
  6. Wells RE, Burch R, Paulsen RH, Wayne PM, Houle TT, Louder E. Meditation for Migraines: A Pilot Randomized Controlled Trial. Headache 2014:54:1484-95.

Physiological complexity

Research in the MBM lab draws heavily on a systems biology framework and related quantitative tools for studying IM therapies. In two seminal papers, we framed Tai Chi as a multimodal intervention that targets multiple physiological systems and delivers what we refer to as multiple ‘active ingredients’.1,2  In these and in subsequent publications, we also highlight the need for translational biomarkers that inform cross-system therapeutic effects.3  To address these needs, we have forged collaborations with the Institute for Nonlinear Dynamics in Medicine and the Center for Dynamical Biomarkers, both based at HMS.

Working closely with leaders and faculty of these centers, especially Drs. CK Peng, Lew Lipstiz, Andrew Ahn, and Jeff Hausdorff, we have begun to collaborate on studies to evaluate how complexity-based metrics of physiological dynamics inform how Tai Chi and related multimodal therapies impact system-wide changes.

One NIH funded study characterized the impact of Tai Chi on center of pressure (COP) dynamics during balance tasks and found that multiscale entropy (MSE) measures of COP better discriminated the effects of both long- and short-term training in Tai Chi, when compared to traditional measures of sway.4

A second study led by a postdoctoral student Dr. Manor, reported that MSE of COP, but not traditional sway parameters were associated with functional changes in gait in individuals with peripheral neuropathy that undertook Tai Chi training.5 Current ongoing work is exploring the impact of mind-body practices on complexity-based metrics of heart rate variability.

Representative publications

 

  1. Wayne PM, Kaptchuk TJ. Challenges inherent to Tai Chi Research: Part I–Tai Chi as a complex multi-component intervention. J Alter Compl Med 2008;14:95-102.
  2. Wayne PM, Kaptchuk TJ. Challenges inherent to the Tai Chi Research: Part II — Defining the intervention and optimal study design. J Alter Compl Med 2008;14:191-7.
  3. 3. Wayne PM, Manor B, Novak V, Costa M, Hausdorff JM, Goldberger AL, Ahn AC, Yeh GY, Peng CK, Lough M, Davis RB, Quilty MT, Lipsitz LA. A systems biology approach to studying Tai Chi, physiological complexity and healthy aging: Design and rationale of a pragmatic randomized controlled trial. Contemporary Clinical Trials 2013;34:21-34.
  4. Wayne PM, Gow BJ, Costa MD, et al. Complexity-based measures inform effects of Tai Chi training on standing postural control: Cross-sectional and randomized trial studies. PLoS One. 2014;9(12):e114731.
  5. Manor B, Lipsitz LA, Wayne PM, Peng CK, Li L. Complexity-based measures inform tai chi’s impact on standing postural control in older adults with peripheral neuropathy. BMC complementary and alternative medicine. 2013;13:87.

Acupuncture research

Research in acupuncture has involved a long-standing collaboration with the New England School of Acupuncture, as well as other HMS laboratories.  One early trial demonstrated potential for improvement with acupuncture of upper extremity function in chronic stroke survivors;1 a companion fMRI study reported associated changes in motor cortex activation.2 This trial was also one of the first to employ a formal interdisciplinary consensus approach to develop validated, manualized verum and sham acupuncture treatment protocols.3

Another trial reported that Japanese style acupuncture reduces pain and improves QOL in adolescents with endometriosis.4 With support from an NIH, we collaborated with Dr. Weidong Lu on a sham-controlled RCT that concluded acupuncture may reduce chemoradiation induced neutropenia in gynecological cancers.5

Another collaboration with Dr. Lu demonstrated safety and feasibility of acupuncture for dysphagia in head and neck cancer.6   Other acupuncture research led by Dr. Andrew Ahn (T32 fellow) explored biophysical mechanisms of acupuncture.7,8

More generally, we have contributed to the acupuncture research through White Papers that tackle challenging methodological issues and summarizing the state of the field.9,10,11,12

 

Representative publications

 

  1. Wayne PM, Krebs DE, Macklin EA, et al. Acupuncture for upper-extremity rehabilitation in chronic stroke: a randomized sham-controlled study. Arch Phys Med Rehabil. 2005;86(12):2248-2255.
  2. Schaechter JD, Connell BD, Stason WB, et al. Correlated change in upper limb function and motor cortex activation after verum and sham acupuncture in patients with chronic stroke. J Altern Complement Med. 2007;13(5):527-532.
  3. Schnyer RN, Wayne PM, Kaptchuk TJ, Cheng X, Zhang Z, Stason WB. Standardization of individualized treatments in a randomized controlled trial of acupuncture for stroke rehabilitation. J Altern Complement Med. 2006;12(2):106-109.
  4. Wayne PM, Kerr CE, Schnyer RN, et al. Japanese-style acupuncture for endometriosis-related pelvic pain in adolescents and young women: results of a randomized sham-controlled trial. Journal of pediatric and adolescent gynecology. 2008;21(5):247-257.
  5. Lu W, Matulonis UA, Doherty-Gilman A, et al. Acupuncture for chemotherapy-induced neutropenia in patients with gynecologic malignancies: a pilot randomized, sham-controlled clinical trial. J Altern Complement Med. 2009;15(7):745-753.
  6. Lu WD, Wayne PM, Davis RB, Buring JE, Li H, Macklin E, Lorch JH, Burke E, Haddad TC, Goguen LA, Rosenthal DS, Tishler RB, Posner RM, Haddad RI. Acupuncture for Chemoradiation Therapy-Related Dysphagia in Head and Neck Cancer. The Oncologist 2016: 21:1522-1529.
  7. Ahn AC, Schnyer R, Conboy L, Laufer MR, Wayne PM. Electrodermal measures of Jing-Well points and their clinical relevance in endometriosis-related chronic pelvic pain. J Altern Complement Med. 2009;15(12):1293-1305.
  8. Ahn AC, Colbert AP, Anderson BJ, et al. Electrical properties of acupuncture points and meridians: a systematic review. Bioelectromagnetics. 2008;29(4):245-256.
  9. Langevin HM, Schnyer R, MacPherson H, et al. Manual and electrical needle stimulation in acupuncture research: pitfalls and challenges of heterogeneity. J Altern Complement Med. 2015;21(3):113-128.
  10. Langevin HM, Wayne PM, Macpherson H, et al. Paradoxes in acupuncture research: strategies for moving forward. Evid Based Complement Alternat Med. 2011:180805.
  11. MacPherson H, Coeytaux RR, Davis R, Harris RE, Kong JT, Langevin H, Lao L, Milley RJ, Napadow V, Schnyer RN, Stener-Victorin E, Witt CM, Wayne PM. Unanticipated insights into biomedicine from the study of acupuncture JACM. 2015; In Press.
  12. Ma Y, Dong M, Zhou K, Carol M, Liu J, Wayne PM. Publication Trends in Acupuncture Research: A 20 year Bibliometric Analysis. PLoS ONE 2016. In Press