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Cited by 12Mindfulness and Compassion InterventionsBiofield Effects and BiophysicsSmoking Behavior and Cessation

Effectiveness of a Novel Qigong Meditative Movement Practice for Impaired Health in Flight Attendants Exposed to Second-Hand Cigarette Smoke

Open access
Payne, Peter, Fiering, Steven, Leiter, James C., Zava, David T., Crane-Godreau, Mardi A.·2017·Frontiers in Human Neuroscience
DOI 10.3389/fnhum.2017.00067PMC PMC5318411
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Abstract

This single-arm non-randomized pilot study explores an intervention to improve the health of flight attendants exposed to second-hand cigarette smoke prior to the smoking ban on commercial airlines. This group exhibits an unusual pattern of long-term pulmonary dysfunction. We report on Phase I of a two-phase clinical trial; the second Phase will be a randomized controlled trial testing digital delivery of the intervention. Subjects were recruited in the Northeastern US; testing and intervention were administered in 4 major cities. The intervention involved 12 hours of training in Meditative Movement practices. Based on recent research on the effects of nicotine on fear learning, and the influence of the autonomic nervous system on immune function, our hypothesis was that this training would improve autonomic function and thus benefit a range of health measures. Primary outcomes were the six-minute walk test and blood levels of C-reactive protein. Pulmonary, cardiovascular, autonomic and affective measures were also taken. Fourteen participants completed the training and post-testing. There was a 53% decrease in high sensitivity C-Reactive Protein (p<=0.05), a 7% reduction in systolic blood pressure (p<=0.05), a 13% increase in the 6-minute walk test (p<=0.005), and significant positive changes in several other outcomes. These results tend to confirm the hypothesized benefits of MM training for this population, and indicate that autonomic function may be important in the etiology and treatment of their symptoms. No adverse effects were reported. This trial is registered at ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT02612389/), and is supported by a grant from the Flight Attendant Medical Research Institute (FAMRI).

AI snapshot

Written from the paper’s full text.

TL;DR

This single-arm pilot study tested 12 h of Meditative Movement/qigong training in 14 flight attendants exposed to second-hand cigarette smoke, reporting improved 6-min walk distance, hs-CRP, systolic blood pressure, and several autonomic/affective measures. The authors conclude the results support hypothesized benefits and a possible role for autonomic function, but the lack of a control group and high dropout limit causal inference.

Key findings

  • The 6-min walk test increased 13% (522 to 590 m; p ≤ 0.004/0.01), hs-CRP decreased 53% (2.8 to 1.3 mg/l; p ≤ 0.05), average systolic blood pressure decreased 7% (130.5 to 121.4 mmHg; p ≤ 0.05), and resting heart rate decreased 6% (73.2 to 68.6; p ≤ 0.05).
  • COMPASS 31 dropped from 15 to 11.5 (p ≤ 0.05), Zung Anxiety dropped from 29.4 to 26.9 (8%; p ≤ 0.05), and MAIA increased from 25.1 to 27.8 (10%; p ≤ 0.05).
  • No significant changes were reported for FEV1, FVC, FEF 25–75, PEF, vitamin D, or Zung Depression; no adverse events were reported.
  • Of 26 recruited participants, 14 completed and were analyzed; 10 discontinued (6 lifestyle conflicts, 4 affective issues) and 2 were disqualified by researchers.

Methods

  • Single-arm, non-randomized Phase I pilot study; participants acted as their own controls, with pre- and post-intervention testing around at least 12 h of face-to-face qigong/Meditative Movement training over 4–5 months in Burlington VT, New York NY, and Woburn MA.
  • Participants were non-smoking former or current flight attendants with at least 5 years of occupational second-hand cigarette smoke exposure; 26 were recruited and 14 completed. All recruits and completers were female; completers had an average age of 67.7 years and all were White.
  • Primary outcomes were the 6-min walk test and hs-CRP; secondary outcomes included blood pressure, heart rate, spirometry, CAT, COMPASS 31, Zung Anxiety and Depression scales, MAIA, and vitamin D. Pre-post changes used one-tailed t-tests, with chi-squared tests for categorical changes; missing data were handled by excluding that subject from the affected measure.

Limitations

  • The paper states there was no control group, so results could be due to attention, seasonal, or other factors; it also states the high percentage of non-completers is a possible source of bias, the study was not designed for significant affective disturbance, and generalizability is limited to females over 49 with reasonable functional ability.
  • The paper states the 6-min walk test is influenced by motivation, and that Phase II will use an attention/health education control group; it notes that negative Phase II results could reflect ineffective digital delivery rather than ineffective intervention.
  • Evident from the text: the analyzed sample was very small (N = 14), all completers were female and White, the design was single-arm pre-post, and many outcomes were tested without adjustment, all of which limit precision and causal inference.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3389/fnhum.2017.00067

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 66 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Resting heart rate decreased by 6% from pre- to post-intervention (p ≤ 0.05).

    “resting heart rate decreased significantly by 6%”
    • Also stated in: § Outcome measures · plain
      “Resting HR | 73.2 | 68.6 | −6% | ≤0.05*”
    Quote in the paperSubstantial claim
  • Findingown data

    COMPASS 31 score decreased by 26% from pre- to post-intervention (p ≤ 0.05).

    “Compass 31 | 15 | 11.5 | −26% | ≤0.05*”
    Quote in the paperSubstantial claim
  • Findingown data

    High sensitivity C-reactive protein decreased by 53% from pre- to post-intervention (p ≤ 0.05).

    “There was a 53% decrease in high sensitivity C-Reactive Protein (p ≤ 0.05)”
    • Also stated in: § Outcome measures · plain
      “significant reduction in hs-CRP levels”
    • Also stated in: § Outcome measures · plain
      “There was a 53% decrease in average hs-CRP levels (p ≤ 0.05 using Students t-test)”
    Quote in the paperSubstantial claim
  • Findingown data

    Zung Self-rating Anxiety Scale score decreased by 8% from pre- to post-intervention (p ≤ 0.05).

    “Zung Anxiety | 29.4 | 26.9 | −8% | ≤0.05*”
    Quote in the paperNot a substantial claim
  • Findingown data

    There was a non-significant trend of reduced COPD Assessment Test score (12% decrease, ns).

    “reduced (improved) COPD Assessment Test score”
    • Also stated in: § Outcome measures · hedged
      “CATest score | 7.5 | 6.6 | −12% | ns+”
    Quote in the paperNot a substantial claim
  • The quote only partly states this claim. 2
  • Classified as probably not a substantial claim. 41
  • May combine two claims. 36

  • The quote only partly states this claim.

    Findingown data

    Spirometry measures FEV1, FVC, and FEF 25-75 did not change significantly from pre- to post-intervention.

    “despite no significant change in FEV1 or FVC”
    • Also stated in: § Outcome measures · plain
      “FEV1 | 86.57 | 86.07 | 0% | ns”
    • Also stated in: § Outcome measures · plain
      “FVC | 90 | 86 | −1% | ns”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Thirteen percent of recruits were non-White.

    “Thirteen percent of our recruits were non-White.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    There was no correlation between improvement in distance walked and pre-intervention scores.

    “There was no correlation between improvement in distance walked and pre-intervention scores.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    All consented participants were female.

    “100% of those consented for the study were female.”
    • Also stated in: § Participants · plain
      “Female | 100% | 100%”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There was a 22% reduction in the number of participants with diastolic pressure above 90 mmHg and a 36% reduction in the number with systolic pressure above 140, although only the systolic figure reached significance.

    “We note that there was a 22% reduction in the number of participants with a diastolic pressure above the clinical threshold of 90 mmHg and a 36% reduction in the number with a systolic pressure above 140, although only the figure for systolic blood pressure reached significance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Eleven of 14 participants showed reduced systolic blood pressure, and the number above the clinical level declined from 4 to 1.

    “11 out of 14 participants showed reduced systolic blood pressure, and the number of participants above the clinical level declined from 4 to 1.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    There was a non-significant trend of increased peak expiratory flow (3% increase, ns).

    “increased peak expiratory flow (PEF)”
    • Also stated in: § Outcome measures · plain
      “PEF | 92.7 | 95.9 | 3% | ns+”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Vitamin D levels did not change from pre- to post-intervention.

    “Vitamin D levels did not change.”
    • Also stated in: § Outcome measures · plain
      “Vit D level | 40.6 | 40.7 | 0% | ns”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    All 4 participants with hs-CRP levels over the clinical norm (3.0) reduced substantially, 3 to below the clinical threshold.

    “All 4 participants with levels over the clinical norm (3.0) reduced substantially, 3 to below the clinical threshold.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    The 6-min walk test distance increased by 13% (67 m) from pre- to post-intervention (p ≤ 0.004).

    “There was a highly significant improvement in the 6MWT comparing pre- to post-intervention distances”
    • Also stated in: § Outcome measures · plain
      “Average distance walked increased by 67 m (13%). Significant at a p ≤ 0.01 level using Students t-test.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Ten of 14 participants decreased hs-CRP, 2 remained at sub-clinical levels, and 2 increased.

    “with 10 out of 14 decreasing and 2 remaining at sub-clinical levels”
    • Also stated in: § Primary outcomes · plain
      “10 of 14 participants improved, 2 stayed the same at low levels, and two increased.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    There was a non-significant trend of reduced diastolic blood pressure (4% decrease, ns).

    “reduced diastolic blood pressure”
    • Also stated in: § Outcome measures · plain
      “Avg Diastolic BP | 81.4 mmHg | 78.2 mmHg | −4% | ns”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The COMPASS 31 score dropped from 15 to 11.5, a 24% change that was significant at p ≤ 0.05.

    “The COMPASS 31, a questionnaire evaluating general autonomic function, dropped from 15 to 11.5. This 24% change was significant (p ≤ 0.05)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the study's systolic blood pressure and hs-CRP measures, values in the normal range showed relatively little change whereas values outside clinical range moved into normal range, with the amount of change approximately proportional to the prior deviation from normal.

    “In systolic blood pressure and hs-CRP, values in the normal range showed relatively little change whereas values outside clinical range moved into normal range, with the amount of change approximately proportional to the prior deviation from normal.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The Zung Anxiety score dropped from 29.4 to 26.9, a significant 8% drop at p ≤ 0.05.

    “The Zung Anxiety score dropped from 29.4 to 26.9 (p ≤ 0.05), a significant 8% drop.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Life-style was claimed as the reason for non-completion of this study by non-Caucasian participants.

    “Life-style was claimed as the reason for non-completion of this study by non-Caucasian participants”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Many of the flight attendants manifested pulmonary dysfunction as well as other symptoms recognized as co-morbidities of COPD.

    “many of them manifested pulmonary dysfunction (as previously noted by Arjomandi) as well as other symptoms that are recognized as co-morbidities of COPD (Vestbo et al., 2013b).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Vestbo et al., 2013b

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Ten participants discontinued the study (6 due to lifestyle conflicts, 4 due to affective issues) and 2 were disqualified by researchers.

    “6 participants discontinued the study due to stated lifestyle conflicts and 4 discontinued due to stated affective issues. At the Analysis stage, 2 were disqualified by the researchers due to non-compliance and the disclosure of major pre-existing pathology.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    Flight attendants who flew before the smoking ban present with many co-morbidities of COPD, but their pulmonary dysfunction differs from the standard definition of COPD.

    “Flight attendants (FA) who flew before the ban on smoking in commercial aircraft (implemented progressively from 1988 to 2000) present with many of the co-morbidities of chronic obstructive pulmonary disease (COPD) but their pulmonary dysfunction differs from the standard definition of this disorder.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Of 47 flight attendants approached, 20 did not meet inclusion criteria and 1 who met criteria declined to participate.

    “Forty-seven (FA) were approached, and of those 20 did not meet inclusion criteria and one who met the criteria declined to participate.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Fourteen participants completed the study and were analyzed.

    “Fourteen completed the study and were analyzed.”
    • Also stated in: § Participants · plain
      “14 completed the study.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Twenty-six participants were recruited and consented.

    “Twenty-six participants were then recruited and consented.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    There are increased rates of cardiac disease, depression and anxiety, sleep disturbances, skin and reproductive cancers, and hearing loss in this population.

    “There are also increased rates of cardiac disease, depression and anxiety (Pinkerton et al., 2012), sleep disturbances, skin and reproductive cancers and hearing loss (Czura, 2005; McNeely et al., 2014).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Pinkerton et al., 2012 source

      Not checked in the free run.

    • cites Czura, 2005 source

      Not checked in the free run.

    • cites McNeely et al., 2014 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Recent studies demonstrate significant rates of abnormal pulmonary function in this population, including air trapping, reduced flow at mid-volume, reduced exercise tolerance, and elevated rates of chronic bronchitis and sinusitis.

    “Recent studies (Whelan et al., 2003; Arjomandi et al., 2009, 2012; McNeely et al., 2014) demonstrate significant rates of abnormal pulmonary function in this population: air trapping, reduced flow at mid-volume, reduced exercise tolerance, and significantly elevated rates of chronic bronchitis and sinusitis.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Whelan et al., 2003 source

      Not checked in the free run.

    • cites Arjomandi et al., 2009, 2012

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites McNeely et al., 2014 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There are both speculative and well-established links between the autonomic and immune systems which could provide a mechanism for these results.

    “there are both speculative (Pavlov and Tracey, 2012) and well-established (Felten, 1999) links between the autonomic and immune systems which could provide a mechanism for these results.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Pavlov and Tracey, 2012 source

      Not checked in the free run.

    • cites Felten, 1999 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Specific meditative movement practices have been shown to be an effective intervention for COPD and equivalent or superior to conventional pulmonary rehabilitation in benefiting several symptoms.

    “Specific MM practices have been shown to be an effective intervention for COPD (Ng et al., 2011; Liu et al., 2012; Chan et al., 2013) and to be equivalent or superior to conventional pulmonary rehabilitation in benefiting several of its symptoms (Xu et al., 2010; Ng et al., 2014).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Ng et al., 2011

      Not checked in the free run.

    • cites Liu et al., 2012 source

      Not checked in the free run.

    • cites Chan et al., 2013 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In a cohort of women, average age 68, systemic inflammation would be expected to increase with advancing age, and is a risk factor for the development of many diseases of the elderly, including cardiovascular disease, COPD, diabetes, and cancer.

    “In a cohort of women, average age 68, systemic inflammation would be expected to increase with advancing age, and is a risk factor for the development of many diseases of the elderly, including cardiovascular disease, COPD, diabetes, and cancer (Il'yasova et al., 2005; Franceschi et al., 2007; Guarner and Rubio-Ruiz, 2014).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Il'yasova et al., 2005 source

      Not checked in the free run.

    • cites Franceschi et al., 2007 source

      Not checked in the free run.

    • cites Guarner and Rubio-Ruiz, 2014

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Studies of qigong have shown positive effects on inflammation as well as AD.

    “Studies of qigong have shown positive effects on inflammation as well as AD (Lee et al., 2005; Jahnke et al., 2010)”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Lee et al., 2005 source

      Not checked in the free run.

    • cites Jahnke et al., 2010 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Meditative movement practices help restore functionality to the autonomic nervous system, benefit depression and anxiety, and improve quality of life in many chronic diseases.

    “MM practices help restore functionality to the ANS (Sun and Yan, 1992; Lee et al., 2003a,b, 2004), and also benefit depression and anxiety (Payne and Crane-Godreau, 2013) and improve quality of life in many chronic diseases (Chan and Larson, 2015; Wang et al., 2015).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Sun and Yan, 1992

      Not checked in the free run.

    • cites Lee et al., 2003a,b, 2004 source

      Not checked in the free run.

    • cites Payne and Crane-Godreau, 2013

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Qigong has been used in China for hundreds of years in treating people with respiratory, autonomic and immune dysfunction.

    “Qigong, a traditional Chinese health practice, has been used in China for hundreds of years in treating people with respiratory, autonomic and immune dysfunction (Johnson, 2002).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Johnson, 2002

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Many qigong practices have a broad positive influence on a range of pathologies and tend to restore physiological functions to normal range.

    “Many of these practices have a broad positive influence on a range of pathologies (Lee, 2015; Dong and Bergren, 2016), and tend to restore physiological functions to normal range (Cohen, 1999).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Lee, 2015

      Not checked in the free run.

    • cites Dong and Bergren, 2016

      Not checked in the free run.

    • cites Cohen, 1999

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Exposure to cigarette smoke at the time of stressful experience potentiates fear conditioning and makes long-term post-traumatic stress and autonomic imbalance more likely.

    “Exposure to CS at the time of stressful experience potentiates fear conditioning (Davis et al., 2006; Cohen et al., 2007; Kutlu and Gould, 2015), and makes long-term post-traumatic stress and autonomic imbalance more likely (van der Velden et al., 2008).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Davis et al., 2006 source

      Not checked in the free run.

    • cites Cohen et al., 2007 source

      Not checked in the free run.

    • cites Kutlu and Gould, 2015 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Meditative movement has been shown to benefit the immune system by reducing chronic systemic inflammation and increasing the effectiveness of acquired immune response to infection.

    “MM has also been shown to benefit the immune system, both reducing chronic systemic inflammation (Jahnke et al., 2010) and increasing the effectiveness of acquired immune response to infection (Wang et al., 2012).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Jahnke et al., 2010 source

      Not checked in the free run.

    • cites Wang et al., 2012 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    All participants gave written informed consent prior to enrollment.

    “All participants gave written informed consent using IRB-approved informed consent forms (Payne and Crane-Godreau, 2016a) prior to enrollment in the study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Participants were instructed to discontinue exercises if they experienced adverse symptoms, and instructors monitored participants for signs of distress during classes.

    “Participants were instructed to discontinue the exercises (in the class or at home) immediately if they experienced any of the following: dizziness, rapid or irregular heart-beat, sudden or excessive dyspnea, chest pain, significant pain anywhere in the body, pressure in the head, headache. During the classes the instructor carefully monitored the participants for signs of distress including”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Qigong practice may have preventive and ameliorative health effects in flight attendants exposed to second-hand cigarette smoke and possibly in other populations.

    “suggesting that Qigong practice may have preventive and ameliorative health effects in FA exposed to SHCS and possibly in other populations.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The observed pre-to-post changes are attributable to the MM intervention rather than to other factors such as regression to the mean, placebo, or seasonal variation.

  • May combine two claims.

    Interpretationown data

    The results indicate improved autonomic function, improved exercise tolerance and cardio-pulmonary function, and reduced systemic inflammation.

    “Our results indicate improved autonomic function, improved exercise tolerance and cardio-pulmonary function, and reduced systemic inflammation.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The observed pre-to-post changes are attributable to the MM intervention rather than to other factors such as regression to the mean, placebo, or seasonal variation.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study was registered at ClinicalTrials.gov.

    “this study is registered at ClinicalTrials.gov: (https://clinicaltrials.gov/ct2/show/NCT02612389/)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The intervention was effective in the primary outcomes, the 6MWT and hs-CRP.

    “Our intervention was effective in the primary outcomes, the 6MWT and hs-CRP.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The observed pre-to-post changes are attributable to the MM intervention rather than to other factors such as regression to the mean, placebo, or seasonal variation.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The instructors were well versed in the practice and instruction of qigong.

    “The instructors were well versed in the practice and instruction of qigong.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    An earlier paper describing the proposed protocol has been published.

    “an earlier paper describing the proposed protocol has been published (Payne et al., 2016).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Payne et al., 2016

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Spirometry was obtained according to ATS guidelines and specific validated spirometric cut points were used.

    “Spirometry. FEV1, FVC, and Flow/Volume Curves were obtained according to the ATS guidelines (Society, 2002). We used specific validated spirometric cut points (Rabe et al., 2007).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Society, 2002 source

      Not checked in the free run.

    • cites Rabe et al., 2007 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The MAIA questionnaire evaluates the degree of awareness of interoceptive cues and the degree of comfort with these cues.

    “Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire (Mehling et al., 2012) evaluates the degree of awareness of interoceptive cues, and the degree of comfort with these cues.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Mehling et al., 2012 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The number of participants above clinical range diminished substantially in all three blood pressure-related measures, a result which may be meaningful in clinical terms.

    “in all three blood pressure-related measures (systolic, diastolic and pulse pressures), the number of participants above accepted clinical range diminished substantially, a result which may be meaningful in clinical terms.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The 13% increase in 6MWT distance indicates that participants had a substantial and significant increase in functional ability despite no significant change in FEV1 or FVC.

    “There was a 13% increase in the distance walked in the 6MWT. This indicates that, despite no significant change in FEV1 or FVC, participants had a substantial and significant increase in functional ability.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The observed pre-to-post changes are attributable to the MM intervention rather than to other factors such as regression to the mean, placebo, or seasonal variation.

  • May combine two claims.

    Interpretationcitation

    These results are in line with other studies of the effects of Qigong on respiratory disease and other health factors, supporting the possibility that Qigong may be a useful therapeutic intervention for this target population.

    “These results are in line with other studies of the effects of Qigong, specifically on respiratory disease (Ng et al., 2011) as well as on other health factors (Jahnke et al., 2010), supporting the possibility that Qigong may be a useful therapeutic intervention for our target population.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Ng et al., 2011

      Not checked in the free run.

    • cites Jahnke et al., 2010 source

      Not checked in the free run.

    • Rests on an assumption: The observed pre-to-post changes are attributable to the MM intervention rather than to other factors such as regression to the mean, placebo, or seasonal variation.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    All aspects of the study were approved by the Dartmouth IRB.

    “All aspects of this study were approved by the Dartmouth IRB (CPHS # 28572).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study recruited 26 participants to compensate for anticipated drop-out.

    “To compensate for anticipated drop-out, we recruited a total of 26 participants into the Selection group.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The 6-min walk test was conducted according to American Thoracic Society guidelines.

    “The 6 min walk test (6MWT), was conducted on an indoor level surface free of obstructions according to the guidelines established by the American Thoracic Society (ATS).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The COMPASS 31 questionnaire detects symptoms of autonomic dysfunction.

    “COMPASS 31: Each subject completed the COMPASS 31, a questionnaire for detecting symptoms of autonomic dysfunction (Sletten, 2012).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Sletten, 2012 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The Zung Self-Rating Anxiety and Depression Scales provide self-report of symptoms of anxiety or depression.

    “Zung Self-Rating Anxiety and Depression Scales: These questionnaires, which provide self-report of symptoms of anxiety or depression, were completed by each subject in the presence of a research team member.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Both core pathology and the co-morbidities of COPD are associated with chronic dysfunction of the autonomic nervous system.

    “Both core pathology and the co-morbidities of COPD are known to be associated with chronic dysfunction of the autonomic nervous system (ANS) (van Gestel and Steier, 2010).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites van Gestel and Steier, 2010

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There is evidence that nicotine exposure precedes and exacerbates the effects of exposure to stress or trauma.

    “However, there is evidence that nicotine exposure precedes and exacerbates the effects of exposure to stress or trauma (Elias et al., 2010).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Elias et al., 2010 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Cigarette smoke, whether inhaled directly or second-hand, is a principal cause of COPD and its comorbidities as well as other respiratory system disorders.

    “Cigarette smoke (CS), whether inhaled directly or second-hand, is known to be a principle cause of COPD and its comorbidities as well as other respiratory system disorders (Moritsugu, 2007).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Moritsugu, 2007 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The pulmonary pathology of COPD is accompanied by systemic abnormalities including inflammation and neuro-humoral activation.

    “The pulmonary pathology of COPD is accompanied by systemic abnormalities including inflammation and neuro-humoral activation (Andreas et al., 2005)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Andreas et al., 2005 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The large percentage of participants failing to complete the study is a possible source of bias.

    “The large percentage of participants failing to complete the study is a possible source of bias.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The capacity for self-regulation includes the ability of the prefrontal cortex, insula and anterior cingulate gyrus to modulate arousal in the limbic system and hypothalamus.

    “This capacity includes the ability of the prefrontal cortex, insula and anterior cingulate gyrus to modulate arousal in the limbic system and hypothalamus (Critchley et al., 2003; Craig, 2008).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Critchley et al., 2003 source

      Not checked in the free run.

    • cites Craig, 2008

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    COPD is accompanied by multiple co-morbidities, including cardiovascular, immune, musculoskeletal and affective disorders.

    “as well as multiple co-morbidities, including cardiovascular, immune, musculoskeletal and affective disorders (Sin et al., 2006; Fabbri et al., 2008).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Sin et al., 2006 source

      Not checked in the free run.

    • cites Fabbri et al., 2008 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    In some cases, affective disturbance only became apparent after participants had been consented and had begun testing.

    “In some cases, affective disturbance only became apparent to us after participants had been consented and had begun to undergo testing.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    Given the results of other qigong studies with different populations, it appears likely that similar results would be obtained in non-flight-attendant populations, males, younger people, and those with more severe pathology.

    “however given the results of other qigong studies with different populations, it appears likely that similar results would be obtained.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    Every precaution has been taken by the researchers to standardize the administration of the 6MWT.

    “Every precaution has been taken by the researchers to standardize the administration of the test.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The MAIA is hypothesized to relate to the capacity for self-regulation.

    “This is hypothesized to relate to the capacity for self-regulation (Farb, 2015; Payne et al., 2015).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Farb, 2015 source

      Not checked in the free run.

    • cites Payne et al., 2015 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    This study was not designed to accommodate people with significant levels of affective disturbance.

    “This study was not designed to accommodate people with significant levels of affective disturbance.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    In the Selection stage, subjects may be more highly motivated in the post-test situation, and this could skew results.

    “Nonetheless, in the Selection stage, subjects may be more highly motivated in the post-test situation, and this could skew results.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All subjects gave written informed consent in accordance with the Declaration of Helsinki.

    “All subjects gave written informed consent in accordance with the Declaration of Helsinki.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The Committee for the Protection of Human Subjects-Dartmouth College approved the study design.

    “The Committee for the Protection of Human Subjects–Dartmouth College approved the study design.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Materials necessary for verification and replication of the results, in addition to supplemental materials, have been deposited at the Harvard Dataverse.

    “Materials necessary for verification and replication of our results, in addition to supplemental materials, have been deposited at the Harvard Dataverse.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The protocol was approved by the Committee for the Protection of Human Subjects-Dartmouth College.

    “The protocol was approved by the The Committee for the Protection of Human Subjects–Dartmouth College.”
    Quote in the paperNot a substantial claim
68 of 68

  • The authors state this as an assumption.

    Pre-intervention measurements in this single-arm study provide a valid control for post-intervention measurements.

    “There was a baseline set of measurements for each subject before any MM intervention, and each participant acted as his/her own control so that data collected before the intervention could be compared to data collected after the MM training.”

  • The paper relies on this without support.

    The observed pre-to-post changes are attributable to the MM intervention rather than to other factors such as regression to the mean, placebo, or seasonal variation.

    “These results tend to confirm the hypothesized benefits of MM training for this population”

  • The paper relies on this without support.

    Participants did not significantly modify their lifestyle during the study period apart from the practice required by the study.

    “Participants were asked not to modify their lifestyle significantly during the study period apart from the practice required by the study.”

  • The paper relies on this without support.

    No therapeutic approaches specifically aimed at autonomic disturbance from second-hand cigarette smoke in flight attendants have been proposed.

    “The possible role of autonomic disturbance induced by workplace exposure to SHCS in causing pulmonary, immune or affective disorders has largely been ignored, and as far as we know, no therapeutic approaches specifically aimed at such conditions have been proposed.”

  • The paper relies on this without support.

    Autonomic imbalance negatively affects the immune, cardiovascular, respiratory and musculoskeletal systems and may reinforce pathological changes triggered directly in the lungs by cigarette smoke.

    “This imbalance of the ANS negatively affects the immune, cardiovascular, respiratory and musculoskeletal systems and may reinforce the pathological changes triggered directly in the lungs by CS.”

  • The paper relies on this without support.

    The sample of 14 completers is representative of the broader population of flight attendants exposed to second-hand cigarette smoke.

    “These data may help to explain the low levels of diversity within this study population.”

  • The paper relies on this without support.

    The 4-month training period is sufficient to produce the observed changes.

    “All participants were asked to complete 12 mandatory hours of class time over a period of 4–5 months.”

  • The paper relies on this without support.

    The statistical significance of pre-post changes in a single-arm study with 14 completers is not inflated by multiple comparisons.

    “Significance levels for changes in measures from pre- to post-intervention test were determined using a one-tailed t-test.”

  • The paper relies on this without support.

    Anxiety is associated with autonomic imbalance (increased sympathetic and reduced parasympathetic activity).

    “Since anxiety is associated with autonomic imbalance (increased sympathetic and reduced parasympathetic activity)”

  • The paper relies on this without support.

    In COPD, inflammation, mucous secretion and plasma extravasation are in excess, and antigen responsiveness is inhibited, all together giving rise to pathology.

    “In COPD, inflammation, mucous secretion and plasma extravasation are in excess, and antigen responsiveness is inhibited, all together giving rise to pathology.”

  • The paper relies on this without support.

    Autonomic nervous system dysfunction negatively affects the immune, cardiovascular, respiratory, and musculoskeletal systems.

    “ANS dysfunction negatively affects the immune, cardiovascular, respiratory, and musculoskeletal systems.”

  • The paper relies on this without support.

    Flight attendants are first responders and are at risk for high-stress exposure.

    “Since FA are first responders and are at risk for high-stress exposure”
12 of 12

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conflicting counts above the systolic blood-pressure threshold

    Major

    Table 2 reports 43% above 140 mmHg before training, which is 6 of the 14 participants analyzed. Figure 6 instead says the count declined from 4 to 1. The discrepancy affects the reported significant change in the threshold count.

  • Different percentage changes reported for COMPASS 31

    Minor

    Table 2 gives a 26% decrease in COMPASS 31, whereas the discussion calls the change 24%.

2 of 2

The citation lists haven’t been fetched yet

References 76 · Cited by 12

Research works printed but not linked: 9

  1. Cohen, 1999, The Way of Qigong
  2. Johnson, 2002, Chinese Medical Qigong Therapy
  3. McNeely, 2016, Supplemental Materials for Study NCT02612389: Personal Email From Dr. E. McNeely Providing Unpublished Data on Demographics of US Flight Attendants, 1 Edn
  4. Payne, 2016a, Supplemental Materials for Study NCT02612389: Consent form, 1 Edn
  5. Payne, 2016b, Replication Data for Study NCT02612389: Video Material to Supplement MM Instruction, 1 Edn
  6. Payne, 2016c, Replication Data for Study NCT02612389: PDF Files of Written Material Supplementing the Individual Class Instruction in MM, 1 Edn
  7. Payne, 2016d, Replication Data for Study NCT02612389: Audio Files Used in MM Instruction, 1 Edn
  8. Payne, 2016e, Supplemental Materials for Study NCT02612389: Survey Monkey form Used for Participants to Provide Feedback on their Experiences from the MM Intervention Training, 1 Edn
  9. Payne, 2016f, Replication Data for Study NCT02612389: Raw Data On Pre- and Post-Intervention Outcome Measure Results in Excel Format. 1 Edn

Authors
Payne, P., Fiering, S., Leiter, J. C., Zava, D. T., & Crane-Godreau, M. A.
Affiliations
  • Dartmouth College (US)
  • ZRT Laboratory (US)
Corresponding author
Payne, Peter
ORCID
Venue
Frontiers in Human Neuroscience
Publisher
Frontiers Media SA
Published
2017-02-21
Volume
11
Pages
67-67
ISSN
1662-5161 (ISSN-L)
DOI
10.3389/fnhum.2017.00067
PMC
PMC5318411
OpenAlex
W2589814763
Semantic Scholar
977abf73ce2f1b9e9063f15a3e18a5b0ffb505bf
Cited by
12
References
76
Citations by year
2025: 1 · 2024: 1 · 2022: 1 · 2021: 2 · 2019: 4 · 2018: 2 · 2017: 1
FWCI
2.37
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Frontiers in Human Neuroscience (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
Flight Attendant Medical Research Institute (CIA 130052, CIA 130051)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Health Sciences › Medicine › Physiology › Biofield Effects and Biophysics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
Keywords
qigong, flight attendants, passive smoking, pulmonary dysfunction, autonomic nervous system, C-reactive protein, inflammation, 6-minute walk test, blood pressure, nicotine, fear learning, immune function, digital interventions

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