Abstract
Depression is prevalent among one-third to two-thirds of acute and chronic stroke survivors. Despite the availability of pharmacotherapies and/or psychotherapies, depression persists, even for 5–10 years after stroke, reflecting limited treatment responses and/or adherence to this conventional care. Mind-body interventions are commonly used among adults to ameliorate depressive symptoms. Thus, the feasibility of Tai Chi, alongside conventional care, to manage poststroke depression was investigated using a single-group pre-post intervention design. Recruitment and retention, intervention adherence, safety, acceptability, and fidelity were assessed. Symptoms of depression, anxiety, and stress were assessed using standardized questionnaires, objective sleep was assessed via a research-grade triaxial accelerometer, and blood samples were taken to measure oxidative stress, inflammatory markers, and a neurotrophic growth factor using commercially available kits per manufacturer's protocol. Pre-post intervention changes were assessed using paired t-tests. We enrolled stroke survivors (N = 11, mean age = 69.7 ± 9.3) reporting depression symptoms. After the intervention, we observed significant reductions in symptoms of depression (−5.3 ± 5.9, p=0.01), anxiety (−2.2 ± 2.4, p=0.01), and stress (−4.6 ± 4.8, p=0.01), along with better sleep efficiency (+1.8 ± 1.8, p=0.01), less wakefulness after sleep onset (−9.3 ± 11.6, p=0.04), and less time awake (−9.3 ± 11.6, p=0.04). There was a 36% decrease in oxidative stress (p=0.02), though no significant changes in the other biomarkers were found (all p values >0.05). Tai Chi exercise is a feasible intervention that can be used alongside conventional care to manage poststroke depression, aid in reducing symptoms of anxiety and stress, and improve sleep.
Highlights
Depression symptoms are widespread among acute and chronic stroke survivors with prevalence rates of 33–66% [1, 2]
A total of 26 stroke survivors were assessed for study eligibility, of which 9 did not meet the eligibility criteria and 6 declined study participation
We found a 36% decrease in superoxide dismutase (SOD) activity (ES 0.75, p 0.02) indicative of a decreased oxidative environment after intervention (Figure 2), though no significant changes in 8-isoprostane were observed
Summary
Depression symptoms are widespread among acute and chronic stroke survivors with prevalence rates of 33–66% [1, 2]. Poststroke depression leads to increased disability and mortality rates, along with a higher risk for recurrent stroke [3,4,5]. While increased levels of oxidative stress are associated with greater depression among stroke survivors [11, 12]. Depression in poststroke patients is currently treated with pharmacotherapies, psychotherapies, or both. Despite the availability of pharmacotherapies and/or psychotherapies, depression persists, even for 5–10 years after stroke, reflecting limited treatment responses and/or adherence to this conventional care [13, 14]. The use of pharmacotherapies to treat poststroke depression is Evidence-Based Complementary and Alternative Medicine associated with adverse events, such as recurrent stroke, seizures, delirium, and dizziness [15]
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