***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Tai Chi , a moving meditation , is examined for its efficacy in post-stressor recovery . Forty-eight male and 48 female Tai Chi practitioners were r and omly assigned to four treatment groups : Tai Chi , brisk walking , mediation and neutral reading . Mental arithmetic and other difficult tests were chosen as mental challenges , and a stressful film was used to produce emotional disturbance . Tai Chi and the other treatments were applied after these stressors . After all treatments , the salivary cortisol level dropped significantly , and the mood states were also improved . In general the stress-reduction effect of Tai Chi characterized moderate physical exercise . Heart rate , blood pressure , and urinary catecholamine changes for Tai Chi were found to be similar to those for walking at a speed of 6 km/hr . Although Tai Chi appeared to be superior to neutral reading in the reduction of state anxiety and the enhancement of vigour , this effect could be partially accounted for by the subjects ' high expectations about gains from Tai Chi . Approaches controlling for expectancy level are recommended for further assessment Abstract Ten volunteer subjects each attended four training sessions of 1 hr , during which they were instructed to raise or lower blood pressure . They were provided with immediate analogue feedback of pulse wave velocity from a PDP-12 computer , and successful performance was rewarded with money . Significant differences in PWV between Increase and Decrease conditions were produced , the mean divergence in the final trial being equivalent to 11 mm Hg . These changes were accompanied by adjustments in heart rate and respiration rate , and did not improve with repeated sessions — indeed on some measures deterioration in performance was observed . Neither analysis from the initial baseline nor from the pre-trial level , appears to reflect the precise effects of feedback . Different methods of assessment are discussed , together with the use of PWV as a measure of blood pressure in such experiments Abstract Muscle relaxation and noncontinuous biofeedback were investigated as potential nonpharmaceutical treatments for essential hypertension . The two procedures were compared to a waiting list control group . Predictions were made regarding the overall treatment effect , sessions within treatment effect , and periods within session effect . The results of this experiment reveal that biofeedback significantly lowers diastolic blood pressure between pre measures and post measures . It was also shown that muscle relaxation has a significant effect upon lowering diastolic and systolic blood pressures between pre measures and post measures and has a significant effect upon lowering diastolic and systolic blood pressures as subjects progress from the first period of a treatment session to the last period of a treatment session Meditation training appears to be a promising psychological approach to the control of hypertension . However , most studies to date have had serious deficiencies . This study attempted to correct many of these deficiencies . Forty-one unmedicated hypertensives referred by general practitioners were r and omly allocated to three groups . The treatment group ( SRELAX ) underwent training procedures based on Transcendental Meditation ; a placebo control group ( NSRELAX ) underwent identical training but without a mantra . Both procedures were compared with a no-treatment control group . The results showed modest reductions in blood pressure in both SRELAX and NSRELAX groups , compared with the no-treatment controls , with diastolic percentage reductions reaching significance ( p<0.05 ) . There was considerable subject variation in response , with overall a mean decline in diastolic blood pressure of 8–10 % on 3-month follow-up . Possible indicators to predict the response of subjects are considered and reasons for the similarity in the effectiveness of the SRELAX and NSRELAX conditions are discussed In order to assess the effectiveness of the thermal biofeedback training combined with the progressive muscle relaxation therapy in the treatment of patients with essential hypertension , blood pressure decline was measured on the treatment group who had the combined thermal biofeedback and progressive muscle relaxation training ( N = 11 ) , and on the control group who had only the progressive muscle relaxation training ( N = 8) .  Baseline blood pressure was measured four times for two weeks on both groups . For the treatment group , blood pressure was measured twice before and after each of eight sessions of thermal biofeedback training for four weeks . For the control group , blood pressure was measured every two visits to a clinic for progressive muscle relaxation self-training twice before and after the self-training . A significant decline of the systolic blood pressure by 20.6 mmHg and of the diastolic blood pressure by 14.4 mmhg was observed in the treatment group . There was a tendency for both blood pressures to increase in the control group To examine the relative cost-effectiveness of single versus multiple patient education strategies to reduce hypertension , we assigned patients to seven intervention groups and to a  usual-care control group  using a r and omized factorial design . We compared cost-effectiveness measures for single , double , and triple combinations of ( a ) a clinic exit interview with patients to clarify their medical regimens , ( b ) an educational meeting with a member of the patient 's family to aid in management at home , and ( c ) a series of small group sessions to help patients overcome personal barriers to management . We observed consistent results for six different effectiveness measures under a variety of decision-making rules . Our results suggest that in the absence of targeting of multiple interventions to systematic ally selected high-risk patients , multiple intervention combinations are not more cost-effective than single interventions We have investigated prospect ively the efficacy of two nonpharmacologic relaxation techniques in the therapy of anxiety . A simple , meditational relaxation technique ( MT ) that elicits the changes of decreased sympathetic nervous system activity was compared to a self-hypnosis technique ( HT ) in which relaxation , with or without altered perceptions , was suggested . 32 patients with anxiety neurosis were divided into 2 groups on the basis of their responsivity to hypnosis : moderate-high and low responsivity . The MT or HT was then r and omly assigned separately to each member of the two responsivity groups . Thus , 4 treatment groups were studied : moderate-high responsivity MT ; low responsivity MT ; moderate-high responsivity HT ; and low responsivity HT . The low responsivity HT group , by definition largely incapable of achieving the altered perceptions essential to hypnosis , was design ed as the control group . Patients were instructed to practice the assigned technique daily for 8 weeks . Change in anxiety was determined by three types of evaluation : psychiatric assessment ; physiologic testing ; and self- assessment . There was essentially no difference between the two techniques in therapeutic efficacy according to these evaluations . Psychiatric assessment revealed overall improvement in 34 % of the patients and the self-rating assessment indicated improvement in 63 % of the population . Patients who had moderate-high hypnotic responsivity , independent of the technique used , significantly improved on psychiatric assessment ( p = 0.05 ) and decreased average systolic blood pressure from 126.1 to 122.5 mm Hg over the 8-week period ( p = 0.048 ) . The responsivity scores at the higher end of the hypnotic responsivity spectrum were proportionately correlated to greater decreases in systolic blood pressure ( p = 0.075 ) and to improvement by psychiatric assessment ( p = 0.003 ) . There was , however , no consistent relation between hypnotic responsivity and the other assessment s made , such as diastolic blood pressure , oxygen consumption , heart rate and the self-rating question naires . The meditational and self-hypnosis techniques employed in this investigation are simple to use and effective in the therapy of anxiety To study the effects of caffeine on serum lipids and blood pressure , we conducted a double-blind , r and omized trial with two parallel groups in 69 young , healthy subjects . After a 3-wk run-in period , subjects were r and omly assigned to one of two groups receiving either 4 - 6 140-mL cups filtered decaffeinated coffee per day and an equal number of pills containing 75 mg caffeine or 4 - 6 140-mL cups filtered decaffeinated coffee per day and an equal number of placebo pills , for 9 wk . In both groups caffeine intake from other sources was not allowed . The main finding of this study is that abstinence from caffeine for a period of 9 wk has no effect on either serum lipids or blood pressure Twenty-nine patients who had been treated with antihypertensive medication for at least the preceding 6 months were r and omly assigned to ( 1 ) therapistconducted , face-to-face progressive , deep-muscle relaxation training for 10 weekly sessions , or ( 2 ) progressive deep-muscle relaxation therapy conducted mainly by home use of audio cassettes , or ( 3 ) nonspecific individual psychotherapy for 10 weekly sessions . No differences between the groups were found immediately after therapy ; however , the therapist-conducted relaxation therapy group showed the greatest changes : −17.8 mm Hg systolic , −9.7 mm Hg diastolic at 6 months follow-up . Some significant trends in results among the three therapists were also found . No correlation existed between blood pressure changes and changes in dopamine-β-hydroxylase ( DbH ) levels To study the effects of device-guided breathing on office systolic blood pressure ( SBP ) , five centers r and omized 149 untrained hypertensives ( 50 % male , age 59+/-10 years , baseline blood pressure 150+/-9/86+/-9 mm Hg , 77 % taking drug therapy ) . One half received a device to guide slow breathing ; all received a home blood pressure monitor and only simple , written instructions . The changes in office SBP ( adjusted for office-to-home difference in baseline SBP and accumulated time spent in slow breathing , guided and measured by the device ) were significantly ( p<0.001 for trend ) correlated with accumulated time spent in slow breathing . Greater decreases in SBP ( -15.0+/-1.8 vs. -7.3+/-1.9 mm Hg ) were observed for those who spent more ( vs. less ) than 180 minutes over 8 weeks in slow breathing , as well as those who just monitored their blood pressure at home ( -9.2+/-1.6 mm Hg ) . Thus , even without training , hypertensive patients who receive a device to guide slow breathing significantly lowered their office SBP if the total time spent in slow breathing over 8 weeks exceeded a " threshold " value of 180 minutes OBJECTIVE To test the efficacy of individualized stress management for primary hypertension in a r and omized clinical trial with the use of ambulatory blood pressure ( BP ) measures . METHODS Men and women aged 28 to 75 years with mean ambulatory BP greater than 140/90 mm Hg received 10 hours of individualized stress management by means of semist and ardized treatment components . They were r and omly assigned to immediate treatment ( n = 27 ) or a wait list control group ( n = 33 ) . Participants on the wait list were subsequently offered treatment . Six-month follow-up data were available from 36 of the 45 participants who completed treatment . Measures were 24-hour ambulatory BP , lipid levels , weight , and psychological measures . RESULTS Blood pressure was significantly reduced in the immediate treatment group and did not change in control subjects ( -6.1 vs + 0.9 mm Hg for systolic and -4.3 vs + 0.0 mm Hg for diastolic pressure ) . When the wait list control group was later treated , BP was similarly reduced by -7.8 and -5.2 mm Hg , and for the combined sample , total change at follow-up was -10.8 and -8.5 mm Hg . Level of BP at the beginning of treatment was correlated with BP change ( r = 0.45 [ P<.001 ] and 0.51 [ P<.001 ] , respectively ) , and amount of systolic BP change was positively correlated with reduction in psychological stress ( r = 0.34 ) and change in anger coping styles ( r = 0.35 - 0.41 ) . CONCLUSIONS Individualized stress management is associated with ambulatory BP reduction . The effects were replicated and further improved by follow-up . Reductions in psychological stress and improved anger coping appear to mediate the reductions in BP change OBJECTIVE The objective of the study was to compare blood pressure ( BP ) biofeedback treatment ( BF ) effects between white-coat hypertension and essential hypertension . METHODS Fifteen white-coat hypertensive out- patients and 23 essential hypertensive out- patients were r and omly assigned to groups A or B. Subjects in group A underwent BF once a week for a total of four sessions . Those in group B visited the clinic only to measure BP  and later underwent the same BF . RESULTS In group A , BPs of white-coat hypertensives and essential hypertensives were significantly reduced by 22/11 and 14/8 mmHg , respectively . In group B , they were unchanged during the same period but later suppressed by BF . Under BF , pulse and respiratory rates were significantly higher , and elevation of diastolic BP due to mental stress testing was better suppressed in white-coat hypertensives than in essential hypertensives . CONCLUSION This treatment was effective in both types of hypertension , and pressor response to stress seems to be important in the differentiated BF effect The contribution of training procedures design ed to alter individuals ' psychological responses to stressful life stimuli to the reduction of blood-pressure levels of hypertensives was evaluated . The treatment consisted of a set of coping skill-building experiences .  Forty-one black males , mildly to moderately hypertensive and under medical supervision in an outpatient cardiovascular unit of a veterans ' hospital , participated . Subjects were r and omly assigned to one of three groups : Cognitive Self-Management Training ( CSM ) , Attention Placebo Control , and Current Clinic Conditions Control . The dependent measures were the State Anxiety Scale , Trait Anxiety Scale , Coping Strategic Inventory , systolic blood pressure , and diastolic blood pressure . Subjects in the CSM group reported significant increases in the use of cognitive coping strateg 
    Output:
    
The substantial heterogeneity between trials was not explained by duration of follow-up , type of control , type of relaxation therapy or baseline blood pressure .
In view of the poor quality of included trials and unexplained variation between trials , the evidence in favour of causal association between relaxation and blood pressure reduction is weak .
Some of the apparent benefit of relaxation was probably due to aspects of treatment unrelated to relaxation