**Discussion**

The Tense Arousal significantly decreased both in the non-risk group and the hight-risk group. The effects size was large in both groups. These results show that the BMP decrease tension or anxiety, regardless the mental health status. It is because that breathing and meditation leads people to focus attention on themselves, and attention moves from things with tension or anxiety to themselves. The effects of decrease of tension by mindfulness agree with the previous studies (Garland, et al., 2007; Matchim & Armer, 2007).

The Energetic Arousal of the non-risk group significantly decreased after the therapy and showed middle effect size. It shows that BMP decrease of activity and sedate their feelings for good mental health. This result is different from Ogasawara, et al. (2006) in which the Energetic Arousal of college healthy students did not significantly change by relaxation of aroma hand massage. Ditto, et al. (2006) shows that mindfulness meditation produced different cardiovasucular and autonomic effects that relaxation, giving weight to the criticism against the conceptualization of mindfulness practice as a mere relaxation technique (Bishop, 2002).

In the high-risk group, the score did not change, showing no effect size. This result suggests that the BMP did not decrease activities for non- risk persons. The reasons of this phenomenon were that this therapy is useful to maintain energy for high-risk persons.

As for the salivary level of amylase, the high score demonstrates high level of negative stress. The scores of amylase significantly decreased in the high-risk group, but it did not change in non-risk group. It means that the BMP is more effective to reduce stress for high risk persons than non risk persons to reduce negative stress. In the previous study, the efficacy of mindfulness like decrease cortisol level which shows stress level as the physiological indicator (Carlson, et al., 2007) agreed with the present study for high risk persons. Carlson et al. (2007) demonstrated that breast cancer patients felt much psychological stress than healthy women, but the level of the salivary cortisol as the physiological indicator did not differ between patients and healthy women. Their studies suggest that physiological level was the same between patients and healthy women. However, from the present study, the effects of mindfulness program may be different by mental health level.

About GSR scores, a low score means high tension or stress. The GSR scores did not change in no-risk group, however, those of the high-risk group increased with middle effects size. It shows that the BMP has much more effects to reduce tension or stress for high risk persons than non-risk persons. Erisman & Roemer (2010) showed that the level of skin conductance was not differ between the mindfulness group and the non-mindfulness group. Though the present study design is different from Erisman & Roemer, contents of program or health level might affect people differently. The effects of mindfulness to physiological aspect will be needed to examine further more.

#### **2.1 The efficacy of the Bedside Mindfulness Program on mood of cancer patients**

We investigated the effects of the Bedside Mindfulness Program on mood by a level of mental status of cancer patients. We hypothesized that effects of the program on tension arousal may be the same regardless of mental status, however, effects of the program on energetic arousal may be differently.

#### **Participants and methods**

170 Topics in Cancer Survivorship

The Tense Arousal significantly decreased both in the non-risk group and the hight-risk group. The effects size was large in both groups. These results show that the BMP decrease tension or anxiety, regardless the mental health status. It is because that breathing and meditation leads people to focus attention on themselves, and attention moves from things with tension or anxiety to themselves. The effects of decrease of tension by mindfulness agree with the previous studies (Garland, et al., 2007; Matchim & Armer,

The Energetic Arousal of the non-risk group significantly decreased after the therapy and showed middle effect size. It shows that BMP decrease of activity and sedate their feelings for good mental health. This result is different from Ogasawara, et al. (2006) in which the Energetic Arousal of college healthy students did not significantly change by relaxation of aroma hand massage. Ditto, et al. (2006) shows that mindfulness meditation produced different cardiovasucular and autonomic effects that relaxation, giving weight to the criticism against the conceptualization of mindfulness practice as a mere relaxation

In the high-risk group, the score did not change, showing no effect size. This result suggests that the BMP did not decrease activities for non- risk persons. The reasons of this phenomenon were that this therapy is useful to maintain energy for high-risk persons. As for the salivary level of amylase, the high score demonstrates high level of negative stress. The scores of amylase significantly decreased in the high-risk group, but it did not change in non-risk group. It means that the BMP is more effective to reduce stress for high risk persons than non risk persons to reduce negative stress. In the previous study, the efficacy of mindfulness like decrease cortisol level which shows stress level as the physiological indicator (Carlson, et al., 2007) agreed with the present study for high risk persons. Carlson et al. (2007) demonstrated that breast cancer patients felt much psychological stress than healthy women, but the level of the salivary cortisol as the physiological indicator did not differ between patients and healthy women. Their studies suggest that physiological level was the same between patients and healthy women. However, from the present study, the effects of mindfulness program may be different by

About GSR scores, a low score means high tension or stress. The GSR scores did not change in no-risk group, however, those of the high-risk group increased with middle effects size. It shows that the BMP has much more effects to reduce tension or stress for high risk persons than non-risk persons. Erisman & Roemer (2010) showed that the level of skin conductance was not differ between the mindfulness group and the non-mindfulness group. Though the present study design is different from Erisman & Roemer, contents of program or health level might affect people differently. The effects of mindfulness to physiological aspect will

**2.1 The efficacy of the Bedside Mindfulness Program on mood of cancer patients**  We investigated the effects of the Bedside Mindfulness Program on mood by a level of mental status of cancer patients. We hypothesized that effects of the program on tension arousal may be the same regardless of mental status, however, effects of the program on

**Discussion** 

2007).

technique (Bishop, 2002).

mental health level.

be needed to examine further more.

energetic arousal may be differently.

Four cancer patients participated in the study. Table 3 shows patients' back ground. We used the same questionnaire to patients as college students. The primary physician selected participants. A pastoral care worker conducted the BMP, in which she conducted the program about from 30 to 60 minutes. Before the program, patients completed the General Health Questionnare-30 and the Japanese UWIST Mood Adjective Check List (JUMACL), and after the program, they completed the JUMACL.


Table 3. Back ground of cancer patients.

#### **Results**

Table 4 shows the results. We reviewed each patient, patient A, Patient B, Patient C, and patient D. The score of GHQ was low and under the cut-off point. The scores of Patient A and Patient D was 1 and they had no mental problems. The scores of Patient B and Patient C show a little mental problem. The score 10 of TA was the lowest in the JUMACL, thus, patients had originally low tense arousal except patient C. As for EA, the score of Patient A and patient D who had no mental problems decreased (from 39 to 36, from 39 to 31), however, those of patient B and Patient C who had a little mental problem increased (from 30 to 40, from 34 to 39).


Table 4. Score of GHQ (pre), Tense Arousal (TA) and Energetic Arousal (EA)

The Relationships Between Stress

**Results** 

0

**Discussion** 

Fig. 6. Changes of HADS score

supported patients' mental aspect.

depression, even though patients have symptoms.

2

4

6

8

10

Reduction Induced by Bedside Mindfulness Program and Mental Health Status 173

The scores of HADS decreased from 9.57±7.1 to 6.86±6.9 after the program (t=1.49, p=0.161). The score of Anderson symptoms increased from 18.4±18.3 to 21.3±26.4 (t=-0.43,

HADS

p=0.67). The Peason's correlation coefficient was 0.84 (p=0.00).

Pre Post

The HADS score decreased in 10 % significance. It suggests that the BMP affects to decrease patients' anxiety or depression. Like the cyclic meditation therapy which alleviated patients' anxiety or depression (Ando, Morita, Akechi, et al., 2009), our mindfulness program for cancer patient affects on anxiety or depression. Since the cut-off points of the HADS score was 19/20, the patients in the present study did not have serious problems. It might be because the primary physician in the present study

The Anderson symptom score increased a little, though it was not significant. It might be because patients under treatments were easily affected by the treatment process and the physical states were changeable. Since anxiety or depression of patients decreased regardless of the increase of symptom, this program may be useful to alleviate anxiety or

As the co-relation coefficient between HADS score and Anderson scores was significantly high (r=0.84), patients who had much physical symptoms feel much more anxiety or depression. In the present study, since the duration was only one week, and session times

### **Discussion**

Although patients in this study felt no mental problems originally, the decrease of TA of patient C suggests that BMP affects to decrease tense arousal. This facts support the results of college students. As for EA, the scores of Patient B and Patient C with a little mental problems increased, oppositely patient A and Patient C with no mental problem decreased. This facts also are the same of those of college students who received the same progrm, such that the EA score of the high-risk group increased, but that of the non-risk group decreased. Patients reflected the process of the program.

There were 2 patters. Some patients reflected that they were very calm before the program and they felt much more calm after the program. Other patients reflected that they had some problems before the program and they felt some energy to active something after the program. That is, this program affects on energy to elevate, particular for persons with some mental problems. In near future, we need to investigate further more.

### **2.2 The efficacy of the Bedside Mindfulness Program on anxiety or depression**

We assess the efficacy of the Bedside Mindfulness Program (BMP) on anxiety or depression of cancer patients, because most of cancer patients feel anxiety or depression about treatments, future, works, economy, or recurrence. It seemed to be important for us to examine the efficacy of the Bedside Mindfulness Program on anxiety or depression.

#### **Purpose**

The aim of this study was to examine the efficacy of the BMP on anxiety of depression of cancer patients.

#### **Participants and methods**

Participants were cancer patients who received treatments like chemotherapy or radiation. The primary physicians selected patients. Table 5 shows the background of patients. The interviewer was a pastoral care worker. There were two sessions. In the first session, a patient received the BMP. The duration was about 60 minutes. Patients completed the questionnaires pre and post the intervention. Participants completed the Hospital Anxiety and Depression Scale.


Table 5. Basic data of participants.

#### **Results**

172 Topics in Cancer Survivorship

Although patients in this study felt no mental problems originally, the decrease of TA of patient C suggests that BMP affects to decrease tense arousal. This facts support the results of college students. As for EA, the scores of Patient B and Patient C with a little mental problems increased, oppositely patient A and Patient C with no mental problem decreased. This facts also are the same of those of college students who received the same progrm, such that the EA score of the high-risk group increased, but that of the non-risk group decreased.

There were 2 patters. Some patients reflected that they were very calm before the program and they felt much more calm after the program. Other patients reflected that they had some problems before the program and they felt some energy to active something after the program. That is, this program affects on energy to elevate, particular for persons with some

We assess the efficacy of the Bedside Mindfulness Program (BMP) on anxiety or depression of cancer patients, because most of cancer patients feel anxiety or depression about treatments, future, works, economy, or recurrence. It seemed to be important for us to

The aim of this study was to examine the efficacy of the BMP on anxiety of depression of

Participants were cancer patients who received treatments like chemotherapy or radiation. The primary physicians selected patients. Table 5 shows the background of patients. The interviewer was a pastoral care worker. There were two sessions. In the first session, a patient received the BMP. The duration was about 60 minutes. Patients completed the questionnaires pre and post the intervention. Participants completed the Hospital Anxiety

Basic Data

56 Male:1 Female:13 II : 2 III : 1 IV: 12 0:7 1:3 2:1 3:1 4:1 Yes:10 No:1 Unclear:3

**2.2 The efficacy of the Bedside Mindfulness Program on anxiety or depression** 

examine the efficacy of the Bedside Mindfulness Program on anxiety or depression.

mental problems. In near future, we need to investigate further more.

**Discussion** 

**Purpose** 

cancer patients.

**Participants and methods** 

and Depression Scale.

Mean age Gender Stage

Metastasis

Table 5. Basic data of participants.

Performance stage

Patients reflected the process of the program.

The scores of HADS decreased from 9.57±7.1 to 6.86±6.9 after the program (t=1.49, p=0.161). The score of Anderson symptoms increased from 18.4±18.3 to 21.3±26.4 (t=-0.43, p=0.67). The Peason's correlation coefficient was 0.84 (p=0.00).

Fig. 6. Changes of HADS score

#### **Discussion**

The HADS score decreased in 10 % significance. It suggests that the BMP affects to decrease patients' anxiety or depression. Like the cyclic meditation therapy which alleviated patients' anxiety or depression (Ando, Morita, Akechi, et al., 2009), our mindfulness program for cancer patient affects on anxiety or depression. Since the cut-off points of the HADS score was 19/20, the patients in the present study did not have serious problems. It might be because the primary physician in the present study supported patients' mental aspect.

The Anderson symptom score increased a little, though it was not significant. It might be because patients under treatments were easily affected by the treatment process and the physical states were changeable. Since anxiety or depression of patients decreased regardless of the increase of symptom, this program may be useful to alleviate anxiety or depression, even though patients have symptoms.

As the co-relation coefficient between HADS score and Anderson scores was significantly high (r=0.84), patients who had much physical symptoms feel much more anxiety or depression. In the present study, since the duration was only one week, and session times

The Relationships Between Stress

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#### **3. Conclusion**

The Bedside Mindfulness Program decreases tension and maintains energy of mood, and it is supported by the results of Galvanic Skin Response level and amylase. For cancer patients, this program may be useful to reduce anxiety and depression. Since anxiety and depression related with physical symptoms, we assess the efficacy of this program from long term perspective.

#### **4. Acknowledgments**

This research was supported by a Grant-in-Aid for Scientific Research (C). We specially thanks for all participants and staffs in hospitals, and for an illustrator, Mrs. Yukio Matsuo.

#### **5. References**


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**Rehabilitation in Cancer Survivors: Interaction** 

Cancer is not a new disease, there are findings of neoplasia in the mummies of ancient Egypt, there are descriptions of the Romans and the Greeks and even remains in the fossil of dinosaurs. The study of the epidemiology of cancer, however, demonstrates an increasing incidence with an alarming progression, which is also involving countries which were

 The progressive industrialization has led to an increase of environmental pollution with newly synthesized toxic substances, unknown by biological systems during the evolutionary process. Technological innovation has also increased the yield in agriculture, which has resulted in an increased food availability and a profound change in eating habits both for the type and for the amount of introduced nutrients. Technological development has also radically changed lifestyle with a progressive increase in sedentariness, a reduction to the sun exposure, causing a vitamin D deficiency also in children, by altering the circadianicity of circadian rhythms which regulate, depending on sunlight, the correct functioning of our body, including cell

In general, the standard of living has increased in many countries, it has lengthened the life

The improvement of recovery rates and survival with the progressive increase in the average age, in association with a greater focus on the quality of life, has led to basic definitions for cancer rehabilitation. This aims to help both to minimize the effects induced by the disease and the treatment (surgery, chemotherapy, radiotherapy, hormone therapy) and to regain control of many aspects of life in order to become an effective means of

The rehabilitative intervention, therefore, shouldn't aim only to control physical pain but also to relieve the mental, social and spiritual pain, with all the other symptoms ( Mikkelsen

Since the 80's, scientific literature has stressed the link between sedentariness and certain

prevention for recurrences and comorbidity (Carver, JR.; Shapiro, CL 2007 ).

**1. Introduction** 

proliferation.

expectancy and, with it has increased cancer.

T .2009) (Fialka-Moser, V Crevenna, R.. 2003 ).

types of cancer (Garabrant 1984).

**1.1 Physical activity, body composition and cancer** 

considered "protected" or otherwise at low risk until last century.

**Between Lifestyle and Physical Activity** 

*2Scuola di Specializzazione in Medicina Fisica e Riabilitativa,* 

Raoul Saggini1 and Menotti Calvani2 *1Dipartimento Università G. D'Annunzio, Chieti,* 

*Università G. D'Annunzio, Chieti,* 

*Italy* 

Kabat-Zinn, J.; Massion, A.O.; Hebert, J.R.; Rosenbaum, E. (1998). Meditation. In: Holland JF (ed) Psycho-Oncology. Oxford University Press, New York, pp 767-779 **12** 
