ABC | Volume 113, Nº6, December 2019

Editorial Evidence-Based Alternative Therapies that “Touch the Heart” Anderson Donelli da Silveira 1,2, 3 and Ricardo Stein 1,2, 3 Hospital de Clinicas de Porto Alegre, 1 Porto Alegre, RS – Brazil Programa de Pós Graduação em Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul, 2 Porto Alegre, RS – Brazil Vitta Centro de Bem Estar Físico, 3 Porto Alegre, RS – Brazil Mailing Address: Ricardo Stein • Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Rua Ramiro Barcelos 2350 - Serviço de Fisiatria/Térreo. Postal Code 90035-903, Porto Alegre, RS – Brazil E-mail: kuqui.r@gmail.com Keywords Cardiovascular Diseases; Meditation; Relaxation; Yoga; Tai Chi; Sense of Humor; Laughter Therapy. DOI: https://doi.org/10.36660/abc.20190719 Introduction Subcutaneous implantable defibrillator, bioabsorbable polymer stents, transcatheter aortic valve implant for certain patients with severe aortic stenosis, as well as the use of novel anticoagulants, are tangible examples of therapeutic advances in Cardiology in the end of this second decade of the 21 st century. In parallel, despite their infinitely lower financial support and prominence in scientific journals and Cardiology Congresses, the non-pharmacological interventions defined as “alternative” have also been tested with the purpose of improving important outcomes in these patients. In Cardiology, studies also use Meditation, Tai Chi (TC), Yoga and even Laughter Therapy as forms of treatment. In this context, this clinical updating has two objectives: 1) To provide the reader of the Arquivos Brasileiros de Cardiologia (ABC cardiol) with access to information on the alternative therapies aforementioned; 2) To enable them, if they are interested, to use these therapies in their everyday professional life; 3) To show that Brazilian researchers have been publishing articles involving some of these alternative therapies in journals like the Arquivos Brasileiros de Cardiologia, as well as in international high impact journals. Preamble - Meditation, TC and Yoga These are ancient oriental practices which, over the last decades, have become more popular and have spread throughout the West. All of them share the fact that they can be found in ancient texts and scriptures, with their foundations often representing an intersection of “sacred” and science. These activities share the integration between body and mind, aiming, in addition to physical and physiological benefits, at changing the perspective of the world in search for greater happiness, quality of life and inner peace. There has been a marked increase in the number of publications on this issue over the last decades, but there are still fewwell-designed observational studies and randomized clinical trials (RCTs), with no potential bias or conflict of interest, contemplating these three practices. Some of them are detailed below. Meditation It is a practice whose origins reach back to more than 5,000 years and, in spite of being often associatedwith Buddhism and Hinduism, is present in most religious doctrines, including the three great monotheistic religions (Christianity, Judaism and Islam). Thewordmeditation includes several practices with similar principles like techniques based on Buddhism ( zazen , shamatha and vipassana ), Yoga (Raja Yoga meditation), transcendental meditation, mindfulness and even compassion meditation (Tibetan Buddhism). An adequate definition of the technique and the procedures is very important to replicate results and, its absence, is a major methodology problem of several trials that used meditation and have already been published. Studies report a modest effect of meditation on blood pressure (BP) decrease, in response to stress, anxiety and smoking cessation. 1 The effect on BP is small, with a meta‑analysis of 19 studies, showing a reduction of 4 to 5 mmHg in systolic pressure and 2 to 4 mmHg in diastolic pressure. 2 Numerous studies in health and ill populations have explored the effects of meditation in psychological and psychosocial results. It is worth to highlight that most of them report some improvement in perceived stress levels, humor, anxiety, depression, quality of sleep or overall well-being. 3 An analysis carried out by the Health Research and Quality Agency, restricted to RCTs and with active control groups, concluded, with low level of evidence, that meditation and mindfulness programs showed modest improvements in stress, anxiety and negative affect. 4 On the other hand, a group of researchers from the Clinics Hospital of Sao Paulo assessed, through an RCT, the practice of meditation compared with a control group in patients with heart failure (HF). 5 A decrease in sympathetic activation was observed in these individuals, as well as improvements in quality of life and increased respiratory efficacy measured by the VE/VCO 2 slope ratio. Based on the data aforementioned, it is possible to note some benefits of meditation for patients at high risk or with already established cardiovascular disease. Nevertheless, several gaps still need to be fulfilled, such as the potential effect of meditation on the endothelial function, on heart rate variability (HRV), as well as on primary and secondary prevention of cardiovascular diseases. Tai Chi It is a Chinese martial art with its origins in Chinese traditional medicine and in Taoism. The slow and rhythmic movements aim at interconnecting the movements of the upper and lower limbs synchronously, moving smoothly, continuously and with no breaks and searching for stillness inside the movement. Although the movements of TC are slow and seem to be easy to perform, they work, for many patients, as a type of structured physical exercise. Studies have demonstrated the beneficial effects of its practice, both in terms of physical and mental aspects, 1059