used.

Literature reports a secondary venous outflow pattern ex-
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Purpose: Hot flashes and/or night sweats are the most common
ists for many migraine patients. The significance of increase in
compliance with this study group remains unknown requiring
further study.
Contact: H Charles Woodfield, III, chuckwoodfield@yahoo
.com
P02.34
Effects of Early Adversity and Stress Vulnerability
on Treatment Response to Mindfulness-Based Stress
Reduction
Kirstin Aschbacher (1), Clifford Saron (2), Amanda Gilbert (1),
and troubling symptoms associated with menopause, experi-
enced by 64% to 80% of women undergoing natural menopause
and almost all women who undergo surgical menopause.
Hormone therapy is currently the gold standard for treatment,
but many women have sought alternative treatments including
other pharmaceutical agents, herbal or dietary remedies, and
behavioral therapies. These treatments show mixed results. The
purpose of this study was to obtain preliminary data on the
efficacy of yoga for reducing self-reported menopausal hot
flashes in a randomized study including an attention control
group.
Methods: We randomized 54 late perimenopausal and post-
menopausal women, aged 4558 years, with at least 4 hot flashes
per day to one of three groups: yoga, health and wellness edu-

Justine Arenander (1), Elissa Epel (1)

(1) University of California, San Francisco, CA, USA
(2) University of California, Davis, CA, USA
Purpose: Early adversity may contribute to the development of
a stress-vulnerable endophenotype i.e., a tendency to experi-
ence more intense negative affect in response to daily stressors,
attribute stressful events to personal short-comings (internaliz-
ing), and have poorer affective recovery. However, little re-
search has explored whether early adversity and associated stress
vulnerability makes individuals more or less likely to benefit
from stress-reduction interventions. Objectives: 1) To evaluate
the association between early adversity and response to Mind-
fulness intervention for parenting stress (HEART Health En-
hancement And Resiliency Training), and 2) To investigate
whether endorsing a stress-vulnerable endophenotype may ex-
plain this relationship.
Methods: 25 premenopausal women with a range of chronic
stress participated in the intervention, including four 6-hour
workshops and weekly 1-hour calls over 12 weeks. The Child-
hood Trauma Questionnaire (CTQ) was used to assess early
adversity. Negative affective reactivity, recovery, and attribu-
tions in response to daily stressors were assessed using averages
across a 7-day nightly diary. The primary outcome was per-
ceived stress over the last month.
Results: Women endorsing higher CTQ scores experienced
significantly greater decreases in stress from pre to post HEART
(r = - .52, p = .008). Higher CTQ was also associated with
greater negative affective reactivity to daily stressors (r = .45,
p = .03), greater internalizing (r = .58, p = .003), and poorer re-
covery from feelings of shame (r = - .42, p = .04), but not neg-
ative affectivity in general (r = - .31, p = .14). In turn, women
who endorsed more internalizing and slower recovery from
feelings of shame had greater HEART-related reductions in
stress (respectively: r = - .44, p = .027; r = .46, p = .02).
Conclusion: Women exposed to early adversity may benefit
more from mindfulness interventions than those who were not.
Heightened stress sensitivity may be a mechanism that helps
explain this enhanced treatment response.
Contact: Kirstin Aschbacher, kirstin.aschbacher@ucsf.edu
P02.35
A Pilot Study of Integral Yoga for Menopausal
Hot Flashes
Nancy Avis (1), Claudine Legault (1), Gregory Russell (1),
Kathryn Weaver (1), Suzanne Danhauer (1)
(1) Wake Forest School of Medicine, Winston-Salem, NC, USA
cation (HW), and a wait list (WL) control group. Yoga and HW
classes consisted of weekly 90-minute classes for 10 weeks. All
women completed daily hot flash diaries throughout the 10 week
trial
Results: Hot flash frequency declined significantly over time for
all three groups with the strongest decline during the first week.
There was no overall significant difference in hot flash frequency
decrease over time by treatment groups, but the yoga and HW
groups followed similar patterns and both showed greater de-
creases than the WL group. By week 10, women reported a
decrease of approximately 66% in hot flash frequency in the
yoga group, 63% in HW, and 36% in the WL group corre-
sponding to a decrease in means of 6.5 hot flashes/day in the
yoga group, 5.9 in the HW group, and 4.2 in the WL.
Conclusion: Results suggest that yoga can serve as a behavioral
option for reducing hot flashes, but yoga may not offer an ad-
vantage over some other types of interventions. Results also
highlight the importance of including attention control groups in
RCTs.
Contact: Nancy Avis, navis@wakehealth.edu
P02.36
Pilot Study Intra-Dialysis Yoga and Educational
Comparison Group for Patients with End-Stage
Renal Disease
Gurjeet Birdee (1), Russell Rothman (1), Amy Wheeler (2),
Dolphi Wertenbaker (4), Chase Bossart (4), Alp Ikizler (1),
Russell Phillips (5)
(1) Vanderbilt University, Nashville, TN, USA
(2) California State University, San Bernandino, CA, USA
(3) L Loyola Marymount University, Los Angeles, CA, USA
(4) Yoga as Therapy North America (YATNA), New York, USA
(5) Harvard Medical School, Boston, MA, USA
Purpose: Patients with end-stage renal disease on maintenance
hemodialysis have high morbidity and mortality due to cardio-
vascular disease and poor physical functioning. Novel behav-
ioral and exercise programs are necessary to improve outcomes
in this chronic disease population.
Methods: We conducted a prospective pilot study to assess the
feasibility and safety of a 12-week intra-dialysis yoga program
among 15 patients with end-stage renal disease. In addition, we
assessed the feasibility of a 12-week intra-dialysis educational
program among 8 patients to inform development of a control
group for future studies. Subjects were randomized by dialysis
shift to receive either intervention. The pilot study was also used

A51
 to train yoga teachers to deliver the intervention and measure of
intervention fidelity utilizing a developed checklist.
Results: A total 23 subjects were recruited over a 12 month
period for participation in the pilot study with 15 subjects re-
ceiving the yoga intervention and 8 subjects receiving the intra-
dialysis educational intervention. 11 of 15 subjects (73%)
completed the 12-week yoga intervention and 6 of 8 subjects
(75%) completed the 12-week educational program. Reasons
patients did not complete the intervention included personal
preference not to continue (n = 2) and changing of dialysis shift
(n = 2). More than 80% of subjects who participated in the yoga
and the educational intervention participated during hemodial-
ysis at least two times a week. There were no serious or non-
serious adverse events related to the interventions during the
12-week period. Four yoga teachers were trained to deliver the
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intervention and demonstrated more than 80% fidelity in deliv-
ering the yoga intervention.
Conclusion: Our pilot study demonstrated feasibility of intra-
dialysis yoga in regards to patient recruitment, high adherence to
the intervention, and no adverse effects related to the yoga in-
tervention. A large randomized clinical trial for patients with
end-stage renal disease to evaluate intra-dialysis yoga versus an
educational intervention is warranted.
Contact: Gurjeet Birdee, gurjeet.birdee@vanderbilt.edu
P02.37
Qigong Versus Exercise Therapy for Chronic Low Back
Pain in Adults - A Randomized Controlled Non-
Inferiority Trial
Susanne Blodt (1), Daniel Pach (1), Theresa Kaster (1), Rainer
Ludke (2), Anett Reishauer (1), Claudia M Witt (1)
(1) Institute for Social Medicine, Epidemiology and Health
Economics, Charite-Universitatsmedizin Berlin, Germany
(2) Karl und Veronica Carstens Foundation, Essen, Germany
Purpose: Physical activity is considered as standard care for
chronic low back pain, whereas the value of qigong in the
treatment of chronic low back pain is unclear. In a randomized
controlled trial we evaluated whether qigong is non-inferior
(5 mm non-inferiority margin on the visual analogue scale,
VAS) to exercise therapy in the treatment of chronic low back
pain.
Methods: German outpatients (aged 46.7 10.4) with chronic
low back pain (average pain intensity VAS 40mm in the last
seven days) were enrolled and randomly allocated in a 1:1 ratio
to receive either qigong (64 patients, 12 sessions with 1 90 min
a week over 3 months) or exercise therapy (63 patients, 12
sessions 1 60 min a week). The primary outcome was a non-
inferiority comparison between qigong and exercise of the av-
erage pain intensity in the last seven days (VAS 0100) after
three months. Secondary outcomes included Roland- Morris
disability, health related quality of life, self-efficacy, sleep
quality, suspected adverse reactions and serious adverse events.
Follow-up was measured after 6 and 12 months. The primary
analysis was by intention to treat using a generalized estimation
equation regression model with baseline values, time point and
patients baseline expectations for treatment success as covari-
ates.
Results: For the primary outcome, the mean change in pain
intensity after three months measured on the VAS between qi-
gong and exercise, no relevant differences were observed (qi-
gong: 34.8 95% CI 29.540.2; exercise 33.1 CI 27.738.4). The
A52
non-inferiority (margin of 5mm) of qigong compared to exercise
could not be proven (group difference - 1.8 mm 95% CI:-9.4 to
5.8, one-sided non-inferiority = 0.204). For the secondary pa-
rameters we didnt find any difference.
Conclusion: Qigong was not proven to be non-inferior to ex-
ercise therapy for the treatment of low back pain.
Contact: Susanne Blodt, susanne.bloedt@charite.de
P02.38
Tibetan Yoga Can Help People with Lung Cancer
and Their Caregivers
Alejandro Chaoul (1), Kathrin Milbury (1), Rosalinda Engle (1),
Zhongxing Liao (1), Chunyi Yang (1), Cindy Carmack (1),
Vickie Shannon (1), Amy Spelman (1), Tenzin Wangyal (2),
Lorenzo Cohen (1)
(1) University of Texas, M.D. Anderson Cancer Center, Hous-
ton, TX, USA
(2) Ligmincha Institute, Shipman, VA, USA
Purpose: Although lung cancer leads to more debilitating
physical and psychological sequelae than other cancer sites,
evidence for effective behavioral interventions targeting quality
of life (QOL) is limited. Moreover, in the context of patient care,
the needs of caregivers are rarely addressed. The purpose of this
study was to establish feasibility and preliminary efficacy of a
mind-body intervention in lung cancer patients and caregivers.
Methods: Patients with stage I-III non-small cell lung cancer
undergoing radiotherapy and their family caregiver participated
in a 15-session Tibetan Yoga (TY) program that included
breathing exercises, guided visualizations, and gentle move-
ments. This single-arm trial assessed pre/post intervention levels
of mental health (CESD; BSI), fatigue (BFI), sleep disturbances
(PSQI), spiritual well-being (FACT-SP) and overall QOL (SF-
36). Feasibility data (e.g., accrual, retention, etc.) were also
collected. Fourteen of the 19 couples approached consented
(74%) and 10 (71%) completed the program (1 became ineli-
gible; 3 withdrew). Patients (mean age: 73 yrs., 62% male, 85%
stage III) and caregivers (mean age: 65 yrs., 73% female, 85%
spouses) completed a mean of 12 TY sessions (range: 615).
Results: Paired t-tests revealed a significant increase in spiritual
well-being (P = .03; d = 1.12) for patients and decrease in fatigue
(P = .03; d = .87) and anxiety (P = .04; d = .91) for caregivers. Al-
though not statistically significant, effect sizes for change scores
were large for sleep disturbances (d = .60 and .72; patients and
caregivers, respectively) and medium for depressive symptoms
(d = .48; patients). Ninety-five percent of the participants (patients
and caregivers) rated the program as useful or very useful.
Conclusion: This first couple-based mind-body program appears
to be a safe, feasible, acceptable and subjectively useful sup-
portive care strategy for patients and their caregivers. Based on
these promising preliminary findings regarding treatment gains,
the next step is to conduct a randomized controlled pilot trial.
Contact: Alejandro Chaoul, machaoul@mdanderson.org
P02.39
Hatha Yoga for Patients with Colorectal Cancer:
A Randomized Controlled Mixed-Methods Study
Holger Cramer (1), Bijay Pokhrel (1), Florian Gass (1), Clem-
ens Eisenmann (2), Romy Lauche (1), Beate Meier (3), Martin
K. Walz (3), Gustav Dobos (1), Jost Langhorst (1)