Stretching, Meditation Reduce Muscle Cramps in Patients with Cirrhosis, Diabetes

Elliot Tapper M.D.

Credit: MedTweetorials

Results of the RELAX randomized controlled trial (RCT) revealed both stretching and meditation were able to reduce muscle cramp severity while improving sleep quality and global impression of change among a cohort of patients with cirrhosis or diabetes. Although patients preferred stretching over meditation, there were no observed differences in effect between options.

Muscle cramps—a common symptom that affects 2 in 3 patients with cirrhosis—are often linked to poor HRQoL. Cramps also affect half of people aged >60 years and those receiving dialysis. Unfortunately, available treatment options are limited.

“We wanted to test two different treatments for cramps: One was coping with meditation and the other was physically stretching to prevent the occurrence of the cramp,” explained lead investigator Elliot Tapper M.D., director of the University of Michigan’s Cirrhosis Program.

A total of 98 patients who experienced >4 muscle cramps in the previous month were recruited into the RCT between July 2022 and July 2023. Cramps were defined as “painful muscle spasms, cramps, or charley horses of the lower body that come on while resting.” Patients were randomized 1:1 to receive either stretching or meditation for 35 days (a 1-week training period followed by a 28-day intervention period).

The stretching cohort was required to perform 3 sets of exercises to stretch the calf and hamstring each night using an instructional YouTube video. The control group followed a 10-minute guided calming meditation video designed by a licensed meditation therapist.

Investigators evaluated the change in cramp severity using the visual analogue scale for cramps (VAS-cramps). Other outcomes of interested included the patient global impression of change (PGIC), changes in sleep quality, and global health-related quality of life (HRQoL), as assessed using the VAS-global HRQoL and the EuroQol 5 Dimension (EQ-5D), a self-reported questionnaire that determines HRQoL across domains including pain/discomfort, anxiety/depression, self-care, mobility and usual activities.

Approximately half (48%) of patients had cirrhosis and 40% were diagnosed with diabetes. The median age was 63 years, most (67%) were women, and 81% were college educated.

Both groups reported a reduction in muscle cramp severity, with a median of 1.44 points for stretching and 1.97 points for meditation from baseline, which were deemed significant by investigators and were equivalent between cohorts. Subgroup analyses showed no differences between meditation and stretching regarding sex or the presence of diabetes, neuropathy or cirrhosis. However, within groups, stretching exercises did seem to be more effective among patients without cirrhosis, diabetes or neuropathy.

The patient impression of changes was improved by 1.33 for stretching and 1.05 for meditation, and sleep was improved across intervention arms. Although HRQoL did not change according to the EQ-5D, according to the VAS, HRQoL increased among patients in the meditation cohort by 6 points. No changes in HRQoL were noted in the stretching cohort. Despite this, more patients recommended stretching rather than meditation (79.2% vs 55.3%).

Investigators were unsure why stretching was preferred despite the larger effect size seen in the meditation intervention, but they hypothesized it may be due to potential stigma surrounding meditation or that people would be more comfortable recommending a physical intervention for a physical condition.

The only adverse events were discomfort with stretching, which were reported by two patients. Both were advised to stop the intervention for at least one night and one resumed the trial after a brief hiatus.

“These results really show that that, if practiced, these mind-body methods have the ability to train people to overcome truly distressing physical symptoms,” Tapper concluded.