New study finds both practices reduce nocturnal muscle cramps in patients with cirrhosis

A recent one Liver International study investigates the effects of stretching and meditation on nocturnal muscle cramps in patients with cirrhosis.

Study: The RELAX randomized controlled trial: Stretching versus meditation for nocturnal muscle cramps. Image credit: 220 Selfmade studio / Shutterstock.com

Do muscle cramps affect sleep quality?

Muscle cramps cause pain that can affect sleep and mobility, thus negatively affecting the overall quality of life of affected individuals. Regardless of the severity of the disease, two out of three patients with cirrhosis experience muscle cramps. People over the age of 60, especially those on dialysis, are also at increased risk of developing muscle cramps. Therefore, these patients would likely benefit from cramp reduction interventions.

Current treatments for cramps, such as quinidine therapy and albumin infusion, are effective. However, they are associated with negative side effects. For example, quinidine has the potential to cause cardiotoxic effects, while albumin infusions increase the risk of volume overload.

Taurine is another remedy that can effectively relieve muscle cramps. However, it is often expensive and unregulated. Although many clinicians prescribe magnesium, it has been found to be ineffective for muscle cramps. A previous study also reported the effectiveness of a stretching-based intervention in reducing cramp severity by 1.3 points on a 10-point visual analog scale (VAS) and cramp frequency by 1.2 cramps/night.

Despite the availability of these therapeutic agents, there is still an urgent need for safe, effective, and inexpensive interventions to reduce muscle cramping and ultimately improve sleep quality and health-related quality of life (HRQOL), particularly in patients with cirrhosis.

About the study

The current study compares the results of the RELAX randomized controlled trial with the effectiveness of nighttime stretching and meditation for lower body muscle cramps. Adult participants with cirrhosis who experienced muscle cramps at least four times in the previous month were recruited to participate in the study. Patients with a history of stroke with paralysis, cerebral palsy and multiple sclerosis were excluded from the study.

Study participants were randomly assigned to either the overnight stretching group or the intervention group in a 1:1 ratio. All participants underwent a one-week training period for their intervention and were then followed up for 28 days to assess outcome.

The stretching intervention included three sets of calf and hamstring stretching exercises with intervals in seated and standing positions. During the study period, each participant in the stretching intervention group was instructed to exercise every evening. Ten minutes of guided meditation was used as a control.

During the intervention period, study participants were asked how many cramps they experienced, the severity of their cramps, and how often they exercised and meditated over the previous three days. Outcomes related to reductions in cramping, improvements in sleep quality, and overall well-being were also evaluated.

Study findings

Study participants in both the stretching and meditation groups reported a reduction in cramping severity. The median reduction was 1.44 points for stretching and 1.97 points for meditation.

Although individually significant, no significant difference was observed between the two intervention groups. However, patients’ overall perception of change was positive at 1.05 and 1.33 points for meditation and stretching, respectively.

Significant improvements were seen in both groups for sleep quality by 0.37 and 0.35 points for meditation and stretching, respectively. However, these increases were not significantly different between the two groups.

Study participants in the stretching group were more likely to recommend their intervention than those in the meditation group. However, global HRQOL was numerically higher for those who practiced meditation.

No differences were observed in subgroup analyzes based on the presence of cirrhosis, diabetes or neuropathy, or sex. In within-group analyses, stretching was found to be more effective for patients without diabetes, cirrhosis, and neuropathy. Consideration of gender did not influence these results.

No significant differences were observed in the duration of cramping between the two intervention groups Women were found to respond more positively to both treatments, while patients with cirrhosis appeared to benefit more from meditation.

Although rare, some side effects were reported, including two patients who reported discomfort during stretching. First, both subjects stopped stretching for at least one night. Subsequently, only one of these patients continued the stretching exercises, while the other permanently discontinued participation in the trial.

Two additional patients were withdrawn from the study, as one subject had congestive heart failure with compensated heart failure and the other developed severe coronavirus disease 2019 (COVID-19).

conclusions

In the RELAX trial, meditation and stretching were associated with significant and similar reductions in cramp severity and improvement in patients’ assessment of their overall health status. Overall, the study findings support the incorporation of these non-pharmacological interventions for patients with cirrhosis who experience frequent muscle cramps.