Stretching, Meditation Reduces Cramp Severity and Improves Sleep Quality

Elliot Tapper, MD

Credit: Precision Health, University of Michigan

A new study demonstrated stretching and meditation both reduced cramp severity and improved sleep quality, with both equally effective.

Muscle cramps, often common among individuals with cirrhosis are linked to poor health-related quality of life. Two in 3 people with cirrhosis face muscle cramps at night that disrupt their sleep. Worse, the interrupted sleep exacerbates other symptoms.

Yet, few treatment options are available for cramps. An earlier study discovered drinking pickle juice could help stop cramps but did not improve overall quality of life.

Investigators conducted a randomized controlled trial to see how stretching and meditation compare in reducing cramp severity and improving sleep quality. The meditation would help participants cope with their cramps, and stretching would prevent cramps from occurring in the first place. Investigators selected meditation as an active placebo following recent research on mindfulness techniques for caregivers of people with cirrhosis which did not work.

“What we ended up finding was that both interventions significantly reduced cramps severity and improved quality of life, which was somewhat unexpected,” said lead author Elliot Tapper, MD, director of the University of Michigan’s Cirrhosis Program, in a press release.

Their primary outcome was the change in cramp severity measured by the visual analog scale for cramps (VAS-camps, scaled 0 – 10). Secondary outcomes included a patient global impression of change (PGIC), change in sleep quality, and global health-related quality of life measured with the EQ-5D and VAS-global health-related quality of life.

The study included 98 participants, enrolled from July 2022 to July 2023 with a history of > 4 cramps in the previous month. Nearly half (48%) had cirrhosis and 40% had diabetes. Participants had a mean of 63 years, and most were women (67%) and college-educated (81%).

The team randomized participants 1:1 to either stretching or meditation for 35 days. Afterward, groups were assigned a 1-week training period where they had to watch an instructional video training for their intervention, followed by 28 days of outcome assessment.

Both arms had a reduction in cramp severity, with a median of 1.44 (0.58 – 2.29) points for stretching and 1.97 (1.01 – 2.93) points for meditation. The change in cramp severity was significant from baseline for both stretching (P = .001) and meditation (P < .0001). The stretching and meditation arms had equivalent changes (P = .4).

Participants had improved PGIC scores, with a score of 1.33 (1.02 – 1.65) for stretching and 1.05 (.70 – 1.41for meditation, with a nonsignificant difference (P = .2).

Both arms also demonstrated improvement in sleep. Although the health-related quality of life did not change according to the Eq5D, the VAS showed the health-related quality of life increased for meditation by 6 (.1 – 11.8) points but not for stretching.

Yet, despite this, more patients said they would recommend stretching (79.2%) over meditation (55.3%) (P = .02). This suggests meditating was more likely to improve overall health-related quality of life, and stretching may have helped more with the cramps.

Investigators hoped the meditation would produce positive effects for patients, so the technique could be used in other studies of generalized chronic pain. However, the findings for meditation in particular had taken the team by surprise.

“I just didn't expect it to have anything to do with cramp severity,” Tapper said. “I thought it could improve quality of life, but not reduce cramps.”

References

1. ^{Tapper EB, Trivedi H, Simonetto DA, et al. The RELAX randomized controlled trial: Stretching versus meditation for nocturnal muscle cramps. Liver Int. Published online June 11, 2024. doi:10.1111/liv.16007}
2. ^{Can Meditation And Stretching Relieve Cramping Caused By Cirrhosis? EurekAlert! August 12, 2024. https://www.eurekalert.org/news-releases/1054349. Accessed August 2024.}