A recent 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 may affect sleep and mobility, thereby negatively influencing affected individuals’ overall quality of life. Irrespective of the disease severity, two out of three patients with cirrhosis experience muscle cramps. Individuals above 60 years of age, particularly those receiving dialysis, are also at an increased risk of developing muscle cramps; therefore, these patients would likely benefit from cramp reduction interventions.

Current cramp treatments, such as quinidine treatment and albumin infusion, are effective; however, they are associated with negative side effects. For example, quinidine has the potential to induce cardiotoxic effects, whereas albumin infusions increase the risk of volume overload.

Taurin is another treatment that can effectively alleviate muscle cramps; however, it is often expensive and unregulated. Although many clinicians prescribe magnesium, it has been found to be ineffective for muscle cramps. One previous study also reported the efficacy 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 therapeutics, there remains an urgent need for safe, effective, and inexpensive interventions to reduce muscle cramp and ultimately improve sleep quality and health-related quality of life (HRQOL), particularly among cirrhosis patients.

About the study

The current study compares the results of the randomized and controlled RELAX trial to the effectiveness of night-time stretching and meditation for lower body muscle cramps. Adult participants with cirrhosis who experienced muscle cramps at least four times 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 night-time stretching or mediation group at a 1:1 ratio. All participants underwent a one-week training period for their intervention and were subsequently monitored for 28 days for outcome assessment.

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

During the intervention period, study participants were asked how many cramps they experienced, the severity of their cramps, as well as the frequency of exercise and meditation in the preceding three days. Outcomes related to cramp reduction, improvements in sleep quality, and overall wellness were also assessed.

Study findings

Study participants in both the stretching and meditation groups reported a reduction in cramp 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. Nevertheless, the patients’ overall perception of change was positive at 1.05 and 1.33 points for meditation and stretching, respectively.

Notable improvements were observed 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. Nevertheless, the global HRQOL was numerically higher for those who meditated.

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

No significant differences were observed in cramp duration between both intervention groups Women were found to respond more positively to both therapies, whereas cirrhosis patients appeared to benefit more from meditation.

Although rare, some adverse events were reported, including two patients who reported discomfort while stretching. Initially, both subjects stopped stretching for at least one night. Thereafter, only one of these patients resumed stretching exercises, while the other permanently discontinued their participation in the trial.

Two additional patients withdrew from the study, as one individual had decompensated congestive 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 improving patients’ assessment of their overall health status. Taken together, the study findings support the incorporation of these non-pharmacological interventions for cirrhosis patients experiencing frequent muscle cramps.