August 09, 2022
2 minute read
Munoz GE. Functional and lifestyle interventions for microbiome dysbiosis in immunomodulatory drugs. Presented at the Rheumatology Nurses Society Annual Conference; August 3-6, 2022.
Disclosures: Munoz did not report any relevant financial information.
ORLANDO — Proper management of sleep, exercise and stress are essential for patients with autoimmune diseases, according to a presenter at the 2022 Rheumatology Nurses Society conference.
“On average, an individual needs 7 to 8 hours of uninterrupted sleep,” George E. Munoz, MD, the medical director of American Arthritis and Rheumatology Associates and the chief medical officer of the Oasis Institute, in Miami, told attendees. He added that four REM cycles per night are optimal.
If these sleep levels are not consistently achieved, immune pathways and cytokines can be impaired, according to Munoz.
“If you have an immune-mediated inflammatory disease, pain, inflammation, HAQ scores, and patient-reported outcomes are affected,” he said. “It actually affects the state of the disease.”
Importantly, interleukin-6 and TNF are the pro-inflammatory markers most easily affected by poor sleep, according to Munoz.
He urged participants to perform ongoing fatigue assessments in patients, noting that the cycle of fatigue and lack of sleep can impact pain, and vice versa.
Additionally, Munoz said it is necessary to understand that acute stress is not as big a problem as chronic stress. He used the example of COVID-19.
“We are 30 months away from the pandemic and all the associated stress,” he said. “After 3-6 months, depending on how you measure it, it went from acute stress to chronic stress.”
Anything healthcare workers can do to help patients reduce their stress will be beneficial, according to Munoz.
For example, simple breathing techniques can have a positive impact on patients. He suggested the 4-7-8 technique, which involves inhaling through the nose for four counts, holding it for seven counts, and exhaling for eight counts.
“It has amazing results in terms of reducing stress and anxiety,” Munoz said. “If you have that anxious person, you can teach them that.”
Transcendental meditation, yoga, tai chi, and qigong are other stress-reduction interventions that are “easy, accessible, and affordable,” according to Munoz.
“They’ve all been noted in the scientific and peer-reviewed literature for improving stress and balance,” he said. “They can also improve mortality.”
Just getting out into nature can also improve stress.
“Kiss a tree, water the garden, take a walk,” Munoz said.
Although these steps may seem simple, access to nature is not always guaranteed.
“It’s a problem in up-and-coming cosmopolitan areas,” Munoz said.
As for exercise, most doctors recommend 3-5 days a week for a total of 150 minutes.
“The association with this type of exercise volume is a significant reduction in all-cause mortality,” Munoz said, adding that reductions in cardiovascular events, cancer and mortality were also observed. “There is no pill that does that.”
He added that it is important to codify the exercise recommendation.
“When I say recommend, I mean prescribe,” Munoz said.
He urged RNS participants to write a prescription for walking, cycling or yoga, with the number of days a week and the number of minutes clearly defined. If patients are unable to train to the recommended threshold, Munoz is willing to compromise.
“If a patient tells me they don’t exercise at all, I start with 2 days a week for 10 minutes,” he said. “I work with them.”