{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T12:22:31Z","timestamp":1782735751427,"version":"3.54.5"},"reference-count":17,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T00:00:00Z","timestamp":1718064000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Muscle cramps are common among persons with cirrhosis and are associated with poor health\u2010related quality of life (HRQOL). Treatment options are limited. We compared stretching or meditation in a randomized\u2010controlled trial (RCT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>We enrolled 98 patients with a history of &gt;4 muscle cramps in the prior month from 7\/22\u20137\/23. We randomized patients 1:1 to stretching versus meditation for 35\u2009days. Our primary outcome was the change in cramp severity measured by the visual analogue scale for cramps (VAS\u2010cramps, scaled 0\u201310). Secondary outcomes included a patient global impression of change (PGIC), change in sleep quality and global HRQOL measured using the EQ\u20105D and VAS\u2010global HRQOL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 48% of patients had cirrhosis, 40% had diabetes, 16% the median age was 63, most were women (67%) and 81% were college educated. Both arms experienced a reduction in cramp severity\u2014a median of 1.44 (.58\u20132.29) points for stretching and 1.97 (1.01\u20132.93) points for meditation. These changes were significant changes from baseline (<jats:italic>p<\/jats:italic>\u2009=\u2009.001 for stretching, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001 for meditation) but these changes were equivalent between arms (<jats:italic>p<\/jats:italic>\u2009=\u2009.4). The PGIC was improved: 1.33 (1.02\u20131.65) for stretching, 1.05 (.70\u20131.41) for meditation, <jats:italic>p<\/jats:italic>\u2010difference .2. Sleep was also improved for both. HRQOL did not change according to the Eq5D; according to the VAS, HRQOL rose for meditation by 6 (.1\u201311.8) points but not for stretching. More patients recommended stretching than meditation (79.2% vs. 55.3%, <jats:italic>p<\/jats:italic>\u2009=\u2009.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In a randomized trial, stretching and meditation both reduced cramp severity and improved sleep quality and global impression of change. While patients preferred stretching, there was no difference in effect between arms.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.16007","type":"journal-article","created":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T05:47:54Z","timestamp":1718084874000},"page":"2434-2441","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The <scp>RELAX<\/scp> randomized controlled trial: Stretching versus meditation for nocturnal muscle cramps"],"prefix":"10.1111","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0839-1515","authenticated-orcid":false,"given":"Elliot B.","family":"Tapper","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirsh","family":"Trivedi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Cedars Sinai  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas A.","family":"Simonetto","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vilas","family":"Patwardhan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Beth Israel Deaconess Medical Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Ospina","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beanna","family":"Martinez","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Walker","sequence":"additional","affiliation":[{"name":"Holistic Integrated Massage and Meditation  Poland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Nikirk","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,11]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29756"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep4.1512"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1755-6686.2013.12022.x"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-016-0509-9"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/0168-8278(91)90944-7"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.510230211"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12827"},{"key":"e_1_2_13_9_1","article-title":"Magnesium for skeletal muscle cramps","volume":"9","author":"Garrison SR","year":"2020","journal-title":"Cochrane Database Syst 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