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The Effect of T'ai Chi Exercise on Immunity and Infections: A Systematic Review of Controlled Trials


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Purpose: The aim of this review is to summarize and assess critically clinical trial evidence of the effect of t'ai chi (TC) exercise on immunity and TC efficacy for treating infectious diseases. Methods: Fourteen databases were searched from their respective inceptions through January 2011. No language restrictions were imposed. Quality and validity of the included clinical trials were evaluated using standard scales. Results: Sixteen (16) studies, including 7 randomized controlled trials, 4 controlled clinical trials, and 5 retrospective case-control studies, met the inclusion criteria for this review. One (1) study examined clinical symptoms, 3 studies tested functional measures of immunity (antigen-induced immunity), and the other studies tested enumerative parameters of immunity. such as lymphocytes, immunoglobulins, complements, natural-killer cells, and myeloid dendritic cells. Overall, these studies suggested favorable effects of TC exercise. Conclusions: TC exercise appears to improve both cell-mediated immunity and antibody response in immune system, but it remains debatable whether or not the changes in immune parameters are sufficient to provide protection from infections.
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Review Article
The Effect of T’ai Chi Exercise on Immunity and Infections:
A Systematic Review of Controlled Trials
Rainbow T.H. Ho, PhD,
Chong-Wen Wang, MD, PhD,
Siu-Man Ng, PhD,
Andy H.Y. Ho, MSocSc,
Eric T.C. Ziea, MD, PhD,
Vivian Taam Wong, MD, FRCP,
and Cecilia L.W. Chan, PhD,
Purpose:The aim of this review is to summarize and assess critically clinical trial evidence of the effect of t’ai chi
(TC) exercise on immunity and TC efficacy for treating infectious diseases.
Methods:Fourteen databases were searched from their respective inceptions through January 2011. No language
restrictions were imposed. Quality and validity of the included clinical trials were evaluated using standard
Results:Sixteen (16) studies, including 7 randomized controlled trials, 4 controlled clinical trials, and 5 retro-
spective case-control studies, met the inclusion criteria for this review. One (1) study examined clinical symp-
toms, 3 studies tested functional measures of immunity (antigen-induced immunity), and the other studies tested
enumerative parameters of immunity. such as lymphocytes, immunoglobulins, complements, natural-killer cells,
and myeloid dendritic cells. Overall, these studies suggested favorable effects of TC exercise.
Conclusions:TC exercise appears to improve both cell-mediated immunity and antibody response in immune
system, but it remains debatable whether or not the changes in immune parameters are sufficient to provide
protection from infections.
Tai Chi (TC), a complementary and alternative
modality of Traditional Chinese Medicine, combines
characteristics of physical exercise and meditative practice.
TC is popularly practiced by a large number of people in
Chinese communities to improve physical fitness and overall
well-being. The gentle movements and postures of the exer-
cise coordinated with breathing patterns and meditation are
designed to achieve a harmonious flow of energy (qi) in the
body. TC exercise is equivalent to moderate-intensity aerobic
exercise. However, TC is not only an exercise but also a mind–
body intervention. Its beneficial effects on health have been
documented in increasing number of studies.
It is hy-
pothesized that TC as a modality of mind–body intervention
with a moderate intensity of physical exercise may improve
immune functions of human body.
However, few reviews
have examined the scientific evidence of the effect of TC on
immunity. It is well-known that infections, such as influenza
and herpes zoster, are associated with human body’s immu-
nity, and that individuals who have substantial declines in
immune function are at increased risk for contracting a
number of infectious diseases. Epidemiologic studies have
suggested that moderate exercise training is associated with
reduction in the incidence of upper respiratory–tract infection
(URTI), whereas endurance athletes are at increased risk for
URTIs during periods of heavy training.
It is still unclear
whether or not TC exercise may reduce the incidence or the
severity of infectious diseases. Thus, this systematic review
aims to summarize and evaluate critically clinical trial evi-
dence of the effectiveness of TC exercise for improving im-
mune functions and its efficacy for treating infectious
Data sources
The following electronic databases were searched from
their respective inceptions through January 2011: PubMed/
and Energy Medicine Database; SPORTDiscus Database;
China Journals Full-text Database-Medicine/Hygiene Series,
China Proceedings of Conference Full-text Database, Chinese
Master Theses Full-text Database, China Doctor Dissertations
Centre on Behavioral Health,
Department of Social Work and Social Administration, and
Family Institute, The University of Hong
Kong, Hong Kong SAR, China.
Chinese Medicine Department, Hospital Authority of Hong Kong, Hong Kong SAR, China.
Volume 19, Number 2, 2013, pp. 1–8
ªMary Ann Liebert, Inc.
DOI: 10.1089/acm.2011.0593
Full-text Database, Electronic Theses and Dissertation Sys-
tem (Taiwan), Taiwan Electronic Periodical Services, and
Index to Taiwan Periodical Literature System. The search
terms used for this review included: tai chi, taichi, tai ji, taiji,
taijichuan, shadowboxing, influenza, infection, infectious,
inflammation, inflammatory, immune, immunity, immuno-
logical, lymphocyte, and antibody. Both traditional and
simplified Chinese translations of these terms were used in
Chinese databases. Reference lists of all included studies,
existing reviews, and other archives of the located publica-
tions were hand-searched for further relevant articles.
Study selection
All controlled clinical trials (CCTs) were included if they
examined the effects of TC exercise on the parameters of im-
munity or for treatment of various infectious diseases. Given
the limited number of prospective clinical trials in the field,
retrospective case-control studies (RCSs) were also included to
provide alternative evidence, but uncontrolled observational
studies were excluded, because of their susceptibility to bias
and lack of significant evidence. Case reports and qualitative
studies were also excluded for lack of significant evidence. To
assess the effect of TC on immunity, studies on any subject
were included, but studies among athletes were excluded
because of their high intensity of physical exercise. To evalu-
ate the effect of TC on infections, any study about TC con-
cerning the incidence or severity of infectious diseases were
included. For all included studies, primary data from the
original sources were reviewed and analyzed.
To assess the effects of TC exercise on improvement of
immunity and TC’s effectiveness for treating infectious dis-
eases, such outcome measures as physical symptoms rele-
vant to infections and biomedical indicators of immunity
were considered. Generally, an individual’s immune status
can be assessed using either enumerative or functional
Functional measures assess how well a specific
immune process works (e.g., how effectively natural-killer
[NK] cells destroy laboratory-grown tumor cells or how
much lymphocytes divide following stimulation with a mi-
togen [a substance that induces mitosis or cell division]). In
clinical practice, one of the most valid and commonly used
functional measures of immunity is used to assess people’s
immune responses to antigens that people are highly sensi-
tive to. This technique involves placing a small piece of an-
tigen directly underneath the skin, a procedure that causes a
local inflammatory response consisting of induration (a
swollen round bump) and erythema (redness around the
bump), and measuring the magnitude of this response im-
mediately or 24–48 hours later, depending on the antigen
that is used. Enumerative measures involve counting dif-
ferent immune-system components (or biomarkers), includ-
ing white blood–cell populations (granulocytes, monocytes,
lymphocytes, NK cells, B-lymphocytes, T-lymphocytes,
helper T-lymphocytes, and suppressor/cytotoxic T-lympho-
cytes), antibody populations in the blood (immunoglobulin
[Ig]A, IgG, and IgM) and in saliva (secretory IgA), and an-
tibodies to specific pathogens. The current review focused on
the number and the percentage of white blood cells, mainly
T-lymphocytes, and levels of serum Igs and complements in
peripheral blood, because these biomarkers are commonly
used parameters in clinical practice and in the field of exer-
cise research. Psychosocial outcomes, such as quality of life
and psychologic well-being, were not considered because it
is difficult to attribute effects on such outcomes to the change
of immunity.
Data extraction and assessment
For each included study, data were extracted by 1 main
researcher and then verified by another researcher. All dis-
crepancies were resolved by discussion. The strength of the
evidence was evaluated for all the included studies using the
Oxford Centre for Evidence-based Medicine Levels of Evi-
These criteria are applied to grade the methodolog-
ical rigor of studies from level 1 or grade A (systematic
review of RCTs, 1a; individual RCT with narrow confidence
interval, 1b) to level 5 or grade D (expert opinion). The
quality and validity of the included RCTs were also evalu-
ated using the Jadad scale,
which is based on three criteria:
(1) description of randomization and allocation concealment;
(2) double-blinding; and (3) withdrawals or dropouts (the
score ranges from 0 to 5). This is a standard scale used in
systematic reviews of RCTs. Given that it was difficult to
blind patients to TC, only assessor blinding was evaluated.
The risk of bias in the included trials was assessed using the
framework for methodological quality recommended by Juni
et al.
According to this framework, biases fall into four
categories: (1) selection bias (biased allocation to comparison
groups); (2) performance bias (unequal provision of care
apart from intervention under evaluation); (3) detection bias
(biased assessment of outcomes); and (4) and attrition bias
(biased occurrence of loss to follow-up).
Study description
The database searches identified 87 potentially relevant
articles (Fig. 1). Of them, 51 articles were excluded because
they were not clinical trials or not related to infection or
immunity. Full reports of 36 studies were acquired, and 20
were also excluded because they were uncontrolled observa-
tional studies (10), studies with unparallel controls (2), du-
plicate publications (3), studies using athletes (2), and studies
with other outcome measures (3). Sixteen studies published
between 1988 and 2010, including 7 RCTs,
and 5 RCSS,
met this review’s inclusion criteria. These
studies were conducted in the United States,
and mainland China.
11,12,15,1 7,18,20,21,23 –26
Seven (7)
were published in English, 8 stud-
11,12,15,17,18, 21,23,26
were published in Chinese, and the re-
maining 1 study
was a proceeding.
Of the 16 included studies, 4 used samples of young col-
lege students;
1 study used a sample of persons with
HIV infection,
and the other studies used samples of
middle-age or older healthy adults. Four (4) studies
focused solely on females and 2 studies
focused solely on
males. Sample sizes in the included studies ranged from 16
to 252. A sample shared by 2 studies
was considered to
be one sample. In total, these studies covered 939 subjects,
including 577 subjects in the TC exercise groups and 362
subjects in the control groups. Characteristics of the included
RCTs and non-RCTs (CCTs and RCSs) are presented in Ta-
bles 1 and 2, respectively.
Durations of TC intervention ranged from 5 weeks to 6
months for the 11 prospective studies (7 RCTs and 4 CCTs).
The five RCSs
reported durations of TC practice span-
ning 12 months to 12 years. The majority of the included
studies were conducted with a two-armed parallel-group
design except for 2 studies
with a 3-armed parallel
group-design and 3 studies
with a 4-armed parallel
group design. One (1) study
compared TC with qigong, and
another study
used group health education as a control
while the other studies used a wait-list group or a group
with routine activites as a control.
According to outcome measures, these studies could be
divided into 3 categories: (1) 1 study
on clinical symptoms
relevant to infections; (2) 3 studies
on functional mea-
sures of immunity (antigen-induced immunity); and (3) other
studies on enumerative parameters of immunity. The most-
often used outcome measure in the included studies was T-
followed by Igs (IgA, IgE, IgG, and
complements (C3, C4),
myeloid dendritic cells.
Effects of TC intervention
on clinical symptoms suggested a favorable
effect of TC exercise. Three (3) studies, including 2 RCTs
and 1 CCT,
examined the effects of TC on antigen-induced,
virus-specific cell-mediated immunity and antibody re-
sponse in the human immune system. The results of these
studies indicated that TC exercise could augment immune
responses to virus and influenza vaccines.
Six (6) studies, including 2 RCTs,
1 CCT,
and 3
examined number and/or percentage of T-
lymphocytes. One (1) RCT
on older adults suggested that
the number of CD4
and the ratio of CD4
significantly after 8 weeks of TC practice. Another RCT
persons with HIV suggested that lymphocyte proliferation
function was augmented significantly at the 6-month follow-
up visit after 10 weeks of TC exercise. One (1) CCT
and 3
suggested that the number of lymphocytes,
mainly CD4
, and the ratio of CD4
were signifi-
cantly higher in TC groups, compared to control groups. One
(1) RCS
examined the number and percentage of B-lym-
phocytes and suggested that the number of ZC-rosette-
forming cells (B-lymphocytes) was lower in a TC group at
resting status but increased significantly after 20 minutes of
exercise, compared to controls.
One (1) RCT
indicated that number of NK cells increased
significantly after 6 months of TC practice, but 1 RCS
suggested that the percentage of NK cells decreased signifi-
cantly in a TC group after 25 minutes of exercise. One RCS
examined the effect of TC on circulating myeloid dendritic
cells (the potent antigen-presenting cells linking innate and
adoptive immunity) and indicated a favorable effect of TC
Five (5) studies, including 2 RCTs and 3 CCTs, examined
the concentration of Igs in peripheral blood. One (1) RCT
and 3 CCTs
suggested favorable effects of TC exercise
on IgG and IgA, while another RCT
only suggested a fa-
vorable effect on IgG. One (1) RCT
examined concentra-
tions of complements (C3, C4), and the results indicated that
concentrations of C3 and C4 increased significantly after 12
weeks of TC exercise. One (1) CCT
also suggested a fa-
vorable effect of TC exercise on C3.
Study quality
Jadad scores for the included RCTs ranged from 1 to 4,
with a value of 3 or above only for 2 studies. Levels of evi-
dence for the included studies were ranked as ‘‘A’’ for 3
studies, ‘‘B’’ for 12 studies, and ‘‘C’’ for 1 study.
This review aimed to assess the efficacy and the effec-
tiveness of TC exercise for treating infectious diseases. Fol-
lowing a comprehensive search of existing literature, it was
found that clinical trials of TC in patients with infectious
diseases were very limited. Only one study
clinical symptoms relevant to infections among female stu-
dents. The results indicated that the durations of URTIs
shortened significantly after 6 months of TC exercise. In-
stead, many studies in the field examined the effectiveness of
TC exercise on improvement of human immune function.
Overall, this review demonstrated that the available evi-
dence suggested favorable effects of TC exercise both for
increasing effective components of the immune system and
for improving immune function, as indicated by functional
measures of immunity.
The risk of bias for the studies examined in this review
was assessed, based on the descriptions of randomization,
allocation concealment, blinding, and withdrawals.
A high
risk of bias might have existed in some of the included trials,
which might have led to false–positive results. Of the 7 in-
cluded RCTs, only 3
described method of randomiza-
tion and allocation concealment; 2 RCTs
assessor blinding, and 4 RCTs
reported details about
dropouts and withdrawals and adopted intention-to-treat
FIG. 1. Selection process for included studies. RCTs, ran-
domized controlled trials; CCTs, clinical controlled trials;
RCSs, retrospective case-control studies.
Table 1. Summary of RCTsofT’ai Chi Exercise on Functional Measures and Enumerative Measures of Immunity
& references
(ages) n
(styles) & frequency Control Duration
measures Results
et al.,
from a
TG 1: 10
TG 2: 10
TG 3: 10
CG: 10
TC exercise (style: NR):
TG 1: 1 time per week
TG 2: 2 time per week
TG 3: 3 time per week
(45 minutes each time)
Wait-list 12 weeks Complement
3, 4 (C3, C4);
activities of
Concentration of serum C3 & C4 as well as
overall supplement activity increased
significantly in TG 3 at 10th & 12th week,
compared to CG & TG1 ( p<0. 05).
1 B (3b)
et al.,
from a
TG 1: 10
TG 2: 10
TG 3: 10
CG: 10
TC exercise (style: NR):
TG 1: 1 times per week
TG 2: 2 times per week
TG 3: 3 times per week
(45 minutes each time)
Wait-list 12 weeks Serum IgG, IgM,
IgA, IgE
Only IgG increased significantly among
participants in TG 3 at post-intervention ( p
value: NR).
1 B (3b)
et al.,
TG: 59
CG: 53
TCC (a Westernized
Standardized version
of TC)
(40 minutes, 3 times
per week); varicella
vaccine at 16th week
& evaluated 9 weeks
& group
25 weeks Levels of VZV-CMI,
indicated by
frequency of
peripheral blood
mononuclear cells
& memory T-cells)
Compared to CG, level of VZV-CMI
increased significantly in TC group at
postintervention ( p<0.05)
4 A (1b)
et al.,
adults( 60)
TG: 18
CG: 18
TCC exercise
(45 minutes, 3 times
per week)
Wait-list 15 weeks Levels of VZV-CMI. VZV-specific CMI increased 50% from
baseline to 1-week postintervention in TCC
group ( p<0.05) but unchanged in CG
3 A (1b)
Liu, 2006
Older adults
TG: 10
CG: 10
24-style t’ai chi chuan
(1 hour, 4 times
per week)
8 weeks 1. T-lymphocytes
2. Serum IgG,
IgM, & IgA
1. Significant increase in expression of CD4 +
(p<0.05) & CD4 +/CD8 +ratio ( p<0.01) &
decrease in expression of CD8 +(p<0.05)
in TG at postintervention; no significant
change in T-lymphocytes in CG
2. Concentrations of IgG & IgA increased
significantly ( p<0.05) in TG at
postintervention; no significant change for
these variables in CG
2 B (3b)
et al.,
Persons with
TG 1: 62
TG 2: 65
TG 3: 68
CG: 57
TG 1: Focused TC
(style: NR)
TG 2: Cognitive–
relaxation exercise
TG 3: Spiritual
Wait-list 10 weeks T-lymphocytes,
NKC cytotoxicity,
Compared to CG, all treatment groups had
augmented lymphocyte proliferative
function or increased cellular proliferation
capacity at 6-month follow-up visit
4 A (2b)
TG: 10
CG: 6
Group TC exercise
(style: NR
(1 hour/day)
6 months IL-2
Number of NK cells & concentration of IL-2
increased significantly in TG at
postintervention, compared to CG ( p
values: NR)
1 B (3b)
RCTs, randomized controlled trials; NR, not reported; TC, t’ai chi; TG, t’ai chi group; CG, control group; Ig, immunoglobulin; TCC, T’ai Chi Chih; VZV, varicella zoster virus; CMI, cell-mediated
immunity; HIV, human immunodeficiency virus; NKC, natural-killer cells, NK, natural killer; IL, interleukin.
Table 2. Summary of CCTs and RCSsofT’ai Chi Exercise on Functional and Enumerative Measures of Immunity &Clinical Symptoms
author, year
& reference Subjects (ages) n
(frequency) Controls Duration
measures Results
et al.,
Female students
in a college
TG 1: 30
TG 2: 30
CG: 30
24-style t’ai chi chuan
TG 1: 3 times per week
TG 2: 5 times per week
(1 hour each time)
6 months Symptoms;
serum IgA,
IgM, IgG
1. Duration of URTI became shorter significantly at
postintervention in participants in TG 1 & TG 2,
compared to CG ( p<0.05)
2. Levels of IgA and IgG increased significantly at
postintervention, compared to CG ( p<0.05)
B (2b)
et al.,
Older adults
(TG: 79.5 1.9)
(CG: 74.5 1.6)
TG: 27
CG: 23
Equal parts of TC & qigong
(1 hour, 3 classes
per week), influenza
vaccine during
1st week of
20 weeks Anti-influenza
1. Significant increase ( p<0.05) in magnitude & duration
of antibody response to influenza vaccine in
TG, compared to CG
2. Significant between-group difference at 3 & 20 weeks
after vaccine, & at 20 weeks TG had
significantly higher titers, compared to the prevaccine
timepoint ( p<0.05), whereas CG did not
B (2b)
College students TC: 40
CG: 30
T’ai chi exercise
1 month Serum IgA,
IgG, IgM,
C3 & saliva
Compared with baseline measures, all measures in
TC group increased significantly; in qigong group,
only levels of serum complement C3 & saliva
lysozyme increased significantly
Older adults
TG: 12
CG: 12
T’ai chi exercise
(style: NR)
1 hour, 3 times
per week
Wait-list 5 weeks T-lymphocytes;
serum IgG,
IgM, IgA
1. Number of CD4 +and the ratio of CD4 +/CD8 +
increased significantly ( p<0.05; 0.01) & number of CD8 +
decreased significantly ( p<0.05) in TG, whereas number
of CD8 +decreased significantly in CG2.
2. Levels of IgG & IgA increased significantly in TG
(p<0.05); no significant change observed in CG
B (3b)
et al.
Healthy male adults,
(TG 1: 54.2 8.4
TG 2: 53.8 7.9
CG: 53.1 7.1)
TG 1: 21
TG 2: 22
CG: 20
Yang style t’ai chi
TG 1: Practice
for >5 years
TG 2: Practice
for 2–5 years
Retrospective Myeloid
cells in
1. Compared to CG,
2. Number of myeloid dendritic cells was significantly
greater in TGs ( p<0.05), whereas the quantity of myeloid
plasmacytoid dendritic cells was similar ( p>0.05).
2. Number of myeloid dendritic cells in TG 1 was
significantly more than in TG 2 ( p<0.05)
B (3b)
Liu and
Older male adults
TG: 25
CG: 10
TC exercise
(style: NR)
for 6–12 years
Retrospective T-lymphocytes,
NK cells
Compared to CG, percentage of CD3 +& CD4 +cells
& ratio of CD4 +/CD8 +increased significantly
(p<0.05), whereas percentage of CD16 +(NKC)
decreased significantly in TC group after 25 minutes
exercise ( p<0.05)
B (3b)
et al.,
Healthy aging
TG: 24
CG: 24
88-style t’ai chi chuan,
Practice for
average of 7 years
Retrospective Number
& percentage
Number & percentage of ZC-RFL in peripheral blood
increased significantly in TG after 20 minutes of exercise,
compared to CG ( p<0.01)
B (3b)
et al.,
Healthy aging
TG: 30
CG: 30
88-style t’ai chi chuan
Practice for
2–10 years
Retrospective Total & active
Total number of T-lymphocytes & number of active
T-lymphocytes increased significantly in TG,
compared to CG controls ( p<0.01)
B (3b)
& Sun,
& older healthy
TG: 24
CG: 24
88-style t’ai chi chuan
Practice for
average of 7 years
Retrospective WBC; LC, LC%;
1. The numbers and the percentages of LC and
E-RFC were higher in TG at resting status, compared
to CG ( p<0.01)
2. After 20 minutes of exercise, number & percentage
of E-RFC & Y-RFC increased significantly in TG,
compared to CG ( p<0.01)
B (3b)
CCTs, controlled clinical trials; RCSs, retrospective case-control studies; TG, t’ai chi group; CG, control group; URTI, upper–respiratory tract infection; Ig, immunoglobulin; TC, t’ai chi; NR, not
reported; ZC-RFL, ZC-rosette-forming lymphocytes; E-RFL, E-rosette-forming lymphocytes; WBC, white blood cells; LC, lymphocytes; E-RFC, E-rosette-forming cells; Y-RFC, Y-rosette-forming cells;
NK, natural killer; NKC, natural-killer cell.
(ITT) analyses. The other RCTs did not have descriptions of
their methods of sequence generation or allocation conceal-
ment and the details on dropouts, and were rated as ‘‘un-
clear’’ for these domains, thus, introducing the potential risk
of bias. Details on dropouts and withdrawals were also de-
scribed in 1 CCT,
but the ITT analysis was not adopted in
any CCT, which might have led to the exclusion of some
particular patients and might have introduced attrition bia-
ses. The 4 included CCTs and 5 RCSs were subject to a high
risk of selection bias caused by nonrandomized allocation.
Moreover, the 5 included RCSs
did not adjust the values
of baseline measures; thus, the reliability of the evidence
presented in these studies was clearly limited. One (1)
was presented at a conference on medical qigong and
had not undergone the process of peer-review, thus, intro-
ducing potential for a number of biases. In the majority of the
included prospective trials, group TC exercise training was
provided preferentially to the intervention groups, whereas
the control groups did not have a matched number of social
contact hours with coparticipants. Thus, these studies might
have been subject to potential risk of performance bias.
Furthermore, the majority of the included studies had small
samples ( <50 subjects) and the results were prone to a type
II error. Therefore, further vigorously designed, large-scale,
placebo-controlled, randomized studies are needed.
Despite methodological flaws, nearly all of the included
studies demonstrated a beneficial effect of TC exercise on one
or more parameters of immunity. Apart from the included
studies, one CCT
of TC exercise on mediators (interleukins,
transforming growth factor, and transcription factors) of the
Th1/Th2/T regulatory reaction also suggested a beneficial
effect of TC on improvement of T-cell helper function. All of
the uncontrolled observational studies
also reported fa-
vorable effects of TC exercise on different parameters of
immunity, but such data were highly susceptible to bias and,
hence, provided little scientific evidence of the specific effects
of TC exercise for improving immune function.
It has been suggested that the mechanisms underlying
exercise-associated immune changes are multifactorial and
include many neuroendocrine factors.
TC as a form of
moderate-intensity exercise may promote release of neu-
roendocrinologic factors, such as catecholamines (adrenaline,
noradrenaline), growth hormone, and cortisol, through the
sympathetic–adrenal medullary (SAM) axis.
These fac-
tors induce changes in cellular trafficking, lymphocyte pro-
liferation, and antibody production.
As a consequence of
muscular contraction and catecholamine-induced immediate
changes, for instance, cellular components of the immune
system may be mobilized to the blood.
Moreover, TC ex-
ercise may lead to an increased oxygen supply and alter-
ations in metabolism and metabolic factors, such as plasma
glutamine and plasma glucose, which also contribute to ex-
ercise-associated changes in immune function.
An addi-
tional possibility is that immune enhancement is mediated,
in part, by improvements of psychosocial factors that are
promoted by TC as a mind–body intervention.
It has been
suggested that psychologic stress can affect immunity
through the hypothalamic–pituitary–adrenal (HPA) axis.
Stress-induced activation of the HPA axis results in the re-
lease of neuroendocrine hormones, such as adrenocortico-
tropin, from the anterior pituitary gland. Adrenocotropin
then circulates through the bloodstream to the adrenal
glands, where the hormone induces release of glucocorti-
coids, which can bind receptors at the cell surfaces of lym-
phoid and myeloid cells.
TC as a form of mind–body
intervention may buffer the effects of stress on plasma glu-
cocorticoids and, thus, induce alterations in immune func-
It should be noted that the immune system is a complex
system, and both functional and enumerative measures of
immunity provide rough estimates of specific processes ra-
ther than global indications of the immune system’s capacity
to resist infectious disease.
First, the normal functioning
range is very broad for most immune measures, and it is still
unclear whether or not the magnitude of changes induced by
exercise are sufficient to move outside of the normal ranges.
Even if these changes were sufficient, it is not clear whether
or not the alterations would persist for a sufficient duration
of time to alter risk for infectious disease.
Second, most of
the included studies were conducted using healthy adults,
and the clinical implications of the changes in these param-
eters in healthy people are unclear. Changes in cell number
may just reflect changes in the dynamics of lymphocyte
migration and recirculation, or shifts in plasma volume, ra-
ther than absolute changes in total cell numbers.
In addi-
tion, absolute changes in cell number will not necessarily
result in a significant change in the capacity of the immune
system to make an effective response to antigenic chal-
Thus, it would be inappropriate to conclude that TC-
induced changes in any specific immune parameter signal a
state of ‘‘immune enhancement’’ or resistance to infections.
This review may have had some limitations. Similar to any
systematic review, one major limitation was the potential
incompleteness of the evidence reviewed. The aim was to
identify all controlled trials in this area in a large number of
databases with no restrictions on publication language. The
current authors are confident that the search strategy used
for this review had located all relevant data; however, a
degree of uncertainty remains. Moreover, selective publish-
ing and reporting can be major causes of bias in the included
studies. In addition, it was not possible to perform meta-
analyses because of the heterogeneity of study designs and
outcome measures in the included studies.
The available evidence suggest that TC exercise may im-
prove both cell-mediated immunity and antibody response
in immune system, but it remains debatable whether or not
the exercise-induced alterations in immune function are
sufficient to alter human body defense, disease susceptibility,
and severity.
Because of methodological flaws in existing
studies, further vigorously designed large-scale placebo-
controlled, randomized trials are needed. Future studies
should also test the efficacy of TC exercise for reducing the
incidence or the severity of infectious disease.
This review was supported by the Hospital Authority of
Hong Kong (HA105/48 PT5).
Disclosure Statement
No competing financial interests exist.
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Address correspondence to:
Chong-Wen Wang, MD, PhD
Center on Behavioral Health
The University of Hong Kong
5 Sassoon Road
Pokfulam, Hong Kong, SAR
... Tai Chi exercise is a traditional Chinese physical exercise characterized by meditation and low-to-moderate intensity activity, and it is practiced worldwide by older adults. In addition to improving muscle strength (Manson et al., 2013b;Wehner et al., 2021), balance (Wehner et al., 2021), body mass index (Manson et al., 2013a,b), and systolic blood pressure (SBP) (Manson et al., 2013a), research has also found Tai Chi exercise to have favorable effects on immunity (Yeh et al., 2006;Ho et al., 2013)as well as physical and mental health in older adults (Holly and Helen, 2012;Zheng et al., 2017). Square dance is considered an expansion of line dancing and was introduced in 2004, to China (Li, 2011). ...
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Objective: To compare the effects of Tai Chi and Square dance on immune function, physical health, and life satisfaction in urban, empty-nest older adults. Methods: This cross-sectional study included 249 older adults (60–69 years) who were categorized into Tai Chi ( n = 81), Square dance ( n = 90), and control groups ( n = 78). We evaluated immunoglobulin G (IgG) and interleukin-2 (IL-2) levels by enzyme-linked immunosorbent assay (ELISA), natural killer (NK) cell cytotoxicity by MTT assay, physical health indices by physical fitness levels, and life satisfaction by Life Satisfaction Index A (LSIA) scores. Results: Immune function, physical health, and life satisfaction in older adults in the Tai Chi and Square dance groups were significantly better than those in the control group ( P < 0.05). Regarding immune function and physical health, the Tai Chi group exhibited significantly higher levels of IgG (15.41 ± 0.26 g/L vs. 11.99 ± 0.35 g/L, P < 0.05), IL-2 (4.60 ± 0.20 ng/mL vs. 4.45 ± 0.21 ng/mL, P < 0.05), and NK cell cytotoxicity (0.28 ± 0.02 vs. 0.22 ± 0.02, P < 0.05) than the square dance group, significantly lower waist-to-hip ratio (0.87 ± 0.02 vs. 0.89 ± 0.02, P < 0.05), resting pulse (78.4 ± 4.6 beats/min vs. 81.0 ± 3.1 beats/min, P < 0.05), systolic blood pressure (132.0 ± 5.2 mmHg vs. 136.2 ± 3.2 mmHg, P < 0.05), diastolic blood pressure (80.0 ± 2.6 mmHg vs. 83.0 ± 2.7 mmHg, P < 0.05), and significantly higher vital capacity (2978.0 ± 263.0 mL vs. 2628.3 ± 262.8 mL, P < 0.05) and duration of one-leg standing with eyes closed (16.2 ± 1.9 s vs. 12.0 ± 1.7 s). However, there was no significant difference in LSIA scores between the Tai Chi and Square dance groups (12.05 ± 1.96 vs. 13.07 ± 1.51, P > 0.05). Further, there was a significant correlation between LSIA scores and immune function ( r = 0.50, P = 0.00) and physical health ( r = 0.64, P = 0.00). Conclusion: (1) Both Tai Chi and square dance practitioners had better health outcomes, compared with sedentary individuals; (2) Tai Chi practitioners had better physical health and immune function than Square dance practitioners. (3) Tai Chi and Square dance exercises had similar effects on life satisfaction among urban empty-nest older adults. Suggestions: For urban empty-nest older adults who want to have better physical health and immune function, long-term Tai Chi exercise may be a better choice; however, those who are concerned about life satisfaction can choose either Tai Chi or Square dance exercise.
... [41][42][43][44] Massage therapy and tai chi have been associated with improved immune function, enhanced vaccination response, and increased circulating myeloid dendritic cells. [45][46][47][48][49] Compelling evidence in the emerging field of affective immunology suggests a multitude of pathways linking emotion and immune function. 50 Excessive cognitive load can increase our propensity to form negative thoughts. ...
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In light of the coronavirus disease 2019 pandemic, we explore the role of stress, fear, and the impact of positive and negative emotions on health and disease. We then introduce strategies to help mitigate stress within the health care team, and provide a rationale for their efficacy. Additionally, we identify strategies to optimize patient care and explain their heightened importance in today's environment.
... The current study is the first to investigate inflammatory markers such as ESR and CRP after Tai Chi exercises in AS. The literature states that Tai Chi improves both cell-mediated immunity and antibody response in the immune system, but it is necessary to discuss whether changes in immune parameters are sufficient to prevent infection [36]. In this study, inflammatory markers decreased after Tai Chi. ...
Introduction Ankylosing Spondylitis (AS) is a chronic inflammatory rheumatic disease characterized by pain, functional deformities, negatively affecting quality of life. A previous study showed that Tai Chi had a positive effect on disease activity and flexibility of patients with AS. The aim of this study was to investigate the effect of Tai Chi exercises on disease activity, functionality, spinal mobility, quality of life and inflammatory markers in patients with AS. Methods This randomised controlled trial allocated 36 patients with AS to either a Tai Chi or a home exercise group using the block randomization. Both groups received a 1-h exercise program twice a week for 10 weeks and encouraged to practice at home. Outcome measures included: The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functionality Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Ankylosing Spondylitis Quality of Life (ASQoL) scales and Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP). Results After training, there was a statistically significant difference within groups for the Tai Chi and the home exercise groups for all parameters (p:0.00). When the delta values were compared between the groups, BASDAI (p:0.00), cervical rotation (p:0.02), and ASQoL (p:0.00) were found to be significantly in favor of the Tai Chi group. No side-effects were noted during or after the exercise programs. Conclusion Tai Chi should be considered for inclusion in rehabilitation programs as a safe alternative type of exercise to reduce disease activity, improve spinal mobility and quality of life in patients with AS. Trial registration Clinical trial number NCT03807180.
... Tai Chi is a form of traditional Chinese low-to-moderateintensity mind-body exercise with a long practicing history for body and mind fitness in the East. [3] Many studies have shown that Taichi is effective in treating chronic conditions, like immunity and infection, [4] cardiovascular conditions [5] and chronic musculoskeletal pain conditions. [6] This review aims to systematically evaluate the effectiveness and safety of Tai Chi for COVID-19 in recovery period by including multiple clinical trials published over the past 10 years. ...
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Background: Assessing the effectiveness and safety of Tai Chi for coronavirus disease 2019 (COVID-19) in recovery period is the main purpose of this systematic review protocol. Methods: The following electronic databases will be searched from inception to April 2020: MEDLINE, Ovid, EMBASE, the Cochrane Library, the Allied and Complementary Medicine Database, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP Database and Wanfang Database. In addition, Clinical trial registries, like the Chinese Clinical Trial Registry, the Netherlands National Trial Register and, will be searched for ongoing trials with unpublished data. No language restrictions will be applied. The primary outcome will be the time of disappearance of main symptoms (including fever, asthenia, cough disappearance rate, and temperature recovery time), and serum cytokine levels. The secondary outcome will be the accompanying symptoms (such as myalgia, expectoration, stuffiness, runny nose, pharyngalgia, anhelation, chest distress, dyspnea, crackles, headache, nausea, vomiting, anorexia, diarrhea) disappear rate, negative COVID-19 results rate on 2 consecutive occasions (not on the same day), CT image improvement, average hospitalization time, occurrence rate of common type to severe form, clinical cure rate, and mortality. Two independent reviewers will conduct the study selection, data extraction and assessment. Review manager software V.5.3 will be used for the assessment of risk of bias and data synthesis. Results: The results will provide a high-quality synthesis of current evidence for researchers in this subject area. Conclusion: The conclusion of the study will provide an evidence to judge whether Tai Chi is effective and safe for COVID-19 in recovery period. Ethics and dissemination: This protocol will not evaluate individual patient information or infringe patient rights and therefore does not require ethical approval. Results from this review will be disseminated through peer-reviewed journals and conference reports.PROSPERO registration number CRD42020181456.
... Our findings are comparable with similar studies that assessed the effect of mind-body therapies using mixed interventions including meditation, Yoga and TQ [33,66]. Prior reviews that examined the effect of TQ on immunity and inflammation have reported no strong evidence of a favorable effect of TQ on inflammation [67] and the immune system [68] and insufficient evidence to support the clinical application of TQ to reduce infection [68,69]. These earlier reviews included fewer RCTs, and non-RCT studies, and a less comprehensive literature search which limits the conclusions made. ...
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Background: Effective preventative health interventions are essential to maintain well-being among healthcare professionals and the public, especially during times of health crises. Several studies have suggested that Tai Chi and Qigong (TQ) have positive impacts on the immune system and its response to inflammation. The aim of this review is to evaluate the current evidence of the effects of TQ on these parameters. Methods: Electronic searches were conducted on databases (Medline, PubMed, Embase and ScienceDirect). Searches were performed using the following keywords: “Tai Chi or Qigong” and “immune system, immune function, immunity, Immun*, inflammation and cytokines”. Studies published as full-text randomized controlled trials (RCTs) in English were included. Estimates of change in the levels of immune cells and inflammatory biomarkers were pooled using a random-effects meta-analysis where randomised comparisons were available for TQ versus active controls and TQ versus non-active controls. Results: Nineteen RCTs were selected for review with a total of 1686 participants and a range of 32 to 252 participants within the studies. Overall, a random-effects meta-analysis found that, compared with control conditions, TQ has a significant small effect of increasing the levels of immune cells (SMD, 0.28; 95% CI, 0.13 to 0.43, p = 0.00), I2 = 45%, but not a significant effect on reducing the levels of inflammation (SMD, −0.15; 95% CI, −0.39 to 0.09, p = 0.21), I2 = 85%, as measured by the systemic inflammation biomarker C-reactive protein (CRP) and cell mediated biomarker cytokines. This difference in results is due to the bidirectional regulation of cytokines. An overall risk of bias assessment found three RCTs with a low risk of bias, six RCTs with some concerns of bias, and ten RCTs with a high risk of bias. Conclusions: Current evidence indicates that practising TQ has a physiologic impact on immune system functioning and inflammatory responses. Rigorous studies are needed to guide clinical guidelines and harness the power of TQ to promote health and wellbeing.
... Correspondingly, increasing the physical activity of patients after a diagnosis of colorectal cancer has been associated with prolongation of survival [158][159][160] . Moderate physical exercise is known to enhance cell-mediated immunity 161,162 and to reduce stress responses and inflammation 163 . Thus, the aforementioned benefits of exercise in patients with cancer might be mediated through several immunological, as well as non-immunological, mechanisms. ...
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The immediate perioperative period (days before and after surgery) is hypothesized to be crucial in determining long-term cancer outcomes: during this short period, numerous factors, including excess stress and inflammatory responses, tumour-cell shedding and pro-angiogenic and/or growth factors, might facilitate the progression of pre-existing micrometastases and the initiation of new metastases, while simultaneously jeopardizing immune control over residual malignant cells. Thus, application of anticancer immunotherapy during this critical time frame could potentially improve patient outcomes. Nevertheless, this strategy has rarely been implemented to date. In this Perspective, we discuss apparent contraindications for the perioperative use of cancer immunotherapy, suggest safe immunotherapeutic and other anti-metastatic approaches during this important time frame and specify desired characteristics of such interventions. These characteristics include a rapid onset of immune activation, avoidance of tumour-promoting effects, no or minimal increase in surgical risk, resilience to stress-related factors and minimal induction of stress responses. Pharmacological control of excess perioperative stress–inflammatory responses has been shown to be clinically feasible and could potentially be combined with immune stimulation to overcome the direct pro-metastatic effects of surgery, prevent immune suppression and enhance immunostimulatory responses. Accordingly, we believe that certain types of immunotherapy, together with interventions to abrogate stress–inflammatory responses, should be evaluated in conjunction with surgery and, for maximal effectiveness, could be initiated before administration of adjuvant therapies. Such strategies might improve the overall success of cancer treatment.
... In China, Qigong exercise is widely practiced in management of cancer in conjunction with standard care. Applied theoretical research suggests that practice of Qigong exercise may also have a supportive role in cancer prevention and improved survival[7][8][9]. However, additional large-scale population studies are needed to fully assess these associations. ...
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Integrative oncology, including Qigong, is a relatively new concept in modern healthcare. Evidence of benefits of Qigong in cancer survivors is emerging. As such, several cancer centers, world-wide, have introduced Qigong as part of integrative medicine within supportive cancer care programming. Qigong exercise programming content and quality varies among institutions due to lack of standard guidelines and, at present, relies solely on the instructor’s skills, knowledge, personal preferences and clinical experience. Development of consensus guidelines recommending the basic structure and delivery of Qigong programming in cancer care can potentiate quality assurance and reduce risk of harm. This applied qualitative research utilized a modified Delphi approach to formulate consensus guidelines. Guidelines were developed through discussions among an international expert panel (N = 13) with representation from Australia, Canada, Ireland, and the United States. Panel communication was predominantly conducted by email and occurred from November 2016 through February 2017. Expert panel work resulted in the generation of a work product: Qigong in Cancer Care Guidelines: A Working Paper including: (a) Consensus Guidelines for structure and delivery of Qigong exercise for Cancer care programming; (b) Consensus guidelines for instructor competence for teaching Qigong exercise for cancer care classes; (c) Screening tool for safe participation in Qigong exercise; (d) Class participant instructions for maintaining safety during Qigong exercise; and (e) Advice from the field. Generation of these resources is the first step in establishing recommendations for ‘best practice’ in the area of Qigong for cancer care programming.
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Background This overview summarizes the best available systematic review (SR) evidence on the health effects of Tai Chi. Methods Nine databases (PubMed, Cochrane Library, EMBASE, Medline, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Sino-Med, and Wanfang Database) were searched for SRs of controlled clinical trials of Tai Chi interventions published between Jan 2010 and Dec 2020 in any language. Effect estimates were extracted from the most recent, comprehensive, highest-quality SR for each population, condition, and outcome. SR quality was appraised with AMSTAR 2 and overall certainty of effect estimates with the GRADE method. Results Of the 210 included SRs, 193 only included randomized controlled trials, one only included non-randomized studies of interventions, and 16 included both. Common conditions were neurological (18.6%), falls/balance (14.7%), cardiovascular (14.7%), musculoskeletal (11.0%), cancer (7.1%), and diabetes mellitus (6.7%). Except for stroke, no evidence for disease prevention was found; however, multiple proxy-outcomes/risks factors were evaluated. One hundred and fourteen effect estimates were extracted from 37 SRs (2 high, 6 moderate, 18 low, and 11 critically low quality), representing 59,306 adults. Compared to active and/or inactive controls, 66 of the 114 effect estimates reported clinically important benefits from Tai Chi, 53 reported an equivalent or marginal benefit, and 6 an equivalent risk of adverse events. Eight of the 114 effect estimates (7.0%) were rated as high, 43 (37.7%) moderate, 36 (31.6%) low, and 27 (23.7%) very low certainty evidence due to concerns with risk of bias (92/114, 80.7%), imprecision (43/114, 37.7%), inconsistency (37/114, 32.5%), and publication bias (3/114, 2.6%). SR quality was often limited by the search strategies, language bias, inadequate consideration of clinical, methodological, and statistical heterogeneity, poor reporting standards, and/or no registered SR protocol. Conclusions The findings suggest Tai Chi has multidimensional effects, including physical, psychological and quality of life benefits for a wide range of conditions, as well as multimorbidity. Clinically important benefits were most consistently reported for Parkinson’s disease, falls risk, knee osteoarthritis, low back pain, cerebrovascular, and cardiovascular diseases including hypertension. For most conditions, higher-quality SRs with rigorous primary studies are required. Systematic review registration PROSPERO CRD42021225708.
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With the aging of the world's population, the quality of life of older adults is becoming more important. There are many studies on the use of Tai chi exercise, a popular form of mind-body exercise practiced by older adults. However, the effectiveness of Tai chi exercise on the quality of life of older adults is unclear. For this systematic review and meta-analysis, six databases (PubMed, CENTRAL, CINAHL, EMBASE, Scopus, CNKI) were searched in English and Chinese languages to screen for relevant randomized controlled trials (RCT), and their risk of bias was assessed by two independent reviewers. The results of quality of life, physical component, and psychological component among older adults were meta-analyzed using RevMan5.3 software. The search retrieved 2577 records. After screening, a total of 10 RCTs were included in this evaluation, with a total of 1170 participants. The meta-analysis showed that compared with the control group, Tai chi exercise had a significant impact on the overall quality of life (SMD=1.23; 95%CI: 0.56–1.98; P<0.0001), and on the physical component of quality of life (MD=5.90; 95%CI: 1.05–10.75; P=0.02), but no significant impact on the psychological component of quality of life. This study had high heterogeneity. The results of this study suggest the potential use of Tai chi exercise as an activity for increased quality of life in older adults. Future research may enhance experimental rigor and explore the rationale behind Tai chi exercise.
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Background In recent decades, the evidence supporting the physical and mental health benefits of holistic movement practices such as yoga and t’ai chi have become increasingly established. Consequently, investigating the participation prevalence and patterns of these practices is a relevant pursuit in the public health field. Few studies have provided population-level assessment of participation rates, however, and even fewer have focused on patterns over time. The purpose of this study was to examine participation prevalence and trends in yoga/Pilates and t’ai chi/qigong over a ten-year period in a nationally representative sample of Australians aged 15 years and over, with particular attention to sex and age. A secondary purpose was to juxtapose these findings with participation trends in traditional fitness activities over the same period. Methods Data comprised modes and types of physical activity, age, and sex variables collected through the Exercise, Recreation and Sport Survey (ERASS), a series of independent cross-sectional Australia-wide surveys conducted yearly between 2001 and 2010. For each year, weighted population estimates were calculated for those participating in yoga/Pilates, t’ai chi/qigong, and fitness activities (e.g. aerobics, calisthenics). Linear regression and multiple logistic regression analyses were used to examine trends in prevalence rates over time and differences among sex and age (15–34; 35–54; 55+ years) groups, respectively. Results Average prevalence rates between 2001 and 2010 were 3.0% (95% CI 2.9–3.1) for yoga/Pilates, 0.6% (95% CI 0.5–0.6) for t’ai chi/qigong, and 19.2% (95% CI 18.9–19.4) for fitness activities. Across the decade, overall participation rates remained relatively stable for yoga/Pilates and t’ai chi/qigong, while increasing linearly for fitness activities. For both genders and in all three age groups, participation in fitness activities increased, whereas only in the 55+ age group was there a significant increase in yoga/Pilates participation; participation in t’ai chi/qigong declined significantly in the two younger age groups. Conclusions Participation rates in yoga/Pilates and t’ai chi/qigong in Australia were low and relatively stable. As fitness activities increased in popularity across the decade, holistic movement practices did not. These findings point to the need to investigate activity-specific barriers and facilitators to participation, including intrapersonal, interpersonal, organisational, and environmental factors.
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This article reviews evidence for the hypothesis that psychological interventions can modulate the immune response in humans and presents a series of models depicting the psychobiological pathways through which this might occur. Although more than 85 trials have been conducted, meta-analyses reveal only modest evidence that interventions can reliably alter immune parameters. The most consistent evidence emerges from hypnosis and conditioning trials. Disclosure and stress management show scattered evidence of success. Relaxation demonstrates little capacity to elicit immune change. Although these data provide only modest evidence of successful immune modulation, it would be premature to conclude that the immune system is unresponsive to psychological interventions. This literature has important conceptual and methodological issues that need to be resolved before any definitive conclusions can be reached.
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Several studies examining transient stress and immunological functioning were performed. Measurement issues involving method of saliva collection for use in measuring secretory IgA was explored and differences between whole and parotid saliva were detected. Analyses of sIgA antibody to a novel antigen serially measured over several weeks were performed and relationships with psychological coping variables were tentatively observed. IL- 2 and Natural Killer cell assays were developed and tested, and we found that NK assays could not be successfully run from cryopreserved cells. A study replicating and extending previous work with a transient stressor (examinations) was run. Although overall group results did not replicate some previous work, ipsative analyses revealed that subjects who became more anxious in response to the stress had higher levels of lymphocyte proliferation. Keywords: Stress(Psychology), Immunoglobulin A, Interleukin 2, Concanavalin A.
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b>Objective : This systematic review aimed to critically appraise published clinical trials designed to assess the effect of Tai Chi on psychosocial well-being. Data Sources : Databases searched included MEDLINE, CINAHL, EMBASE, HEALT, PsycINFO, CISCOM, the Cochrane Central Register of Controlled Trials of the Cochrane Library, and dissertations and conference proceedings from inception to August 2008. Review Methods : Methodological quality was assessed using a modified Jadad scale. A total of 15 studies met the inclusion criteria (i.e. English publications of randomized controlled trials with Tai Chi as an intervention and psychological well-being as an outcome measure), of which eight were high quality trials. The psychosocial outcomes measured included anxiety (eight studies), depression (eight studies), mood (four studies), stress (two studies), general mental health three studies), anger, positive and negative effect, self-esteem, life satisfaction, social interaction and self-rated health (one study each). Results : Tai Chi intervention was found to have a significant effect in 13 studies, especially in the management of depression and anxiety. Although the results seemed to suggest Tai Chi is effective, they should be interpreted cautiously as the quality of the trials varied substantially. Furthermore, significant findings were shown in only six high quality studies. Moreover, significant between group differences after Tai Chi intervention was demonstrated in only one high quality study (the other three significant results were observed in non-high quality studies). Two high quality studies in fact found no significant Tai Chi effects. Conclusion : It is still premature to make any conclusive remarks on the effect of Tai Chi on psychosocial well-being.<br /
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An ever-growing volume of peer-reviewed publications speaks to the recent and rapid growth in both scope and understanding of exercise immunology. Indeed, more than 95% of all peer-reviewed publications in exercise immunology (currently >2, 200 publications using search terms "exercise" and "immune") have been published since the formation of the International Society of Exercise and Immunology (ISEI) in 1989 (ISI Web of Knowledge). We recognise the epidemiological distinction between the generic term "physical activity" and the specific category of "exercise", which implies activity for a specific purpose such as improvement of physical condition or competition. Extreme physical activity of any type may have implications for the immune system. However, because of its emotive component, exercise is likely to have a larger effect, and to date the great majority of our knowledge on this subject comes from exercise studies. In this position statement, a panel of world-leading experts provides a consensus of current knowledge, briefly covering the background, explaining what we think we know with some degree of certainty, exploring continued controversies, and pointing to likely directions for future research. Part one of this position statement focuses on 'immune function and exercise' and part two on 'maintaining immune health'. Part one provides a brief introduction and history (Roy Shephard) followed by sections on: respiratory infections and exercise (Maree Gleeson); cellular innate immune function and exercise (Jeffrey Woods); acquired immunity and exercise (Nicolette Bishop); mucosal immunity and exercise (Michael Gleeson and Nicolette Bishop); immunological methods in exercise immunology (Monika Fleshner); anti-inflammatory effects of physical activity (Charlotte Green and Bente Pedersen); exercise and cancer (Laurie Hoffman-Goetz and Connie Rogers) and finally, "omics" in exercise (Hinnak Northoff, Asghar Abbasi and Perikles Simon). The focus on respiratory infections in exercise has been stimulated by the commonly held beliefs that the frequency of upper respiratory tract infections (URTI) is increased in elite endurance athletes after single bouts of ultra-endurance exercise and during periods of intensive training. The evidence to support these concepts is inconclusive, but supports the idea that exercised-induced immune suppression increases susceptibility to symptoms of infection, particularly around the time of competition, and that upper respiratory symptoms are associated with performance decrements. Conclusions from the debate on whether sore throats are actually caused by infections or are a reflection of other inflammatory stimuli associated with exercise remains unclear. It is widely accepted that acute and chronic exercise alter the number and function of circulating cells of the innate immune system (e.g. neutrophils, monocytes and natural killer (NK) cells). A limited number of animal studies has helped us determine the extent to which these changes alter susceptibility to herpes simplex and influenza virus infection. Unfortunately, we have only 'scratched the surface' regarding whether exercise-induced changes in innate immune function alter infectious disease susceptibility or outcome and whether the purported anti-inflammatory effect of regular exercise is mediated through exercise-induced effects on innate immune cells. We need to know whether exercise alters migration of innate cells and whether this alters disease susceptibility. Although studies in humans have shed light on monocytes, these cells are relatively immature and may not reflect the effects of exercise on fully differentiated tissue macrophages. Currently, there is very little information on the effects of exercise on dendritic cells, which is unfortunate given the powerful influence of these cells in the initiation of immune responses. It is agreed that a lymphocytosis is observed during and immediately after exercise, proportional to exercise intensity and duration, with numbers of cells (T cells and to a lesser extent B cells) falling below pre-exercise levels during the early stages of recovery, before returning to resting values normally within 24 h. Mobilization of T and B cell subsets in this way is largely influenced by the actions of catecholamines. Evidence indicates that acute exercise stimulates T cell subset activation in vivo and in response to mitogen- and antigen-stimulation. Although numerous studies report decreased mitogen- and antigen-stimulated T cell proliferation following acute exercise, the interpretation of these findings may be confounded by alterations in the relative proportion of cells (e.g. T, B and NK cells) in the circulation that can respond to stimulation. Longitudinal training studies in previously sedentary people have failed to show marked changes in T and B cell functions provided that blood samples were taken at least 24 h after the last exercise bout. In contrast, T and B cell functions appear to be sensitive to increases in training load in well-trained athletes, with decreases in circulating numbers of Type 1 T cells, reduced T cell proliferative responses and falls in stimulated B cell Ig synthesis. The cause of this apparent depression in acquired immunity appears to be related to elevated circulating stress hormones, and alterations in the pro/anti-inflammatory cytokine balance in response to exercise. The clinical significance of these changes in acquired immunity with acute exercise and training remains unknown. The production of secretory immunoglobulin A (SIgA) is the major effector function of the mucosal immune system providing the 'first line of defence' against pathogens. To date, the majority of exercise studies have assessed saliva SIgA as a marker of mucosal immunity, but more recently the importance of other antimicrobial proteins in saliva (e.g. alpha-amylase, lactoferrin and lysozyme) has gained greater recognition. Acute bouts of moderate exercise have little impact on mucosal immunity but prolonged exercise and intensified training can evoke decreases in saliva secretion of SIgA. Mechanisms underlying the alterations in mucosal immunity with acute exercise are probably largely related to the activation of the sympathetic nervous system and its associated effects on salivary protein exocytosis and IgA transcytosis. Depressed secretion of SIgA into saliva during periods of intensified training and chronic stress are likely linked to altered activity of the hypothalamic-pituitary-adrenal axis, with inhibitory effects on IgA synthesis and/or transcytosis. Consensus exists that reduced levels of saliva SIgA are associated with increased risk of URTI during heavy training. An important question for exercise immunologists remains: how does one measure immune function in a meaningful way? One approach to assessing immune function that extends beyond blood or salivary measures involves challenging study participants with antigenic stimuli and assessing relevant antigen-driven responses including antigen specific cell-mediated delayed type hypersensitivity responses, or circulating antibody responses. Investigators can inject novel antigens such as keyhole limpet haemocyanin (KLH) to assess development of a primary antibody response (albeit only once) or previously seen antigens such as influenza, where the subsequent antibody response reflects a somewhat more variable mixture of primary, secondary and tertiary responses. Using a novel antigen has the advantage that the investigator can identify the effects of exercise stress on the unique cellular events required for a primary response that using a previously seen antigen (e.g. influenza) does not permit. The results of exercise studies using these approaches indicate that an acute bout of intense exercise suppresses antibody production (e.g. anti-KLH Ig) whereas moderate exercise training can restore optimal antibody responses in the face of stressors and ageing. Because immune function is critical to host survival, the system has evolved a large safety net and redundancy such that it is difficult to determine how much immune function must be lost or gained to reveal changes in host disease susceptibility. There are numerous examples where exercise alters measures of immunity by 15-25%. Whether changes of this magnitude are sufficient to alter host defence, disease susceptibility or severity remains debatable. Chronic inflammation is involved in the pathogenesis of insulin resistance, atherosclerosis, neurodegeneration, and tumour growth. Evidence suggests that the prophylactic effect of exercise may, to some extent, be ascribed to the anti-inflammatory effect of regular exercise mediated via a reduction in visceral fat mass and/or by induction of an anti-inflammatory environment with each bout of exercise (e.g. via increases in circulating anti-inflammatory cytokines including interleukin (IL)-1 receptor antagonist and IL-10). To understand the mechanism(s) of the protective, anti-inflammatory effect of exercise fully, we need to focus on the nature of exercise that is most efficient at allieviating the effects of chronic inflammation in disease. The beneficial effects of endurance exercise are well known; however, the antiinflammatory role of strength training exercises are poorly defined. In addition, the independent contribution of an exercise-induced reduction in visceral fat versus other exercise-induced anti-inflammatory mechanisms needs to be understood better. There is consensus that exercise training protects against some types of cancers. Training also enhances aspects of anti-tumour immunity and reduces inflammatory mediators. However, the evidence linking immunological and inflammatory mechanisms, physical activity, and cancer risk reduction remains tentative. (ABSTRACT TRUNCATED)
Exercise influences natural immunity, T- and B-cell functions, and cytokine responses, through circulatory (hemodynamic) changes and by endocrine hormones secreted in response to physical stress. The magnitude of the effects on the immune system reflects the intensity, duration and chronicity of the exercise. In this review, Laurie Hoffman-Goetz and Bente Klarlund. Pedersen suggest that exercise-immune interactions can be viewed as a subset of stress immunology.
Aim: To observe the effect of Tai Chi Chuan (TCC) exercise on T lymphocyte and B lymphocyte immune functions in healthy older individuals. Methods: 1 Twenty older inhabitants from Shiguang third country of Shanghai city in October 2004 were selected as subjects. They, aged 55-56 years and including 10 males and 10 females, were randomly divided into two groups: training group (n=10) and control group (n=10). These older individuals have known and consented to the testing scheme and have no disciplinarian exercise recently. 2 Training group: Exercise contents were mostly twenty-four TCC (Commencing form, Part the Wild Horse's Mane on Both Side, White Crane Spreads its Wings, Brush Knee and Twist Step on Both Side and Play Pipa, etc). Exercise loads were sixty minutes every time and four times every week for eight weeks. Every time exercise comprised ten minutes warming-up, forty minutes TCC exercise and ten minutes relaxation at medium intensity (50%-65% maximal heart rate). Control group: The patients had no exercise with individual or collective scheme. 3 At one day before and after 8-week exercise, the percentages of lymphocyte subpopulations were determined by flow cytometry, then the ratio of CD4+/CD8+ was calculated. In addition, the serumal immunoglobulin G (IgG), IgM and IgA were determined by Array 360 system autoanalyzer. Results: Totally 20 older people entered the result analysis. 1The testing results of T lymphocyte subpopulation in two groups had no significant difference before TCC exercise (P > 0.05). After eight-week TCC exercise, the training group showed an increase in the expression of CD4+ and significant increase in CD4+/CD8+ ratio [(41.59±4.32)%, 1.87±0.28; (32.58±3.16)%, 1.07±0.33, t=-4.02, -5.23, P < 0.05,0.01], and decrease in the expression of CD88 [(22.25±5.12)%, (30.41±3.57)%, t=3.05, P < 0.05]. 2There was no significant change in the testing results of T lymphocyte subpopulation in control group before and after TCC exercise (P > 0.05). 2The testing results of immunoglobulin in two groups had no significant difference before TCC exercise (P > 0.05). After eight-week TCC exercise, the training group showed increase in the concentrations of IgG and IgA [(12.78±3.30), (3.18±0.96) g/ L, (11.20±2.32), (2.56±0.42) g/L, t=-3.72, -2.98, P < 0.05], and little increase in concentration of IgM, without significant difference (P > 0.05). The control group showed no significant change in these variables, which were still lower than those before exercise (P > 0.05). Conclusion: TCC exercise is effective for improving T lymphocyte and B lymphocyte immune functions in healthy older individuals.
To evaluate the effects of a behavioral intervention, Tai Chi, on resting and vaccine-stimulated levels of cell-mediated immunity (CMI) to varicella zoster virus (VZV) and on health functioning in older adults. A prospective, randomized, controlled trial with allocation to two arms (Tai Chi and health education) for 25 weeks. After 16 weeks of intervention, subjects were vaccinated with VARIVAX, the live attenuated Oka/Merck VZV vaccine licensed to prevent varicella. Two urban U.S. communities between 2001 and 2005. A total of 112 healthy older adults aged 59 to 86. The primary endpoint was a quantitative measure of VZV-CMI. Secondary outcomes were scores on the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). The Tai Chi group showed higher levels of VZV-CMI than the health education group (P<.05), with a significant rate of increase (P<.001) that was nearly twice that found in the health education group. Tai Chi alone induced an increase in VZV-CMI that was comparable in magnitude with that induced by varicella vaccine, and the two were additive; Tai Chi, together with vaccine, produced a substantially higher level of VZV-CMI than vaccine alone. The Tai Chi group also showed significant improvements in SF-36 scores for physical functioning, bodily pain, vitality, and mental health (P<.05). Tai Chi augments resting levels of VZV-specific CMI and boosts VZV-CMI of the varicella vaccine.