ArticleLiterature Review

The effect of Tai Chi on four chronic conditions-cancer, osteoarthritis, heart failure and chronic obstructive pulmonary disease: A systematic review and meta-analyses

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Abstract

Background: Many middle-aged and older persons have more than one chronic condition. Thus, it is important to synthesise the effectiveness of interventions across several comorbidities. The aim of this systematic review was to summarise current evidence regarding the effectiveness of Tai Chi in individuals with four common chronic conditions-cancer, osteoarthritis (OA), heart failure (HF) and chronic obstructive pulmonary disease (COPD). Methods: 4 databases (MEDLINE, EMBASE, CINAHL and SPORTDiscus) were searched for original articles. Two reviewers independently screened the titles and abstracts and then conducted full-text reviews, quality assessment and finally data abstraction. 33 studies met the inclusion criteria. Meta-analyses were performed on disease-specific symptoms, physiological outcomes and physical performance of each chronic condition. Subgroup analyses on disease-specific symptoms were conducted by categorising studies into subsets based on the type of comparison groups. Results: Meta-analyses showed that Tai Chi improved or showed a tendency to improve physical performance outcomes, including 6-min walking distance (6MWD) and knee extensor strength, in most or all four chronic conditions. Tai Chi also improved disease-specific symptoms of pain and stiffness in OA. Conclusions: The results demonstrated a favourable effect or tendency of Tai Chi to improve physical performance and showed that this type of exercise could be performed by individuals with different chronic conditions, including COPD, HF and OA.

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... [8][9][10] As a lowimpact, low-to moderate-intensity exercise originating in China, tai chi is suitable for older adults to perform, including those with chronic health conditions or poor exercise tolerance. 11,12 According to a systematic review examining adverse events reported in tai chi intervention studies, 13 tai chi is a safe form of exercise. Reported adverse events were typically minor and primarily musculoskeletal related (eg, knee or back pain), whereas no intervention-related serious adverse events as a result of participation in tai chi were reported. ...
... To date, a total of 4 meta-analyses focused on CHF have been conducted, examining the effectiveness of tai chi. 12,[26][27][28] However, these meta-analyses were limited in scope (eg, search limited to 2 or 4 databases), 12,27 included data from the same study twice (second article was a secondary analysis reporting outcome data on the same participants), 26,28 or included studies with a high risk of bias (lack of allocation concealment and blinding of outcome assessors absent). 26,28 Thus, the aim of this systematic review and meta-analysis was to address these issues, examining clinical trials published during the past 15 years, to assess the potential benefits of tai chi exercise among persons with CHF. ...
... To date, a total of 4 meta-analyses focused on CHF have been conducted, examining the effectiveness of tai chi. 12,[26][27][28] However, these meta-analyses were limited in scope (eg, search limited to 2 or 4 databases), 12,27 included data from the same study twice (second article was a secondary analysis reporting outcome data on the same participants), 26,28 or included studies with a high risk of bias (lack of allocation concealment and blinding of outcome assessors absent). 26,28 Thus, the aim of this systematic review and meta-analysis was to address these issues, examining clinical trials published during the past 15 years, to assess the potential benefits of tai chi exercise among persons with CHF. ...
Article
Background: Exercise-based cardiac rehabilitation is safe and effective for adults with chronic heart failure (CHF), yet services are greatly underutilized. However, tai chi is a popular and safe form of exercise among older adults with chronic health conditions. Objective: A systematic review and meta-analysis was conducted to examine the benefits of tai chi exercise among persons with CHF. Methods: An electronic literature search of 10 databases (Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Embase, OpenGrey, PsycARTICLES, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science) was conducted from January 1, 2004, to August 1, 2019. Clinical trials that examined tai chi exercise, were published in English or German languages, and conducted among participants with CHF were included. Comprehensive Meta-Analysis version 2.0 software (Biostat, Inc) was used to calculate effect sizes (ie, Hedges g) and 95% confidence intervals using random effects models. Results: A total of 6 studies met the inclusion criteria, enrolling 229 participants (mean age, 68 years; 28% women; mean ejection fraction = 37%). At least 3 studies reported outcomes for exercise capacity (n = 5 studies), quality of life (n = 5 studies), depression (n = 4 studies), and b-type natriuretic peptide (n = 4 studies), allowing for meta-analysis. Compared with controls, tai chi participants had significantly better exercise capacity (g = 0.353; P = .026, I = 32.72%), improved quality of life (g = 0.617; P = .000, I = 0%), with less depression (g = 0.627; P = .000, I = 0%), and decreased b-type natriuretic peptide expression (g = 0.333; P = .016, I = 0%). Conclusion: Tai chi can be easily integrated into existing cardiac rehabilitation programs. Further research is needed with rigorous study designs and larger samples before widespread recommendations can be made.
... They mostly focused on the healthrelated consequences of Tai Chi training, and either investigated specific groups of of individuals with chronic diseases, for example, Parkinson's disease, 2 or specific health-related issues, for example, risk of falling. 3 Positive effects of Tai Chi training were reported for cancer, 4 osteoarthritis, 4 heart failure, 4 ...
... They mostly focused on the healthrelated consequences of Tai Chi training, and either investigated specific groups of of individuals with chronic diseases, for example, Parkinson's disease, 2 or specific health-related issues, for example, risk of falling. 3 Positive effects of Tai Chi training were reported for cancer, 4 osteoarthritis, 4 heart failure, 4 ...
... They mostly focused on the healthrelated consequences of Tai Chi training, and either investigated specific groups of of individuals with chronic diseases, for example, Parkinson's disease, 2 or specific health-related issues, for example, risk of falling. 3 Positive effects of Tai Chi training were reported for cancer, 4 osteoarthritis, 4 heart failure, 4 ...
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Objective To investigate the impact of Tai Chi training on muscle strength, physical endurance, postural balance and flexibility, as measured by tests commonly used in health-related fitness or competitive sports contexts. Design Systematic review and meta-analysis. Data sources The following databases were searched up to 31 July 2020: CINAHL, Cochrane Library, MEDLINE via PubMed and SPORTDiscus. Eligibility criteria for studies Inclusion: (1) Randomised controlled trials published in German or English; (2) Tai Chi used as an intervention to improve physical performance; (3) Test methods commonly used in health-related fitness or competitive sports and (4) Participants aged ≥16 years (irrespective of health status). Exclusion: (1) Studies not focusing on Tai Chi or including Tai Chi mixed with other interventions and (2) Modified or less than eight Tai Chi movements. Results Out of 3817 records, 31 studies were included in the review, 21 of them in the meta-analysis. Significant improvements in handgrip strength (2.34 kg, 95% CI 1.53 to 3.14), walking distance during 6 min (43.37 m, 95% CI 29.12 to 57.63), standing time in single-leg-stance with open eyes (6.41 s, 95% CI 4.58 to 8.24) and thoracolumbar spine flexibility (2.33 cm, 95% CI 0.11 to 4.55) were observed. Conclusion Tai Chi training seems to moderately improve physical fitness when evaluated by tests used in health-related fitness or competitive sports. Moreover, thoracolumbar spine flexibility seems to be a factor in the improvement of postural balance. Further research is needed, including younger healthy participants performing a widely used, standardised form (eg, Peking-style routine) with high-intensity movements (eg, use of lower stances).
... None of the reviews focused specifically on community dwelling older adults as they included inpatients and healthy participants Ć wi ękała-Lewis et al., 2017 ;Wang et al., 2004 ;Wang et al., 2010 ;Wang et al., 2015 ). Furthermore, Wang et al. (2015) and Chen et al. (2015) reported mixed interventions with various types of traditional Chinese exercise including Tai Chi, Banduanjin, Qigong and Liuzijue on QoL and depression for people with chronic diseases. Hence, the effectiveness was not solely due to Tai Chi. ...
... A meta-analysis is the highest tier in terms of the evidence hierarchy and is a powerful way to look across datasets ( Haidich, 2010 ). Chen et al. (2015) reported on effectiveness of Tai Chi on four chronic diseases but was limited to articles in four databases and only English studies were included due to the authors' language proficiency. However, the impacts of Tai Chi alone remained vague. ...
... The results were consistent with one review regarding the efficacy of Tai Chi in osteoarthritic patients that reported statistically significant positive effect on QoL-PCS ( Lauche, Langhorst, Dobos & Cramer, 2013 ). Chen et al. (2015) and Wang et al. (2015) reported a statistically significant improvement on overall QoL. However, no meta-analysis was done to examine QoL-PCS specifically. ...
Article
Background With a rapid increase in aging population and prevalence of chronic diseases worldwide, older adults are seen facing more physical and psychological burdens, affecting their quality of life (QoL). Tai Chi, a traditional Chinese mind-body physical activity, appeals to many older adults and has been extensively studied. However, the effectiveness of Tai Chi on QoL, depressive symptoms and physical function on community-dwelling older adults remains vague. Objectives To synthesise and evaluate effectiveness of Tai Chi on QoL, depressive symptoms and physical function among community-dwelling older adults with chronic disease. Methods Searches were performed across seven databases systematically (PubMed, Embase, Cochrane, CINAHL, Scopus, ProQuest, CNKI). Only randomised controlled trials (RCTs), written in English or Chinese were included. All eligible studies were screened with risk of bias examined by two independent reviewers. Meta-analyses were conducted using RevMan 5.3 software while narrative syntheses were performed where meta-analysis was inappropriate and heterogeneity was present. Results A total of 3416 records were generated and 13 RCTs were eligible for inclusion. Meta-analysis reported statistically significant small effect size favouring Tai Chi on QoL and depressive symptoms. No statistically significant differences were seen for mobility and endurance of physical function. Majority had high heterogeneity hence findings should be interpreted carefully. Conclusion Tai Chi was found to have favourable effects on QoL and depressive symptoms of older adults with chronic disease which can act as a complement to disease management. However, future research can be improved to explore theoretical framework and include high-quality studies with larger sample sizes.
... On the other hand, adequately dosed martial arts and combat sports have been described as alternatives to improve one's health [17]. For example, interventions consisting of six to twelve weeks of tai chi have induced significant improvements for cognitive, functional, and metabolic function, and reduce pain perception and improve mental health and sleep quality in men and women of different ages [18,19]. Additionally, a systematic review that includes interventions based on kung-fu, wushu, karate, taekwondo, muay-thai, kickboxing, jujitsu, judo, and kenpo, among others, intended for people over 18 years old, reported positive effects-derived from regular martial arts and combat sports practice-on balance, cognitive function, and mental health. ...
... However, the authors propose that the quality of the evidence is affected by methodological deficiencies caused-among other factors-by the fact that half of the studies were cross-sectional [20]. Apparently, martial arts and combat sports are PA strategies that meet the requirements of muscle strength, cardiorespiratory capacity, flexibility, agility, and postural balance that older adults need [18][19][20], as the specific activities of martial arts and combat sports involve attack and defense movements where the upper and lower extremities are used, in addition to choreographies or forms (sequences of arms and legs movements that simulate an imaginary combat) that allow performing dynamic low-impact actions at moderate to vigorous intensities [21]. Therefore, knowing the possible benefits of combat sports with a competitive orientation-such as Olympic modalities-on older adults' health status from a biomedical perspective through high-quality studies (e.g., randomised-controlled trials) becomes relevant because of their status as dangerous activities [22]. ...
... The main result of our review indicates that regular practice of OCS in older adults produces beneficial changes on physical-functional, physiological, and psychoemotional variables. This strengthens the scientific evidence supporting the use of martial arts and combat sports as PA alternatives to improve the older adults' health status [18,20,49]. ...
Article
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The aim of this systematic review was to analyse the studies centered on the effects of Olympic combat sports (OCS [i.e., boxing, fencing, judo, karate, taekwondo, wrestling]) on older adults' physical-functional, physiological, and psychoemotional health status. The review comprised randomised-controlled trials with OCS interventions, including older adults (>60 years), and measures of physical-functional, physiological, and/or psychoemotional health. The studies were searched through SCOPUS, PubMed/MEDLINE, Web of Science, PsycINFO, and EBSCO da-tabases until January 5, 2021. The PRISMA-P and TESTEX scales were used to assess the quality of the selected studies. The protocol was registered in PROSPERO (code: CRD42020204034). Twelve OCS intervention studies were found (scored ≥60% for methodological quality), comprising 392 females and 343 males (mean age: 69.6 years), participating in boxing, judo, karate, and taekwondo. The qualitative analysis revealed that compared to control, OCS training improved muscle strength, cardiorespiratory capacity, agility, balance, movement, attention, memory, mental health, anxiety, and stress tolerance. Meta-analysis was available only for the chair stand test, and an improvement was noted after OCS training compared to control. In conclusion, OCS interventions improves older adults' physical-functional, physiological, and psychoemotional health. Our systematic review confirms that OCS training has high adherence (greater than 80%) in older adults.
... Among these, the MBTTCM showed positive effects for breast cancer, fatigue, and general cancer symptoms (21)(22)(23). The systematic reviews showed potential positive effects for general cancer symptoms (24)(25)(26), as well as no effects for cancer pain and adjuvant cancer treatment (27)(28)(29)(30). One systematic review showed mixed effects for nausea and vomiting (31). ...
... The effects of MBTTCM were positive for osteoarthritis (33)(34)(35), coronary diseases (36)(37)(38)(39), hypertension (40,41), cardiovascular disease and risk factors (32,42), and diabetes (43,44). The MBTTCM presented a potentially positive effect for Parkinson's disease (45)(46)(47), fibromyalgia (48,49), osteoarthritis (50), premenstrual syndrome (51-53), COPD (27,(54)(55)(56)(57), and vestibulopathies (58). ...
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Background: The mind-body therapies of traditional Chinese medicine include several intervention types and combine physical poses with conscious relaxation and breathing techniques. The purpose of this Evidence Map is to describe these different interventions and report related health outcomes. Methods: This evidence map is based on the 3iE Evidence Gap Map methodology. We searched seven electronic databases (BVS, PUBMED, EMBASE, PEDro, ScienceDirect, Web of Sciences, and PschyInfo) from inception to November 2019 and included systematic reviews only. Systematic reviews were analyzed based on AMSTAR 2. We used Tableau to graphically display quality assessment, the number of reviews, outcomes, and effects. Results: The map is based on 116 systematic reviews and 44 meta-analyses. Most of the reviews were published in the last 5 years. The most researched interventions were Tai Chi and Qi Gong. The reviews presented the following quality assessment: 80 high, 43 moderate, 23 low, and 14 critically low. Every 680 distinct outcome effect was classified: 421 as potential positive; 237 as positive; 21 as inconclusive/mixed; one potential negative and none no effect. Positive effects were related to chronic diseases; mental indicators and disorders; vitality, well-being, and quality of life. Potential positive effects were related to balance, mobility, Parkinson's disease, hypertension, joint pain, cognitive performance, and sleep quality. Inconclusive/mixed-effects justify further research, especially in the following areas: Acupressure as Shiatsu and Tuiná for nausea and vomiting; Tai Chi and Qi Gong for acute diseases, prevention of stroke, stroke risk factors, and schizophrenia. Conclusions: The mind-body therapies from traditional Chinese medicine have been applied in different areas and this Evidence Map provides a visualization of valuable information for patients, professionals, and policymakers, to promote evidence-based complementary therapies.
... Wayne, et al., [51] in 2014 explored and critically evaluated the influence of Tai Chi on cognitive functions, reporting that Tai Chi may be an potential method to improve cognition of aged groups, especially strengthened the realm of executive function in healthy individuals. Chen, et al., [52] in 2016 summarized the effectiveness of Tai Chi in individuals with four common chronic conditions-cancer, osteoarthritis, heart failure and chronic obstructive pulmonary disease, and concluded that Tai Chi could be considered as an complementary therapy in the rehabilitation of these chronic diseases. ...
... Aging is a leading issue nowadays. As the aging process intensifies, degenerative disorders include osteoarthritis, stoke, Parkinson's and other diseases may distributed both the patients and their families [52]. More studies aimed at specific populations, such as people who are prone to falls, breast cancer sufferers, and patients with cardiovascular, cerebrovascular and brain related diseases should be individually designed and carried out to clarify the effect and quality of Tai Chi intervention. ...
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While studies on the health benefits of Tai Chi have sprung up over the past four decades, few have engaged in collecting global data, estimating the developing trends, and conducting reviews from the perspective of visualization and bibliometric analysis. This study aimed to provide a summary of the global scientific outputs on Tai Chi research from 1980 to 2020, explore the frontiers, identify cooperation networks, track research trends and highlight emerging hotspots. Relevant publications were downloaded from the Web of Science Core Collection (WoSCC) database between 1980 and 2020. Bibliometric visualization and comparative analysis of authors, cited authors, journals, co-cited journals, institutions, countries, references, and keywords were systematically conducted using CiteSpace software. A total of 1078 publications satisfied the search criteria, and the trend of annual related publications was generally in an upward trend, although with some fluctuations. China (503) and Harvard University (74) were the most prolific country and institution, respectively. Most of the related researches were published in the journals with a focus on sport sciences, alternative medicine, geriatrics gerontology, and rehabilitation. Our results indicated that the current concerns and difficulties of Tai Chi research are “Intervention method”, “Targeted therapy”, “Applicable population”, “Risk factors”, and “Research quality”. The frontiers and promising domains of Tai Chi exercise in the health science field are preventions and rehabilitations of “Fall risk”, “Cardiorespiratory related disease”, “Stroke”, “Parkinson’s disease”, and “Depression”, which should receive more attention in the future.
... Recent studies indicated that tai chi facilitates both physical function and psychological well being in older adults and people with neurological, rheumatologic, orthopedic, and cardiopulmonary diseases [11,12], and the safety of tai chi has also been well-evaluated [13]. Furthermore, positive effects of tai chi exercise on degenerative OA were also evident in previous research [14,15]. In a previous randomized controlled trial, the study showed that tai chi exercise three times a week for 24 weeks improved gait performance, balance, and muscle power of the lower extremities and reduced pain among older adults with knee OA [14]. ...
... In a previous randomized controlled trial, the study showed that tai chi exercise three times a week for 24 weeks improved gait performance, balance, and muscle power of the lower extremities and reduced pain among older adults with knee OA [14]. A systematic review and meta-analysis study also indicated that tai chi has a tendency to improve walking and knee extensor strength, and ameliorate pain and stiffness in individuals with OA [15]. In addition, some researchers have indicated that tai chi produces beneficial effects similar to those of a standard course of physical therapy for knee OA. ...
Article
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Background Degenerative osteoarthritis (OA) often leads to pain and stiffness of the affected joints, which may affect the physical performance and decrease the quality of life of people with degenerative knee OA. Compared to traditional exercise, tai chi is a safe exercise with slow movements which can facilitate physical functioning and psychological well being, and might be suitable for improving the physical activities of older adults with knee OA. Therefore, this study investigated the impacts of tai chi exercise on the functional fitness of community-dwelling older adults with degenerative knee OA. Methods Sixty-eight community-dwelling older adults with knee OA were recruited from the local community to participate in this randomized controlled clinical trial. All subjects were randomly assigned to either an TCE group that practiced tai chi exercise (TCE) ( n = 36) or a control group (CON) ( n = 32) that received regular health education programs twice per week for 12 weeks. Outcome measurements were determined using functional fitness tests before and after the intervention, including a 30-s chair stand (number of repeats), 30-s arm-curl (number of repeats), 2-min step (number of steps), chair sit-and-reach (reaching distance, cm), back-scratch flexibility (distance between hands, cm), single-leg stand (time, s), functional reach (reaching distance, cm), 8-foot up-and-go (time, s), and 10-m walk tests (time, s). Pre-post comparisons of functional fitness were analyzed using the ANCOVA test with SPSS software version 18.0. Results Results revealed that participants’ functional fitness in the TCE group had significantly higher adjusted mean post-tests scores than that in the CON group after the intervention, including the 8-foot up-and-go (s) (mean difference [MD]=-2.92 [-3.93, -1.91], p = 2.39*10 − 7 ), 30-s arm curl (MD = 4.75 (2.76, 6.73), p = 1.11*10 − 5 ), 2-min step (MD = 36.94 [23.53, 50.36], p = 7.08*10 − 7 ), 30-s chair stand (MD = 4.66 [2.97, 6.36], p = 6.96*10 − 7 ), functional-reach (MD = 5.86 [3.52, 8.20], p = 4.72*10 − 6 ), single-leg stand with eyes closed (MD = 3.44 [1.92, 4.97], p = 2.74*10 − 5 ), chair sit-and-reach (MD = 3.93 [1.72, 6.15], p = 0.001), and single-leg stand with eyes opened (MD = 17.07 [6.29, 27.85], p = 0.002), with large effect sizes (η²=0.14 ~ 0.34). Conclusions Community-dwelling older adults with knee OA in the TCE group had better functional fitness performances after the 12-week tai chi intervention than those receiving only health education.
... It has developed into various kinds of styles or forms during its evolution, including Chen-, Wu-, Sun-, and Yangstyle with 24 forms or 42 forms (17,18) which is considered a complex, multicomponent intervention that integrates physical, psychosocial, emotional, spiritual, and behavioral elements (13,19). Previous research and meta-analyses have suggested that Tai Chi offers a therapeutic benefit in patients with CHF (17,(20)(21)(22)(23). However, mental health and sleep quality as important components of health status were not concerned in the previous meta-analyses, so we found new outcomes to evaluate the effects of Tai Chi on patients with CHF, including Hamilton Depression Rating Scale (HAMD) and Pittsburgh Sleep Quality Index (PSQI). ...
... The effects of Tai Chi on MLHFQ, 6MWT, LVEF, and BNP/NT-pro-BNP detected were generally similar to previous studies (17,(20)(21)(22)(23). However, one meta-analysis conducted by Ren et al. in 2017 (17) demonstrated inconclusive clinical evidence about Tai Chi in CHF. ...
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Background Chronic heart failure (CHF) is among the top causes of cardiovascular morbidity, and most patients with CHF have poor health status. Tai Chi, a mind-body exercise that originated in China, is beneficial for health status. This study was conducted to evaluate the effects of Tai Chi on health status in adults with CHF. Methods The Cochrane Library, PubMed, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Database, and Chinese Scientific Journal Database were searched from the inception to 22 October 2021. This meta-analysis was performed using the fixed- or random-effects model. Continuous outcomes were carried out using mean difference (MD) or standardized mean difference (SMD) with 95% confidence interval (CI). Dichotomous outcomes were determined using risk ratio (RR) with 95%CI. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE)pro Guideline Development Tool (GDT) online software was used to present outcome-specific information regarding overall certainty of evidence from studies. Results In total, 15 studies including 1,236 participants were finally included. Compared with usual care alone, Tai Chi combined with usual care achieved efficacy in improving Minnesota Living with Heart Failure Questionnaire (MD = −8.51; 95% CI: −10.32 to −6.70; p < 0.00001), 6-min walk test (MD = 43.47; 95% CI: 33.38 to 54.10; p < 0.00001), left ventricular ejection fraction (MD = 6.07; 95% CI: 3.44 to 8.70; p < 0.00001), B-type natriuretic peptide/N-terminal fragment of pro-BNP (SMD = −1.12; 95% CI: −1.70 to −0.54; p = 0.0002), Hamilton Depression Rating Scale (MD = −2.89; 95% CI: −4.87 to −0.91; p = 0.004), Pittsburgh Sleep Quality Index (MD = −2.25; 95% CI: −3.88 to −0.61; p = 0.007), timed up and go test (MD = −1.34; 95% CI: −2.50 to −0.19; p = 0.02), and reduced the risk of heart failure hospitalization (RR = 0.47; 95% CI: 0.25 to 0.88; p = 0.02). However, there was no difference in the outcome of peak oxygen uptake (MD = 1.38; 95% CI: −1.51 to 4.28; p = 0.35). All-cause mortality or cardiovascular death could not be evaluated due to insufficient data. The certainty of evidence ranged from very low to moderate due to the risk of bias, inconsistency, imprecision, and publication bias. Conclusion Tai Chi might be safe and showed beneficial effects on health status in patients with CHF. However, more high-quality and long-term studies are still needed to further evaluate the effects of Tai Chi.
... Tai Chi Quan, often just called Tai Chi, is widely known as a healthy form of exercise, especially for older adults and individuals with chronic diseases (Hempel et al., 2014;Chen et al., 2016). As a style of Chinese martial arts (Wushu), Tai Chi includes defined motion sequences performed with and without weapons (e.g. ...
... In the past few decades, a considerable number of studies, systematic reviews and meta-analyses concerning Tai Chi have been published. Most of them deal with health aspects of Tai Chi, e.g. its effects on individuals with chronic obstructive pulmonary disease (COPD) (Chen et al., 2016;Wang et al., 2019), type 2 diabetes mellitus (Zhou et al., 2019), coronary heart disease (Liu et al., 2018) or its ability to improve balance and mobility in individuals with Parkinson disease (Hackney and Earhart, 2008). A meta-analysis examining the effect of Tai Chi training on muscle strength, physical endurance, postural balance and thoracolumbal spine flexibility revealed significant enhancement of the standing time in single-leg-stance with open eyes and of thoracolumbal spine flexibility (Wehner et al., 2021). ...
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The impact of spinal mobility and sagittal spinal shape on the development of balance impairment supports the hypothesis that enhancing spine flexibility results in an improvement in postural balance ability. Therefore, the aim of this study was to investigate whether the range of motion of thoracolumbar rotation during the movements of the Tai Chi Peking style routine is sufficient to improve thoracolumbar flexibility. Three-dimensional kinematic and kinetic data were collected from eight athletes of the German Wushu Federation, while performing all movements of the entire Peking style routine (1) in a competition version corresponding to national/international championships and (2) in a health sport version performed with shorter and higher stances (i.e. a smaller distance between the feet and thus less knee flexion). For each movement the total mean and standard deviation values for the total range of motion of thoracolumbar rotation was calculated. Statistical analysis was performed using the Wilcoxon signed-rank test for paired differences. Eight movements showed major differences (10.12–19.73◦) between the two versions. For the remainingmovements, only minor differences (0.7–9.56◦) were observed. All movements performed on both sides showed no significant lateral differences. Most of the Tai Chi movements, regardless of the performed version, cover a range of motion of thoracolumbar rotation that has the potential to lead to an improvement of thoracolumbal spine flexibility with appropriate training. The most effective single movements (25.97–72.22◦) are Brush Knee and Step Forward, Step Back and Repulse Monkey, Grasp the Sparrow‘s Tail, Wave Hand in the Clouds, and Fair Lady Weaves with Shuttle.
... In senior female cancer survivors, TCC affects systolic blood pressure and cortisol area-under-curve which may regulate the endocrine system (35). In general, TCC plays a good role in improving the quality of life (QOL) in cancer patients (36). TCC is recommended to patients with chronic conditions for multi-effects, easily learning, good safety, and low-cost (28). ...
... American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline recommends that primary care clinicians should counsel breast cancer patients to engage in regular physical activity to reduce cancer-related fatigue, musculoskeletal symptoms, pain, and obesity (86). Previous meta-analyses discovered that TCC improved psychological wellbeing including reduced stress, anxiety, depression and mood disturbance, and physical function in people with cancer (36,87). In this review, TCC improved pain, shoulder function, strength of arm, and anxiety in breast cancer patients in 12 weeks, and also increased QOL in 12 and 25 weeks. ...
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Background: Tai Chi Chuan(TCC), as a mind-body exercise, may have a positive impact on physical function and psychological well-being in breast cancer patients. The latest systematic review and meta-analysis of TCC for breast cancer was made 4 years ago and some new clinical trials about it were published. We remade a systematic review and meta-analysis to evaluate the effect of TCC in breast cancer patients. Methods: In this systematic review and meta-analysis, we searched MEDLINE (via PubMed), EMBASE (via embase.com), CENTRAL, CNKI, COVIP, Wanfang, Chaoxing, CiNii, J-SSTAGE, DBpia, and ThaiJO with no language restrictions from inception to December 31, 2018 (updated on February 16, 2020), for randomized clinical trials comparing TCC with non-exercised therapy in breast cancer patients. The primary outcome was quality of life in patients with breast cancer and data pooled by a random-effects model. Subgroup analyses were conducted to estimate the effect of different durations of TCC for breast cancer patients. This study was registered in PROSPERO, number CRD 4201810326. Results: Fifteen articles involving a total of 885 breast cancer participants were included in this review. Compared with non-exercised therapy, TCC had a significant effect on quality of life in breast cancer patients (SMD = 0.37, 95% CI 0.15–0.59, p = 0.001), and subgroup analysis found that TCC showed beneficial effect in 12 weeks and 25 weeks (12 weeks: SMD = 0.40, 95% CI 0.19–0.62, p = 0.0003; 25 weeks: SMD = 0.38, 95% CI 0.15–0.62, p = 0.002). Meta-analyses of secondary outcomes showed that 3 weeks TCC increased shoulder function (SMD = 1.08, 95% CI 0.28–1.87, p = 0.008), 12 weeks TCC improved pain (SMD = 0.30, 95% CI 0.08–0.51, p = 0.007), shoulder function (SMD = 1.34, 95% CI 0.43–2.25, p = 0.004), strength of arm (SMD = 0.44, 95% CI 0.20–0.68, p = 0.0004), and anxiety (MD = −4.90, 95% CI −7.83 to −1.98, p = 0.001) in breast cancer patients compared with the control group. Conclusions: TCC appears to be effective on some physical and psychological symptoms and improves the quality of life in patients with breast cancer. Additional randomized controlled trials with a rigorous methodology and low risk of bias are needed to provide more reliable evidence.
... However, different types of tai chi have a common method. All of the styles involve continuous, gentle and slow movements involving balance, strengthening, breath control, mental concentration and relaxation (9). Tai chi can therefore play a role in both physical and mental rehabilitation. ...
... Tai chi has potential benefits in treating different diseases, including chronic obstructive pulmonary disease (16), Parkinson's disease (17), osteoarthritis (18) and stroke (19). Thus, tai chi may be a suitable exercise for individuals with chronic diseases (9,20). ...
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Objective: To systematically synthesize and critically evaluate evidence on the effects of tai chi for patients with type 2 diabetes mellitus. Data sources: Seven electronic databases (Wan Fang, SinoMed, China National Knowledge Infrastructure, VIP, PubMed, Embase, and Cochrane Library) were systematically searched from their inception to March 2018. Study selection: Randomized controlled trials investigating the effects of tai chi on individuals with type 2 diabetes mellitus were eligible. Data extraction: Biomedical outcomes (fasting plasma glucose, glycosylated haemoglobin (HbA1c), fasting insulin, insulin resistance, body mass index, total cholesterol, blood pressure) as well as balance and quality of life-related outcomes were extracted independently by 2 reviewers. Stata 12.0 software was used to synthesize data if there was no or moderate heterogeneity across studies. Otherwise, narrative summaries were performed. Data synthesis: A total of 23 studies (25 articles) involving 1,235 patients were included in this meta-analysis. Significant changes in tai chi-related effects were observed in lowering fasting plasma glucose (standardized mean difference; SMD –0.67; 95% confidence interval (95% CI) –0.87 to –0.47; p
... 45 However, in our study, chronic heart failure participants in the Tai Chi groups did not have a significant improvement in QOL, but had significantly less depression and psychological distress, compared with controls. These results are similar to findings in a prior meta-analysis examining the benefits of Tai Chi among adults with chronic heart failure, 46 though are in contrast to other meta-analyses reporting significantly better QOL in Tai Chi participants among adults with chronic heart failure. 47,48 In our study, we found hypertensive participants in Tai Chi groups had significantly better physical health QOL compared with controls. ...
Article
Background Regular exercise is beneficial for adults with cardiovascular disease to improve psychological well-being. Tai Chi is a mind–body exercise thought to promote psychological well-being. Aim Examine the efficacy of Tai Chi in improving psychological well-being among persons with cardiovascular disease. Methods An electronic literature search of 10 databases (AMED, CINAHL, Embase, OpenGrey, PsycARTICLES, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science) was conducted. Clinical trials that examined one or more aspect of psychological well-being, incorporated a Tai Chi intervention among cardiovascular disease participants, and were published in English or German languages were included. Comprehensive Meta-Analysis version 2.0 software (Biostat, Inc.) was used to calculate the effect sizes (i.e. Hedges’ g) and the 95% confidence intervals using random effects models. Results A total of 15 studies met the inclusion criteria, enrolling 1853 participants (mean age = 66 years old, 44% women). Outcomes included: quality of life (QOL), stress, anxiety, depression, and psychological distress. When Tai Chi was compared with controls, significantly better general QOL (Hedges’ g 0.96; p=0.02, I ² =94.99%), mental health QOL (Hedges’ g=0.20; p=0.01, I ² =15.93) and physical health QOL (Hedges’ g=0.40; p=0.00, I ² =0%); with less depression (Hedges’ g=0.69; p=0.00, I ² =86.64%) and psychological distress (Hedges’ g=0.58; p=0.00, I ² =0%) were found. Conclusions Few Tai Chi studies have been conducted during the past decade examining psychological well-being among older adults with cardiovascular disease. Further research is needed with more rigorous study designs, adequate Tai Chi exercise doses, and carefully chosen outcome measures that assess the mechanisms as well as the effects of Tai Chi.
... Similarly, as far as we could determine, searches of research databases in the NTR 2014-15 also did not include broader terms such as either "meditative movement" or "mind-body" therapies, which by definition includes Tai Chi, Qigong and Yoga (Larkey et al., 2009; U.S. Dept Human Services and Health, 2019), and have previously been examined in systematic reviews for chronic, non-communicable disease processes (Chen et al., 2016;Klein et al., 2019;Lee & Ernst, 2012). ...
Technical Report
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In 2019, the Australian Government removed 16 natural therapies, including tai chi, from the list of rebated therapies for private health insurance, on the basis of a lack of reliable research evidence. The review of evidence that informed this decision related to published studies between 2008 to 2014. This submission brings the research evidence supporting tai chi as a form of aerobic exercise of light-to-moderate intensity, up to date, citing selected higher quality systematic reviews published between 2015 and early 2020, evidencing tai chi as an intervention for disease processes in all of the major physiological systems in humans. The submission also identifies over 30 Australian and International peak representative medical and health organisations who recommend tai chi, generally, and/or in clinical practice guidelines for these specific disease processes.
... 11 12 TC has been shown to beneficially affect multiple physical and psychological processes in both healthy and chronic disease populations, such as cardiovascular, neurological and chronic pain conditions. [13][14][15] Studies have reported benefits including musculoskeletal strength, flexibility, balance, fall prevention, as well as improved cardiovascular indices, mood, stress and cognitive function, supporting TCs safety and promise for prevention and rehabilitation. [16][17][18] A number of components of TC may be relevant to the treatment of deconditioned, pulmonary patients with COPD (eg, physical exercise, breathing training, mindbody awareness, stress management), 19 20 however, there have been few large-scale studies of TC in COPD. ...
Article
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Background Despite therapeutic advances, the management of chronic obstructive pulmonary disease (COPD) remains complex. There is growing interest in multidimensional, mind-body exercises to improve both physical and psychosocial aspects of COPD burden. Few US data are available in this population on tai chi (TC) a mind-body exercise incorporating physical activity, breathing and mindful awareness. We explored feasibility and preliminary efficacy of TC in COPD in an US academic medical setting. Methods Patients with COPD Global Obstructive Lung Disease (GOLD) stages 2–4 were randomised to a 12-week TC programme or education control. At 12 weeks, those in TC were randomised again to continue in maintenance classes or not to further explore optimal duration. All groups were followed to 24 weeks. Feasibility/safety parameters were analysed descriptively. Preliminary between-group differences were estimated in symptoms (dyspnoea, fatigue), health-related quality-of-life (Chronic Respiratory Questionnaire CRQ), cognitive-emotional measures (mood, COPD self-efficacy) and functional status (6 min walk test, lower body strength, flexibility, physical activity). Results Ninety-two subjects were randomised (N=61 TC, N=31 education). Mean age was 68±8 years, 66% male, mean forced expiratory volume in 1 s % predicted 57±13, 28% were GOLD stage 3–4. Overall retention was 85%. Nineteen adverse events occurred, most being study-unrelated COPD exacerbations. From baseline to 12 weeks, there were between-group improvements favouring TC, in CRQ-total (Cohen’s d effect size (ES)=0.46; adj mean diff (AMD)=0.31), CRQ-emotion (ES=0.54; AMD=0.49), Centre for Epidemiologic Studies Depression (ES=−0.37; AMD=2.39) and Patient-Reported Outcome Measurement Information System (PROMIS)-fatigue (ES=−0.34; AMD=−0.17). From baseline to 24 weeks, there was an improvement favouring TC in CRQ-dyspnoea (ES=0.41; AMD=0.46). Among TC participants, there was a positive effect of maintenance classes on self-efficacy (ES=−0.69; AMD=−0.40), 6 min walk (ES=0.56; AMD=49.26 feet), PROMIS-fatigue (ES=−0.41; AMD=−0.28) and chair stand (0.43; AMD=0.56). Conclusion TC in patients with COPD is feasible and safe. Preliminary analyses support a potential modest role in improving quality-of-life, cognitive-emotional health and function that should be further studied. Trial registration number NCT01551953 . IRB reference BIDMC 2010P-000412; VA 2540.
... As well as the stand alone studies highlighted above, available meta-analyses have been generally in favor of Tai Chi form of intervention as outlined below by Wang et al. [44], Yan et al. [45], Chen et al [46]. Tai Chi also appears to improve disease-specific symptoms of pain and stiffness in osteoarthritis, and appears safe for individuals with different chronic conditions, including chronic obstructive airways disease, heart failure and frailty. ...
Article
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This article specifically focuses on examining the efficacy of various forms of Tai Chi as intervention strategies for minimizing osteoarthritis disability, and for fostering independence and life quality. To this end, the author attempted to include a broad overview of all relevant articles published in the English language on the topic, rather than any systematic review. Collectively, these data reveal that while more research may be helpful, Tai Chi─practiced widely in China for many centuries as an art form, as well as a religious ritual, relaxation technique, exercise, and self-defense method─may be a very useful intervention strategy for older adults in the community diagnosed as having osteoarthritis, as well as for reducing associated health problems that heighten COVID-19 risk.
... These results seem to be consistent with those obtained from various populations living with chronic disease. In fact, results from systematic reviews show that Tai Chi improves physical performance in people living with cancer, osteoarthritis, heart failure and chronic obstructive pulmonary disease [178], as well as with symptoms of depression and anxiety in elderly and other populations living with chronic disease [16]. The practice of Qigong also seems to have a positive effect on the severity of depressive symptoms in people living with chronic disease [179]. ...
Article
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Background Mind-body practices are frequently used by people living with HIV to reduce symptoms and improve wellbeing. These include Tai Chi, Qigong, yoga, meditation, and all types of relaxation. Although there is substantial research on the efficacy of mind-body practices in people living with HIV, there is no summary of the available evidence on these practices. The aim of this scoping review is to map available evidence of mind-body practices in people living with HIV. Methods The Arksey and O’Malley (Int J Soc Res Methodol 8:19-32, 2005) methodological framework was used. A search of 16 peer-review and grey literature databases, websites, and relevant journals (1983–2015) was conducted. To identify relevant studies, two reviewers independently applied the inclusion criteria to all abstracts or full articles. Inclusion criteria were: participants were people living with HIV; the intervention was any mind-body practice; and the study design was any research study evaluating one or several of these practices. Data extraction and risk of bias assessment were performed by one reviewer and checked by a second, as needed, using the criteria that Cochrane Collaboration recommends for systematic reviews of interventions (Higgins and Green, Cochrane handbook for systematic reviews of intervention. 2011). A tabular and narrative synthesis was carried out for each mind-body practice. Results One hundred thirty-six documents drawing on 84 studies met the inclusion criteria. The most widely studied mind-body practice was a combination of least three relaxation techniques (n = 20), followed in declining order by meditation (n = 17), progressive muscle relaxation (n = 10), yoga (n = 9) and hypnosis (n = 8). Slightly over half (47/84) of studies used a RCT design. The interventions were mainly (46/84) conducted in groups and most (51/84) included daily individual home practice. All but two studies were unblinded to participants. Conclusion The amount of available research on mind-body practices varies by practice. Almost half of the studies in this review were at high risk of bias. However, mindfulness, a combination of least three relaxation techniques and cognitive behavioral strategies, and yoga show encouraging results in decreasing physical and psychological symptoms and improving quality of life and health in people living with HIV. More rigorous studies are necessary to confirm the results of Tai Chi, Qigong, and some relaxation techniques.
... It is possible that the frail individuals in the studies did not have impaired strength to the point of exhibiting an improvement after exercise. Some studies indicate that an improvement of the lower limb muscle strength occurs in conditioned individuals (Chen, Hunt, Campbell, Peill, & Reid, 2016;Liu, Liu, Zhu, Mo, & Cheng, 2011;Manson, Rotondi, Jamnik, Ardern, & Tamim, 2013). ...
Article
Objective Investigate the effects of complementary therapies on functional capacity and quality of life among prefrail and frail older adults. Materials and Method An electronic search was performed in the PubMed, EMBASE, Web of Science, Cochrane Library, LILACS and PEDro databases for relevant articles published up to September 2019. Only randomized controlled trials with interventions involving complementary therapies for prefrail and frail older adults were included. This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Cochrane recommendations. The methodological quality of the selected studies was appraised using the PEDro scale and the evidence was synthesized using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) scale. Results Fifteen studies met the inclusion criteria and were selected for the present review. Six different complementary therapies were identified and the main findings were related to Tai Chi. A very low to moderate level of evidence was found regarding the effectiveness of Tai Chi in terms a functional capacity (balance, mobility, gait speed, functional reach and lower limb muscle strength) and a low level of evidence was found regarding its effect on quality of life. To the other complementary therapies it was not possible to synthetize evidence level. Conclusion Tai chi may be used as an important resource to improve functional capacity and quality of life among prefrail and frail older adults.
... So far, we did a search of related SRs and retrieved 18 published meta-analyses. [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] We used A Measurement Tool to Assess systematic Reviews 2.0 (AMSTAR 2.0) [41] to evaluate the quality of 18 included metaanalyses. The results of AMSTAR 2.0 showed that 17 SRs were considered critically low methodological quality and 1 SR was DZ, QX, and MH contributed equally to this work. ...
Article
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Introduction: To investigate the effectiveness and safety of Tai Chi for improving balance and reducing falls on people. Methods and analysis: The following databases will be searched: China Biology Medicine (CBM), China National Knowledge infrastructure (CNKI), Wan Fang Data, the Chinese Science and Technology Periodical Database (VIP), Medline, EMBASE, Web of Science, The Cochrane Library from inception to March 2019. All randomized controlled trials (RCTs) utilized Tai Chi to improve balance ability and reduce falls will be included. Primary outcomes are the fall-related indicators, including the number of falls, fall rate, and other fall-related outcomes. Additional outcomes include the Berg Balance Scale (BBS), standing-walk test, single-legged time, or other balance-related outcomes. Study selection, data extraction, and quality assessment will be performed independently by 2 reviewers. Assessment of risk of bias and data synthesis will be performed using Review Manager V5.3 software. Ethics and dissemination: The findings of this systematic review will be disseminated through peer-reviewed publication or conference presentations.Trial registration number PROSPERO CRD42019127810.
... Tai Chi is a traditional Chinese health-promoting exercise which has a supportive broad appeal in China, and it is easy to perform in parks or communities. Evidence has shown that Tai Chi can improve HRQoL, 9 insomnia, 10 fatigue, 11 and physical performance outcomes 12 in cancer survivors. The safety and health benefits of Tai Chi exercise have been documented in a large number of clinical studies focused on specific diseases and health conditions while in cancer populations studies have mainly been conducted in individuals with breast cancer. ...
Article
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Objective To assess the feasibility, safety, and preliminary effect of a 12-week multi-modal rehabilitation program targeted at improving health-related quality of life and physical activity levels of patients with lung cancer following treatment. Methods Patients with stage I to IIIA non-small cell lung cancer were included 6 to 12 weeks following completion of treatment. The intervention comprised of aerobic exercise (brisk walking), resistance training and 8-style Tai Chi. The 12-week program included 2 supervised center-based sessions per week of 90 minutes duration and home-based exercise. The primary outcomes were the feasibility and safety of the intervention. Secondary outcomes (assessed pre and post program) were physical and patient-reported outcomes. Results Seventy-eight patients were approached during the 6-month recruitment period and 17 (22%) consented to the study. Eight participants (47%) met the definition of adherence to the program (attending at least 70% of supervised sessions). No serious adverse events occurred. A significant reduction in anxiety and depression was observed post-program. In addition, improvements in respiratory function, sleep quality, and some health-related quality of life domains were observed post-program. There were no significant differences in functional capacity or physical activity levels. Conclusion This multi-modal exercise training program was safe, although the feasibility of the program in its current state is not supported given the low consent rate and low adherence to the intervention.
... The primary outcome measures of the reviews included short and long-term cancer-related fatigue, quality of life, aerobic capacity, muscular strength, and flexibility. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Although adjusting the immune system can offer potential benefits to cancer survivors, there is no systematic review evaluating the effect of Tai Chi on immune system in cancer patients thus far. Khosravi et al [40] conducted separate meta-analyses in cancer survivors to determine the effects of exercise training on pro-and antiinflammatory markers, and immune cell proportions and function. ...
Article
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Background: Tai Chi has been reported to be potentially effective for health and well-being of cancer survivors. It is worth to assess the effectiveness and safety of Tai Chi on immunological function in people with cancer. Methods: All relevant randomized controlled trials (RCT) will be reviewed on Tai Chi for immunological function in cancer survivors. Literature searching will be conducted until March 9, 2019 from major English and Chinese databases: Cochrane Library, Excerpta Medica Database (EMBASE), PubMed, CINAHL, Sprotdicus, American Association for Cancer Research Journals, Sino-Med database, China National Knowledge Infrastructure, Chinese Science and Technique Journals Database, and Wanfang Data Chinese database. Two authors will conduct data selection and extraction independently. Quality assessment will be conducted using the risk of bias tool recommended by the Cochrane Collaboration. We will conduct data analysis using Cochrane's RevMan software (V.5.3). Forest plots and summary of findings tables will illustrate the results from a meta-analysis if sufficient studies with the same outcomes are identified. Funnel plots will be developed to evaluate reporting bias. Results: This review will summarize the evidence on Tai Chi for immunological function in cancer survivors. Conclusions: We hope that the results of this study will provide significant evidence to assess the value Tai Chi practice on immunological function in cancer survivors. Ethics and dissemination: Ethics approval is not required as this study will not involve patients. The results of this study will be submitted to a peer-reviewed journal for publication.
... Like yoga, tai chi has mostly been investigated for musculoskeletal pain conditions including knee osteoarthritis, chronic neck and low-back pain, and fibromyalgia. Systematic reviews have reported that tai chi is effective for reducing pain and functional disability in chronic musculoskeletal pain patients [69][70][71][72]. ...
Thesis
Pain is the most common symptom for which people seek medical care. Chronic pain is common worldwide, and often not treated adequately, thereby leading to reduced quality of life and high healthcare costs. Recently, there has been increasing attention toward the complexity and biopsychosocial nature of pain, and the need for multidisciplinary pain management has been increasingly acknowledged. Various mind-body interventions are being used for pain management, and some of them have been found to be effective. Slow, deep breathing is a commonly applied mind-body intervention for the management of pain. Some of the previous experimental studies found an influence of slow, deep breathing on pain outcomes. However, the results have not been consistent across studies and the underlying mechanisms are largely unknown. Some of the proposed mechanisms are emotional and cognitive modulation of pain perception and stimulation of the arterial baroreceptors and pulmonary vagal afferents. The aim of this Ph.D. project was to evaluate the effect of slow, deep breathing on pain perception in healthy subjects and to investigate the underlying psychophysiological mechanisms. To further investigate the arterial baroreceptors and pulmonary vagal afferents as possible mechanisms for the hypoalgesic effects of slow, deep breathing, we first determined whether adding an inspiratory threshold load to slow, deep breathing can enhance its effects on the cardiovascular responses (Chapter 3). We found an increase in the amplitude of blood pressure variation accompanied by an increase in respiratory sinus arrhythmia in response to increasing loads, suggesting that applying inspiratory threshold loads during slow, deep breathing results in stronger stimulation of the arterial baroreceptors. In a complementary study (Chapter 4) we compared four slow, deep breathing techniques (loaded slow, deep breathing, left and right unilateral nostril breathing, and pursed-lips breathing) with regards to psychophysiological responses. We found that loaded slow, deep breathing and pursed-lips breathing techniques are associated with a larger amplitude of blood pressure variation and respiratory sinus arrhythmia, suggesting stronger stimulation of the arterial baroreceptors with these techniques. Moreover, the pursed-lips breathing technique was associated with lower emotional arousal and more pleasantness and a sense of control. Based on these two studies, we investigated the effect of loaded slow, deep breathing and pursed-lips breathing on somatic pain perception (Chapter 5). We found that loaded slow, deep breathing, but not pursed-lips breathing, reduces pain intensity compared with a control condition. However, physiological responses to loaded slow, deep breathing did not mediate its effect on pain perception. Finally, we evaluated the effect of slow, deep breathing on visceral pain perception. We found that slow, deep breathing reduces visceral pain intensity compared with uncontrolled breathing, but the effect is similar to controlled breathing at normal breathing frequency. Physiological and emotional responses to slow, deep breathing did not mediate its effects on visceral pain perception. The studies in this PhD project helped us to better test and understand the role of different psychophysiological mechanisms in somatic and visceral pain modulation by slow, deep breathing. Overall, our studies do not support the role of baroreceptors and vagal afferents stimulation as possible mechanisms mediating the effect of slow, deep breathing on pain perception, suggesting other potential mechanisms, notably attentional modulation may be at play. Further experimental studies are required to better investigate the role of attentional and emotional modulation on pain inhibition by breathing exercises. Also, clinical studies are required to test whether breathing exercises can modulate pain perception in various patient populations and if so, the underlying mechanisms will need elucidation.
... First, it is recommended that people with chronic diseases, such as chronic obstructive pulmonary disease, Parkinson disease, and breast cancer, learn t'ai chi or qigong to improve their quality of life. [2][3][4][5][6][7][8][9][10][11] Qigong can also improve cognitive function in the early stages of dementia, 12 whereas TCM decoctions can be used as adjuvant treatment for patients with stroke and chronic obstructive pulmonary disease, chronic liver disease, chronic heart failure, and chronic or type 2 diabetic kidney disease. [13][14][15][16][17][18][19][20][21][22][23][24][25][26] Second, TCM can improve symptoms. ...
... The latter's focus is usually on health rather than martial applications. A large number of clinical studies focusing on specific diseases and health conditions, such as hypertension, diabetes, osteoarthritis, osteoporosis or osteopenia, cancer, heart failure, chronic obstructive pulmonary disease, coronary heart disease, schizophrenia, and depression, have documented the safety and health benefits of Tai Chi (41)(42)(43)(44)(45)(46). Tai chi is a Chinese martial art that can help older people avoid falling (47). ...
Article
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Background: The contagious COVID-19 coronavirus was first identified in Wuhan city of China and its rapid spreading led to the historic nationwide lockdown of China from January to April 2020, which imposed a heavy impact on both the routine life and the mental health. The international students studying in China experienced this lockdown, during which their stress, anxiety and the coping strategies employed need to be explored. Methods: One hundred international students studying in different provinces/cities in China were surveyed by completing online questionnaire to evaluate the stress and anxiety and to identify the factors responsible for the stress and the effective coping strategies used during the nationwide lockdown of China. Results: The study reveals that 84% of the students were worried about the pandemic while 70% of students were observed to be stressed at the self-identified medium level during the nationwide lockdown. Factors closely related to study performance were the most influential for international students. Indoor aerobic physical exercises were most widely employed by international students to cope with stress. In this study, we also noticed that 15% of international students did not do any particular activities to cope with stress or use alcohol or smoking as a stress-coping strategy. Conclusion: The study recommends that international students in China need to be trained and educated in stress awareness and coping to improve their physical and mental health for better academic performance during an emergency situation like a nationwide lockdown.
... Since Tai Chi exercise relies heavily on horse stance or single leg, knee joints are in a state of weight bearing for a long time. Practitioners with insufficient lower body muscle strength are highly likely to suffer from severe strain in their own knee joints and lower limb muscles, which harms patients' rehabilitation [15]. ...
Article
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Objective: To determine whether lower body strength such as keen extension and flexion strength may be improved by Tai Chi exercise in older adults from the perspective of evidence-based medicine. Methods: Databases of PubMed, Embase, and Cochrane Library were searched up to July 1, 2021. Randomized clinical trials are adopted to compare Tai Chi exercise with sedentary behavior or other low intensity exercise in terms of influence on lower body strength rehabilitation, especially keen extension and flexion strength in people aged over 60. A meta-analysis was performed to discuss outcomes of lower body strength, knee muscle strength, and knee extension/flexion strength. Results: A total of 25 randomized trials involving 1995 participants fulfilled the inclusion criteria. (1) Tai Chi exercise significantly improved elderly lower body strength (-0.54, [-0.81, -0.28], p < 0.00001, I 2 = 74%), but there was no differential improvement in the strength of the knee joints (0.10, [-0.02, 0.23], p=0.11, I 2 = 34%). (2) Elderly individual lower body strength declined with age, while this trend was suppressed by Tai Chi exercise (-0.35, [0.14, 0.56], p=0.001, I 2 = 70%). (3) Although Tai Chi exercise did no significantly improve the large muscle group of knee joint extensor like quadriceps femoris (3.15, [-0.69, 6.99], p=0.24, I 2 = 26%), it showed marked enhancement to the strength of deep small muscle group of knee joint flexor (10.25, [6.90, 13.61], p < 0.00001, I 2 = 0%). The heterogeneity might be caused by distinguished measurements of muscle strength. Therefore, Tai Chi exercise specifically enhanced some certain muscle strength of knee joints and improved muscle fitness rehabilitation as well as function activity for elderly. Conclusions: In this RCT meta-analysis, Tai Chi exercise has positive effects on lower body strength of elderly. Although no obvious improvement on the knee extensor is observed, it may be used as a rehabilitation treatment for training stable deep muscle groups to improve the knee flexion strength significantly.
... Tai Chi is a popular exercise in Chinese society, consisting of slow, gentle, and flowing movements that involve strengthening, balance, postural alignment, mind concentration, relaxation, and breath control [7]. Tai Chi has multifaceted benefits to improving health-related fitness, such as lower extremity muscle strength, balance, flexibility, and cognitive problems [8,9]. ...
Article
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Objective: Parkinson's disease adversely affects function and quality of life, leading to increased mortality. The practice of Tai Chi has been associated with multifaceted improvements in health-related fitness. Considering the limited number of clinical studies included in previous reviews, inconsistent methodological quality, and inconclusive results, this meta-analysis aims to assess the effects of Tai Chi in patients with Parkinson's disease. Method: Four English language databases and four Chinese databases were systematically searched for existing randomized controlled trials (RCTs) of Tai Chi in Parkinson's disease from database inception through August 1, 2020. Methodological quality was appraised with the Cochrane Risk of Bias tool. A meta-analysis of comparative effects was performed using the Review Manager v.5.3 software. Results: Seventeen published RCTs totaling 951 subjects were included. Results showed that Tai Chi has a statistically significant effect on the outcomes of gait velocity, unified Parkinson's disease rating scale (UPDRS) motor score, activities-specific balance confidence (ABC) score, and Berg Balance Scale (BBS). The effects on the Timed Up and Go Test (TUGT) and Parkinson's Disease Questionnaire-39 (PDQ-39) were not statistically significant. Conclusions: This systematic review and meta-analysis of Parkinson's disease and Tai Chi suggests Tai Chi is a relatively safe activity that can result in gains in general motor function and improve bradykinesia and balance. It has no statistically significant advantage for quality of life and functional mobility. Further randomized trials with larger sample sizes and of higher methodological quality are needed to confirm these results and to assess the feasibility of Tai Chi intervention for potential different clinical applications.
... MBE have shown good analgesic effects in the elderly with KOA and CLBP. Moreover, the recent metaanalysis (Morone and Greco, 2007;Chen et al., 2016;Zhang et al., 2017) results of separately summarizing KOA also demonstrated that TC and qigong have a good pain relief effect. However, due to the small sample size and high heterogeneity of CLBP, this effect needed to be carefully explained. ...
Article
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Background Aging is a significant risk factor in chronic pain development with extensive disability and greater health care costs. Mind-body exercise (MBE) has been scientifically proven to affect the pain intensity and physical health. Objectives To assess the effects of MBE modes (Tai Chi, yoga, and qigong) for treating chronic pain among middle-aged and old people, compared with nonactive and active treatment, as well as function, quality of life, and adverse events. Methods We searched PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chinese Scientific Journals Full-Text Database (VIP) till March 2022. No restrictions were chartered within the year and language of publication. We included randomized controlled trials of MBE treatment in middle-aged and elderly people with chronic pain. The overall certainty of evidence was evaluated by using the GRADE approach. Results A total of 17 studies ( n = 1,332) were included in this review. There was low-certainty evidence indicating that MBE had a moderate effect on reducing pain compared with the nonactive and active control group (standard mean difference (SMD): −0.64, 95% confidence interval (CI): −0.86 to −0.42, P < 0.001). Very-low-certainty evidence showed that the pooled SMD for the functional improvement was −0.75 (95% CI: −1.13 to −0.37, P < 0.001). Low-certainty evidence presented that no influence was observed in physical component summary (SMD: 0.23, 95% CI: −0.16 to 0.62, P = 0.24) and mental component summary (SMD: −0.01, 95% CI −0.39 to 0.36, P = 0.95). Conclusion Our results indicated that MBE was an effective treatment for reducing symptoms of middle-aged and elderly people with chronic pain compared with nonactive and active control groups. TC and qigong had obvious benefits for knee osteoarthritis in self-reported function, but the efficacy of chronic low back pain was uncertain. No significant benefit of MBE on quality of life in older adults with chronic pain was found. More high-quality RCTs should be conducted to explore the efficacy and mechanism of MBE on chronic pain in middle-aged and elderly people from various dimensions, such as affective and cognitive dimensions. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=316591 , identifier CRD42022316591.
... Being a versatile movement-based inter-vention, Tai Chi improves the general physical state in patients with various chronic diseases (Chen, Hunt, Campbell, Peill, & Reid, 2016). Tai Chi strengthens the musculoskeletal system and enhances the psychomotor reactivity. ...
... TCQ has been shown to be safe and effective at promoting aerobic cardiovascular fitness, muscle strength, emotional functioning, and quality of life in patients with a variety of chronic conditions, such as chronic heart failure, cancer, osteoarthritis, and pulmonary disease (Chen et al., 2016;Song et al., 2017;Taylor-Piliae & Finley, 2020). A study comparing Tai Chi with physical therapy for patients with knee osteoarthritis found the two treatments to be similar in improving pain, physical function, and stiffness, although the Tai Chi group showed significantly better improvements in depression and the physical component of quality of life ). ...
Article
Background Trauma exposure and posttraumatic stress are highly prevalent and comorbid with health problems. Despite the apparent systemic nature of posttraumatic stress, recommended treatments neglect trauma's deleterious effects on health. Integrative mind-body treatments for posttraumatic stress, such as Tai Chi and Qigong (TCQ), may offer a promising adjunct to first-line treatments. Method A systematic search was conducted to identify trials that examined Tai Chi and/or Qigong as treatments for trauma-exposed populations. Studies were examined for rigor; design, sample and intervention characteristics, dropout, attendance, satisfaction, acceptability, and key findings were systematically extracted. Results The 7 studies included are all pilot or feasibility trials with descriptive or mixed-methods outcomes. No randomized trials or rigorous studies were identified. Dropout rates ranged widely, and adverse reactions were not evident. Reported satisfaction was high and benefits of relaxation, reductions in mental health symptoms, and improvements in pain and physical and cognitive functioning were noted. Limitations All the studies were non-rigorous and relatively small, with no comparison groups, or follow-up assessments; in many cases, posttraumatic stress symptoms were not formally assessed. Conclusions The paucity and lack of rigor of the studies identified for this review highlights the need for larger, methodologically sound clinical trials. The reviewed studies suggest that TCQ practices have the potential to reduce symptoms and improve functioning for individuals exposed to trauma and provide evidence that TCQ is feasible, acceptable, and low risk in these populations. Possible mechanistic pathways supporting TCQ as a treatment for posttraumatic stress are considered.
... Of these 12 SRs, six 24-29 studies were written in Chinese and six 11,[30][31][32][33][34] in English. They were published from 2013 to 2021. ...
Article
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Objective: Since current systematic reviews (SRs) show that results of effectiveness on Tai Chi for chronic obstructive pulmonary disease (COPD) are inconsistent, the purpose of this study is to find the reasons of the disparity by comprehensively appraising the related SRs. Methods: Six databases were systematically searched from the inception date to April 17, 2021. The methodological quality, the risk of bias, the reporting quality, and the quality of evidence were independently assessed by two reviewers with the AMSTAR 2, ROBIS, PRISMA, and GRADE. Results: A total of 12 studies met the inclusion criteria: 10 SRs were rated critically low quality and two SRs were low quality by AMSTAR 2. By the ROBIS, four out of 12 SRs were rated as "low risk". According to PRISMA, nine out of 12 SRs were adequately reported over 80%. With the GRADE tool, three out of 12 SRs rated the FEV1 as "Moderate", one out of 12 SRs (1/12, 9%) rated the FEV1/FVC (%) as "Moderate", three out of 12 SRs assessed the 6MWD as "Moderate", three out of 12 SRs evaluated the SGRQ as "Moderate", and the remaining evidence was fully rated as "Low" or "Very Low". Conclusion: We found that the methodological quality, risk of bias, reporting quality, and quality of evidence of the included SRs on Tai Chi for COPD were suboptimal. These limitations may have a negative impact on SRs, consequently leading to inconsistent results. Further well-conducted SRs with less risk of bias, more rigorous methodology, normative reporting and high-quality of evidence are needed to provide robust evidence on Tai Chi for COPD. Registration number: This study has been registered in the PROSPERO International Prospective Register of Systematic Reviews (registration number: CRD42019126600).
... Tai Chi, which originated in China, is a systematic aerobic exercise training and is considered a suitable medium-intensity exercise training for patients with COPD. A Meta-study by Wu et al 45 , which included 824 patients with COPD, reported that compared with other exercise training, Tai Chi has a higher safety coefficient and for patients in stable phase, it can improve their dyspnea symptoms, increase exercise endurance and has a positive effect on BODE index, mental health status and quality of life. Chen et al 46 suggested that Tai Chi can produce a stimulus similar to the effect of a treadmill on physiology of patients with COPD by exercising the muscles and joints of the whole body, making respiratory muscle fibers thicker, thus reducing respiratory rate and increasing the depth of effective breathing. ...
Article
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Pulmonary rehabilitation (PR) is an important part of the management of COPD, which can reduce symptoms of dyspnea, times of hospitalizations, and improve exercise capacity and health-related quality of patients. As a key element of PR, PR exercise training consists of exercise assessment and training methods. Exercise assessments should include the evaluation of dyspnea, exercise capacity, and health-related quality of life. Following a thorough assessment of patients, individualized exercise training programs, including endurance, resistance, and other exercise training methods, should be developed based on physiologic requirements and individual demands of patients. Although there have been many studies on the types of exercise for patients with COPD, there are still no conclusions about how to develop the best exercise prescription. Choosing the most appropriate methods for patients with COPD to calculate the situation is crucial. Therefore, this review aims to summarize the common methods of exercise assessments and exercise trainings in PR.
... [16][17][18][19] Only one review attempted to characterize the Tai Chi curricula/protocols. 20 More importantly, moving research into practice in oncology requires a systematic and comprehensive road mapping of research evidence in relation to the specific phase of the cancer care continuum, which has been previously absent. [20][21][22][23] We aim to conduct a systematic review of the effects of Tai Chi in cancer survivors at all phases of the cancer continuum. We follow a logic model 24 adapted from the previously published framework PACC (Physical Activity and Cancer Control), an organizational model for examining physical exercise across the cancer continuum, 25 to create a roadmap for Tai Chi research in cancer care. ...
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To manage acute, long‐term, and late effects of cancer, current guidelines recommend moderate‐to‐vigorous intensity aerobic and resistance exercise. Unfortunately, not all cancer survivors are able or willing to perform higher intensity exercise during difficult cancer treatments or because of other existing health conditions. Tai Chi is an equipment‐free, multicomponent mind–body exercise performed at light‐to‐moderate intensity that may provide a more feasible alternative to traditional exercise programs for some cancer survivors. This systematic review evaluated the therapeutic efficacy of Tai Chi across the cancer care continuum. We searched MEDLINE/PubMed, Embase, SCOPUS, and CINAHL databases for interventional studies from inception to 18 September 2020. Controlled trials of the effects of Tai Chi training on patient‐reported and objectively measured outcomes in cancer survivors were included. Study quality was determined by the RoB 2 tool, and effect estimates were evaluated using the Best Evidence Synthesis approach. Twenty‐six reports from 14 trials (one non‐randomized controlled trial) conducted during (n = 5) and after treatment (after surgery: n = 2; after other treatments: n = 7) were included. Low‐level evidence emerged to support the benefits of 40–60 min of thrice‐weekly supervised Tai Chi for 8–12 weeks to improve fatigue and sleep quality in cancer survivors. These findings need to be confirmed in larger trials and tested for scaling‐up potential. Insufficient evidence was available to evaluate the effects of Tai Chi on other cancer‐related outcomes. Future research should examine whether Tai Chi training can improve a broader range of cancer outcomes including during the pre‐treatment and end of life phases. Tai Chi training may improve fatigue and sleep quality in cancer survivors. Future research should examine a broader range of outcomes, particularly during difficult cancer treatments and for those with significant comorbidities.
... Grade I or grade II hypertension patients were involved in all 45 studies, and only four studies included grade III patients. In fact, mild and/or moderate patients were included in the majority of studies of Tai Chi on chronic diseases [19,20] due to its modulating and lowrisk characteristics. ...
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The modulation of Tai Chi in physiological function and psychological status attracts sustaining attention. This paper collected original articles regarding the effects of Tai Chi practice on modulating primary hypertension from 7 electronic databases (PubMed, Excerpta Medica Database, Cochrane Library, Web of Science, Chinese Knowledge Resource Integrated Database, Wanfang Database, and China Science and Technology Journal Database) from their dates of origin to October 1st, 2020. A total of 45 articles were included. The literature analyses have shown that the benefits of Tai Chi practice for blood pressure management have been identified in all of the included 45 studies, and Tai Chi exercise has shown significant efficacy in improving hypertension clinical symptoms and quality of life, compared to the majority of control interventions, though there are also some methodological issues, including small sample sizes, lack of exact randomization methods and quality control criteria, and lack of specific standards used to measure the characteristics of Tai Chi practice. In the future, the inclusion of additional design standards, stricter quality controls, and evaluation measures for the features of Tai Chi practice is required in trials evaluating its effects on hypertension.
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Background. Since the first, pioneering works were published in 1974 [Ryan], interest in the effects of Taijiquan on health has increasingly involved biomedical research, producing many publications in English on scientific journals. Problem and aim. This study focuses specifically on oncological or neoplastic pathologies to evaluate the degree of integration between the biomedical organicistic approach, typical of western medicine and the holistic approach of traditional Chinese medicine , related to the effects of Taijiquan (TJQ) on this type of pathology. Methods. The study proposes an analysis of the methods and results of two meta-analyses and eight experimental case studies. Results. The fundamental difference in dealing with neoplasic pathology between Western Medicine and Traditional Chinese Medicine is that in the West the cancer is fought, while the cancer patient is treated in the Far East. Here we examine only the aspect of the practice of Taijiquan (TJQ) in dealing with the tumor and the benefits that derive from this practice. Checks related to TJQ show clearly how this discipline and also Qigong (QG) are able to allow for a rebalancing of physiological parameters. This process takes place through various mechanisms: the first of these is a reduction in cellular metabolism involving a reduction in oxygen consumption and therefore the capacity of the organism to reduce its energy intake, its energy consumption, to optimize its biological functions. In this case TJQ is a supplementary practice of the mind/body of Chinese Medicine with a component of physical activity that has positive effects on aerobic capacity, muscle strength and quality of life among cancer survivors. Conclusion. The combined use of chemotherapy and Chinese Medicine increases the effect of chemotherapy and reduces side effects. Often the use of the combination helps the patient to better tolerate the therapy and to complete the therapeutic plan.
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Background: Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease with increasing morbidity and mortality that cause huge social and economic loss. Although recommended by guidelines, pulmonary rehabilitation has not been widely applied in clinics because of its inherent limitations. Free from restrictions of specific training venues and equipment, Tai Chi, as a kind of pulmonary rehabilitation, has been used to cure the COPD, yet the efficacy and safety of Tai Chi remains to be assessed. In this study, we aim to draw up a protocol for systematic review to evaluate the efficacy and safety of Tai Chi for COPD. Methods: We will search the following electronic databases from inception to December 31, 2018: PubMed, Web of Science, Medline, Cochrane Central Register of Controlled Trials, Springer, EMBASE, the China National Knowledge Infrastructure Database, Wan Fang Database, the Chinese Scientific Journal Database, and Chinese Biomedical Literature Database. Clinical trial registrations, potential gray literatures, relevant conference abstracts and reference list of identified studies will also be searched. The literature selection, data extraction, and quality assessment will be completed by 2 independent authors. Either the fixed-effects or random-effects model will be used for data synthesis based on the heterogeneity test. Changes in lung function will be evaluated as the primary outcome. Symptom assessment, quality of life (SGRQ), medication usage, exacerbations, and adverse events will be assessed as the secondary outcomes. The RevMan V.5.3.5 will be used for Meta-analysis. Results: This study will provide a synthesis of current evidence of Tai Chi for COPD from several aspects, such as lung function, SGRQ, medication usage, exacerbations, and adverse events. Conclusion: The conclusion of our study will provide updated evidence to judge whether Tai Chi is an effective solution to COPD patients. Prospero registration number: PROSPERO CRD42019122791.
Article
Background: As a mind-body exercise, Tai Chi (TC) may have a positive impact on physical function and psychological well-being in patients with breast cancer (BC). The aim of this current overview of systematic reviews (SRs) and meta-analyses (MAs) was to identify and summarize the existing evidence regarding the effectiveness of TC in patients with BC. Methods: A computerized search of electronic databases was performed to identify relevant SRs/MAs of TC related to BC from inception to June 2020. The Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklists were used to assess the methodological quality and reporting quality of SRs and MAs, respectively. The Grades of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to assess the evidence quality of outcome measures. Results: Six SRs/MAs in which quantitative synthesis was used to assess various outcomes of TC related to BC were included in this overview. The quality of the SRs/MAs and the evidence quality of the outcome measures were generally unsatisfactory. The limitations of the past SRs/MAs were the lack of a protocol and registration, a list of excluded studies, or inadequately reported computational details of meta-analyses. The critical problems were that the qualitative data synthesis relied on the trials with small sample sizes and of critical low quality. Conclusions: TC is possibly beneficial to BC treatment. However, further rigorous and comprehensive studies are required to provide robust evidence for definitive conclusions.
Article
Objectives: To review current publications to examine safety of tai chi (TC). Design: Cochrane Library, EBSCO host and MEDLINE/PubMed were searched for randomized controlled trials (RCTs) including TC as the core intervention and reporting adverse events (AEs). Data were extracted considering active vs. inactive control group comparisons and presence of an AE monitoring protocol. Meta-analyses were conducted for overall results as well as control group and reporting specific conditions. Results: In 256 RCTs of TC, 24 met eligibility criteria (1794 participants) and were assessed using the Cochrane Risk of Bias tool. The frequency of non-serious, serious and intervention-related AEs were not found to be significantly different between TC and inactive or active control conditions. In studies with an AE monitoring protocol, more non-serious adverse events (RD = 0.05; 95% CI: 0.00, 0.10; P = 0.05) were reported for TC compared to inactive interventions. Given the higher overall AE risks related to studies of participants with heart failure, additional analyses examined this set separately. More serious AEs were found for inactive interventions compared with TC in studies with heart failure participants (RD = -0.11; 95% CI: -0.20, -0.03; P = 0.01). Conclusion: Findings indicate that TC does not result in more AEs than active and inactive control conditions, and produces fewer AEs than inactive control conditions for heart failure patients.
Article
Purpose of review: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation because of airway and/or alveolar abnormalities. Symptoms include dyspnea, cough, chronic sputum production. As the third-ranked cause of death as well as disability-adjusted life years (DALYs), it poses a significant burden on patients, families, healthcare system and society. Regular physical activity is linked to decrease in morbidity and mortality associated with COPD, but implementation remains challenging. There is a need for community-based interventions that promote physical activity. Yoga and Tai Chi are widely available in the community and have been shown to be beneficial in patients with COPD as well as many of the co-morbid conditions associated with COPD. Recent findings: Yoga and Tai Chi have been found to be more effective than usual care in COPD with clinically meaningful improvements in 6-min walk distance (6MWD), forced expiratory volume in 1 s (FEV1), and health-related quality of life (HRQoL). They have also been found to be comparable to pulmonary rehabilitation interventions. Summary: Yoga and Tai Chi provide community-based options for patients with COPD to improve their physical activity, quality of life, and pulmonary function.
Article
Exercise training confers health benefits for people with chronic obstructive pulmonary disease (COPD). This article reviews the evidence for several exercise training modalities shown to be beneficial among individuals with COPD. These modalities include aerobic, resistance, nonlinear periodized, upper limb and balance training, as well as yoga, Tai Chi, inspiratory muscle training, whole body vibration training and neuromuscular electrical stimulation. The literature pertaining to each modality was critically reviewed, and information on the rationale, mechanism(s) of action (where known), benefits, and exercise prescription is described to facilitate easy implementation into clinical practice.
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Background A European League Against Rheumatism (EULAR) taskforce was convened to develop recommendations for lifestyle behaviours in rheumatic and musculoskeletal diseases (RMDs). This paper reviews the literature on the effects of physical exercise and body weight on disease-specific outcomes of people with RMDs. Methods Three systematic reviews were conducted to summarise evidence related to exercise and weight in seven RMDs: osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, axial spondyloarthritis (axSpA), psoriatic arthritis, systemic sclerosis and gout. Systematic reviews and original studies were included if they assessed exercise or weight in one of the above RMDs, and reported results regarding disease-specific outcomes (eg, pain, function, joint damage). Systematic reviews were only included if published between 2013–2018. Search strategies were implemented in the Medline, Embase, Cochrane Library of systematic reviews and CENTRAL databases. Results 236 articles on exercise and 181 articles on weight were included. Exercise interventions resulted in improvements in outcomes such as pain and function across all the RMDs, although the size of the effect varied by RMD and intervention. Disease activity was not influenced by exercise, other than in axSpA. Increased body weight was associated with worse outcomes for the majority of RMDs and outcomes assessed. In general, study quality was moderate for the literature on exercise and body weight in RMDs, although there was large heterogeneity between studies. Conclusion The current literature supports recommending exercise and the maintenance of a healthy body weight for people with RMDs.
Article
Background: Falls play a pivotal role in the cause of injury or death and have become a public health problem, especially for older people. Tai Chi may be an effective approach to improving balance and reducing falls. However, the conclusions of systematic reviews (SRs) have been inconsistent and the quality needs to be appraised critically. Objective: To provide an overview of the methodological quality, risk of bias and reporting quality as well as quality of evidence of SRs of Tai Chi for improving balance and reducing falls. Methods: We conducted a systematic search of English- and Chinese-language SRs in 8 electronic databases, from inception to October 2019. The methodological quality, risk of bias, reporting quality and the quality of evidence were independently assessed by 2 reviewers who used the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), Risk of Bias in Systematic reviews (ROBIS), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Grades of Recommendations, Assessment, Development and Evaluation (GRADE). Primary outcomes were fall rate and the Berg Balance Scale score in older people and people with Parkinson disease. Secondary outcomes included these outcomes in stroke, osteoarthritis and heart failure. Results: A total of 14 relevant SRs was included: 13 were rated critically low quality and 1 was rated low quality by AMSTAR 2. By the ROBIS, all SRs were rated low risk in Phase 1 (assessing relevance) and Domain 1 of Phase 2 (study eligibility criteria). With regard to Domain 2, assessing the identification and selection of studies, 3 (21.4%) SRs were rated low risk. 11 (71.4%) were rated low risk in Domain 3 (data collection and study appraisal), 11 (71.4%) were rated low risk in Domain 4 (synthesis and findings), and 9 (64.3%) were rated low risk in Phase 3 (risk of bias in the review). According to PRISMA, the reporting was relatively complete, but there were still some reporting flaws in the topic of protocol and registration (2/14, 14.3%), search strategy (5/14, 35.7%), risk of bias (6/14, 42.9%), additional analyses (6/14, 42.9%) and funding (4/14, 28.6%). Among the 14 SRs, Tai Chi had benefits for improving balance and reducing falls in older people and people with Parkinson disease; however, no definitive conclusions could be drawn for its effectiveness in stroke, osteoarthritis and heart failure. The level of evidence for fall rate was "moderate" to "high" for older people and "low" for those with Parkinson disease. The level of evidence of the Berg Balance Scale was "low" to "moderate" for older people and "low" for those with Parkinson disease. Among the downgraded factors, imprecision was the most common, followed by inconsistency and publication bias. Conclusions: Tai Chi may be beneficial for improving balance and reducing falls in older people and those with Parkinson disease. Because of limitations and inconsistent conclusions, further rigorous, normative and comprehensive SRs are needed to provide robust evidence for definitive conclusions.
Article
Purpose: To complete a scoping review of meta-analyses summarizing evidence of the effectiveness of Tai Chi for adults with health conditions. Materials and Methods: Meta-analyses were retrieved from Medline, Embase, AMED, CINAHL, SPORTDiscus, PsychINFO, Web of Science, PubMed Health and the Cochrane Library from database inception to early September 2018. Multistage deduplication and screening processes identified full-length, unique, peer-reviewed meta-analyses. Two people independently appraised 42 meta-analyses based on the GRADE system and organized results into 3 appendices subsequently collated into heterogeneous, statistically significant, and statistically insignificant tables. Results: “High” and “moderate” quality evidence indicates that Tai Chi can significantly benefit adults with health conditions including cancers, chronic obstructive pulmonary disease, coronary heart disease, depression, heart failure, hypertension, low back pain, osteoarthritis, osteoporosis, Parkinson’s Disease and stroke. Outcomes included significant improvements in activities of daily living, balance, exercise capacity, gait, mastery, mental health, mobility, motor function, participation in daily life, physical function, quality of life, range of motion, and strength; with reductions in blood pressure, body mass index, depression, disability, dyspnea, falls, fatigue, pain, stiffness, and waist circumference. Conclusions: Healthcare providers now have information to advise clients with health conditions on the effectiveness of Tai Chi for overall health promotion. • IMPLICATIONS FOR REHABILITATION • Tai Chi is a form of safe, enjoyable, light-to-moderate aerobic physical activity for adults that is inexpensive to implement in diverse community settings. • Adults with health conditions require physical activity for prevention of secondary impairments and over-all health promotion. • This scoping review of meta-analyses elucidates “high” and “moderate” quality evidence of the effectiveness of Tai Chi in improving important outcomes for people with numerous health conditions. • This information can be useful for healthcare providers who wish to recommend effective community-based physical activity to clients they are serving.
Article
Background: Most tai chi studies conducted among stroke survivors have focused on physical functioning, whereas inclusion of stroke survivors' feelings and perceptions of participating in tai chi is lacking. Objective: The aim of this study was to identify stroke survivors' feelings and perceptions of participating in a tai chi intervention during their poststroke recovery. Methods: This qualitative descriptive study examined stories from community-dwelling stroke survivors, collected as part of a larger randomized clinical trial. To examine these stories, an inductive content analysis approach was used with a priori theoretical codes (and subcodes): (1) Feelings (confidence, enjoy, hopeful, helpful, other) and (2) Perceptions of Impact (physical abilities, mental/cognitive abilities, challenges, other). Lincoln and Guba's criteria were followed to ensure trustworthiness of the study findings. Results: Participants (n = 17) were on average 71 years old (range, 54-87 years), mainly men (65%), and had the option of writing their own story or having someone write it for them. Stories from these stroke survivors revealed feelings of confidence (n = 4), enjoyment (n = 7), hope (n = 1), and helpfulness (n = 15). Perceptions of the impact of tai chi on their poststroke recovery process identified improved physical abilities (n = 23), better mental/cognitive abilities (n = 12), moving forward (n = 7), and developing friendships (n = 4), with few challenges (n = 1). Conclusions: Using storytelling, healthcare providers can discuss the benefits of tai chi and then relate the feelings and perceptions of other stroke survivors' experiences to encourage engagement in regular physical activity to aid in the poststroke recovery process.
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In this chapter, we describe the impact and etiology of chronic pain, the associated changes in the nervous system, and the mechanisms by which exercise may be able to affect and reverse these changes. Evidence for efficacy of exercise in different conditions associated with chronic pain is presented, with focus on chronic low back pain, fibromyalgia, osteoarthritis, rheumatoid arthritis, and migraines. While the efficacy of exercise and level of evidence supporting it vary in different diseases, exercise has direct and indirect benefits for most patients suffering from chronic pain. Effective exercise regimens include education and cognitive restructuring to promote behavioral activation and reconceptualization of what pain means, with the goal of gradually reversing the vicious cycle of pain, inertia, sedentary behavior, and worsening disability. Long-term, consistent, individualized exercise-based treatment approaches are most likely to result in improvements in pain and function.
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Knee osteoarthritis is a chronic degenerative disease. Cartilage and subchondral bone degeneration, as well as synovitis, are the main pathological changes associated with knee osteoarthritis. Mechanical overload, inflammation, metabolic factors, hormonal changes, and aging play a vital role in aggravating the progression of knee osteoarthritis. The main treatments for knee osteoarthritis include pharmacotherapy, physiotherapy, and surgery. However, pharmacotherapy has many side effects, and surgery is only suitable for patients with end-stage knee osteoarthritis. Exercise training, as a complementary and adjunctive physiotherapy, can prevent cartilage degeneration, inhibit inflammation, and prevent loss of the subchondral bone and metaphyseal bone trabeculae. Increasing evidence indicates that exercise training can improve pain, stiffness, joint dysfunction, and muscle weakness in patients with knee osteoarthritis. There are several exercise trainings options for the treatment of knee osteoarthritis, including aerobic exercise, strength training, neuromuscular exercise, balance training, proprioception training, aquatic exercise, and traditional exercise. For Knee osteoarthritis (KOA) experimental animals, those exercise trainings can reduce inflammation, delay cartilage and bone degeneration, change tendon, and muscle structure. In this review, we summarize the main symptoms of knee osteoarthritis, the mechanisms of exercise training, and the therapeutic effects of different exercise training methods on patients with knee osteoarthritis. We hope this review will allow patients in different situations to receive appropriate exercise therapy for knee osteoarthritis, and provide a reference for further research and clinical application of exercise training for knee osteoarthritis.
Article
Background Many middle-aged and older adults have more than one chronic health condition. It is therefore important to explore the effectiveness of interventions for multiple chronic conditions. Tai Chi is widely used in China and other countries, and many studies have examined the effect of Tai Chi on anxiety and depression. However, there are no systematic reviews of the effect of Tai Chi on anxiety and depression in various chronic conditions. This systematic review and meta-analysis aimed to evaluate the effects of Tai Chi on anxiety and depression symptoms in four chronic conditions: cancer, stroke, heart failure (HF), and chronic obstructive pulmonary disease (COPD). Methods We searched Chinese and English databases (Cochrane Library, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Database, and Sinomed) from inception to October 2020. Review Manager version 5.2 and Stata version 12.0 were used to perform a systematic review. The quality of the included studies was evaluated using the Cochrane risk of bias tool. The study was registered with the PROSPERO database (number CRD42020209594). Results Of the 596 studies identified, we included 25 randomized controlled trials involving 1819 participants. Combined analysis of the four diseases showed statistically significant differences between the Tai Chi and control groups for anxiety symptoms (SMD −0.99, 95%CI: −1.5, −0.47; P < 0.01) and depressive symptoms (SMD 0.70, 95%CI: −1.01, −0.39; P < 0.01). Subgroup analyses showed statistically significant differences between the Tai Chi and control groups for depressive symptoms in stroke (SMD −0.43, 95%CI: −0.67, −0.18; P < 0.01) and HF (SMD −0.57, 95%CI: −0.8, −0.33; P < 0.01). However, no statistically significant differences were found for depressive symptoms in COPD or cancer. There were statistically significant differences between the Tai Chi and control groups for anxiety symptoms in stroke (SMD −0.60, 95%CI: −0.88, −0.32; P < 0.01) and cancer (SMD −0.69, 95%CI: −1.22, −0.17; P < 0.01), but not in COPD or HF. Subgroup, sensitivity, meta regression, and publication bias analyses showed high heterogeneity correlated with a single study and study quality. Sensitivity analysis showed that most meta-analysis results had good stability, but those for anxiety symptoms in COPD were unstable; therefore, careful interpretation is required. Conclusion Tai Chi has a positive effect on anxiety and depression, especially for patients with cancer, stroke, and HF. However, given the weak evidence, this approach is not a substitute for psychiatric treatment.
Chapter
Patients with chronic pulmonary disease will benefit from engaging in physical activity (PA). Technology-based platforms (e.g., internet, mobile devices, smartphone apps, pedometers) are increasingly being recognized as potentially promising approaches to increase PA. This chapter reviews the role that technology can play in promoting access and adherence to PA promotion interventions. One of the pressing questions is how to effectively motivate patients to engage in and adhere to positive behavior change like increasing PA. We review theory- and evidence-based methods to encourage PA and foster patients’ knowledge, self-efficacy, outcome expectations, goals, and perceived facilitators, and reduce perceived barriers to PA. We review past research, beginning with lessons learned in healthy adults and then extrapolate these lessons to patients with chronic lung disease. This chapter also discusses the benefit of utilizing multicomponent interventions to increase patients’ adherence and chance for success. Technology offers a unique method to deliver multicomponent, efficacious interventions to encourage PA, but it is acknowledged that technological solutions are not one size fits all.
Article
Background: Despite current rehabilitation programs, long-term engagement in physical activity remains a significant challenge for patients with chronic obstructive pulmonary disease (COPD) and heart failure (HF). Novel strategies to promote physical activity in these populations are greatly needed. Emerging literature on the benefits of both mind-body interventions and web-based interventions provide the rationale for the development of the Mindful Steps intervention for increasing walking behavior. Objective: This study aims to develop a novel multimodal mind-body exercise intervention through adaptation of an existing web-based physical activity intervention and incorporation of mind-body exercise, and to pilot test the delivery of the new intervention, Mindful Steps, in a randomized controlled feasibility trial in older adults with COPD and/or HF. Methods: In phase 1, guided by a theoretical conceptual model and review of the literature on facilitators and barriers of physical activity in COPD and HF, we convened an expert panel of researchers, mind-body practitioners, and clinicians to inform development of the novel, multimodal intervention. In phase 2, we are conducting a pilot randomized controlled feasibility trial of the Mindful Steps intervention that includes in-person mind-body exercise classes, an educational website, online mind-body videos, and a pedometer with step-count feedback and goals to increase walking behavior in patients with COPD and/or HF. Outcomes include feasibility measures as well as patient-centered measures. Results: The study is currently ongoing. Phase 1 intervention development was completed in March 2019, and phase 2 data collection began in April 2019. Conclusions: Through the integration of components from a web-based physical activity intervention and mind-body exercise, we created a novel, multimodal program to impact long-term physical activity engagement for individuals with COPD and HF. This developmental work and pilot study will provide valuable information needed to design a future clinical trial assessing efficacy of this multimodal approach. Trial registration: ClinicalTrials.gov NCT03003780; https://clinicaltrials.gov/ct2/show/NCT03003780. International registered report identifier (irrid): DERR1-10.2196/27826.
Chapter
This evidence map is based on the 3iE Evidence Gap Map methodology. We searched seven electronic databases (BVS, PUBMED, EMBASE, PEDro, ScienceDirect, Web of Sciences, and PschyInfo) from inception to November 2019 and included systematic reviews only. Systematic reviews were analyzed based on AMSTAR 2. We used Tableau to graphically display quality assessment, the number of reviews, outcomes, and effects. Results: The map is based on 116 systematic reviews and 44 meta-analyses. Most of the reviews were published in the last 5 years. The most researched interventions were Tai Chi and Qi Gong. The reviews presented the following quality assessment: 80 high, 43 moderate, 23 low, and 14 critically low. Every 680 distinct outcome effect was classified: 421 as potential positive; 237 as positive; 21 as inconclusive/mixed; one potential negative and none no effect. Positive effects were related to chronic diseases; mental indicators and disorders; vitality, well-being, and quality of life. Potential positive effects were related to balance, mobility, Parkinson’s disease, hypertension, joint pain, cognitive performance, and sleep quality. Inconclusive/mixed-effects justify further research, especially in the following areas: Acupressure as Shiatsu and Tuiná for nausea and vomiting; Tai Chi and Qi Gong for acute diseases, prevention of stroke, stroke risk factors, and schizophrenia. Conclusions: The mind-body therapies from traditional Chinese medicine have been applied in different areas and this Evidence Map provides a visualization of valuable information for patients, professionals, and policymakers, to promote evidence-based complementary therapies.
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[Purpose] The aim of the present study was to seek evidence for the effectiveness of Tai Chi for patients with knee osteoarthritis (KOA). [Subjects and Methods] Systematic searches were conducted of the China Journals Full-text Database, Pubmed, Medline, Science Direct-Online Journals and CINAHL for studies published between 2000 and 2012. Studies were evaluated based on following inclusion criteria: 1) design: randomized control, clinical trial; 2) subjects: patients with a knee osteoarthritis diagnosis; 3) intervention: exercise involving Tai Chi; 4) studies published in English or Chinese. [Results] Six randomized control studies involving Tai Chi and knee osteoarthritis were found. [Conclusion] Tai Chi was an effective way of relieving pain and improving physical function. Further randomized controlled trials with large sample sizes and long training period are needed to compare groups who perform Tai Chi training with other groups who undergo other forms of physical exercise in order to confirm the efficacy of Tai Chi.
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Objectives. To evaluate the sustaining effects of Tai Chi Qigong (TCQ) in improving the psychosocial health in chronic obstructive pulmonary disease (COPD) patients in the sixth month. Background. COPD affects both physical and emotional aspects of life. Measures to minimize patients' suffering need to be implemented. Methods. 206 COPD patients were randomly assigned into three groups: TCQ group, exercise group, and control group. The TCQ group completed a three-month TCQ program, the exercise group practiced breathing and walking exercise, and the control group received usual care. Results. Significant group-by-time interactions in quality of life (QOL) using St. George's respiratory questionnaire (P = 0.002) and the perceived social support from friends using multidimensional scale of perceived social support (P = 0.04) were noted. Improvements were observed in the TCQ group only. Conclusions. TCQ has sustaining effects in improving psychosocial health; it is also a useful and appropriate exercise for COPD patients.
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Tai chi chuan (TCC) is a Chinese conditioning exercise and is well known for its slow and graceful movements. Recent investigations have found that TCC is beneficial to cardiorespiratory function, strength, balance, flexibility, microcirculation and psychological profile. The long-term practice of TCC can attenuate the age decline in physical function, and consequently it is a suitable exercise for the middle-aged and elderly individuals. TCC can be prescribed as an alternative exercise programme for selected patients with cardiovascular, orthopaedic, or neurological diseases, and can reduce the risk of falls in elderly individuals. The exercise intensity of TCC depends on training style, posture and duration. Participants can choose to perform a complete set of TCC or selected movements according to their needs. In conclusion, TCC has potential benefits in health promotion, and is appropriate for implementation in the community.
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Objective. In a randomized trial of women with early stage breast cancer undergoing adjuvant chemotherapy, two stress management interventions, tai chi training and spiritual growth groups, were compared to a usual care control group, to evaluate psychosocial functioning, quality of life (QOL), and biological markers thought to reflect cancer- and treatment-specific mechanisms. Method. The sample consisted of 145 women aged 27-75 years; 75% were Caucasian and 25% African American. A total of 109 participants completed the study, yielding a 75% retention rate. Grounded in a psychoneuroimmunology framework, the overarching hypothesis was that both interventions would reduce perceived stress, enhance QOL and psychosocial functioning, normalize levels of stress-related neuroendocrine mediators, and attenuate immunosuppression. Results. While interesting patterns were seen across the sample and over time, the interventions had no appreciable effects when delivered during the period of chemotherapy. Conclusions. Findings highlight the complex nature of biobehavioral interventions in relation to treatment trajectories and potential outcomes. Psychosocial interventions like these may lack sufficient power to overcome the psychosocial or physiological stress experienced during the chemotherapy treatment period. It may be that interventions requiring less activity and/or group attendance would have enhanced therapeutic effects, and more active interventions need to be tested prior to and following recovery from chemotherapy.
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Currently, several studies assessed the role of Tai Chi (TC) in management of chronic obstructive pulmonary disease, but these studies have wide variation of sample and convey inconclusive results. We therefore undertook a meta-analysis to assess the effects of TC. A computerized search through electronic databases was performed to obtain sample studies. The primary outcomes were 6-min walking distance (6MWD) and dyspnea. Secondary outcomes included health-related quality of life and pre-bronchodilator spirometry. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated and heterogeneity was assessed with the I(2) test. A random-effects meta-analysis model was applied. Eight randomized controlled trials involving 544 patients met the inclusion criteria. The pooled WMDs were 34.22 m (95% CI 21.25-47.20, P<0.00001) for 6 MWD, -0.86 units (95% CI -1.44--0.28, P = 0.004) for dyspnea, 70 ml (95% CI 0.02-0.13, P = 0.01) for FEV1, 120 ml (95% CI 0.00-0.23, P = 0.04) for FVC. TC significantly improved the Chronic Respiratory Disease Questionnaire total score, and the St George's Respiratory Questionnaire score except impact score. Findings suggest that TC may provide an effective alternative means to achieve results similar to those reported following participation in pulmonary rehabilitation programs. Further studies are needed to substantiate the preliminary findings and investigate the long-term effects of TC.
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Objective: The purpose of this randomized controlled trial (RCT) was to examine the feasibility and acceptability of a Tai Chi Chih (TCC) intervention in senior female cancer survivors with physical functioning limitations, and its effects on health-related quality of life (QOL). Design: This was a two-armed, parallel group, RCT with 12-weeks of Tai Chi Chih or Health Education Control. Methods: Sixty-three senior (M age = 67 years, SD = 7.15) female cancer survivors (83% breast cancer, stages I-III) with physical functioning limitations (SF-12 Health Survey role-physical & physical functioning subscales) were randomized to 12-weeks of TCC or Health Education control (HEC). Primary outcomes were feasibility and acceptability. Secondary outcomes included health-related QOL (SF-36 Health Survey), and participants' qualitative feedback on the intervention. Results: Retention (TCC = 91%; HEC = 81%) and class attendance (TCC = 79%; HEC = 83%) rates, and satisfaction levels for both study arms were high, but did not significantly differ from one another. At one-week post-intervention, none of the SF-36 scores differed between the TCC and HEC groups. Within-group analyses revealed significant improvements in the mental component summary score in TCC (p = 0.01), but not in HEC. Qualitative analyses indicated that the TCC group felt they received mental and physical benefits, whereas HEC group reported on social support benefits and information received. Conclusion: The TCC intervention was found to be a feasible and acceptable modality for senior female cancer survivors. Future, larger definitive trials are needed to clarify TCC dosage effects on QOL in this vulnerable population.
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Aim: Whether Tai Chi (TC) is effective in the cardiac rehabilitation of patients with chronic heart failure (CHF) remains controversial. We performed a meta-analysis to examine the effects of TC on exercise capacity and quality of life (QoL) in CHF patients. Methods and results: PubMed and EMBASE databases were searched (up to May 2012) for relevant studies. Studies including participants with reduced left ventricular systolic function (ejection fraction ≤ 45%) were selected. Interventions considered were TC with or without comparisons (education or usual care). Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I(2) test. Four randomized controlled trials (RCTs) (n = 242) met the inclusion criteria. TC significantly improved QoL (WMD -14.54 points; 95% CI -23.45 to -5.63). TC was not associated with a significant reduction in N-terminal pro brain natriuretic peptide (WMD -61.16 pg/mL; 95% CI -179.27 to 56.95), systolic blood pressure (WMD -1.06 mmHg; 95% CI -13.76 to 11.63), diastolic blood pressure (WMD -0.08 mmHg; 95% CI -3.88 to 3.73), improved 6 min walking distance (WMD 46.73 m; 95% CI -1.62 to 95.09), or peak oxygen uptake (WMD 0.19 mL/kg/min; 95% CI -0.74 to 1.13). Conclusions: TC may improve QoL in patients with CHF and could be considered for inclusion in cardiac rehabilitation programmes. However, there is currently a lack of evidence to support TC altering other important clinical outcomes. Further larger RCTs are urgently needed to investigate the effects of TC.
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The aims of the study were to determine the effect of short-form Sun-style Tai Chi (SSTC) (Part A) and investigate exercise intensity of SSTC (Part B) in people with COPD.Part A: After confirmation of eligibility, participants were randomly allocated to either the Tai Chi Group (TCG) or Control Group (CG) (usual medical care). Participants in the TCG trained twice weekly for 12 weeks. Part B: Participants who had completed training in the TCG performed a peak exercise test (incremental shuttle walk test) and SSTC while oxygen consumption (VO2) was measured. Exercise intensity of SSTC was determined by the percent of VO2 reserve.Of 42 participants (mean (SD) FEV1 59 (16) % predicted), 38 completed Part A and 15 completed Part B. Compared to control, SSTC significantly increased endurance shuttle walk time (mean difference, 95%CI) (384 seconds, 186 to 510); reduced medial-lateral body sway in semi-tandem stand (-12.4 millimetres, -21 to -3); and increased total score on the Chronic Respiratory Disease Questionnaire (11 points, 4 to 18). The exercise intensity of SSTC was 53 (18) % of VO2 reserve.SSTC was an effective training modality in people with COPD achieving a moderate exercise intensity which meets the training recommendations.
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Introduction: Breast cancer survivors experience diminished health-related quality of life (HRQOL). We report on the influence of tai chi chuan exercise (TCC) on HRQOL and explore associations between changes in HRQOL and biomarkers. Methods: Breast cancer survivors (N = 21) were randomly assigned to TCC or standard support therapy (SST) for 12 weeks (three times/week; 60 min/session). Interleukin-6, interleukin-8 (IL-8), insulin-like growth factor-1 (IGF-1), insulin-like growth factor-binding protein (IBFBP)-1, IGFBP-3, glucose, insulin, and cortisol were measured pre- and postintervention. Overall HRQOL and subdomains were assessed at preintervention (T1), midintervention (T2) and postintervention (T3) and biomarkers at T1 and T3. Results: The TCC group improved in total HRQOL (T1-T2:CS = 8.54, P = 0.045), physical functioning (T1-T2:CS = 1.89, P = 0.030), physical role limitations (T1-T2 CS = 1.55, P = 0.023), social functioning (T1-T3:CS = 1.50, P = 0.020), and general mental health (T1-T2:CS = 2.67, P = 0.014; T1-T3:CS = 2.44, P = 0.019). The SST improved in social functioning (T1-T2:CS = 0.64, P = 0.043) and vitality (T1-T2:CS = 0.90, P = 0.01). There were relationships between changes in IGF-1 and overall HRQOL (r = -0.56; P < 0.05), physical role limitation (r = -0.68; P < 0.05), and social functioning (r = -0.56; P < 0.05). IGFBP-1 changes were associated with physical role limitations changes (r = 0.60; P < 0.05). IGFBP-3 changes were associated with physical functioning changes (r = 0.46; P ≤ 0.05). Cortisol changes were associated with changes in physical role limitations (r = 0.74; P < 0.05) and health perceptions (r = 0.46; P < 0.05). Glucose changes were associated with emotional role limitation changes (r = -0.70; P < 0.001). IL-8 changes were associated with emotional role limitation changes (r = 0.59; P < 0.05). Discussion/conclusions: TCC may improve HRQOL by regulating inflammatory responses and other biomarkers associated with side effects from cancer and its treatments. Implications for cancer survivors: TCC may be an intervention capable of improving HRQOL in breast cancer survivors.
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Purpose. To assess if Tai Chi added to endurance training (ET) is more effective than ET alone in improving exercise tolerance and quality of life (QOL) of elderly patients with chronic heart failure (CHF). Design. Sixty CHF patients, age 73.8 ± 6 years, M/F 51/9, were enlisted. Thirty pts were randomized to combined training (CT) performing Tai Chi +ET and 30 patients to ET (ET only). Methods. At baseline and after 12 weeks all patients underwent 6-minute walking test (6MWT), assessment of amino terminal probrain natriuretic peptide (NT-pro BNP), quadriceps maximal voluntary contraction (MVC) and peak torque (PT), QOL questionnaire (MacNewQLMI), blood pressure (BP), and heart rate (HR). All patients performed 4 sessions of exercise/week. Results. Distance at 6mwt improved in both groups with significant between-groups differences (P = .031). Systolic BP and NT-proBNP decreased significant in the CT group compared to ET (P = .025) and P = .015), resp.). CT group had a greater significant improvement in physical perception (P = .026) and a significant increase of PT compared to ET group. Conclusions. The association of Tai Chi and ET improves exercise tolerance and QOL of patients with CHF more efficiently than ET.
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Background: Preliminary evidence suggests that meditative exercise may have benefits for patients with chronic systolic heart failure (HF); this has not been rigorously tested in a large clinical sample. We sought to investigate whether tai chi, as an adjunct to standard care, improves functional capacity and quality of life in patients with HF. Methods: A single-blind, multisite, parallel-group, randomized controlled trial evaluated 100 outpatients with systolic HF (New York Heart Association class I-III, left ventricular ejection fraction ≤40%) who were recruited between May 1, 2005, and September 30, 2008. A group-based 12-week tai chi exercise program (n = 50) or time-matched education (n = 50, control group) was conducted. Outcome measures included exercise capacity (6- minute walk test and peak oxygen uptake) and disease-specific quality of life (Minnesota Living With Heart Failure Questionnaire). Results: Mean (SD) age of patients was 67 (11) years; baseline values were left ventricular ejection fraction, 29% (8%) and peak oxygen uptake, 13.5 mL/kg/min; the median New York Heart Association class of HF was class II. At completion of the study, there were no significant differences in change in 6-minute walk distance and peak oxygen uptake (median change [first quartile, third quartile], 35 [-2, 51] vs 2 [-7, 54] meters, P = .95; and 1.1 [-1.1, 1.5] vs -0.5 [-1.2, 1.8] mL/kg/min, P = .81) when comparing tai chi and control groups; however, patients in the tai chi group had greater improvements in quality of life (Minnesota Living With Heart Failure Questionnaire, -19 [-23, -3] vs 1 [-16, 3], P = .02). Improvements with tai chi were also seen in exercise self-efficacy (Cardiac Exercise Self-efficacy Instrument, 0.1 [0.1, 0.6] vs -0.3 [-0.5, 0.2], P < .001) and mood (Profile of Mood States total mood disturbance, -6 [-17, 1] vs -1 [-13, 10], P = .01). Conclusion: Tai chi exercise may improve quality of life, mood, and exercise self-efficacy in patients with HF. Trial Registration clinicaltrials.gov Identifier: NCT00110227.
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This paper evaluates the effectiveness of a 3-month Tai chi Qigong (TCQ) program in promoting the psychosocial functional health of clients with chronic obstructive pulmonary disease (COPD) in Hong Kong. This study employed a single-blind, randomized controlled trial. Two hundred and six COPD clients were randomly assigned into three groups, namely, TCQ group, exercise group, and control group. Subjects in the TCQ group received a TCQ program, consisting of two 60-min sessions each week for 3 months. Subjects in the exercise group were taught to practice breathing techniques combined with walking as an exercise. Subjects in the control group received their usual care. Data collections were performed at baseline, on the sixth week and on the third month. The primary outcomes were health-related quality of life using St. George Respiratory Questionnaire-Hong Kong Chinese version and perceived social support using the Multidimensional Scale of Perceived Social Support-Chinese version. The TCQ group showed greater improvements in the symptom (F4, 404=3.351, P=0.010) and activity domains (F4, 404=2.611, P=0.035). No differences were detected in perceived social support among the three groups. Tai chi Qigong promoted health outcomes with respect to clients' perception of their respiratory symptoms. Moreover, TCQ decreased disturbances to their physical activities.
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The quadriceps weakness commonly associated with osteoarthritis of the knee is widely believed to result from disuse atrophy secondary to pain in the involved joint. However, quadriceps weakness may be an etiologic factor in the development of osteoarthritis. To explore the relation between lower-extremity weakness and osteoarthritis of the knee. Cross-sectional prevalence study. Population-based, with recruitment by random-digit dialing. 462 volunteers 65 years of age or older. Radiographs of the knee were graded for the presence of osteoarthritis. Knee pain and function were assessed with the Western Ontario and McMaster Universities Arthritis Index, the strength of leg flexors and extensors was assessed with isokinetic dynamometry, and lower-extremity lean tissue mass was assessed with dual-energy x-ray absorptiometry. Among participants with osteoarthritis, quadriceps weakness, but not hamstring weakness, was common. The ratio of extensor strength to body weight was approximately 20% lower in those with than in those without radiographic osteoarthritis. Notably, among women with tibiofemoral osteoarthritis, extensor weakness was present in the absence of knee pain and was seen in participants with normal lower-extremity lean mass (extensor strength, 30.1 lb-ft for those with osteoarthritis and 34.8 lb-ft for those without osteoarthritis; P < 0.001). After adjustment for body weight, age, and sex, lesser quadriceps strength remained predictive of both radiographic and symptomatic osteoarthritis of the knee (odds ratio for prevalence of osteoarthritis per 10 lb-ft loss of strength, 0.8 [95% CI, 0.71 to 0.90] for radiographic osteoarthritis and 0.71 [CI, 0.51 to 0.87] for symptomatic osteoarthritis). Quadriceps weakness may be present in patients who have osteoarthritis but do not have knee pain or muscle atrophy; this suggests that the weakness may be due to muscle dysfunction. The data are consistent with the possibility that quadriceps weakness is a primary risk factor for knee pain, disability, and progression of joint damage in persons with osteoarthritis of the knee.
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Tai Chi Chuan (TCC) is a Chinese conditioning exercise and is well known for its slow and graceful movements. Recent investigations have found that TCC is beneficial to cardiorespiratory function, strength, balance, flexibility, microcirculation and psychological profile. The long-term practice of TCC can attenuate the age decline in physical function, and consequently it is a suitable exercise for the middle-aged and elderly individuals. TCC can be prescribed as an alternative exercise programme for selected patients with cardiovascular, orthopaedic, or neurological diseases, and can reduce the risk of falls in elderly individuals. The exercise intensity of TCC depends on training style, posture and duration. Participants can choose to perform a complete set of TCC or selected movements according to their needs. In conclusion, TCC has potential benefits in health promotion, and is appropriate for implementation in the community.
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Twelve forms of Sun-style tai chi exercise have been developed specifically to reduce the symptoms and improve the physical functioning of arthritic patients, and this randomized study examined the changes in symptoms and physical characteristics in older women with osteoarthritis (OA) at the completion of a 12-week tai chi exercise program. Seventy-two patients with OA were randomly assigned into 2 groups. Due to a 41% overall dropout rate, 22 experimental subjects and 21 controls completed pre- and post-test measures over a 12 week interval. Outcome variables were physical symptoms and fitness, body mass index, cardiovascular functioning, and perceived difficulties in physical functioning. The independent t test was used to examine group differences. The homogeneity test confirmed that there were no significant group differences in demographic data and pretest measures. Mean comparisons of the change scores revealed that the experimental group perceived significantly less pain (t = -2.19, p = 0.034) and stiffness (t = -2.13, p = 0.039) in their joints, and reported fewer perceived difficulties in physical functioning (t = -2.81, p = 0.008), while the control group showed no change or even deterioration in physical functioning after 12 weeks. In the physical fitness test, there were significant improvements in balance (t = 3.34, p = 0.002) and abdominal muscle strength (t = 2.74, p = 0.009) for the tai chi exercise group. No significant group differences were found in flexibility and upper-body or knee muscle strength in the post-test scores. Older women with OA were able to safely perform the 12 forms of Sun-style tai chi exercise for 12 weeks, and this was effective in improving their arthritic symptoms, balance, and physical functioning. A longitudinal study with a larger sample size is now needed to confirm the potential use of tai chi exercise in arthritis management.
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Background and Purpose. Assessment of the quality of randomized controlled trials (RCTs) is common practice in systematic reviews. However, the reliability of data obtained with most quality assessment scales has not been established. This report describes 2 studies designed to investigate the reliability of data obtained with the Physiotherapy Evidence Database (PEDro) scale developed to rate the quality of RCTs evaluating physical therapist interventions. Method. In the first study, 11 raters independently rated 25 RCTs randomly selected from the PEDro database. In the second study, 2 raters rated 120 RCTs randomly selected from the PEDro database, and disagreements were resolved by a third rater; this generated a set of individual rater and consensus ratings. The process was repeated by independent raters to create a second set of individual and consensus ratings. Reliability of ratings of PEDro scale items was calculated using multirater kappas, and reliability of the total (summed) score was calculated using intraclass correlation coefficients (ICC [1,1]). Results. The kappa value for each of the 11 items ranged from .36 to .80 for individual assessors and from .50 to .79 for consensus ratings generated by groups of 2 or 3 raters. The ICC for the total score was .56 (95% confidence interval=.47–.65) for ratings by individuals, and the ICC for consensus ratings was .68 (95% confidence interval=.57–.76). Discussion and Conclusion. The reliability of ratings of PEDro scale items varied from “fair” to “substantial,” and the reliability of the total PEDro score was “fair” to “good.”
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Background—Tai Chi Chuan (TTC) exercise has beneficial effects on the components of physical condition and can produce a substantial reduction in the risk of multiple falls. Previous studies have shown that short term TCC exercise did not improve the scores in the single leg stance test with eyes closed and the sit and reach test. There has apparently been no research into the effects of TCC on total body rotation flexibility and heart rate responses at rest and after a three minute step test. Methods—In this cross sectional study, 28 male TCC practitioners with an average age of 67.5 years old and 13.2 years of TCC exercise experience were recruited to form the TCC group. Another 30 sedentary men aged 66.2 were selected to serve as the control group. Measurements included resting heart rate, left and right single leg stance with eyes closed, modified sit and reach test, total body rotation test (left and right), and a three minute step test. Results—Compared with the sedentary group, the TCC group had significantly better scores in resting heart rate, three minute step test heart rate, modified sit and reach, total body rotation test on both right and left side (p<0.01), and both right and left leg standing with eyes closed (p<0.05). According to the American Fitness Standards, the TCC group attained the 90th percentile rank for sit and reach and total body rotation test, right and left. Conclusion—Long term regular TCC exercise has favourable effects on the promotion of balance control, flexibility, and cardiovascular fitness in older adults.
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Cancer is a leading cause of death worldwide. Mind-body interventions are widely used by cancer patients to reduce symptoms and cope better with disease- and treatment-related symptoms. In the last decade, many clinical controlled trials of qigong/tai chi as a cancer treatment have emerged. This study aimed to quantitatively evaluate the effects of qigong/tai chi on the health-related outcomes of cancer patients. Five databases (Medline, CINAHL, Scopus, the Cochrane Library, and the CAJ Full-text Database) were searched until June 30, 2013. Randomized controlled trials (RCTs) of qigong/tai chi as a treatment intervention for cancer patients were considered for inclusion. The primary outcome for this review was changes in quality of life (QOL) and other physical and psychological effects in cancer patients. The secondary outcome for this review was adverse events of the qigong/tai chi intervention. A total of 13 RCTs with 592 subjects were included in this review. Nine RCTs involving 499 subjects provided enough data to generate pooled estimates of effect size for health-related outcomes. For cancer-specific QOL, the pooled weighted mean difference (WMD) was 7.99 [95% confidence interval (CI): 4.07, 11.91; Z score=4.00, p<0.0001]. The standardized mean differences (SMDs) for changes in depression and anxiety score were -0.69 (95% CI: -1.51, 0.14; Z score=1.64, p=0.10), and -0.93 (95% CI: -1.80, -0.06; Z score=2.09, p=0.04), respectively. The WMDs for changes in body mass index and body composition from baseline to 12 weeks follow-up were -1.66 (95% CI: -3.51, 0.19; Z score=1.76, p=0.08), and -0.67 (95% CI: -2.43, 1.09; Z score=0.75, p=0.45) respectively. The SMD for changes in the cortisol level was -0.37 (95% CI: -0.74, -0.00; Z score=1.97, p=0.05). This study found that qigong/tai chi had positive effects on the cancer-specific QOL, fatigue, immune function and cortisol level of cancer patients. However, these findings need to be interpreted cautiously due to the limited number of studies identified and high risk of bias in included trials. Further rigorous trials are needed to explore possible therapeutic effects of qigong/tai chi on cancer patients.
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Although the benefits of exercise on the health of patients with chronic obstructive pulmonary disease (COPD) have been widely reported, the effect of Tai Chi as an alternative exercise has not been thoroughly evaluated in patients with COPD. This study reported a randomised controlled trial, which investigated the effects of Tai Chi on lung function, exercise capacity, and diaphragm strength in patients with COPD. Single blind randomised controlled study. Department of Respiratory Medicine, Xiangya Hospital, Central South University. Forty patients with COPD were randomised into either a control group or Tai Chi intervention group. Participants in the control group received only routine care, while participants in the Tai Chi group received routine care and completed a six-month Tai Chi exercise program. Lung function parameters, blood gas parameters, 6-min walking distance (6MWD), and diaphragm strength parameters. Lung function parameters (FEV1: 1.43±0.08 and FEV1 (%) predicted: 47.6±4.76), 6MWD (476±15) and diaphragm strength parameters (TwPes: 1.17±0.07, TwPga: -1.12±0.06, and TwPdi: 1.81±0.09) were found to be significantly increased in participants who successfully completed the six-month Tai Chi program compared to participants in the control group who only received routine care (p<0.05). These parameters were also found to be significantly increased in participants who completed the Tai Chi exercise program compared to the baseline (p<0.05). In contrast, no significant differences in PaO2 and PaCO2 were observed in participants before or after completing a Tai Chi program or between Tai Chi group and control group (p>0.05). Tai Chi enhances lung function, exercise capacity, and diaphragm strength. However, this is only preliminary research data and a larger trial is needed for more detailed results.
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This paper aimed to systematically review and meta-analyze the effectiveness of Tai Chi for osteoarthritis of the knee. MEDLINE, the Cochrane Library, EMBASE, Scopus, PsycInfo and CAMBASE were screened through April 2013. Randomized controlled trials (RCTs) comparing Tai Chi to control conditions were included. Two authors independently assessed risk of bias using the risk of bias tool recommended by the Cochrane Back Review Group. Outcome measures included pain, physical functional, joint stiffness, quality of life, and safety. For each outcome, standardized mean differences and 95% confidence intervals were calculated. 5 RCTs with a total of 252 patients were included. Four studies had a low risk of bias. Analysis showed moderate overall evidence for short-term effectiveness for pain, physical function, and stiffness. Strong evidence was found for short-term improvement of the physical component of quality of life. No long-term effects were observed. Tai Chi therapy was not associated with serious adverse events. This systematic review found moderate evidence for short-term improvement of pain, physical function and stiffness in patients with osteoarthritis of the knee practicing Tai Chi. Assuming that Tai Chi is at least short-term effective and safe it might be preliminarily recommended as an adjuvant treatment for patients with osteoarthritis of the knee. More high quality RCTs are urgently needed to confirm these results.