Traditional Medicine Research, 2017, 2(3): 118-124
Tai Chi: a new star for the administration of chronic diseases?
Yang Hu1, Hao-Ran Zhang1, Xiong-Zhi Wu1,*
1Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.
Yang Hu, Hao-Ran Zhang, Xiong-Zhi Wu. Tai Chi: a new star for the administration of chronic diseases?[J]. Traditional Medicine Research, 2017, 2(3): 118-124. doi:10.12032/TMR201707047

Highlights

The current evidences regarding the effects of Tai Chi on the cardiovascular system, respiratory system, nervous system, musculoskeletal disorders, rheumatism, and cancer were summarized.

Editor’s Summary

Tai Chi integrates deep diaphragmatic breathing with body movements to achieve a harmonious balance between the body and mind.

Abstract

Tai Chi Quan (Tai Chi), a traditional Chinese martial art, has become increasingly popular in western countries. Tai Chi integrates deep diaphragmatic breathing with body movements to achieve a harmonious balance between the body and mind, which facilitates the flow of internal energy (Qi). An increasing number of studies have reported that Tai Chi significantly benefits aerobic capacity, muscular strength, balance, and psychological well-being. In addition, Tai Chi offers unique advantages for physical fitness and the treatment of chronic diseases. This paper reviews the existing literatures on Tai Chi, introduces its health-promotion effects and the potential clinical applications, and summarizes recent studies that prove Tai Chi is safe and effective for patients with neurological diseases, rheumatological diseases, musculoskeletal diseases, cardiovascular diseases, chronic obstructive pulmonary diseases, and cancers. After reviewing the literatures in this field, we conclude that the long-term results of practicing Tai Chi may benefit the cardiovascular system, motor system, respiratory system, and nervous system. However, the potential role and mechanism of Tai Chi has not yet been determined. Further studies with long follow-up periods are necessary to meet the standards of clinical applications.

Key words: Tai Chi ; Health ; Rehabilitation ; Chronic diseases
Background

Tai Chi Quan (Tai Chi) is an ancient Chinese martial art involving the concepts of Yin and Yang, which was originally devised in the Song Dynasty (906 A.D. - 1279 A.D.) by San-Feng Zhang, and originally created for fighting [1-3]. Over time, Tai Chi has developed into multi-element movement forms. All styles of Tai Chi are composed of slow, gentle movements and actions including stretching, balance, posture adjustment, concentration, relaxation, and breathing control, which can be practiced by people of all ages [1]. Therefore, Tai Chi has become increasingly popular in western society in recent years, especially among the elderly. During Tai Chi, deep diaphragmatic breathing is integrated into body movement to achieve the harmony of physical and mental balance and increase internal energy (Qi) in the body [1]. Participants may choose a full set of Tai Chi or individual actions according to their needs. Previous studies have confirmed that Tai Chi has a vital effect on health promotion. Regular Tai Chi practice can improve aerobic capacity, reduce blood lipid levels, regulate heart rate, increase lung capacity, improve balance, and improve health-related quality of life (QOL) and mental health. Recent studies have also shown that Tai Chi is safe and effective for people with neurological diseases such as stroke and Parkinson’s disease, rheumatoid diseases such as rheumatoid arthritis and multiple sclerosis, orthopedic diseases such as osteoarthritis and lumbar pain, cardiovascular diseases such as hypertension, coronary artery bypass surgery, heart failure, chronic obstructive pulmonary disease (COPD), and postoperative rehabilitation of cancer [2, 4-11]. Tai Chi is a moderate exercise. It causes no hypoxia or injuries to the human body, but can fulfill the human body’s exercise requirements and is suitable for implementation in the community. The evidence below will inform health-care practitioners of important considerations when prescribing Tai Chi to people with multiple morbidities, especially older adult patients.

The effects of Tai Chi on the cardiovascular system
Reduction of cardiovascular risk factors

Adherence to Tai Chi can regulate lipid metabolism and microcirculation and adjust the heart rate, which can strengthen the protection of the cardiovascular system mechanism. Jen-Chen et al. found that after 12 weeks of Tai Chi training, total serum cholesterol levels in the treatment group decreased by 15.2mg/dL and high-density lipoprotein cholesterol levels increased by 4.7mg/dL [12]. In a study by Pan et al., the Tai Chi group showed a lower level of blood triglycerides in follow-up and baseline than the control group [13]. In another study, Wang et al. found higher skin blood flow, higher cutaneous vascular conductance, and higher skin temperature at both rest and during exercise in geriatric Tai Chi practitioners than in sedentary men matched for age and body size [14]. As Tai Chi is an aerobic exercise of moderate intensity, it may adjust heart rate, reduce resting blood pressure, and improve the exercise capacity of individuals who regularly practice. Zheng et al. compared Tai Chi exercise with non-intervention in 20 studies that included 1783 healthy adults. They showed that Tai Chi might significantly improve cardiovascular efficiency by reducing resting blood pressure (systolic pressure: standard mean difference = -0.93, diastolic blood pressure: standard mean difference = -0.94) and resting heart rate, and improve the stroke volume and output (mean difference = 0.32L/min) [15].

Rehabilitation effects in patients with cardiovascular disease

Physical inactivity is a major modifiable lifestyle risk factor for cardiovascular disease. A variety of cardiopulmonary fitness indicators have been examined for Tai Chi, and researches have demonstrated that Tai Chi has beneficial effects for patients with heart disease [16]. Pan et al. suggested that Tai Chi might improve the QOL of patients with coronary heart disease (CHD) and could be considered for inclusion in cardiac rehabilitation programs [10]. Chang et al. conducted a six-month cardiac rehabilitation program using Tai Chi that included 54 patients with CHD. They reported that patients had improved peak RPP (heart rate-blood pressure product) and RPP reserve during exercise testing. The results of these studies suggest that a Tai Chi exercise program may result in improving prognosis for cardiac events in patients with CHD [17].

The effects of Tai Chi on the respiratory system
Increasing lung capacity and improving gas exchange capacity

The exercise intensity of Tai Chi, height of the postures, and the duration can improve the overall aerobic capacity. Lan et al. showed that at peak, the Tai Chi group showed a 19% higher oxygen intake (VO2 peak) compared with sedentary people [18]. Ngai et al. concluded that the 6-min walking distance of the Tai Chi group and the first second forced expiratory volume improved compared to the control group [11]. Hirley et al. analyzed 12 studies that included 984 participants and found that Tai Chi plus ordinary care subjects also showed a longer 6-min walking distance and improved lung function compared to control subjects [19]. Song et al. studied 180 elderly men who did not exercise regularly and found that with prolonged exercise, Tai Chi significantly improved the respiratory system (vital capacity increased from 2.84±0.32L to 3.57±1.39L, maximum minute ventilation improved from 97.26±14.71L/min to 117.25±14.86L/min) [20].

Rehabilitation effects in respiratory disease

People with COPD frequently experience dyspnea. Tai Chi reduces dyspnea and improves the exercise capacity and physiological and psychosocial well-being of people with COPD [19]. Qiu et al. compared physiological work as measured by oxygen uptake, esophageal pressure swing, and diaphragm electromyography elicited by Tai Chi compared with that elicited by constant-rate treadmill walking at 60% of maximal load in 11 patients with COPD (Mean FEV1 61% predicted, FEV1/FVC 47%). They found that Tai Chi constituted a physiological stimulus similar to treadmill exercise and might be an acceptable modality for pulmonary rehabilitation [21]. Gloria et al. studied 10 patients with moderate to severe COPD who participated in 12 weeks of Tai Chi plus usual care (n = 5), or usual care alone. After training, there was significant improvement in the chronic respiratory questionnaire score of the Tai Chi group compared with the usual-care group [22]. Leung et al. reported that Tai Chi significantly increased endurance shuttle walk time, reduced medial-lateral body sway during a semi-tandem stand, and increased the total score of the chronic respiratory disease questionnaire compared to controls [23]. Therefore, Tai Chi may be an option for patients with moderate to severe COPD.

The effects of Tai Chi on the nervous system
Improvement of psychological well-being

Tai Chi can be classified as a mind/body technique, potentially reducing stress, affecting physical as well as mental health parameters. A recent meta-analysis of 20 eligible studies that included 2,553 participants showed that Tai Chi could enhance cognitive function in older adults [24, 25]. Lam et al. observed 389 seniors for 1 year and found that subjects in the Tai Chi intervention group showed an improvement in global cognitive function and decreased recall and subjective cognitive complaints [26]. Zheng et al. analyzed nine studies, including four randomized controlled trials and non-randomized controlled trials, and concluded that most results of Tai Chi in the cognitive domain showed a positive effect [27]. At the psychological level, Wang et al. concluded that Tai Chi practice, whether short-term or long-term, seems to have mental health benefits that can help both healthy subjects and patients with chronic conditions of mental health, self-esteem, and life satisfaction [28]. Therefore, the effective use of Tai Chi to improve the mental state is meaningful.

Rehabilitation effects in patients with nervous system diseases

The result of a stroke is a significant decline in the QOL, determined not only by damage to the nervous system, but also by the impairment of cognitive function. Many stroke patients have impaired balance and motor function, and they can increase exercise endurance by increasing oxygen intake and walking distance. Tai Chi may have a potential role in stroke therapy. Zhang et al. randomly divided 50 stroke patients into a control group and a Tai Chi group. Through the assessment of sports injury recovery, the results proved that Tai Chi could be used with another rehabilitation program to treat stroke patients during the recovery phase [4]. Cwiekala-Lewis et al. analyzed seven randomized clinical trials and four quasi-experimental studies and found that Tai Chi participants had better balance and one or more aspects of happiness, although the results were mixed [29]. Based on the above-mentioned results, we can conclude that Tai Chi can be used as rehabilitation training for stroke patients, but some of the studies were not perfect. Further research requires more rigorous study design, larger sample sizes, adequate Tai Chi practice, and carefully selected measurements of the results. Before extensive recommendations, the role and effect of Tai Chi on nervous system diseases must be assessed.

The effects of Tai Chi on musculoskeletal disorders
Balance improvement and fall prevention

In daily activities, poor balance is associated with a high frequency of significant falls, which increases the social and economic burden of patients. This loss of balance is due to specific deterioration in the function of various musculoskeletal systems. Fortunately, proper exercise training can improve balance and prevent accidental falls [3]. Gatts and Woollacott analyzed how Tai Chi improved balance from a biomechanical perspective. Twenty-two elderly people with a history of knee, hip, or back surgery were randomly divided into a control group or a Tai Chi group; each group trained 1.5 hours per day, 5 days per week, for 3 weeks. The final results showed that Tai Chi control training significantly reduced tripping and medial cross-step distance and increased the use of swing leg heel strike. Therefore, Tai Chi training can strengthen the balance response and use balance more actively to control the step strategy of the wobble leg [30]. Li et al. randomly assigned 256 physically inactive older adults to Tai Chi or an exercise stretching control group, followed by six months of follow-up. The Tai Chi group reported significantly fewer falls, a lower proportion of fallers, and fewer injurious falls than the control group [31]. In another study, Voukelatos et al. assigned 702 people who lived in the community to a 16-week Tai Chi training course. The Tai Chi group showed fewer falls than did the control group. After 16 weeks and 24 weeks, the risk ratio for Tai Chi was 0.72 and 0.67, respectively [32]. Therefore, improved functional balance through Tai Chi training is associated with subsequent reductions in fall frequency.

Rehabilitation effects of musculoskeletal disorders

Few remedies effectively treat long-term pain and disability from knee osteoarthritis (OA), but studies suggest that Tai Chi alleviates the symptoms. Hartman et al. first showed that patients with OA benefitted from 6-20 weeks of Tai Chi training [33]. In a randomized controlled study of 79 patients with OA, Song et al. found that after 12 weeks of training, the Tai Chi group perceived significantly less joint pain and stiffness and reported fewer perceived difficulties in physical functioning than the control group [20]. Wang et al. reported that Tai Chi reduced pain and improves physical function, self-efficacy, depression, and health-related QOL for knee OA [2, 34]. In another study, Hall et al. found that a 10-week Tai Chi program reduced pain and disability outcomes and could be considered a safe and effective intervention for those experiencing long-term symptoms of lower back pain [35]. The results of the above-mentioned studies show that Tai Chi has beneficial effects for the treatment of knee OA, it can reduce pain, improve physical function, and improve the QOL.

The effects of Tai Chi on rheumatism

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease characterized by articular and extra-articular involvement. In a recent study, Li et al. assigned 40 patients to a Tai Chi or a control group after 8 weeks of home-based Tai Chi physical training. The Tai Chi group showed a significant improvement in disease activity and flexibility [3]. Shin et al. studied 56 patients with rheumatoid arthritis and found that Tai Chi improved endothelial dysfunction and hardening of the arteries in older women and was a useful strategy for cardiovascular disease prevention in patients with RA [6]. Zou et al. studied a number of sources using electronic and manual searches. They analyzed 10 studies related to their inclusion criteria and reported that existing evidence supports Tai Chi’s effectiveness in improving QOL and functional balance in patients with multiple sclerosis. Based on these findings, it is reasonable to assume that Tai Chi can help patients with RA.

The effects of Tai Chi on cancer

There are approximately 14.1 million cancer survivors worldwide, and this figure is expected to increase to 24 million by 2035 [36]. Physical exercise has been recommended to reduce the symptoms of breast cancer, including QOL, fatigue, and depression [37]. It can also contribute to cancer prevention and may help prevent recurrence. Tai Chi has been reported to be beneficial for physical, emotional, and neuropsychological functions in patients with breast cancer and lung cancer [38, 39].

Zhang et al. conducted a randomized trial of Tai Chi compared with low-impact exercise as a control intervention. They reported that Tai Chi was an effective intervention to manage cancer-related fatigue in patients with lung cancer undergoing chemotherapy. It decreased general fatigue and physical fatigue, and increased vigor [36]. Pan et al. analyzed nine randomized controlled trials that included 322 patients with breast cancer and found that Tai Chi subjects showed improvements in hand strength as measured by a hand dynamometer. The short-term effects of Tai Chi may have potential benefits in upper limb functional mobility in patients with breast cancer [40]. In another study, Sprod et al. reported that Tai Chi may improve health-related QOL by regulating inflammatory responses and other biomarkers associated with side effects from cancer and its treatments [41]. Rehabilitation of cancer patients is critical and affects the patient’s QOL. The above summary suggests that Tai Chi can be used as an effective rehabilitation for cancer patients. However, more reasonable exercise is needed for further study.

Conclusion

In conclusion, given the essential contribution of an exercise regimen, Tai Chi has recently emerged as a new and interesting therapy. Tai Chi is an ancient Chinese practice similar to yoga and has multiple effects on both physical and psychological health. This paper reveals the benefits of Tai Chi in nervous system disease, rheumatology, musculoskeletal disorders, cardiovascular diseases, respiratory diseases, and cancer. Representative clinical trials of the last two years which proved Tai Chi was effective are summarized in (Table 1). The primary reasons to choose Tai Chi as a treatment for chronic diseases are as follows. a) Tai Chi can reduce cardiovascular risks factors by regulating lipid metabolism, improving peripheral microcirculation, and adjusting heart rate. b) Tai Chi may promote the rehabilitation of patients with chronic lung disease by reducing dyspnea and improving exercise capacity. c) Tai Chi can ease motor system disease by reducing pain, improving balance, and preventing accidental falls. d) Tai Chi can improve QOL and balance in patients with rheumatism. e) Tai Chi may provide potential benefits to cancer patients by improving physical, emotional, and neuropsychological functions. In conclusion, Tai Chi effectively promotes health, and it can be prescribed as an alternative exercise program for patients with certain chronic diseases. Unfortunately, many of the effects of Tai Chi on the body have not yet been determined, and more focused research is needed to determine the specific mechanisms considering the variability of the role played by Tai Chi in each disease.

Table 1

The latest important researches on Tai Chi in the past two years

The authors have declared that no competing interests exist.

References

 [1.] Chen Y, Hunt W, Campbell K, et al. The effect of Tai Chi on four chronic conditions-cancer, osteoarthritis, heart failure and chronic obstructive pulmonary disease: a systematic review and meta-analyses. Br J Sports Med 2016, 50(7): 397-407. PMID:26383108 URL 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). 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. 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. 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. [CJCR: 3] [2.] Koh TC. Tai Chi Chuan. Am J Chin Med 1981, 9(1):15-22. [CJCR: 2] [3.] Zou L, Wang H, Xiao Z, et al. Tai chi for health benefits in patients with multiple sclerosis: A review. PLoS One 2017, 12(2): 1-18. PMID:28182629 URL Abstract The aim of this systematic review was to evaluate the existing evidence on the effectiveness and safety of Tai chi, which is critical to provide guidelines for clinicians to improve symptomatic management in patients with multiple sclerosis (MS). After performing electronic and manual searches of many sources, ten relevant peer-reviewed studies that met the inclusion criteria were retrieved. The existing evidence supports the effectiveness of Tai chi on improving quality of life (QOL) and functional balance in MS patients. A small number of these studies also reported the positive effect of Tai chi on flexibility, leg strength, gait, and pain. The effect of Tai chi on fatigue is inconsistent across studies. Although the findings demonstrate beneficial effects on improving outcome measures, especially for functional balance and QOL improvements, a conclusive claim should be made carefully for reasons such as methodological flaws, small sample size, lack of specific-disease instruments, unclear description of Tai chi protocol, unreported safety of Tai chi, and insufficient follow-up as documented by the existing literature. Future research should recruit a larger number of participants and utilize the experimental design with a long-term follow-up to ascertain the benefits of Tai chi for MS patients. [CJCR: 3] [4.] Zhang Y, Liu H, Zhou L, et al. Applying Tai Chi as a rehabilitation program for stroke patients in the recovery phase: study protocol for a randomized controlled trial. Trials 2014, 15(1): 484-491. PMID:4295286 URL As the second commonest cause of death and a major cause of disability worldwide, stroke has greatly influenced patients' quality of life and created a huge public health burden. As a special form of physical activity that has been widely practiced in China, and even throughout the world, Tai Chi may be favorable for the rehabilitation of stroke patients. Several studies have been conducted to investigate the rehabilitative effects of Tai Chi for stroke patients, but none of them have been focused on the recovery phase (2 to 24 weeks) of stroke. This study is an assessor-blinded randomized controlled trial. A total of 50 eligible participants will be randomly assigned to either a control group or a Tai Chi group. Patients in the control group will receive standard, conventional rehabilitation therapies, and a combination of Tai Chi and conventional rehabilitation programs will be applied in the Tai Chi group. The recovery of motor impairment, functional activity and balance abilities as measured with the Fugl-Meyer Assessment, Barthel Index and Berg Balance Scale will be assessed as primary outcome measures. The secondary outcome measures to be used are the scores on the Stroke-Specific Quality of Life Scale, the National Institutes of Health Stroke Scale and the objective parameters of the RSscan footscan gait system. All assessments will be conducted at baseline, 4 weeks after the rehabilitation course and at the end of 3-month follow-up. The results of this study will provide preliminary evidence regarding the efficacy and feasibility of Tai Chi as an additional rehabilitative program for stroke patients in the recovery phase. Chinese Clinical Trial Register ID: ChiCTR-TRC-13003661 (7 October 2013). [CJCR: 2] [5.] Ni X, Liu S, Lu F, et al. Efficacy and safety of Tai Chi for Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials. PLoS One 2014, 9(6): 377-378. PMID:4057148 URL by Xiaojia Ni, Shaonan Liu, Fuchang Lu, Xiaogeng Shi, Xinfeng GuoBackground and Objective In Parkinson's disease (PD), wearing off and side effects of long-term medication and complications pos ... [6.] Shin J, Lee Y, Kim S, et al. The beneficial effects of Tai Chi exercise on endothelial function and arterial stiffness in elderly women with rheumatoid arthritis. Arthritis Res Ther 2015, 17(4): 380-390. PMID:4718020 URL Rheumatoid arthritis (RA) has been known to be associated with increased risk of cardiovascular disease (CVD). The aim of this study was to investigate the effects of Tai Chi exercise on CVD risk in elderly women with RA. In total, 56 female patients with RA were assigned to either a Tai Chi exercise group (29 patients) receiving a 3-month exercise intervention once a week or a control group (27 patients) receiving general information about the benefits of exercise. All participants were assessed at baseline and at 3 months for RA disease activity (Disease Activity Score 28 and Routine Assessment of Patient Index Data 3), functional disability (Health Assessment Questionnaire), CVD risk factors (blood pressure, lipids profile, body composition, and smoking), and three atherosclerotic measurements: carotid intima-media thickness, flow-mediated dilatation (FMD), and brachial-ankle pulse wave velocity (baPWV). FMD, representative of endothelial function, significantly increased in the Tai Chi exercise group (initial 5.8565±652.05 versus 3 months 7.7565±652.53 %) compared with the control group (initial 6.3165±652.12 versus 3 months 5.7865±652.13 %) (P65=651.7665×6510613). Moreover, baPWV, representative of arterial stiffness, significantly decreased in the Tai Chi exercise group (initial 1693.765±65348.3 versus 3 months 1600.165±65291.0 cm/s) compared with the control group (initial 1740.365±65185.3 versus 3 months 1792.865±65326.1 cm/s) (P65=651.5765×6510612). In addition, total cholesterol decreased significantly in the Tai Chi exercise group compared with the control group (617.865±6515.5 versus 2.965±6512.2 mg/dl, P65=652.7265×6510612); other changes in RA-related characteristics were not significantly different between the two groups. Tai Chi exercise remained significantly associated with improved endothelial function (FMD; P65=654.3265×6510613) and arterial stiffness (baPWV; P65=652.2265×6510612) after adjustment for improvement in total cholesterol level. Tai Chi exercise improved endothelial dysfunction and arterial stiffness in elderly women with RA, suggesting that it can be a useful behavioral strategy for CVD prevention in patients with RA. [CJCR: 1] [7.] Wang C, Schmid C, Lversen M, et al. Comparative Effectiveness of Tai Chi Versus Physical Therapy for Knee Osteoarthritis: A Randomized Trial. Ann Intern Med 2016, 165(2): 77-86. DOI:10.7326/M15-2143 PMID:27183035 URL Abstract Background: Few remedies effectively treat long-term pain and disability from knee osteoarthritis. Studies suggest that Tai Chi alleviates symptoms, but no trials have directly compared Tai Chi with standard therapies for osteoarthritis. Objective: To compare Tai Chi with standard physical therapy for patients with knee osteoarthritis. Design: Randomized, 52-week, single-blind comparative effectiveness trial. (ClinicalTrials.gov: NCT01258985 ). Setting: An urban tertiary care academic hospital. Patients: 204 participants with symptomatic knee osteoarthritis (mean age, 60 years; 70% women; 53% white). Intervention: Tai Chi (2 times per week for 12 weeks) or standard physical therapy (2 times per week for 6 weeks, followed by 6 weeks of monitored home exercise). Measurements: The primary outcome was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 12 weeks. Secondary outcomes included physical function, depression, medication use, and quality of life. Results: At 12 weeks, the WOMAC score was substantially reduced in both groups (Tai Chi, 167 points [95% CI, 145 to 190 points]; physical therapy, 143 points [CI, 119 to 167 points]). The between-group difference was not significant (24 points [CI, -10 to 58 points]). Both groups also showed similar clinically significant improvement in most secondary outcomes, and the benefits were maintained up to 52 weeks. Of note, the Tai Chi group had significantly greater improvements in depression and the physical component of quality of life. The benefit of Tai Chi was consistent across instructors. No serious adverse events occurred. Limitation: Patients were aware of their treatment group assignment, and the generalizability of the findings to other settings remains undetermined. Conclusion: Tai Chi produced beneficial effects similar to those of a standard course of physical therapy in the treatment of knee osteoarthritis. Primary Funding Source: National Center for Complementary and Integrative Health of the National Institutes of Health. [8.] Yeh G, Wang C, Wayne P, et al. The effect of tai chi exercise on blood pressure: a systematic review. Prev Cardiol 2008, 11(2): 82-89. PMID:18401235 URL A systematic review of the literature on the effect of tai chi exercise on blood pressure (BP) was performed. The authors searched Medline, CAB, Alt HealthWatch, BIOSIS previews, Science Citation Index, and EMBASE systems (inception through January 2007); researched Chinese Medical, China Hospital Knowledge, China National Knowledge Infrastructure, and China Traditional Chinese Medicine databases (inception to June 2005); and performed hand searches at the medical libraries of Beijing and Nanjing Universities. Clinical studies of tai chi examining BP as an outcome published in English or Chinese were included. Studies reporting only acute exercise effects were excluded. Data were extracted in a standardized manner and 2 independent investigators assessed methodologic quality. Twenty-six studies examining patients with and without cardiovascular conditions met inclusion criteria: 9 randomized controlled trials, 13 nonrandomized studies, and 4 observational studies. Study heterogeneity precluded formal meta-analyses. Twenty-two studies (85%) reported reductions in BP with tai chi (309000932 mm Hg systolic and 209000918 mm Hg diastolic BP reductions). Five randomized controlled trials were of adequate quality (Jadad score 0909063). No adverse effects were reported. Tai chi exercise may reduce BP and serve as a practical, nonpharmacologic adjunct to conventional hypertension management. [9.] Nery R, Zanini M, Ferrari J, et al. Tai Chi Chuan for cardiac rehabilitation in patients with coronary arterial disease. Arq Bras Cardiol 2014, 102(6): 588-592. PMID:4079023 URL Several studies have shown that Tai Chi Chuan can improve cardiac function in patients with heart disease.To conduct a systematic review of the literature to assess the effects of Tai Chi Chuan on cardiac rehabilitation for patients with coronary artery disease.We performed a search for studies published in English, Portuguese and Spanish in the following databases: MEDLINE, EMBASE, LILACS and Cochrane Register of Controlled Trials. Data were extracted in a standardized manner by three independent investigators, who were responsible for assessing the methodological quality of the manuscripts.The initial search found 201 studies that, after review of titles and abstracts, resulted in a selection of 12 manuscripts. They were fully analyzed and of these, nine were excluded. As a final result, three randomized controlled trials remained. The studies analyzed in this systematic review included patients with a confirmed diagnosis of coronary artery disease, all were clinically stable and able to exercise. The three experiments had a control group that practiced structured exercise training or received counseling for exercise. Follow-up ranged from 2 to 12 months.Preliminary evidence suggests that Tai Chi Chuan can be an unconventional form of cardiac rehabilitation, being an adjunctive therapy in the treatment of patients with stable coronary artery disease. However, the methodological quality of the included articles and the small sample sizes clearly indicate that new randomized controlled trials are needed in this regard. [10.] Pan L, Yan J, Guo Y.Effects of Tai Chi training on exercise capacity and quality of life in patients with chronic heart failure: a meta-analysis. Eur J Heart Fail 2013, 15(3): 316-323. PMID:00054711 URL 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 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. [CJCR: 1] [11.] Guo J, Chen B, Lu Y, et al. Tai Chi for improving cardiopulmonary function and quality of life in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Clin Rehabil 2016, 30(8): 750-764. PMID:26396162 URL To examine the effect of Tai Chi on cardiopulmonary function and quality of life in chronic obstructive pulmonary disease. Cochrane Library, PUBMED, EMBASE, China Biology Medicine disc, China National Knowledge Infrastructure, and Wanfang database. Articles on randomized controlled trials comparing Tai Chi with other treatments or no treatment were identified. A random-effects model was used to calculate the pooled mean difference (MD) with 95% confidence interval (CI). Fifteen articles involving 1354 participants were included. Compared with the control group, Tai Chi was more effective in improving exercise capacity on 6-minute walking distance (short term: MD = 16.02, 95% CI 2.86 to 29.17; mid term: MD = 30.90, 95% CI 6.88 to 54.93; long term: MD = 24.63, 95% CI 2.30 to 46.95), as well as pulmonary functions on forced expiratory volume in the first second (mid term: MD = 0.10; 95% CI 0.01 to 0.19), and forced vital capacity (mid term: MD = 0.20; 95% CI 0.04 to 0.36). Concerning quality of life, we found Tai Chi was better than the control group for the Chronic Respiratory Disease Questionnaire dyspnoea score (short term: MD = 0.90; 95% CI 0.51 to 1.29), fatigue score (short term: MD = 0.75; 95% CI 0.42 to 1.09), and total score (short term: MD = 1.92; 95% CI 0.54 to 3.31). Tai Chi may improve exercise capacity in the short, mid, and long terms. However, no significant long term differences in pulmonary function and quality of life were observed for patients with chronic obstructive pulmonary disease. [CJCR: 2] [12.] Chen J.The Beneficial Effects of Tai Chi Chuan on Blood Pressure and Lipid Profile and Anxiety Status in a Randomized Controlled Trial. J Altern Complement Med 2003, 9(5): 747-754. PMID:14629852 URL To evaluate the effects on blood pressure, lipid profile, and anxiety status on subjects received a 12-week Tai Chi Chuan exercise program.Randomized controlled study of a Tai Chi Chuan group and a group of sedentary life controls.Taipei Medical University Hospitals and University campus in the Taipei, Taiwan, area.Two (2) selected groups of 76 healthy subjects with blood pressure at high-normal or stage I hypertension.A 12-week Tai Chi Chuan exercise training program was practiced regularly with a frequency of 3 times per week. Each session included 10-minute warm-up, 30-minute Tai Chi exercise, 10-minute cool-down. Exercise intensity was estimated to be approximately 64% of maximal heart rate.Blood pressure, lipid profile and anxiety status (State-Trait Anxiety Inventory; STAI) were evaluated.After 12-weeks of Tai Chi training, the treatment group showed significant decrease in systolic blood pressure of 15.6 mm Hg and diastolic blood pressure 8.8 mm Hg. The serum total cholesterol level decreased 15.2 mg/dL and high-density lipoprotein cholesterol increased 4.7 mg/dL. By using STAI evaluation, both trait anxiety and state anxiety were decreased.This study shows that under well-designed conditions, Tai Chi exercise training could decrease blood pressure and results in favorable lipid profile changes and improve subjects' anxiety status. Therefore, Tai Chi could be used as an alternative modality in treating patients with mild hypertension, with a promising economic effect. [CJCR: 1] [13.] Cheng T.Tai Chi: the Chinese ancient wisdom of an ideal exercise for cardiac patients. Int J Cardiol 2007, 117(3): 293-295. PMID:16904211 URL Cheng TO. [CJCR: 1] [14.] Wang J, Lan C, Wong M.Tai Chi Chuan training to enhance microcirculatory function in healthy elderly men. Arch Phys Med Rehabil 2001, 82(9): 1176-1180. PMID:11552187 URL Wang J-S, Lan C, Wong M-K. Tai Chi Chuan training to enhance microcirculatory function in healthy elderly men. Arch Phys Med Rehabil 2001;82:1176-80. Objective: To evaluate cutaneous microcirculatory function in geriatric Tai Chi Chuan (TCC) practitioners. Design: Case-control study. Setting: Community setting. Participants: Ten elderly male TCC practitioners (mean age, 69.9 ± 1.5yr) and 10 sedentary men with matched age and body size (mean age, 67.0 ± 1.0yr). Intervention: The TCC group had practiced TCC for 11.2 ± 3.4 years (mean ± standard error of the mean), with an exercise frequency of 5.1 ± 1.8 times weekly. Each session included 20 minutes of warm-up, 24 minutes of TCC practice, and 10 minutes of cool down. Main Outcome Measures: A graded exercise test with gas analysis was conducted on a bicycle ergometer for each subject. Skin blood flow (SkBF), cutaneous vascular conductance, and skin temperature were measured at rest and during exercise testing. Plasma nitric oxide metabolite was analyzed before and immediately after exercise. Results: The TCC group had a 34% higher VO2peak than the control group; it also had a higher SkBF, cutaneous vascular conductance, and skin temperature than the control group at rest and during exercise; and it also had a higher level of plasma nitric oxide metabolite than the sedentary group at rest and after exercise. Conclusion: Older TCC practitioners had higher cutaneous microcirculatory function during exercise than did their sedentary counterparts. Moreover, this change may be partially mediated by enhancement of nitric oxide release. 08 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation [CJCR: 1] [15.] Zheng G, Li S, Huang M, et al. The effect of Tai Chi training on cardiorespiratory fitness in healthy adults: a systematic review and meta-analysis. PLoS One 2015, 10(2): 360-380. PMID:25680184 URL Abstract BACKGROUND: Tai Chi may be efficient for healthy adults to improve the cardiorespiratory fitness, but there is no systematic evaluation for its effectiveness. OBJECTIVE: To systematically assess the effectiveness of Tai Chi on cardiorespiratory fitness in healthy adults. METHODS: Seven electronic databases were searched from their inception to October 2013. The controlled trails including randomized controlled trial (RCT), non-randomized controlled trial (NRCT), self-controlled trial (SCT), and cohort study (CS) testing Tai Chi exercise against non-intervention control conditions in healthy adults that assessed any type cardiorespiratory fitness outcome measures were considered. Two reviewers independently performed the selection of the studies according to predefined criteria. The risk of bias was assessed using Cochrane criteria. RevMan 5.2 software was applied for data analysis. RESULTS: Twenty studies (2 RCTs, 8 NRCTs, 3 SCTs, and 7 CSs) with 1868 participants were included, but most of them belonged to low methodological quality. The results of systematic review showed that Tai Chi exercise had positive effect on majority outcomes of cardio function (Blood pressure: n = 536, SPB SMD = -0.93, 95% CI -1.30 to -0.56, P < 0.00001; DBP SMD = -0.54, 95% CI -0.90 to -0.18, P < 0.00001; heart rate at quiet condition: n = 986, SMD = -0.72, 95% CI -1.27 to -0.18, P = 0.010; stroke volume: n = 583, SMD = 0.44, 95% CI 0.28 to 0.61, P < 0.00001; cardio output: n = 583, MD = 0.32 L/min, 95% CI 0.08 to 0.56, P = 0.009), lung capacity (FVC at quiet condition: n = 1272, MD = 359.16 mL, 95% CI 19.57 to 698.75, P = 0.04 for less than one year intervention, and MD = 442.46 mL, 95% CI 271.24 to 613.68, P<0.0001 for more than one year intervention; V/O2peak: n = 246, SMD = 1.33, 95% CI 0.97 to 1.70, P < 0.00001), and cardiorespiratory endurance (O2 pulse at quiet condition: n = 146, SMD = 1.04; 95% CI 0.69 to 1.39; P < 0.00001; stair test index at quiet condition: n = 679, SMD = 1.34, 95% CI 0.27 to 2.40, p = 0.01). No adverse events were reported. CONCLUSIONS: The results are encouraging and suggest that Tai Chi may be effective in improving cardiorespiratory fitness in healthy adults. However, concerning the low methodological quality in the included studies, more larger-scale well-designed trails are needed till the specific and accurate conclusions can be perorated. [CJCR: 1] [16.] Chan A, Sit J, Ying C, et al. Evaluation of the Effectiveness of Tai Chi versus Brisk Walking in Reducing Cardiovascular Risk Factors: Protocol for a Ranomized Controlled Trial. Int J Environ Res Public Health 2016, 13(7): 682-693. PMID:4962223 URL Physical inactivity is one of the major modifiable lifestyle risk factors for cardiovascular disease (CVD). This protocol aims to evaluate the effectiveness of Tai Chi versus brisk walking in reducing CVD risk factors. This is a randomized controlled trial with three arms, namely, Tai Chi group, walking group, and control group. The Tai Chi group will receive Tai Chi training, which consists of two 60-min sessions each week for three months, and self-practice for 30 min every day. The walking group will perform brisk walking for 30 min every day. The control group will receive their usual care. 246 subjects with CVD risk factors will be recruited from two outpatient clinics. The primary outcome is blood pressure. Secondary outcomes include fasting blood for lipid profile, sugar and glycated haemoglobin (HbA1c); body mass index, waist circumference, body fat percentage; perceived stress level and quality of life. Data collections will be conducted at baseline, 3-month, 6-month and 9-month. Generalized estimating equations model will be used to compare the changes in outcomes across time between groups. It is expected that both the Tai Chi and walking groups could maintain better health and have improved quality of life, and that Tai Chi will be more effective than brisk walking in reducing CVD risk factors. [CJCR: 1] [17.] Chang R, Koo M, Kan C, et al. Effects of Tai Chi rehabilitation on heart rate responses in patients with coronary artery disease. Am J Chin Med 2010, 38(3): 461-472. PMID:20503465 URL The objective of the present study was to evaluate the effect of a six-month Tai Chi (TC) exercise cardiac rehabilitation program on two prognostic factors of cardiac events, rate-pressure product and rate-pressure product reserve, in patients with coronary artery disease (CAD). Patients (N = 54) with CAD were recruited from the clinics of cardiology and cardiovascular surgery at a regional hospital in Taiwan. Twenty-two of them enrolled in the TC rehabilitation program which consisted of weekly 90-min sessions of Yang's style TC for six months in addition to receiving usual care. The remaining 32 patients received usual care only. Modified Bruce treadmill exercise test was performed to evaluate their exercise test responses at baseline and at six months. The change over time was significantly different between the TC and control group in peak rate-pressure product (RPP) (interaction between group and time, p = 0.029) and in RPP reserve (interaction between group and time p = 0.009) over the six-month period, there was a decrease in peak RPP of 32.0 mmHg u00d7 bpm u00d7 10-2 and in RPP reserve of 37.4 mmHg u00d7 bpm u00d7 10-2 in the TC group. In conclusion, participating in a six-month TC exercise-based cardiac rehabilitation program was associated with improved peak RPP and RPP reserve during exercise testing in patients with CAD. TC exercise program may lead to a better prognosis for cardiac events in patients with CAD. [CJCR: 1] [18.] Lan C, Chen S, Lai J.Changes of aerobic capacity, fat ratio and flexibility in older TCC practitioners: a five-year follow-up. Am J Chin Med 2008, 36(6): 1041-1050. PMID:19051334 URL Abstract The objective of this study was to evaluate the 5-year changes of aerobic capacity, fat ratio and flexibility in older Tai Chi Chuan (TCC) practitioners and sedentary controls. Sixty-nine community-dwelling elderly individuals (mean age: 68.6 +/- 6.3 years) completed this study. The TCC group (18 M; 17 F) had been practicing TCC regularly for 6.3 +/- 3.7 years at baseline and continued training in the study interval. The control group (16 M; 18 F) did not participate in any regular exercise program. A graded bicycle exercise testing was conducted at the baseline and at 5-year to evaluate the age-related decline in aerobic capacity. Triceps and subscapular skinfolds, and thoracolumbar flexibility were also measured. At baseline, the TCC group displayed higher peak oxygen uptake $({\dot{\rm V}}{\rm O}_{2{\rm peak}})$ and thoraolumbar flexibility, and lower fat ratio than the control group. At the 5-year follow-up, the TCC group displayed a smaller decrease in $\dot{\rm V}{\rm O}_{2{\rm peak}}$ than the sedentary group. The annual decrease of $\dot{\rm V}{\rm O}_{2{\rm peak}}$ in TCC men and women was 0.32 and 0.22 ml . kg(-1) . min(-1), respectively. In the control group, the annual decrease of $\dot{\rm V}{\rm O}_{2{\rm peak}}$ was 0.50 and 0.36 ml . kg(-1) . min(-1) in men and women, respectively. The TCC group also showed a smaller increase of body fat ratio, and a less decrease of flexibility than the control group. In conclusion, long-term practice of TCC attenuates the age-related decline of aerobic capacity, and it also reduces the increase of body fat ratio in older individuals. TCC may be prescribed as a conditioning exercise for the elderly to maintain their health fitness. [CJCR: 1] [19.] Ngai S, Jones A, Tam W.Tai Chi for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev 2016, 6(6): 953-976. PMID:27272131 URL Abstract Background: Tai Chi, a systematic callisthenic exercise first developed in ancient China, involves a series of slow and rhythmic circular motions. It emphasises use of 'mind' or concentration to control breathing and circular body motions to facilitate flow of internal energy (i.e. 'qi') within the body. Normal flow of 'qi' is believed to be essential to sustain body homeostasis, ultimately leading to longevity. The effect of Tai Chi on balance and muscle strength in the elderly population has been reported; however, the effect of Tai Chi on dyspnoea, exercise capacity, pulmonary function and psychosocial status among people with chronic obstructive pulmonary disease (COPD) remains unclear. Objectives: To explore the effectiveness of Tai Chi in reducing dyspnoea and improving exercise capacity in people with COPD. To determine the influence of Tai Chi on physiological and psychosocial functions among people with COPD. Search methods: We searched the Cochrane Airways Group Specialised Register of trials (which included the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Allied and Complementary Medicine Database (AMED) and PsycINFO); handsearched respiratory journals and meeting abstracts; and searched Chinese medical databases including Wanfang Data, Chinese Medical Current Contents (CMCC), Chinese Biomedical Database (CBM), China Journal Net (CJN) and China Medical Academic Conference (CMAC), from inception to September 2015. We checked the reference lists of all primary studies and review articles for relevant additional references. Selection criteria: We included randomised controlled trials (RCTs) comparing Tai Chi (Tai Chi alone or Tai Chi in addition to another intervention) versus control (usual care or another intervention identical to that used in the Tai Chi group) in people with COPD. Two independent review authors screened and selected studies. Data collection and analysis: Two independent review authors extracted data from included studies and assessed risk of bias on the basis of suggested criteria listed in the Cochrane Handbook for Systematic Reviews of Interventions. We extracted post-programme data and entered them into RevMan software (version 5.3) for data synthesis and analysis. Main results: We included a total of 984 participants from 12 studies (23 references) in this analysis. We included only those involved in Tai Chi and the control group (i.e. 811 participants) in the final analysis. Study sample size ranged from 10 to 206, and mean age ranged from 61 to 74 years. Programmes lasted for six weeks to one year. All included studies were RCTs; three studies used allocation concealment, six reported blinded outcome assessors and three studies adopted an intention-to-treat approach to statistical analysis. No adverse events were reported. Quality of evidence of the outcomes ranged from very low to moderate.Analysis was split into three comparisons: (1) Tai Chi versus usual care; (2) Tai Chi and breathing exercise versus breathing exercise alone; and (3) Tai Chi and exercise versus exercise alone.Comparison of Tai Chi versus usual care revealed that Tai Chi demonstrated a longer six-minute walk distance (mean difference (MD) 29.64 metres, 95% confidence interval (CI) 10.52 to 48.77 metres; participants = 318; I(2) = 59%) and better pulmonary function (i.e. forced expiratory volume in one second, MD 0.11 L, 95% CI 0.02 to 0.20 L; participants = 258; I(2) = 0%) in post-programme data. However, the effects of Tai Chi in reducing dyspnoea level and improving quality of life remain inconclusive. Data are currently insufficient for evaluating the impact of Tai Chi on maximal exercise capacity, balance and muscle strength in people with COPD. Comparison of Tai Chi and other interventions (i.e. breathing exercise or exercise) versus other interventions shows no superiority and no additional effects on symptom improvement nor on physical and psychosocial outcomes with Tai Chi. Authors' conclusions: No adverse events were reported, implying that Tai Chi is safe to practise in people with COPD. Evidence of very low to moderate quality suggests better functional capacity and pulmonary function in post-programme data for Tai Chi versus usual care. When Tai Chi in addition to other interventions was compared with other interventions alone, Tai Chi did not show superiority and showed no additional effects on symptoms nor on physical and psychosocial function improvement in people with COPD. With the diverse style and number of forms being adopted in different studies, the most beneficial protocol of Tai Chi style and number of forms could not be commented upon. Hence, future studies are warranted to address these topics. [CJCR: 2] [20.] Song H, Xu R, Shen G, et al. Influence of Tai Chi exercise cycle on the senile respiratory and cardiovascular circulatory function. Int J Clin Exp Med 2014, 7(3): 770-774. PMID:24753776 URL Observe the improvement effect of different cycles of Tai Chi exercise on the senile respiratory and cardiovascular circulatory function.Select 180 elderly men who don't usually do the fitness exercise and then ask them to do Tai Chi exercise. Test their related indicators respectively prior to exercise and upon exercise for 3 months, 6 months and 12 months. ① The cardiac pump function indicator: "Stroke Volume", "Ejection Fraction" and "Heart Rate"; ② Rheoencephalogram (REG) indicator: "Inflow time", "Wave Amplitude"; ③ Pulmonary ventilation indicator: "Vital Capacity" (VC), "Maximum Minute Ventilation" (MMV).① Compared with the indicators before exercise, each indicator has no significant difference after 3 months of exercise and a part of indicators are improved after 6 months of exercise, but most indicators have no significant differences; ② After 12 months of the exercise, compared with those indicators before exercise, the tested indicators are obviously improved. Specific data indicates that stroke volume (mL) is increased to 71.82 ± 10.93 from 66.21 ± 11.35 and the ejection fraction (%) is improved to 67.89 ± 4.94 from 60.54 ± 5.02, but the heart rate (times/min) is reduced to 67.15 ± 8.39 from 76.62 ± 8.40, mean P<0.05; inflow time (s) is shortened to 0.13 ± 0.04 from 0.17 ± 0.05; the amplitude (Ω) is increased to 1.19 ± 0.23 from 0.97 ± 0.21 before exercise and mean P<0.05; the vital capacity (L) is increased to 3.57 ± 1.39 from 2.84 ± 0.32; maximum minute ventilation (L/min) is improved to 117.25 ± 14.86 from 97.26 ± 14.71, mean P<0.05.The short-term Tai Chi exercise that is less than six months the following 6 months has no significant effect on the senile respiratory and cardiovascular circulatory function, however, with the longer exercise duration, after 12 months' exercise, it can significantly improve the effect. [CJCR: 2] [21.] Guo H, Qiu Z, Zhong H, et al. Physiological responses to Tai Chi in stable patients with COPD. Respir Physiol Neurobiol 2016, 221(11): 30-34. PMID:26549554 URL Abstract We compared the physiological work, judged by oxygen uptake, esophageal pressure swing and diaphragm electromyography, elicited by Tai Chi compared with that elicited by constant rate treadmill walking at 60% of maximal load in eleven patients with COPD (Mean FEV1 61% predicted, FEV1/FVC 47%). Dynamic hyperinflation was assessed by inspiratory capacity and twitch quadriceps tension (TwQ) elicited by supramaximal magnetic stimulation of the femoral nerve was also measured before and after both exercises. The EMGdi and esophageal pressure at the end of exercise were similar for both treadmill exercise and Tai Chi (0.10900±0.047 mV vs 0.11800±0.061 mV for EMGdi and 22.300±7.1 cmH2O vs 21.900±8.1 cmH2O for esophageal pressure). Moreover the mean values of oxygen uptake during Tai Chi and treadmill exercise did not differ significantly: 11.3 ml/kg/min (51.1% of maximal oxygen uptake derived from incremental exercise) and 13.4 ml/kg/min (52.5%) respectively, p>0.05. Respiratory rate during Tai Chi was significantly lower than that during treadmill exercise. Both Tai Chi and treadmill exercise elicited a fall in IC at end exercise, indicating dynamic hyperinflation, but this was statistically significant only after treadmill exercise. TwQ decreased significantly after Tai Chi but not after treadmill. We conclude that Tai Chi constitutes a physiologically similar stimulus to treadmill exercise and may therefore be an acceptable modality for pulmonary rehabilitation which may be culturally more acceptable in some parts of the world. Copyright 0008 2015 Elsevier B.V. All rights reserved. [CJCR: 1] [22.] Gloria Y, Mary T.Tai Chi Exercise for Patients with Chronic Obstructive Pulmonary Disease a Pilot Study. Respir Care 2010, 55(11): 1475-1482. PMID:20979675 URL To determine the feasibility of a randomized controlled trial of the effect of a tai chi program on quality of life and exercise capacity in patients with COPD.We randomized 10 patients with moderate to severe COPD to 12 weeks of tai chi plus usual care (n = 5) or usual care alone (n = 5). The tai chi training consisted of a 1-hour class, twice weekly, that emphasized gentle movement, relaxation, meditation, and breathing techniques. Exploratory outcomes included disease-specific symptoms and quality-of-life, exercise capacity, pulmonary function tests, mood, and self-efficacy. We also conducted qualitative interviews to capture patient narratives regarding their experience with tai chi.The patients were willing to be randomized. Among 4 of the 5 patients in the intervention group, adherence to the study protocol was excellent. The cohort's baseline mean ± SD age, percent-of-predicted FEV69, and ratio of FEV69 to forced vital capacity were 66 ± 6 y, 50 ± 12%, and 0.63 ± 0.14, respectively. At 12 weeks there was significant improvement in Chronic Respiratory Questionnaire score among the tai chi participants (1.4 ± 1.1), compared to the usual-care group (-0.1 ± 0.4) (P = .03). There were nonsignificant trends toward improvement in 6-min walk distance (55 ± 47 vs -13 ± 64 m, P = .09), Center for Epidemiologic Studies Depression Scale (-9.0 ± 9.1 vs -2.8 ± 4.3, P = .20), and University of California, San Diego Shortness of Breath score (-7.8 ± 3.5 vs -1.2 ± 11, P = .40). There were no significant changes in either group's peak oxygen uptake.A randomized controlled trial of tai chi is feasible in patients with moderate to severe COPD. Tai chi exercise as an adjunct to standard care warrants further investigation. [CJCR: 1] [23.] Leung R, Mckeough Z, Peters M, et al. Short-form Sun-style Tai chi as an exercise training modality in people with COPD. Eur Respir J 2013, 41(5): 1051-1057. PMID:22878879 URL The aims of the study were to determine the effect of short-form Sun-style t'ai chi (SSTC) (part A) and investigate exercise intensity of SSTC (part B) in people with chronic obstructive pulmonary disease (COPD).Part A: after confirmation of eligibility, participants were randomly allocated to either the t'ai chi group or control group (usual medical care). Participants in the t'ai chi group trained twice weekly for 12 weeks. Part B: participants who had completed training in the t'ai chi group performed a peak exercise test (incremental shuttle walk test) and SSTC while oxygen consumption (Vo(2)) was measured. Exercise intensity of SSTC was determined by the per cent of Vo(2) reserve.Of 42 participants (mean +/- SD forced expiratory volume in 1 s 59 +/- 16% predicted), 38 completed part A and 15 completed part B. Compared to control, SSTC significantly increased endurance shuttle walk time (mean difference 384 s, 95% CI 186-510); reduced medial-lateral body sway in semi-tandem stand (mean difference -12.4 mm, 95% CI -21- -3); and increased total score on the chronic respiratory disease questionnaire (mean difference 11 points, 95% CI 4-18). The exercise intensity of SSTC was 53 +/- 18% of Vo(2) reserve.SSTC was an effective training modality in people with COPD achieving a moderate exercise intensity which meets the training recommendations. [CJCR: 1] [24.] Wayne P, Walsh J, Taylorpiliae R, et al. The Impact of Tai Chi on Cognitive Performance in Older Adults: A Systematic Review and Meta-Analysis. NIH Public Access Author Manuscript 2014, 62(1): 25-39. PMID:4055508 URL ABSTRACT Objectives To summarize and critically evaluate research on the effects of Tai Chi on cognitive function in older adults. DesignSystematic review with meta-analysis. SettingCommunity and residential care. ParticipantsIndividuals aged 60 and older (with the exception of one study) with and without cognitive impairment. MeasurementsCognitive ability using a variety of neuropsychological testing. ResultsTwenty eligible studies with a total of 2,553 participants were identified that met inclusion criteria for the systematic review; 11 of the 20 eligible studies were randomized controlled trials (RCTs), one was a prospective nonrandomized controlled study, four were prospective noncontrolled observational studies, and four were cross-sectional studies. Overall quality of RCTs was modest, with three of 11 trials categorized as high risk of bias. Meta-analyses of outcomes related to executive function in RCTs of cognitively healthy adults indicated a large effect size when Tai Chi participants were compared with nonintervention controls (Hedges' g = 0.90; P = .04) and a moderate effect size when compared with exercise controls (Hedges' g = 0.51; P = .003). Meta-analyses of outcomes related to global cognitive function in RCTs of cognitively impaired adults, ranging from mild cognitive impairment to dementia, showed smaller but statistically significant effects when Tai Chi was compared with nonintervention controls (Hedges' g = 0.35; P = .004) and other active interventions (Hedges' g = 0.30; P = .002). Findings from nonrandomized studies add further evidence that Tai Chi may positively affect these and other domains of cognitive function. Conclusion Tai Chi shows potential to enhance cognitive function in older adults, particularly in the realm of executive functioning and in individuals without significant impairment. Larger and methodologically sound trials with longer follow-up periods are needed before more-definitive conclusions can be drawn. [CJCR: 1] [25.] Tao J, Chen X, Egorova N, et al. Tai Chi Chuan and Baduanjin practice modulates functional connectivity of the cognitive control network in older adults. Sci Rep 2017, 41(7): 581-590. PMID:28169310 URL Cognitive impairment is one of the most common problem saffecting older adults. In this study, we investigated whether Tai Chi Chuan and Baduanjin practice can modulate mental control functionand the resting state functional connectivity (rsFC) of the cognitive control network in older adults. [CJCR: 1] [26.] Lam L, Chau R, Wong R, et al. Interim follow-up of a randomized controlled trial comparing Chinese style mind body (Tai Chi) and stretching exercises on cognitive function in subjects at risk of progressive cognitive decline. Int J Geriatr Psychiatry 2011, 26(7): 733-740. DOI:10.1002/gps.2602 PMID:21495078 URL Abstract OBJECTIVES: We reported the interim findings of a randomized controlled trial (RCT) to examine the effects of a mind body physical exercise (Tai Chi) on cognitive function in Chinese subjects at risk of cognitive decline. SUBJECTS: 389 Chinese older persons with either a Clinical Dementia Rating (CDR 0.5) or amnestic-MCI participated in an exercise program. The exercise intervention lasted for 1 year; 171 subjects were trained with 24 forms simplified Tai Chi (Intervention, I) and 218 were trained with stretching and toning exercise (Control, C). The exercise comprised of advised exercise sessions of at least three times per week. RESULTS: At 5th months (2 months after completion of training), both I and C subjects showed an improvement in global cognitive function, delayed recall and subjective cognitive complaints (paired t-tests, p < 0.05). Improvements in visual spans and CDR sum of boxes scores were observed in I group (paired t-tests, p < 0.001). Three (2.2%) and 21(10.8%) subjects from the I and C groups progressed to dementia (Pearson chi square = 8.71, OR = 5.34, 95% CI 1.56-18.29). Logistic regression analysis controlled for baseline group differences in education and cognitive function suggested I group was associated with stable CDR (OR = 0.14, 95%CI = 0.03-0.71, p = 0.02). CONCLUSIONS: Our interim findings showed that Chinese style mind body (Tai Chi) exercise may offer specific benefits to cognition, potential clinical interests should be further explored with longer observation period. Copyright © 2010 John Wiley & Sons, Ltd. [CJCR: 1] [27.] Zheng G, Liu F, Li S, et al. Tai Chi and the Protection of Cognitive Ability: A Systematic Review of Prospective Studies in Healthy Adults. Am J Prev Med 2015, 49(1): 89-97. PMID:26094229 URL Compared with usual physical activities, Tai Chi shows potential protective effects on healthy adults’ cognitive ability. Large RCTs with more rigorous designs are needed to fully evaluate and confirm its potential benefits. [CJCR: 1] [28.] Wang C, Bannuru R, Ramel J, et al. Tai Chi on psychological well-being: systematic review and meta-analysis. BMC Complement Altern Med 2010, 23(10): 472-488. PMID:20492638 URL Background Physical activity and exercise appear to improve psychological health. However, the quantitative effects of Tai Chi on psychological well-being have rarely been examined. We systematically reviewed the effects of Tai Chi on stress, anxiety, depression and mood disturbance in eastern and western populations. Methods Eight English and 3 Chinese databases were searched through March 2009. Randomized controlled trials, non-randomized controlled studies and observational studies reporting at least 1 psychological health outcome were examined. Data were extracted and verified by 2 reviewers. The randomized trials in each subcategory of health outcomes were meta-analyzed using a random-effects model. The quality of each study was assessed. Results Forty studies totaling 3817 subjects were identified. Approximately 29 psychological measurements were assessed. Twenty-one of 33 randomized and nonrandomized trials reported that 1 hour to 1 year of regular Tai Chi significantly increased psychological well-being including reduction of stress (effect size [ES], 0.66; 95% confidence interval [CI], 0.23 to 1.09), anxiety (ES, 0.66; 95% CI, 0.29 to 1.03), and depression (ES, 0.56; 95% CI, 0.31 to 0.80), and enhanced mood (ES, 0.45; 95% CI, 0.20 to 0.69) in community-dwelling healthy participants and in patients with chronic conditions. Seven observational studies with relatively large sample sizes reinforced the beneficial association between Tai Chi practice and psychological health. Conclusions Tai Chi appears to be associated with improvements in psychological well-being including reduced stress, anxiety, depression and mood disturbance, and increased self-esteem. Definitive conclusions were limited due to variation in designs, comparisons, heterogeneous outcomes and inadequate controls. High-quality, well-controlled, longer randomized trials are needed to better inform clinical decisions. [CJCR: 1] [29.] Cwiekala K, Gallek M, Taylor R.The effects of Tai Chi on physical function and well-being among persons with Parkinson's Disease: A systematic review. J Bodyw Mov Ther 2017, 21(2): 414-421. PMID:28532886 URL Current medical treatments for Parkinson's disease (PD) are mainly palliative, though research indicates Tai Chi exercise improves physical function and well-being. An electronic database search of PubMed, CINAHL, Web of Science, Cochrane Library, PsycINFO and Embase was conducted, to examine current scientific literature for potential benefits of Tai Chi on physical function and well-being among persons with PD. A total of 11 studies met the inclusion criteria: 7 randomized clinical trials and 4 quasi-experimental studies. PD participants (n=548) were on average age 68 years old and 50% women. Overall, participants enrolled in Tai Chi had better balance and one or more aspect of well-being, though mixed results were reported. Further research is needed with more rigorous study designs, larger sample sizes, adequate Tai Chi exercise doses, and carefully chosen outcome measures that assess the mechanisms as well as the effects of Tai Chi, before widespread recommendations can be made. [CJCR: 1] [30.] Gatts S, Woollacott M.How Tai Chi improves balance: biomechanics of recovery to a walking slip in impaired seniors. Gait Posture 2007, 25(2): 205-214. PMID:16672187 URL Tai Chi training significantly enhanced balance responses by more efficacious use of mechanisms controlling stepping strategies of the swing leg. COM A/P path significantly increased after TC implying improved ability to tolerate unsteadiness. COM-COP A/P separation angle at RHS increased suggesting a longer step and increased mechanical loading at the hip. [CJCR: 1] [31.] Li F, Harmer P, Fisher K, et al. Tai Chi: improving functional balance and predicting subsequent falls in older persons. Med Sci Sports Exerc 2004, 36(12): 2046-2052. PMID:15570138 URL Abstract PURPOSE: To determine whether improved functional balance through a Tai Chi intervention is related to subsequent reductions in falls among elderly persons. METHODS: Two hundred fifty-six healthy, physically inactive older adults aged 70-92 (mean age +/- SD = 77.48 +/- 4.95), recruited from a local health system in Portland, OR, participated in a 6-month randomized controlled trial, with allocation to Tai Chi or exercise stretching control, followed by a 6-month postintervention follow-up. Functional balance measures included Berg balance scale, dynamic gait index, and functional reach, assessed during the 6-month intervention period (baseline, 3-month, and 6-month intervention endpoint) and again at the 6-month postintervention follow-up. Fall counts were recorded during the 6-month postintervention follow-up period. Data were analyzed through intention-to-treat analysis of variance and logistic regression procedures. RESULTS: Tai Chi participants who showed improvements in measures of functional balance at the intervention endpoint significantly reduced their risk of falls during the 6-month postintervention period, compared with those in the control condition (odds ratio (OR), 0.27, 95% confidence interval (CI), 0.07-0.96 for Berg balance scale; OR, 0.27, 95% CI, 0.09-0.87 for dynamic gait index; OR, 0.20, 95% CI, 0.05-0.82 for functional reach). CONCLUSIONS: Improved functional balance through Tai Chi training is associated with subsequent reductions in fall frequency in older persons. [CJCR: 1] [32.] Voukelatos A, Cumming R, Rissel C, et al. A randomized, controlled trial of tai chi for the prevention of falls: the Central Sydney tai chi trial. J Am Geriatr Soc 2007, 55(8): 1185-1191. PMID:17661956 URL OBJECTIVES: To determine the effectiveness of a 16-week community-based tai chi program in reducing falls and improving balance in people aged 60 and older. [CJCR: 1] [33.] Hartman C, John C, Tina M, et al. Effects of Tai Chi training on function and quality of life indicators in older adults with osteoarthritis. J Am Geriatr Soc 2000, 48(12): 1553-1559. PMID:11129742 URL Abstract OBJECTIVE: To determine the effects of T'ai Chi training on arthritis self-efficacy, quality of life indicators, and lower extremity functional mobility in older adults with osteoarthritis. DESIGN: A prospective, randomized, controlled clinical trial. Intervention length was 12 weeks, with outcomes measured before and after intervention using blinded testers. Group (T'ai Chi vs Control) x time (2 x 2) mixed factorial ANOVA. SETTING: Allied Health Sciences Center at Springfield College, Springfield, MA PARTICIPANTS: A total of 33 community-dwelling participants (mean age 68) diagnosed with lower extremity osteoarthritis and having no prior T'ai Chi training longer than 2 weeks. INTERVENTION: T'ai Chi training included two 1-hour T'ai Chi classes per week for 12 weeks. MEASUREMENTS: Arthritis self-efficacy (Arthritis Self-Efficacy Scale), quality of life indicators (Arthritis Impact Measurement Scale), functional outcomes (one-leg standing balance, 50-foot walking speed, time to rise from a chair). RESULTS: T'ai Chi participants experienced significant (P < .05) improvements in self-efficacy for arthritis symptoms, total arthritis self-efficacy, level of tension, and satisfaction with general health status. CONCLUSIONS: A moderate T'ai Chi intervention can enhance arthritis self-efficacy, quality of life, and functional mobility among older adults with osteoarthritis. T'ai Chi training is a safe and effective complementary therapy in the medical management of lower extremity osteoarthritis. [CJCR: 1] [34.] Wang C, Schmid C, Hibberd P, et al. Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial. Arthritis Rheum 2009, 61(11): 1545-1553. [CJCR: 1] [35.] Hall A, Maker C, Lan P, et al. Tai chi exercise for treatment of pain and disability in people with persistent low back pain: a randomized controlled trial. Arthritis Care Res 2011, 63(11): 1576-1583. PMID:22034119 URL Abstract Objective To determine the effect of tai chi exercise on persistent low back pain. Methods We performed a randomized controlled trial in a general community setting in Sydney, New South Wales, Australia. Participants consisted of 160 volunteers between ages 18 and 70 years with persistent nonspecific low back pain. The tai chi group (n = 80) consisted of 18 40-minute sessions over a 10-week period delivered in a group format by a qualified instructor. The waitlist control group continued with their usual health care. Bothersomeness of back symptoms was the primary outcome. Secondary outcomes included pain intensity and pain-related disability. Data were collected at pre- and postintervention and analyzed by intent-to-treat. Results Tai chi exercise reduced bothersomeness of back symptoms by 1.7 points on a 0–10 scale, reduced pain intensity by 1.3 points on a 0–10 scale, and improved self-report disability by 2.6 points on the 0–24 Roland-Morris Disability Questionnaire scale. The followup rate was >90% for all outcomes. These results were considered a worthwhile treatment effect by researchers and participants. Conclusion This is the first pragmatic randomized controlled trial of tai chi exercise for people with low back pain. It showed that a 10-week tai chi program improved pain and disability outcomes and can be considered a safe and effective intervention for those experiencing long-term low back pain symptoms. [CJCR: 1] [36.] Smith L, Scruton A, Dan G, et al. The potential yield of Tai Chi in cancer survivorship. Future Sci OA 2016, 2(4): 152-156. PMID:5242198 URL Abstract The purpose of the current paper is to encourage research into all areas of Tai Chi and cancer survivorship. Tai Chi is defined here as a combination of Chinese philosophy, martial and healing arts. Tai Chi is a form of physical activity that is carried out at either a light or moderate intensity. The practice of Tai Chi integrates mental concentration and breathing control. We first discuss the role of light physical activity in cancer survivorship and then narrow our focus to Tai Chi per se. [CJCR: 2] [37.] Lee M, Choi T, Ernst E.Tai chi for breast cancer patients: a systematic review. Breast Cancer Res Treat 2010, 120(2): 309-316. PMID:20127280 URL The objective of this review was to assess the effectiveness of tai chi for supportive breast cancer care. Eleven databases were searched from inception through December 2009. Controlled trials testing tai chi in patients with breast cancer that assessed clinical outcome measures were considered. The selection of studies, data extraction, and validations were performed independently by two reviewers. Risk of bias was assessed using Cochrane criteria. Three randomized clinical trials (RCTs) and four non-randomized controlled clinical trials (CCTs) met our inclusion criteria. The three RCTs tested the effects of tai chi on breast cancer care compared with walking exercise, psychological support therapy, or spiritual growth or standard health care and showed no significant differences between tai chi and these control procedures in quality of life and psychological and physical outcome measures. The meta-analysis also failed to demonstrate significant effects of tai chi compared with control interventions ( n 02=0238, SMD, 0.45, 95% CI 610.25 to 1.14, P 02=020.21; heterogeneity: χ 2 02=020.23, P 02=020.63; I 2 02=020%). All of the four CCTs showed favorable effects of tai chi. Three trials suggested effectiveness in psychological and physical outcome measures, whereas one study was too poorly reported to be evaluated in detail. All of the CCTs had a high risk of bias. Collectively, the existing trial evidence does not show convincingly that tai chi is effective for supportive breast cancer care. Future studies should be of high methodological quality, with a particular emphasis on including an adequate control intervention. [CJCR: 1] [38.] Mustian K, Katula J, Gill D, et al. Tai Chi Chuan, health-related quality of life and self-esteem: a randomized trial with breast cancer survivors. Support Care Cancer 2004, 12(12): 871-876. PMID:15599776 URL Goals Health-related quality of life ( HRQL ) and self-esteem are often diminished among women diagnosed and treated for breast cancer. Tai Chi is a moderate form of exercise that may be an effective therapy for improving HRQL and self-esteem among these women. We sought to compare the efficacy of Tai Chi Chuan (TCC) and psychosocial support (PST) for improving HRQL and self-esteem among breast cancer survivors. Patients and methods A group of 21 women diagnosed with breast cancer, who had completed treatment within the last 3002months were randomized to receive 1202weeks of TCC or PST. Participants in both groups met three times a week for 6002minutes. HRQL and self-esteem were assessed at baseline, 602weeks, and 1202weeks. Results The TCC group demonstrated significant improvements in HRQL , while the PST group reported declines in HRQL , with the differences between the two groups approaching significance at week0212. Additionally, the TCC group exhibited improvements in self-esteem, while the PST group reported declines in self-esteem, with the differences between groups reaching statistical significance at week0212. These findings, coupled with a visual inspection of the raw change scores, support the plausibility of a dose-response relationship concerning Tai Chi. Conclusions In this pilot investigation, the TCC group exhibited improvements in HRQL and self-esteem from baseline to 6 and 1202weeks, while the support group exhibited declines. Randomized, controlled clinical trials with larger sample sizes are needed. [CJCR: 1] [39.] Zhang L, Wang S, Chen H, et al. Tai Chi Exercise for Cancer-Related Fatigue in Patients With Lung Cancer Undergoing Chemotherapy: A Randomized Controlled Trial. J Pain Symptom Manage, 2016, 51(3): 504-511. PMID:26721747 URL Abstract CONTEXT: Tai Chi is a traditional Chinese health-promoting exercise. It has been shown to enhance mental health and improve psychological condition. OBJECTIVES: We aimed to assess the effectiveness of Tai Chi exercise for cancer-related fatigue in patients with lung cancer undergoing chemotherapy. METHODS: We conducted a randomized trial of Tai Chi exercise as compared with low-impact exercise as a control intervention. Exercises were practiced every other day, a one-hour session for 120002weeks for each of the study groups. The primary end point was a change in total score of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF). Secondary end points were changes in five subscale scores of the MFSI-SF. All assessments were repeated at three time points, T0: before first course of chemotherapy; T1: before third course of chemotherapy; and T2: at the end of the fourth course of chemotherapy. RESULTS: Between January 2012 and December 2014, 96 patients were enrolled in this trial. At six and 120002weeks, the Tai Chi group had a lower MFSI-SF total score compared with the control group (59.5000200±000211.3 vs. 66.8000200±000211.9, P000200020.05) and mental subscale (18.2000200±00024.0 vs. 18.9000200±00023.9, P0002>00020.05) scores between the Tai Chi group and the control group. At 120002weeks, the MFSI-SF subscale scores showed the same trends as at six weeks. CONCLUSION: Tai Chi is an effective intervention for managing cancer-related fatigue in patients with lung cancer undergoing chemotherapy, especially for decreasing general fatigue and physical fatigue, and increasing vigor. Copyright 0008 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved. [CJCR: 1] [40.] Pan Y, Yang K, Shi X, et al. Tai chi chuan exercise for patients with breast cancer: a systematic review and meta-analysis. Evid Based Complement Alternat Med 2015, 53(5): 237-252. PMID:4352428 URL Objective. Tai Chi Chuan (TCC) is a form of aerobic exercise that may be an effective therapy for improving psychosomatic capacity among breast cancer survivors. This meta-analysis analyzed the available randomized controlled trials (RCTs) on the effects of TCC in relieving treatment-related side effects and quality of life in women with breast cancer. Methods. RCTs were searched in PubMed, Embase, Web of Science, and Cochrane Library through April 2014. Data were analyzed on pathology (pain, interleukin-6, and insulin-like growth factor 1), physical capacity (handgrip, limb physical fitness, and BMI), and well-being (physical, social, emotional, and general quality of life). Results. Nine RCTs, including a total of 322 breast cancer patients, were examined. Compared with control therapies, the pooled results suggested that TCC showed significant effects in improving handgrip dynamometer strength, limb elbow flexion (elbow extension, abduction, and horizontal adduction). No significant differences were observed in pain, interleukin-6, insulin-like growth factor, BMI, physical well-being, social or emotional well-being, or general health-related quality of life. Conclusion. The short-term effects of TCC may have potential benefits in upper limb functional mobility in patients with breast cancer. Additional randomized controlled trials with longer follow-up are needed to provide more reliable evidence. [CJCR: 1] [41.] Sprod L, Oxana G, Karen M, et al. Health-related quality of life and biomarkers in breast cancer survivors participating in tai chi chuan. J Cancer Surviv 2012, 6(2): 146-154. [CJCR: 1]
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