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Tai Chi: an effective Therapy for Fibromyalgia

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A Randomized Trial of Tai Chi for Fibromyalgia. Previous research has suggested that tai chi offers a therapeutic benefit in patients with fibromyalgia. Methods; We conducted a single-blind, randomized trial of classic Yang-style tai chi as compared with a control intervention consisting of wellness education and stretching for the treatment of fibromyalgia (defined by American College of Rheumatology 1990 criteria). Sessions lasted 60 minutes each and took place twice a week for 12 weeks for each of the

study groups. The primary end point was a change in the Fibromyalgia Impact Questionnaire (FIQ) score (ranging from 0 to 100, with higher scores indicating more severe symptoms) at the end of 12 weeks. Secondary end points included summary scores on the physical and mental components of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). All assessments were repeated at 24 weeks to test the durability of the response. Results; Of the 66 randomly assigned patients, the 33 in the tai chi group had clinically important improvements in the FIQ total score and quality of life. Mean (±SD) baseline and 12-week FIQ scores for the tai chi group were 62.9±15.5 and 35.1±18.8, respectively, versus 68.0±11 and 58.6±17.6, respectively, for the control group (change from baseline in the tai chi group vs. change from baseline in the control group, −18.4 points; P<0.001). The corresponding SF-36 physical-component scores were 28.5±8.4 and 37.0±10.5 for the tai chi group versus 28.0±7.8 and 29.4±7.4 for the control group (between-group difference, 7.1 points; P=0.001), and the mental-component scores were

42.6±12.2 and 50.3±10.2 for the tai chi group versus 37.8±10.5 and 39.4±11.9 for the control group (between-group difference, 6.1 points; P=0.03). Improvements were maintained at 24 weeks (between-group difference in the FIQ score, −18.3 points; P<0.001). No adverse events were observed. Conclusions; Tai chi may be a useful treatment for fibromyalgia and merits long-term study in larger study populations. (Funded by the National Center for Complementary and Alternative Medicine and others; ClinicalTrials.gov number, NCT00515008. Authors; Chenchen Wang, M.D., M.P.H., Christopher H. Schmid, Ph.D., Ramel Rones, B.S., Robert Kalish, M.D., Janeth Yinh, M.D., Don L. Goldenberg, M.D., Yoojin Lee, M.S. and Timothy McAlindon, M.D., M.P.H. Source Information; From the Division of Rheumatology (C.W., R.K., J.Y., T.M.) and the Institute for Clinical Research and Health Policy Studies (C.H.S., Y.L.), Tufts Medical Center, Tufts University School of Medicine; and Mind–Body Therapies (R.R.) — both in Boston; and Newton–Wellesley Hospital, Newton, MA (D.L.G.). Address reprint requests to Dr. Wang at the Division of Rheumatology, Tufts Medical Center, 800 Washington St., Box 406, Tufts University School of Medicine, Boston, MA 02111, or at cwang2@tuftsmedicalcenter.org  –

The New England Journal of Medicine  nejm.org  ~  Tai chi chuan (literal translation “Supreme Ultimate Fist”) is an internal Chinese martial art practiced for both its defense training and its health benefits. It is also typically practiced for a variety of other personal reasons: its hard and soft martial art technique, demonstration competitions, and longevity. As a consequence, a multitude of training forms exist, both traditional and modern, which correspond to those aims. Some of tai chi chuan’s training forms are especially known for being practiced at what most people categorize as slow movement. Today, tai chi has spread worldwide. Most modern styles of tai chi trace their development to at least one of the five traditional schools: Chen, Yang, Wu/Hao, Wu, and Sun. Before tai chi’s introduction to Western students, the health benefits of tai chi chuan were largely explained through the lens of traditional Chinese medicine, which is based on a view of the body and healing mechanisms not always studied or supported by modern science. Today, tai chi is in the process of being subjected to rigorous scientific studies in the West. Now that the majority of health studies have displayed a tangible benefit in some areas to the practice of tai chi, health professionals have called for more in-depth studies to

determine mitigating factors such as the most beneficial style, suggested duration of practice to show the best results, and whether tai chi is as effective as other forms of exercise. Researchers have found that intensive tai chi practice shows some favorable effects on the promotion of balance control, flexibility, cardiovascular fitness, and has shown to reduce the risk of falls in both healthy elderly patients, and those recovering from chronic stroke, heart failure, high blood pressure, heart attacks, multiple sclerosis, Parkinson’s, Alzheimer’s and fibromyalgia. Tai chi’s gentle, low impact movements burn more calories than surfing and nearly as many as downhill skiing. Tai chi, along with yoga, has reduced levels of LDLs 20–26 milligrams when practiced for 12–14 weeks. A thorough review of most of these studies showed limitations or biases that made it difficult to draw firm conclusions on the benefits of tai chi. A later study led by the same researchers conducting the review found that tai chi (compared to regular stretching) showed the ability to greatly reduce pain and improve

overall physical and mental health in people over 60 with severe osteoarthritis of the knee.In addition, a pilot study, which has not been published in a peer-reviewed medical journal, has found preliminary evidence that tai chi and related qigong may reduce the severity of diabetes.In a randomized trial of 66 patients with fibromyalgia, the tai chi intervention group did significantly better in terms of pain, fatigue, sleeplessness and depression than a comparable group given stretching exercises and wellness education.  A recent study evaluated the effects of two types of behavioral intervention, tai chi and health education, on healthy adults, who, after 16 weeks of the intervention, were vaccinated with VARIVAX, a live attenuated Oka/Merck Varicella zoster virus vaccine. The tai chi group showed higher and more significant levels of cell-mediated immunity to varicella zoster virus than the control group that received only health education. It appears that tai chi augments resting levels of varicella zoster virus-specific cell-mediated immunity and boosts the efficacy of the varicella vaccine. Tai chi alone does not lessen the effects or probability of a shingles attack, but it does improve the effects of the

varicella zoster virus vaccine. There have also been indications that tai chi might have some effect on noradrenaline and cortisol production with an effect on mood and heart rate. However, the effect may be no different than those derived from other types of physical exercise. In one study, tai chi has also been shown to reduce the symptoms of Attention Deficit and Hyperactivity Disorder (ADHD) in 13 adolescents. The improvement in symptoms seem to persist after the tai chi sessions were terminated. In June, 2007 the United States National Center for Complementary and Alternative Medicine published an independent, peer-reviewed, meta-analysis of the state of meditation research, conducted by researchers at the University of Alberta Evidence-based Practice Center. The report reviewed 813 studies (88 involving Tai Chi) of five broad categories of meditation: mantra meditation, mindfulness meditation, yoga, Tai Chi, and Qi Gong. The report concluded that “the therapeutic effects of meditation practices cannot be established based on the current literature,” and “firm conclusions on the effects of meditation practices in healthcare cannot be drawn based on the available evidence.  ~   GoodNews International

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