Tai Chi Exercise in Patients With Chronic Heart Failure

A Randomized Clinical Trial. 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.Author Affiliations: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center (Drs Yeh, McCarthy, Wayne, Davis, and Phillips), Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School (Drs Yeh, Wayne, Davis, and Phillips), Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital (Drs Stevenson and Forman), and Division of Cardiology, Department of Medicine, Massachusetts General Hospital (Dr Wood), Boston, Massachusetts. Source: Archives of Internal Medicine, a bi-monthly professional medical journal

published by the American Medical Association. ~  Tai Chi. Taijiquan 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 Taijiquan’s training forms are especially known for being practiced at what most people categorize as slow movement.Today, Taijquan has spread worldwide. Most modern styles of Taijiquan trace their development to at least one of the five traditional schools: Chen, Yang, Wu/Hao, Wu, and Sun.With purely a health emphasis, Tai chi classes have become popular in hospitals, clinics, and community and senior centers in the last twenty years or so, as baby boomers age and the art’s reputation as a low-stress training for seniors became better known.As a result of this popularity, there has been some divergence between those that say they practice tai chi primarily for self-defense, those that practice it for its aesthetic appeal (see wushu below), and those that are more interested in its benefits to physical and mental health. The wushu aspect is primarily for show; the forms taught for those purposes are designed to earn points in competition and are mostly unconcerned with either health maintenance or martial ability. More traditional stylists believe the two aspects of health and martial arts are equally necessary: the yin and yang of tai chi chuan. The tai chi “family” schools, therefore, still present their teachings in a martial art context, whatever the intention

of their students in studying the art. 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 strok 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. A systematic review and meta-analysis, funded in part by the U.S. government, of the current (as of 2010) studies on the effects of practicing Tai Chi found that, “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, anxiety, and depression, and enhanced mood 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.” 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. In 2003, the National Library of Medicine, the largest medical library in the world and subdivision of U.S. Department of Health and Human Services, awarded a grant to American Tai Chi and Qigong Association to build a website titled “The Tai Chi & Consumer Health Information Center”. The information center was officially released in 2004 and has since then been providing scientific, reliable, and comprehensive information about various health benefits of Tai Chi – for arthritis, diabetes, fall prevention, pain reduction, mental health, cardiovascular diseases, fitness, and general well-being. Good News International

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