Tai Chi linked to improved physical capacity in certain common long term conditions

The ancient Chinese exercise Tai Chi is linked to improved physical capacity among older adults with certain common long term conditions, indicates a pooled analysis of the available evidence, published online in the British Journal of Sports Medicine.

18 sept 2015--Among people with breast cancer, heart failure, osteoarthritis and chronic obstructive pulmonary disease (COPD), these improvements were not at the expense of worsening pain or breathlessness, the findings show.
Tai Chi consists of slow, gentle, flowing movements that aim to boost muscle power, balance, and posture. It also includes mindfulness, relaxation, and breath control.
The researchers wanted to find out how effective Tai Chi was in long term conditions that are common among older adults. So they trawled electronic research databases for relevant studies published up to 2014, on the use of Tai Chi in people with cancer, osteoarthritis, heart failure, and COPD.
They wanted to find out if Tai Chi relieved symptoms, and improved physical capacity and quality of life in all four long term conditions.
Out of 1102 articles, 33, involving 24 studies and 1584 participants, were suitable for inclusion; 21 studies were included in the pooled analysis.
The average age of participants ranged from the mid 50s to the early 70s, while the average length of the Tai Chi training programme was 12 weeks, with most sessions lasting an hour. Tai Chi training was usually offered two to three times weekly.
The results showed that Tai Chi was associated with trends, or definite improvement, in physical capacity and muscle strength in most or all four long term conditions.
This included improvements in the six minute walking test; muscle strength, as measured by bending and stretching the knees; the time it takes to get up and move known as the TUG test; and quality of life.
Tai Chi was also associated with an improvement in the symptoms of pain and stiffness in osteoarthritis and in breathlessness in COPD. And it was associated with improved sit to stand times among patients with osteoarthritis.
This is an observational study so no definitive conclusions can be drawn about cause and effect, added to which the only cancer included in the analysis was breast cancer.
But the findings back those of previous research, and provide a reasonable starting point to look at the value of exercise programmes, such as Tai Chi, for people with several co-existing long term conditions, say the researchers.
"Tai Chi can improve some physical performance outcomes in four chronic conditions...but not at the expense of worsening pain or dyspnoea [breathlessness]," they write, adding that it "may provide a suitable exercise stimulus for people with several comorbidities," and could be used as a complementary therapy in some long term conditions.

More information: The effect of Tai Chi on four chronic conditions—cancer, osteoarthritis, heart failure and chronic obstructive pulmonary disease: a systematic review and meta-analyses, British Journal of Sports Medicine, DOI: 10.1136/bjsports-2014-094388

Provided by British Medical Journal

Tai chi may improve quality of life in chronic heart failure patients

Tai chi, the ancient Chinese meditative exercise, may improve quality of life, mood and exercise self-efficacy in chronic heart failure patients, according to research led by a team at Beth Israel Deaconess Medical Center.

01 may 2011--A study reported in the April 25 edition of the Archives of Internal Medicine found that while tai chi offered no significant physical differences in patients who performed a 6-minute walk, those who engaged in the "mind/body" exercise exhibited significant improvements in standardized tests that track the mood of patients with chronic heart failure.

"Tai chi appears to be a safe alternative to low-to-moderate intensity conventional exercise training in patients with HF," says Gloria Yeh, MD, MPH, a physician in Division of General Medicine And Primary Care at BIDMC and an assistant professor of medicine in the Division of Research and Education in Complimentary and Integrative Medical Therapies at Harvard Medical School.

"Tai chi is safe and has a good rate of adherence and may provide value in improving daily exercise, quality of life, self-efficacy and mood in frail, deconditioned patients with systolic heart failure."

The Chinese exercise – which consists of flowing circular movements, balance and weight shifting, breathing techniques and focused internal awareness – has already been suggested to be helpful for a variety of medical issues, including hypertension, balance and musculoskeletal disease, including fibromyalgia.

Chronic heart failure is a clinical syndrome characterized by the inability of the heart to supply sufficient blood flow to meet the body's needs. Symptoms can include shortness of breath, coughing, chronic venous congestion, ankle swelling, and exercise intolerance. Easy, practical exercise techniques may increase a patient's quality of life.

To study the effects of tai chi, physicians recruited 100 patients from ambulatory clinics at BIDMC, Brigham & Women's Hospital and Massachusetts General Hospital. The patients who used tai chi were contrasted with a control group that received only heart education training.

Although the changes in peak oxygen uptake and 6-minute walks were similar in the tai chi and education-only group, researchers found a significant increase in calories burned per week in moderate-intensity outside activities. They also observed significant improvements in the Minnesota Living with Heart Failure Questionnaire and Profile of Mood States tool used to assess emotional states that are expected to respond to clinical intervention.

"Tai chi offers a complement to standard medical care, despite the absence of differential improvement in some physical benchmarks," says Yeh. "Because chronic heart failure is a progressive and debilitating condition, the independent importance of beneficially affecting patient-perceived quality of life is increasingly appreciated. Improvement of mood in this population is highly relevant."

Researchers suggested additional study at the basic science end should include a look at mechanisms by which tai chi benefits patients with cardiovascular disease and to better understand how the multiple components of tai chi – deep breathing, aerobic exercise, cognitive restructuring and social interactions – might affect outcome such as autonomic physiology, exercise capacity or mood.

"Further research will help us better understand how integrated therapies like tai chi can affect the body and mind, and how we can best offer these exercises to those that may benefit most," Yeh says.

More information: Arch Intern Med. 2011;171[8]:750-757.

Provided by Beth Israel Deaconess Medical Center

Green tea and tai chi enhance bone health, reduce inflammation in postmenopausal women

C.S. Lewis, the famous author and Oxford academic, once proclaimed "You can't get a cup of tea big enough or a book long enough to suit me." We sip it with toast in the morning, enjoy it with sweets and biscuits in the afternoon, and relax with it at the end of the day. Tea has for generations been an integral infusion worldwide, carrying both epicurean and economic significance. But, does it impart honest-to-goodness health benefits? In other words, is its persistence in the human diet perhaps coincident with enhanced quality (or quantity) of life?

15 april 2011--Dr. Chwan-Li (Leslie) Shen, an associate professor and a researcher at the Laura W. Bush Institute for Women's Health at the Texas Tech University Health Sciences Center, is convinced that the answer to this question is a resounding yes – especially if the tea is of the "green" variety. Green tea, historically consumed in the Orient and now an international mainstay, is chock full of compounds called polyphenols known for their potent antioxidant activity. Dozens of epidemiological (observational) studies have shown that people who consume the highest levels of green tea polyphenols (GTP) tend to have lower risks of several chronic degenerative diseases such as cardiovascular disease and osteoporosis. These findings have been followed up with animal studies, including some conducted by Shen, suggesting that the mechanism behind this correlation may have to do with lowering chronic levels of inflammation.

Originally from Taiwan, Dr. Shen has now spent over 2 decades studying how and why some Eastern lifestyle norms (such as drinking green tea) might be beneficial for Westerners as well. For instance, she has developed an animal model (the ovariectomized, middle-aged female rat). With this model Dr. Shen and her team can effectively study the effects of green tea consumption on protection against breakdown of the bone's microarchitecture. In humans, this can lead to osteoporosis, a condition common to older women. It is Dr Shen's hope that what she learns from her animal models might also be applicable to postmenopausal women.

In Shen's most recent research, she focused on postmenopausal women and investigated the potential for green tea to work synergistically with tai chi – a traditional Chinese form of moderately intense aerobic fitness activity grounded in mind-body philosophy – in enhancing bone strength. The results of this work, which was funded by the National Institutes of Health/National Center for Complementary and Alternative Medicine, will be presented as a poster at the Experimental Biology meetings on April 10. Carried out as a double-blind, placebo-controlled, intervention trial (the "holy grail" of scientific studies), this experiment involved 171 postmenopausal women (mean age: ~57 y) who had weak bones but not full-fledged osteoporosis. Subjects were divided into 4 groups:

• Placebo: starch pill (placebo) and no tai chi
  
• GTP: green tea polyphenols (500 mg/day) and no tai chi
  
• Placebo+TC: starch pill and tai chi (3 times/week)
  
• GTP+TC: green tea polyphenols and tai chi

The study lasted for 6 months, during which time blood and urine samples were collected and muscle strength assessed.

The results show that consumption of GTP (at a level equivalent to about 4-6 cups of steeped green tea daily) and participation in tai chi independently enhanced markers of bone health by 3 and 6 months, respectively. A similar effect was found for muscle strength at the 6-month time point. Participants taking tai chi classes also reported significant beneficial effects in quality of life in terms of improving their emotional and mental health. Perhaps most remarkable, however, was the substantial effect that both GTP and tai chi had on biological markers of oxidative stress. Because oxidative stress is a main precursor to inflammation, this finding suggests that green tea and tai chi may help reduce the underlying etiology of not only osteoporosis, but other inflammatory diseases as well.

Dr. Shen and colleagues concluded that there is a "favorable effect of modest green tea consumption on bone remodeling in this pre-osteoporotic population" and hope to soon complete a more long-term study utilizing more technically savvy measures of bone density.

Perhaps C.S. Lewis was correct – it's tea time!

Provided by Federation of American Societies for Experimental Biology

Tai chi beats back depression in the elderly, study shows

The numbers are, well, depressing: More than 2 million people age 65 and older suffer from depression, including 50 percent of those living in nursing homes. The suicide rate among white men over 85 is the highest in the country — six times the national rate.

20 mar 2011--And we're not getting any younger. In the next 35 years, the number of Americans over 65 will double and the number of those over 85 will triple.

So the question becomes, how to help elderly depressed individuals?

Researchers at UCLA turned to a gentle, Westernized version of tai chi chih, a 2,000-year-old Chinese martial art. When they combined a weekly tai chi exercise class with a standard depression treatment for a group of depressed elderly adults, they found greater improvement in the level of depression — along with improved quality of life, better memory and cognition, and more overall energy — than among a different group in which the standard treatment was paired with a weekly health education class.

The results of the study appear in the current online edition of the American Journal of Geriatric Psychiatry.

"This is the first study to demonstrate the benefits of tai chi in the management of late-life depression, and we were encouraged by the results," said first author Dr. Helen Lavretsky, a UCLA professor-in-residence of psychiatry. "We know that nearly two-thirds of elderly patients who seek treatment for their depression fail to achieve relief with a prescribed medication."

In the study, 112 adults age 60 or older with major depression were treated with the drug escitalopram, a standard antidepressant, for approximately four weeks. From among those participants, 73 who showed only partial improvement continued to receive the medication
daily but were also randomly assigned to 10 weeks of either a tai chi class for two hours per week or a health education class for two hours per week.

All the participants were evaluated for their levels of depression, anxiety, resilience, health-related quality of life, cognition and immune system inflammation at the beginning of the study and again four months later.

The level of depression among each participant was assessed using a common diagnostic tool known as the Hamilton Rating Scale for Depression, which involves interviewing the individual. The questions are designed to gauge the severity of depression. A cut-off score of 10/11 is generally regarded as appropriate for the diagnosis of depression.

The researchers found that among the tai chi participants, 94 percent achieved a score of less than 10, with 65 percent achieving remission (a score of 6 or less). By comparison, among participants who received health education, 77 percent achieved scores of 10 or less, with 51 percent achieving remission.

While both groups showed improvement in the severity of depression, said Lavretsky, who directs UCLA's Late-Life Depression, Stress and Wellness Research Program, greater reductions were seen among those taking escitalopram and participating in tai chi, a form of exercise that is gentle enough for the elderly.

"Depression can lead to serious consequences, including greater morbidity, disability, mortality and increased cost of care," Lavretsky said. "This study shows that adding a mind-body exercise like tai chi that is widely available in the community can improve the outcomes of treating depression in older adults, who may also have other, co-existing medical conditions, or cognitive impairment.

"With tai chi," she said, "we may be able to treat these conditions without exposing them to additional medications."

Provided by University of California - Los Angeles

Study: Tai Chi relieves arthritis pain, improves reach, balance, well-being

In the largest study to date of the Arthritis Foundation's Tai Chi program, participants showed improvement in pain, fatigue, stiffness and sense of well-being.

09 nov 2010--Their ability to reach while maintaining balance also improved, said Leigh Callahan, PhD, the study's lead author, associate professor in the University of North Carolina at Chapel Hill School of Medicine and a member of UNC's Thurston Arthritis Research Center.

"Our study shows that there are significant benefits of the Tai Chi course for individuals with all types of arthritis, including fibromyalgia, rheumatoid arthritis and osteoarthritis," Callahan said. "We found this in both rural and urban settings across a southeastern state and a northeastern state."

Callahan will present these results on Monday, Nov. 8, at the annual scientific meeting of the American College of Rheumatology in Atlanta.

In the study, 354 participants were recruited from 20 sites in North Carolina and New Jersey. They were randomly assigned to two groups. The intervention group received the 8-week, twice-weekly Tai Chi course immediately while the other group was a delayed control group. All participants received baseline and 8-week follow-up evaluations, after which the control group also received the Tai Chi course.

To be eligible for study, participants had to have any type of self-reported, doctor-diagnosed arthritis, be 18 years old or older and able to move independently without assistance. However, they did not have to be able to perform Tai Chi standing. They were eligible for the study if they could perform Tai Chi seated, Callahan said.

Self-reports of pain, fatigue and stiffness and physical function performance measures were collected at baseline and at the eight-week evaluation. Participants were asked questions about their ability to perform activities of daily living, their overall general health and psychosocial measures such as their perceived helplessness and self-efficacy. The physical performance measures recorded were timed chair stands (which are a measure of lower extremity strength), gait speed (both normal and fast) and two measures of balance: a single leg stance and a reach test.

At the end of eight weeks the individuals who had received the intervention showed moderate improvements in pain, fatigue and stiffness. They also had an increased sense of well being, as measured by the psychosocial variables, and they had improved reach or balance, Callahan said.

Provided by University of North Carolina School of Medicine

Research proves tai chi benefits for arthritis

19 june 2009--A new study by The George Institute for International Health has found Tai Chi to have positive health benefits for musculoskeletal pain. The results of the first comprehensive analysis of Tai Chi suggest that it produces positive effects for improving pain and disability among arthritis sufferers.

The researchers are now embarking on a new trial to establish if similar benefits can be seen among people with chronic low back pain.

"This is the first robust evidence to support the beneficial effects of Tai Chi. Our study proves that Tai Chi relieves pain and disability among people with arthritis and shows a positive trend towards effects for overall physical health. We now want to see if these benefits are the same for people suffering from low back pain", said author Dr Chris Maher at The George Institute.

Musculoskeletal pain, such as that experienced by people with arthritis, places a severe burden on the patient and community and is recognised as an international health priority. Arthritis is the major cause of disability and chronic pain in Australia, with 3.85million Australians affected. Low back pain is the most prevalent and costly musculoskeletal condition in Australia, estimated to cost up to $1billion per annum with indirect costs exceeding $8billion.

"This research should reassure people with musculoskeletal conditions such as arthritis to seek exercise to relieve the pain. The fact that Tai Chi is inexpensive, convenient, enjoyable and conveys other psychological and social benefits supports the use this type of intervention for pain conditions", added Ms Amanda Hall, The George Institute.

Tai Chi is a form of exercise that is regularly practiced in China for general health purposes and has gained increasing popularity in North America and Australia and thus a growing body of research aimed at investigating its health benefits has emerged.

Tai Chi is a versatile activity that can be easily incorporated into people's daily activities. Usually preformed in a group, Tai Chi can also be practiced individually, which differs from traditional exercise therapy approaches in clinic.

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More details can be found at: http://www.biomedcentral.com/1471-2474/10/55/abstract

Stroke survivors improve balance with tai chi

Stroke can impair balance, heightening the risk of a debilitating fall. But a University of Illinois at Chicago researcher has found that stroke survivors can improve their balance by practicing the Chinese martial art of tai chi.

23 mar 2009--Christina Hui-Chan, professor and head of physical therapy at UIC, has studied and used tai chi as a way to improve balance and minimize falls among healthy elderly subjects. Now she and a colleague have seen similar results in a group of stroke survivors.

The study used 136 subjects in Hong Kong who had suffered a stroke more than six months earlier. Participants were randomly assigned to a tai chi group or a control group that practiced breathing, stretching and other exercises that involved sitting, walking, memorizing and reasoning.

Tai chi consists of constant coordinated movement of the head, trunk and limbs requiring tremendous concentration and balance control. Participants learned a simplified form that had been shown to be beneficial to arthritis patients.

Patients were trained in small groups by physical therapists in a weekly class, then practiced at home three days a week for one hour. They received 12 weeks of training but were able to learn the technique in as little as eight. The goal was to make the patients as independent in their treatment as possible, Hui-Chan said.

They were then tested for their ability to maintain balance while shifting weight, leaning in different directions, and standing on moving surfaces to simulate a crowded bus. In these tests the tai chi group out-performed the control exercise group. The two groups performed about the same on another test, which was not focused solely on balance but involved sitting, standing, walking, and returning to sit down.

"The tai chi group did particularly better in conditions that required them to use their balance control," Hui-Chan said. "In only six weeks, we saw significant improvements. The ability to shift your weight is very important because all reaching tasks require it."

While learning tai chi is not easy, Hui-Chan has found that most people can learn the art if taught by a trained instructor. Many Chinese practice tai chi in morning group exercises, and Hui-Chan thinks the experience can work for Americans and other western nationalities.

"It can be taught at community centers, YWCAs or YMCAs, or in parks in the summer," she said.

Hui-Chan said that benefits of tai chi include improved strength and cardio fitness. Group classes also provide a healthy social gathering for isolated seniors at a fraction the cost of physiotherapy or personal training.

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Hui-Chan conducted the research with former doctoral student Stephanie Au-Yeung while at The Hong Kong Polytechnic University. The findings, now accessible online, will appear in a forthcoming issue of the journal Neurorehabilitation and Neural Repair.

Get with the tai chi program

Marianne Padgett, an 80-year-old from Atlanta, with her classmates in their Tai Chi class. New research shows that seniors who walk daily or those who practice the ancient Chinese martial arts form, Tai Chi, are fitter and less likely to lose their balance and fall.

http://www.usatoday.com/news/health/2007-03-04-tai-chi-cover_N.htm?csp=34