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Long-term Exercise After Pulmonary Rehabilitation (LEAP): a pilot randomised controlled trial of Tai Chi in COPD

Marilyn L. Moy, Peter M. Wayne, Daniel Litrownik, Douglas Beach, Elizabeth S. Klings, Roger B. Davis, Adlin Pinheiro, Gloria Y. Yeh
ERJ Open Research 2021 7: 00025-2021; DOI: 10.1183/23120541.00025-2021
Marilyn L. Moy
1Pulmonary, Sleep, and Critical Care Medicine Section, Dept of Medicine, Veterans Administration Boston Healthcare System, Boston, MA, USA
2Harvard Medical School, Boston, MA, USA
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  • ORCID record for Marilyn L. Moy
  • For correspondence: marilyn.moy@va.gov
Peter M. Wayne
3Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
4Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Daniel Litrownik
5Division of General Medicine, Dept of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, USA
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Douglas Beach
6Division of Pulmonary, Sleep and Critical Care Medicine, Dept of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Elizabeth S. Klings
7The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
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Roger B. Davis
5Division of General Medicine, Dept of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, USA
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Adlin Pinheiro
5Division of General Medicine, Dept of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, USA
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Gloria Y. Yeh
3Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
5Division of General Medicine, Dept of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA, USA
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    Consolidated Standards of Reporting Trials flow chart.

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  • TABLE 1

    Baseline characteristics

    CharacteristicTai ChiGroup walkingUsual care
    Subjects n361837
    Age years69.6±7.566.9±6.770.5±9.2
    Male sex17 (47)9 (50)27 (73)
    Race
     White28 (78)12 (67)27 (73)
     Black6 (17)3 (17)8 (22)
     Other/unknown2 (6)3 (17)2 (6)
    Annual income less than USD 35 00016 (44)7 (39)15 (41)
    Married or living with partner13 (36)8 (44)18 (49)
    Unemployed, retired or disabled32 (89)16 (89)35 (95)
    FEV1 % predicted48.1±17.950.8±24.645.7±17.7
    GOLD stage
     Stage 1–216 (44)10 (56)13 (35)
     Stage 3–420 (56)8 (44)24 (65)
    BODE index
     0–213 (36)7 (39)14 (38)
     3–416 (44)4 (22)14 (38)
     5 or greater7 (19)7 (39)9 (24)
    Regular oxygen use17 (47)7 (39)10 (27)
    Smoking pack-years52±33.744.9±24.854±26.5
    Days since completing pulmonary rehabilitation, median (IQR)35 (99)62 (120)72 (126)
    Charlson Comorbidity Index7.3±2.56.7±2.86.4±2.4
    Comorbidities
     Cardiovascular disease8 (22)4 (22)10 (27)
     Heart failure6 (17)2 (11)7 (19)
     Cancer13 (36)6 (33)9 (24)
     Hypertension24 (67)10 (56)25 (68)
     Limitation of limb#2 (6)3 (17)3 (8)
     Osteoarthritis, sciatica or chronic back pain19 (53)11 (61)18 (49)
     Peripheral vascular disease4 (11)4 (22)4 (11)
     Stroke or cerebrovascular disease6 (17)04 (11)
    6-min walk test distance m324.7±123.4365.3±105.6369.7±104.7
    CES-D12.2±9.211.1±8.111.3±9.3

    Data are presented as n (%) or mean±sd, unless otherwise stated. FEV1: forced expiratory volume in 1 s; GOLD: Global Initiative for Chronic Obstructive Lung Disease; BODE: body mass index, airflow obstruction, dyspnoea, exercise capacity; IQR: interquartile range; CES-D: Center of Epidemiology Studies–Depression Scale. #: paralysis or weakness.

    • TABLE 2

      Mean changes in 6-min walk test (6MWT) distance and secondary outcomes

      Outcome measureBaseline valuesChange from baseline to 24 weeksAdjusted mean difference at week 24Change from baseline to 1 yearAdjusted mean difference at 1 year
      Tai ChiUCTai ChiUCEffect sizeTai ChiUCEffect size
      6MWT distance m324.7±123.4369.7±104.76.8±53.3−5.1±41.20.25 (−0.24–0.73)3.2 (−21.1–27.4)
      CRQ dyspnoea4.97±1.385.67±1.010.06±1.1−0.12±1.060.17 (−0.31–0.64)−0.17 (−0.66–0.32)−0.16±1.13−0.31±1.120.14 (−0.34–0.61)−0.20 (−0.75–0.35)
      CRQ fatigue4.30±1.064.91±0.960.21±1.03−0.16±0.830.40 (−0.08–0.87)0.17 (−0.28–0.62)0.08±0.96−0.23±0.880.33 (−0.15–0.81)0.10 (−0.31–0.5)
      CRQ emotion5.24±1.055.51±1.14−0.06±0.690.05±0.63−0.18 (−0.65–0.3)−0.24 (−0.57–0.1)0.01±0.91−0.25±0.780.3 (−0.17–0.78)0.17 (−0.21–0.56)
      CRQ mastery5.36±1.445.66±1.220.14±1.05−0.14±0.770.30 (−0.18–0.77)−0.11 (−0.51–0.3)0.06±1.29−0.24±1.040.26 (−0.22–0.74)0.06 (−0.39–0.51)
      CRQ total5.01±0.985.46±0.930.06±0.73−0.07±0.620.20 (−0.27–0.67)−0.08 (−0.42–0.27)−0.01±0.81−0.26±0.720.33 (−0.15–0.81)0.08 (−0.29–0.45)
      UCSD shortness of breath39.54±19.4229.58±14.7−0.22±11.24−0.09±11.78−0.01 (−0.48–0.46)2.05 (−4.26–8.37)2.53±12.650.7±14.090.14 (−0.34–0.61)3.79 (−3.27–10.85)
      COPD self-efficacy3.38±0.833.64±0.780.22±0.640.02±0.570.34 (−0.14–0.81)0.14 (−0.11–0.39)0.29±0.60.01±0.650.46 (−0.02–0.94)0.21 (−0.06–0.49)
      CES-D score12.18±9.2211.31±9.28−1.21±4.48−1.54±4.910.07 (−0.4–0.54)0.83 (−1.23–2.89)−0.82±5.72−0.37±6.93−0.07 (−0.55–0.41)0.13 (−2.51–2.78)
      MSPSS social support5.64±1.335.72±1.140.22±1.260.17±1.040.04 (−0.43–0.51)−0.06 (−0.44–0.31)0.33±0.840.22±1.030.12 (−0.35–0.6)0 (−0.29–0.3)
      PSS perceived stress11.73±6.3211.1±5.75−2.47±4.76−0.27±4.56−0.47 (−0.95–0.01)−1.40 (−3.51–0.71)−0.10±5.410.83±4.97−0.18 (−0.66–0.3)−0.37 (−2.66–1.92)
      Resnick exercise self-efficacy57.59±19.2866.23±23.56−10.69±21.52−2.97±18.62−0.38 (−0.86–0.09)−11.64 (−21.44–−1.83)−12.2±21.81−9.34±23.89−0.13 (−0.6–0.35)−7.05 (−17.01–2.91)
      Calorie expenditure – moderate intensity1561±33901317±196965±2276614±2636−0.22 (−0.79–0.35)−242 (−1789–1305)634±3940−558±13210.41 (−0.18–0.99)1546 (−20–3111)
      Daily step count2623±15973205±2265−404±749146±1667−0.43 (−1.01–0.16)−560 (−1190–70)−401±788−206±1819−0.14 (−0.72–0.44)−225 (−863–414)

      Data are presented as mean±sd change or standardised difference (95% CI). Each row represents one model that incorporates all time points. Models adjust for time since completion of pulmonary rehabilitation, supplemental oxygen use, sex and Charlson Comorbidity Index. For measures where higher score means better status, positive values reflect improvement, while negative values indicate deterioration. For measures where higher score reflects worse status, positive values reflect deterioration while negative values indicate improvement. UC: usual care; CRQ: Chronic Respiratory Questionnaire; UCSD: University of California, San Diego; CES-D: Center of Epidemiology Studies–Depression Scale; MSPSS: Multidimensional Scale of Perceived Social Support; PSS: Perceived Stress Scale.

      • TABLE 3

        Adherence, physical activity and exercise engagement

        Baseline to 12 weeks12–24 weeks24 weeks–1 year
        Tai ChiGroup walkingUsual careTai ChiGroup walkingUsual careTai ChiGroup walkingUsual care
        Adherence
         Class time, min·week−1105.3±33.282.5±43.440.6±16.333.1±17.2
         Home practice time, min·week−180.2±55.273.3±48.345.7±48.540.5±39.8
        Physical activity logs, min·week−1
         Total414.9±365.6249.6±203.0402.9±295.5368.3±386.5240.6±200.3382.2±372.9351.8±418.0319.8±312.2376.0±329.2
         Walking125.3±141.6126.2±139.5173.5±191.9115.3±159.6117.0±126.6183.7±310.8107.0±131.4136.0±180.4160.1±208.5
         Stretching exercises17.6±22.421.4±22.927.9±38.915.2±24.116.2±16.727.2±35.311.9±15.726.5±27.529.9±41.0
         Cardiovascular exercise#9.3±19.02.7±5.337.2±51.14.9±11.91.4±2.635.0±66.210.3±25.37.0±15.026.1±38.8
         Strength training¶20.9±37.010.0±15.237.5±60.018.0±28.510.0±18.628.1±40.519.8±33.019.8±26.735.0±57.4
         Playing sports+17.0±62.60.2±0.64.3±23.011.0±32.801.3±5.05.4±13.33.2±10.31.0±4.7
         Heavy housework§33.2±69.79.2±20.222.4±38.657.8±172.15.6±9.719.4±30.665.9±231.227.3±29.822.6±57.5
         Light houseworkƒ132.6±174.369.8±63.988.2±14.295.0±121.370.9±73.778.6±93.796.3±123.992.6±108.490.7±150.4
        Composite exercise engagement, min·week−1538.7±366.9396.3±220.7402.9±295.5404.7±397.7306.3±193.2382.1±373.0322.2±419.5319.8±312.2376.0±329.2

        Data are presented as mean±sd. #: e.g. jogging, running, cycling or rowing; ¶: e.g. general conditioning, chair exercises, or using weights or resistance bands; +: e.g. golf, tennis, squash, basketball, football or swimming; §: e.g. washing windows, cleaning gutters, home repairs, mowing lawn, raking leaves or shovelling snow; ƒ: e.g. sweeping, vacuuming, cleaning, watering plants, weeding or planting.

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        Long-term Exercise After Pulmonary Rehabilitation (LEAP): a pilot randomised controlled trial of Tai Chi in COPD
        Marilyn L. Moy, Peter M. Wayne, Daniel Litrownik, Douglas Beach, Elizabeth S. Klings, Roger B. Davis, Adlin Pinheiro, Gloria Y. Yeh
        ERJ Open Research Jul 2021, 7 (3) 00025-2021; DOI: 10.1183/23120541.00025-2021

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        Long-term Exercise After Pulmonary Rehabilitation (LEAP): a pilot randomised controlled trial of Tai Chi in COPD
        Marilyn L. Moy, Peter M. Wayne, Daniel Litrownik, Douglas Beach, Elizabeth S. Klings, Roger B. Davis, Adlin Pinheiro, Gloria Y. Yeh
        ERJ Open Research Jul 2021, 7 (3) 00025-2021; DOI: 10.1183/23120541.00025-2021
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