Effects of Tai Chi on health related quality of life in patients with chronic conditions: A systematic review of randomized controlled trials

doi:10.1016/j.ctim.2014.06.003

Complementary Therapies in Medicine

Volume 22, Issue 4, August 2014, Pages 743-755

https://doi.org/10.1016/j.ctim.2014.06.003 Get rights and content

Highlights

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Tai Chi has positive effects on health related quality of life in patients with various chronic conditions.
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It is unclear that which part of Tai Chi provides the most benefit in improving quality of life.
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Some studies reported inconsistent results of quality of life with objective measures.
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More larger and well-designed RCTs are needed.

Summary

Objectives

To determine the effects of Tai Chi practice on health related quality of life in patients with various chronic medical conditions.

Background

One of the characters of chronic illness is life-long condition with the deterioration in health related quality of life. Tai Chi has become a popular mind-body exercise and self-management strategy for patients with chronic conditions regarding its various physical and psychological effects.

Methods

Eight databases (the Cochrane Library, PubMed, Medline, EBSCO, Web of science and three Chinese databases: CNKI, Wanfang data and VIP) were searched (up to December 2013) for relevant studies. Studies including participants with chronic conditions were selected. All studies were randomized controlled trials reporting the effects of Tai Chi on health related quality of life. Two independent reviewers extracted trial data and assessed risk of bias using the risk of bias tool recommended by the Cochrane Back Review Group.

Results

Of the 2021 papers which were screened, 21 studies including 1200 patients met the eligibility criteria. Most studies (18 of 21 studies) found significant improvements on health related quality of life for participants with chronic conditions in Tai Chi group. No evidence was observed to suggest that Tai Chi was more effective than other types of exercise. And objective measures were not always consistent with self-reported quality of life measures.

Conclusions

Tai Chi appears to be safe and has positive effects on health related quality of life in patients with chronic conditions, especially for patients with disorders in Cardio-cerebrovascular and respiratory systems, and musculoskeletal system. However, as the delivery mood of Tai Chi provides multiply benefits, which part of the group provides the most benefit in improving quality of life is unclear. Due to the design limitations of previous studies, more larger and well-designed RCTs are needed to confirm the effects. And qualitative researches are warranted to explore how Tai Chi may work exactly from patients’ own perspectives.

Introduction

Chronic illness is a long-term condition with slow disease progression and without effect cure, and has posed one of the most significant challenges facing healthcare providers.¹ When facing chronic illness, health related quality-of-life becomes increasingly important as patients suffer a life-long impact on physical, psychological and social health status. As a result, patients and healthcare providers are seeking for effective strategies for managing patients’ chronic conditions as much as possible.¹ One of the strategies is complementary and alternative medicine (CAM) which has been increasingly substantially used in patients with chronic illness, due to its effects in improving both physical and psychological components.2, 3, 4, 5 And Tai Chi is one of the representatives of CAM practice which has become a world-wide activity to improve health and well-being.6, 7, 8, 9

Tai Chi, which sometimes is known as “taiji”, “taijiquan” or “taijichuan”, is a form of traditional Mind-body exercise originated in China as a martial art and a means of self-defense.10, 11, 12, 13 It combines traditional Chinese culture and philosophy during the development, and has been practiced in China for hundreds of years with the goal of rebalancing the body's healing capacity by supporting a healthy balance of yin and yang (the Chinese concepts of opposing force within the body), and refining the flow of qi (a vital energy within the body).10, 11, 12, 13, 14, 15 In Tai Chi practice, the body presents spiral and circular movements which stimulate the body's meridians and acupuncture points, and thereby improve health status. Differ from intense exercise, Tai Chi as a moving meditation emphasizes gentle movements below the pace of life, which requires practitioners to move their bodies slowly with awareness and deep breath.15, 16, 17 The popularity of Tai Chi may be explained by its non-stress exercise style, the feeling of relaxation and well-being, and the potentiality of addressing multiple health needs both physically and psychologically amongst people with chronic illness.1, 18, 19

There are many different styles of Tai Chi including Chen, Yang, Wu, Sun and Hao.9, 20 They all have their own characteristics in posture, form, order and pace, but with the same principles emphasizing relaxation and mindfulness.¹ Tai Chi is now widely practiced in many countries, and Yang is the most popular style.1, 9, 14 Tai Chi has been reported to have both physical and psychological benefits including promoting balance control, flexibility, musculoskeletal conditions, cardiovascular and respiratory functions, endocrine and immune functions, and mental health.14, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31 There are various perspectives on the mechanisms of Tai Chi. The movements of all the major muscle groups and joints in Tai Chi practice strengthen bones and slow bone loss, thus improving balance and preventing the development of osteoporosis.32, 33 Deep breathing increases lung capacity and enhances blood circulation.³⁴ The moderate intensity, non-competitive atmosphere and meditation decrease muscle tension, lower blood pressure and slower heart beat.8, 35 The frequently and consistently practice of Tai Chi could also increase levels of neurotransmitters such as dopamine, serotonin, nor adrenaline, acetylcholine, GABA, and endorphins, and decrease levels of stress hormones such as cortisol and adrenaline, thus enhancing mental health, reducing anxiety and relieving pain.³⁴

Previous reviews have reported health benefits of Tai Chi for patients with various chronic illnesses, but the effects on health related quality of life are not well understood. Thus a systematic review of randomized controlled trial (RCT), which is considered to be the golden standard for verifying the effectiveness of intervention, may provide the overall situation of Tai Chi practice in enhancing quality of life for patients with chronic conditions.³⁶ The primary aim of this systematic review was to summarize and evaluate RCTs which examined the effects of Tai Chi on health related quality of life for patients with various chronic conditions.

Section snippets

Protocol and registration

The review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines.³⁷ The protocol had not been registered prior to conducting the review.

Search strategy

Eight databases (the Cochrane Library, PubMed, Medline, EBSCO, Web of science and three Chinese databases: CNKI, Wanfang data and VIP) were searched (from inception up to 30 December 2013) for original articles. The literature search was conducted around search terms for Tai Chi

Description of included studies

A total of 3787 articles were initially identified from the database searches. 3628 were excluded after duplication removed and following screening of study titles and abstracts. Among 159 candidate articles, 138 were excluded because they were review articles, case reports, comments, conference proceedings, study reported twice, non-RCT studies, targeting healthy or non chronic condition population, or without outcome measurements of quality of life. Following the exclusion process, a total of

Discussion

Quality of life is the perceived quality of physical and mental aspects of individuals’ daily life and is important for measuring the impact of chronic conditions.⁶⁰ In the studies included in this review, quality of life was measured by self- administered questionnaires. The pooled results of our review suggested that Tai Chi had positive effects on quality of life in patients with chronic conditions. Most of the studies (18 of 21 studies)31, 39, 40, 41, 42, 43, 44, 46, 48, 49, 50, 51, 52, 53,

Conclusion

There were several limitations in these studies included. The sample size for many studies was small and all studies were non-blind or single-blind despite the difficulties of blinding participants and intervention delivery. The design limitations may limit their conclusions. As Tai Chi requires the unification of conscious and movements which depended on long-term practice, the effects on quality of life may possibly increase over a longer period of practicing.⁴² In our included studies, only

Funding

None.

Conflict of interest

The authors declare that they have no conflict of interests.

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Tai Chi is an effective form of exercise to reduce markers of frailty in older age
2020, Experimental Gerontology
Citation Excerpt :
Tai Chi involves low impact and low velocity movements and is an exercise mode with a low risk for falls (Lan et al., 1998) and as such it is a mode of exercise that may be appealing to older age adults. Tai Chi is an ancient Chinese exercise that has been practised for hundreds of years in China (Li et al., 2014). However, Tai Chi is now frequently practised in most Western countries (Lan et al., 2002) and has recently been included in the UK Chief Medical Officers' Physical Activity Guidelines (Davies et al., 2019), yet surprisingly little is known about its health benefits.
Frailty affects the quality of life of older age adults by limiting mobility, reducing physiological reserve and reducing independence. The frailty phenotype is typically characterised by exhaustion, loss or lack of physical activity, weight loss and weakness, although more recently there have been proposals to extend the frailty criteria to include physiological characteristics such as inflammation, oxidative stress and vascular function. Exercise has the potential to prevent, delay or even reverse frailty, but not all exercise is perceived as suitable for an older age population. The purpose of this study was to test Tai Chi and Zumba Gold® as exercise interventions in older age adults (65 to 75 years old) to improve characteristics related to the frailty phenotype. Muscle strength and flexibility (functional fitness as a measure of weakness), cardiorespiratory fitness, blood pressure, vascular function (FMD), markers of oxidative stress (total antioxidant capacity, malondialdehyde, 8-isoprostane, protein carbonyl), inflammation (CRP) and aspects of wellbeing related to exhaustion were assessed at baseline (pre-), 6 weeks (mid-) and 12 weeks (post-intervention). Both Tai Chi and Zumba Gold® improved systolic blood pressure, vascular function, and functional fitness following the 12 week intervention to a similar extent. Furthermore Antioxidant capacity was significantly increased (303 ± 15.56 vs. 336 ± 18.82 μm; p = 0.0028) and lipid oxidation significantly reduced (36.41 ± 6.4 vs 13.49 ± 2.5 pg/ml; p = 0.0042) after 12 weeks of Tai Chi compared to baseline. Anxiety, physical and mental fatigue decreased in both groups, with a greater decrease in mental fatigue in the Tai Chi group. Taken together, these changes suggest that Tai Chi has the potential to reduce outcomes related to the extended frailty phenotype in older age adults.
Living in the mo(ve)ment: An ethnographic exploration of hospice patients’ experiences of participating in Tai Chi
2020, Psychology of Sport and Exercise
Citation Excerpt :
This finding is at odds with much of the literature surrounding the impact of Tai Chi (and physical activity more generally) on patients with advanced, incurable diseases whereby much of the research has conformed to the ‘exercise is medicine’ narrative. Such studies have (often uncritically) advocated exclusively for the positive outcomes and accessibility of Tai Chi as an intervention for patients with a variety of advanced, progressive diseases (e.g., Hui et al., 2008; Li, Yuan, & Zhang, 2014). Through highlighting the potentially negative ways in which patients with advanced disease may experience Tai Chi, this finding presents an original contribution to the field, while also supporting recent critiques of the ‘exercise is medicine narrative’ (Williams, Hunt, Papathomas, & Smith, 2018).
Tai Chi is increasingly being used as a complimentary therapy in hospice care to help patients self-manage multiple and complex health needs. However, currently there is limited understanding of Tai Chi from patients’ perspective, including what participation in this mindfulness based movement (MBM) exercise means to their experiences of living with an advanced, incurable disease. The purpose of this study was to explore outpatients’ lived experiences of hospice-based Tai Chi in relation to mindfulness.
19 participants (15 females; 4 males, aged between 50 and 91 years old) with a range of advanced, incurable diseases (cancer, COPD, pulmonary fibrosis, pulmonary arterial hypertension) who attended day therapy at a local hospice took part in Tai Chi sessions. Using a focused ethnographic approach, multi-methods including 17 semi-structured interviews (averaging 40 min), participant observations (equating to 200 h spent in the day therapy unit), and informal conversations were used to collect data over a 6 month period. Data was analysed using a thematic framework approach.
Four main themes were constructed that demonstrated participants’ lived experiences of mindfulness during participation in hospice-based Tai Chi sessions. Main themes included: (1) mind-body respite; (2) being present with others; (3) tranquil and therapeutic atmosphere and; (4) physical limitations.
Tai Chi may be an important therapeutic strategy for helping patients with advanced, incurable disease experience mindfulness. The findings of this study support the use of MBM exercises such as Tai Chi as a non-pharmacological adjunct to conventional treatments within palliative care settings.
Effects of the tai chi qigong programme on functional capacity, and lung function in chronic obstructive pulmonary disease patients: A ramdomised controlled trial
2020, Journal of Traditional and Complementary Medicine
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TCQ is a mind-body exercise that involves whole body movements, breathing techniques, postural control, and internal awareness.12 Several studies have demonstrated the advantages of TCQ in elderly persons with chronic diseases,13 especially those with disorders of the cardio-cerebro-vascular, respiratory and musculoskeletal systems.14 Previous studies have investigated the effects of TCQ in COPD patients on several outcomes including functional capacity, lung function, quality of life, and findings have been inconclusive.12, 15−21
Although the beneficial effect of exercise on the health of Chronic Obstructive Pulmonary Disease (COPD) patients has been widely demonstrated, that of Tai Chi Qigong (TCQ), as an alternative exercise, has been inconclusive. Therefore, this study aimed to evaluate the effects of combined center-and home-based TCQ on functional capacity and lung function in patients with mildly and moderately severe COPD. A total of 50 patients, with a mild and moderate degree of COPD, were recruited and randomly assigned to either the TCQ (n = 25) or control group (n = 25). The TCQ group completed 12-week center-and 12-week home-based training. The control group attended a meeting class once a week for 12 weeks. Outcome measures were assessed at baseline, and the 6th, 12th and 24th week. The primary outcomes were functional capacity (6-min walk test; 6MWT) and lung function. The secondary outcomes were dyspnea score and quality of life. The TCQ group demonstrated significant improvement in functional capacity at week 12 and 24 (p < 0.05) and dyspnea score and quality of life at week 6, 12 and 24 (p < 0.05) when compared to baseline. Functional capacity, forced expiratory volume in 1st second (FEV₁), dyspnea score, and quality of life were significantly better in the TCQ group from week 6 to week 24 when compared to the control group (p < 0.05). Combined center-and home-based TCQ training for patients with mildly and moderately severe COPD is effective in improving functional capacity, dyspnea score, and quality of life.
The importance of differentiating the three modalities of Tai Chi Chuan practice in clinical trials – A critical review
2018, European Journal of Integrative Medicine
Three different modalities have emerged in the historic evolution of Tai Chi Chuan (martial, sports and therapeutic) with clearly differentiated objectives and methods. The purpose of this article is to identify whether the research that is being carried out in relation to this activity bears these three modalities in mind when delimiting and interpreting its effects on the health of its practitioners.
Eight electronic data bases were searched for publications up to January 2017. Ninety-six systematic reviews and meta-analyses exclusively dedicated to this activity were used. In the analysis we differentiated between the reviews which offered information on the TCC style, the form used in the studies and those which made no mention of them.
The most common forms used in the research design associated with TCC correspond to those linked to the sports modality of this activity, while the forms associated with the therapeutic modality are scarcely present. Moreover, a large number of reviews include in their analyses studies which do not mention the TCC form or styled used.
The current reviews being written on the subject of TCC indiscriminately mix in their analyses the effects of the forms associated with the different modalities and thus contribute to maintaining a partial and confused vision of the scope and potential benefits offered by this activity.
Effects of traditional Chinese exercises on the rehabilitation of limb function among stroke patients: A systematic review and meta-analysis
2017, Complementary Therapies in Clinical Practice
To systematically review literature about the rehabilitative effects of traditional Chinese exercises (TCEs) on limb function among patients with stroke.
Systematic review and meta-analysis of randomized controlled trials (RCTs). Twelve electronic databases were searched from their inceptions to February 2017, including PudMed, The Cochrane Library, Web of Science, EMBase, Science Direct, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine, Chinese Scientific Journal Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and WanFang Data. RCTs were located to examine the rehabilitative effects of TCEs on limb function among stroke patients. Two authors independently screened the literature, extracted data and assessed the risk bias of the included studies. Methodological quality evaluation and meta-analysis of included studies was performed by using Cochrane Collaboration's tool (RevMan 5.3).
A total of 31 RCTs with 2349 participants were included. Results of meta-analysis showed that TCEs produced positive effects on limb motor function (random effects model, standardized mean difference [SMD] = 1.21, 95% confidence interval [CI] = 0.66 to 1.77, P < 0.01), balance function{Berg balance scale: (random effects model, SMD = 2.07, 95%CI = 1.52 to 2.62, P < 0.01), timed-up-and-go test: (fixed effects model, mean difference [MD] = −1.77, 95%CI = −2.87 to −0.67, P < 0.01)}, activities of daily living (ADL) ability {Barthel Index scale: (random effects model, MD = 15.60, 95%CI = 7.57 to 23.63, P < 0.01), Modified Barthel Index scale: (random effects model, MD = 12.30, 95%CI = 7.48 to 17.12, P < 0.01)}, and neurological impairment (fixed effects model, MD = −2.57, 95%CI = −3.14 to −2.00, P < 0.01). After subgroup analysis and sensitivity analysis, the positive effects did not be affected by different types of TCEs and different lengths of intervention time. However, TCEs were no benefit to physical function on Short Physical Performance Battery and 2-min Step Test among stroke patients.
Current evidence showed that TCEs produced positive effects on limb motor function, balance function, ADL ability and neurological impairment among stroke patients. More large-scale, high-quality, multiple center RCTs are required to further verify above conclusions in the future.
Exercise and gut microbiota: clinical implications for the feasibility of Tai Chi
2017, Journal of Integrative Medicine
Recent studies have shown exercise is associated with changes in the gut microbiota in humans as well as in experimental animals. Tai Chi is an exercise that integrates a martial art, deep breathing and mediation, and has various beneficial effects for health. This review summarizes current knowledge and recent literature on the association between exercise and gut microbiota, and explores the feasibility of Tai Chi for improving gut microbiota composition and function. PubMed/MEDLINE was used to search the English literature for the keywords exercise and gut microbiota. Fourteen relevant studies were identified. In humans, exercise increases the gut microbial diversity. However, the evidence for this association is weak, as previous studies were small-scale, non-controlled studies of short duration or cross-sectional design. In animals, exercise alters the composition of gut microbiota, with some studies suggesting exercise increases the Bacteroidetes/Firmicutes ratio. However, these results are controversial, partly because host genetics and physical fitness also influence gut microbiota. Furthermore, the intensity of exercise may play a key role in how exercise affects gut microbiota. Tai Chi is a moderate-intensity exercise that improves immune function and inflammation of the gut. Tai Chi may also affect gut microbiota through vagal modulation and mediating the hypothalamic-pituitary-adrenal axis. However, no studies have investigated the association between Tai Chi and gut microbiota. Well designed studies exploring the effects of Tai Chi on gut microbiota are needed.

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Effects of Tai Chi on health related quality of life in patients with chronic conditions: A systematic review of randomized controlled trials

Highlights

Summary

Objectives

Background

Methods

Results

Conclusions

Introduction

Section snippets

Protocol and registration

Search strategy

Description of included studies

Discussion

Conclusion

Funding

Conflict of interest

Complement Ther Clin Pract

Complement Ther Nurs Midwifery

Phys Med Rehabil Clin N Am

J Psychosom Res

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Complement Ther Clin Pract

J Chron Dis

The benefits of tai chi as a self-management strategy to improve health in people with chronic conditions

J Nurs Health Chronic Illn

Why patients use alternative medicine: results of a national study

JAMA

Complementary medicine research in Australia: a strategy for the future

Med J Aust

Complementary and alternative medicine: the convergence of public interest and science in the United States

Med J Aust

Tai Chi: an alternative exercise form for seniors

J Aging Phys Act

Comprehensive therapeutic benefits of Taiji: a critical review

Am J Phys Med Rehabil

The effect of Tai Chi on health outcomes in patients with chronic conditions: a systematic review

Arch Intern Med

The effectiveness of Tai Chi for chronic musculoskeletal pain conditions: a systematic review and meta-analysis

Arthritis Rheum

Tai Chi Chuan: an ancient wisdom on exercise and health promotion

Sports Med

The use of Tai Chi to improve health in older adults

Orthop Nurs

A randomized controlled trial of tai chi for tension headaches

Evid Based Complement Alternat Med

A comprehensive review of health benefits of qigong and tai chi

Am J Health Promot

Relative exercise intensity of Tai Chi Chuan is similar in different ages and gender

Am J Chin Med

The effects of Tai Chi Chuan relaxation and exercise on stress responses and well-being: an overview of research

Int J Stress Manage

Meditative movement as a category of exercise: implications for research

J Phys Act Health

Balance and strength training in older adults: intervention gains and Tai Chi maintenance

J Am Geriatr Soc

Determination of E-rosette-forming lymphocytes in aged subjects with Taichiquan exercise

Int J Sports Med

T’ai chi and postural control in the well elderly

Am J Occup Ther

Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques

J Am Geriatr Soc

The effects of aerobic exercise and T’ai Chi on blood pressure in older people: results of a randomized trial

J Am Geriatr Soc

Balance control, flexibility, and cardiorespiratory fitness among older Tai Chi practitioners

Br J Sports Med

Enhancing the psychological well-being of elderly individuals through Tai Chi exercise: a latent growth curve analysis

Struct Equ Modeling

Evaluation of the effectiveness of Tai Chi for improving balance and preventing falls in the older population – a review

J Am Geriatr Soc