Hindawi Publishing CorporationEvidence-Based Complementary and Alternative MedicineVolume 2013, Article ID 502131, 17 pageshttp://dx.doi.org/10.1155/2013/502131 Review Article
Tai Chi Chuan in Medicine and Health Promotion
Ching Lan,1 Ssu-Yuan Chen,1 Jin-Shin Lai,1 and Alice May-Kuen Wong2
1 Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, 7 Chung-Shan South Road and National Taiwan University, College of Medicine, Taipei 100, Taiwan 2 Department of Physical Medicine and Rehabilitation, Chang-Gung Memorial Hospital and Department of Physical Therapy, Post-Graduate Institute of Rehabilitation Science, Chang-Gung University, Taoyuan 333, Taiwan Correspondence should be addressed to Ching Lan; clan@ntu.edu.tw Received 16 April 2013; Accepted 29 June 2013 Academic Editor: William W. N. Tsang Copyright 2013 Ching Lan et al. This is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Tai Chi Chuan (Tai Chi) is a Chinese traditional mind-body exercise and recently, it becomes popular worldwide. During thepractice of Tai Chi, deep diaphragmatic breathing is integrated into body motions to achieve a harmonious balance betweenbody and mind and to facilitate the flow of internal energy (Qi). Participants can choose to perform a complete set of Tai Chior selected movements according to their needs. Previous research substantiates that Tai Chi has significant benefits to healthpromotion, and regularly practicing Tai Chi improves aerobic capacity, muscular strength, balance, health-related quality of life,and psychological well-being. Recent studies also prove that Tai Chi is safe and effective for patients with neurological diseases(e.g., stroke, Parkinson's disease, traumatic brain injury, multiple sclerosis, cognitive dysfunction), rheumatological disease (e.g.,rheumatoid arthritis, ankylosing spondylitis, and fibromyalgia), orthopedic diseases (e.g., osteoarthritis, osteoporosis, low-backpain, and musculoskeletal disorder), cardiovascular diseases (e.g., acute myocardial infarction, coronary artery bypass graftingsurgery, and heart failure), chronic obstructive pulmonary diseases, and breast cancers. Tai Chi is an aerobic exercise with mild-to-moderate intensity and is appropriate for implementation in the community. This paper reviews the existing literature on Tai Chiand introduces its health-promotion effect and the potential clinical applications.
The weak can overpower the strong; the flexible can overcome the rigid, the whole world can perceive this, but does not put it into practice. Tao Te Ching (Lao Tze). period. Variations in training approaches result in significantdifferences in exercise intensity and training effect. Tai Chi is Tai Chi Chuan is a branch of Chinese martial arts and has performed in a semisquat position (Figure 1), and the exercise developed since the 17th century in China. The slow, supple, intensity can be easily adjusted by controlling the speed and and graceful movement of Tai Chi is rooted in Taoism. Tao- postural height. The characteristics of Tai Chi include (1) ism is an ancient Chinese philosophy and has been taught by mind concentration with breathing control, (2) whole-body Lao Tze in the 5th-4th century B.C. The Taoist doctrine is exercise in a semisquat posture, and (3) continuous, curved, focused on mind tranquility, and its goal is to achieve longevi- and spiral body movements [1]. Tai Chi can be practiced ty by meditation and lifestyle modification. In the process alone or as a group exercise, and it has significant benefits of development, Tai Chi differentiated into five main styles: for physical, emotional, and social functions. Participants Chen, Yang, Wu (Hao), Wu, and Sun [1]. Among them, Chen may practice several Tai Chi movements instead of a whole style is the oldest, while Yang style is the most popular. The set to achieve specific health benefits, such as flexibility and classical Tai Chi styles consisted of complex forms, and they balance. However, if they want to enhance aerobic capacity take long time to learn and practice. Therefore, many sim- or muscular strength, a complete set of classical Tai Chi is plified Tai Chi forms were developed to shorten the learning recommended. In the recent years, Tai Chi has become a Evidence-Based Complementary and Alternative Medicine Figure 1: An example of a typical form of Tai Chi (push down and stand on one leg). The sequential motions are performed in a semi-squatposture. (From [1], with permission).
popular exercise worldwide, and researches are flourishing.
recommendations of American College of Sports Medicine, The objective of this paper is to review the existing literature moderate-intensity (40%–59% of HRR) aerobic exercise is on Tai Chi and to introduce the characteristics of training recommended for most of the adults [3]. The HR during Tai (exercise intensity and biomechanical aspects), the effect Chi practice is 50%–58% of HRR in subjects aging from 25 to on health promotion (aerobic capacity, muscular strength, 80 years (Figure 3), which indicates that the exercise intensity balance, health-related quality of life and psychological well- is similar across different ages [4]. Previous studies reported being), and potential applications in medicine (e.g., neuro- that the energy cost during Tai Chi practice was between 3 logical diseases, rheumatological diseases, orthopedic dis- and 6 metabolic equivalents (METs) depending on different eases, cardiopumonary diseases, and cancers).
styles and training requirements. Therefore, a suitable styleof Tai Chi and selected movements can be chosen to fit 2. Training Characteristics of Tai Chi
2.1. Exercise Intensity. The exercise intensity of Tai Chi 2.2. Biomechanical Aspects. Wu and Hitt [5] have examined depends on its training style, posture, and duration. Varia- the kinematics of Tai Chi gait (TCG) and normal gait by tions in training approaches result in substantial differences using a motion analysis system and biomechanical force in exercise intensity. Lan and colleagues [2] have measured plates. TCG had a low-impact force, an evenly distributed heart rate (HR) responses and oxygen uptake while perform- body weight between the fore-foot and the rear-foot, and ing classical Yang Tai Chi in middle-aged subjects. Figure 2 a large medial-lateral displacement of the foot center of illustrates the heart rate response, and oxygen uptake ( ̇ pressure (COP). The low-impact force may be attributed to during the practice of Tai Chi. In the 24 minutes of practice, the slow speed of Tai Chi and the coordinated muscular subjects' HR increased rapidly in the first 12 minutes and then activities of the lower extremities. The activation duration of increased slowly towards the end of the exercise. By contrast,subjects' leg muscles, especially the knee extensors, is significantly 2 showed a sharp increase in the first three minutes, and then it achieved a steady state towards the end of affected by the speed of Tai Chi movement. Practicing Tai Chi the exercise. In the steady state of Tai Chi practice, the average at a different speed may alter the role of muscular function HR was 58% of the heart rate reserve (HRR), and the oxygen in movement control [6]. Additionally, the spatial, temporal, uptake was 55% of the peak oxygen uptake ( ̇ and neuromuscular activation patterns of TCG were different the difference between maximum heart rate and resting heart with normal gait. Compared with normal gait, Tai Chi gait rate. HRR is typically utilized to establish HR-based training had (1) a longer cycle duration, and duration of single-leg zones according to the heart rate reserve method. The HRR stance; (2) a larger joint motion in ankle dorsi/plantar flexion, method is demonstrated as follows: Target HR = [(HRmax− knee flexion, hip flexion, and hip abduction; (3) a larger HRrest) × % intensity desired] + HRrest. According to the lateral body shift; and (4) a significant involvement of ankle Evidence-Based Complementary and Alternative Medicine Figure 2: Heart rate response and oxygen uptake during the practice of classical Yang Tai Chi in middle-aged men (values are mean ± SD)[2].
Figure 3: Heart rate responses of men and women during the practice of classical Yang Tai Chi in different age groups (⧫ young group, ◼middle-aged group, and 󳵳 elderly group; values are mean ± SE) [4].
dorsiflexors, knee extensors, hip flexors and abductors, longer pay minimum tuition fees. In the United States, a study [11] isometric and eccentric actions, and longer coactivations of reported that the direct cost of a Tai Chi program was about muscles [7]. Normal muscle activation patterns are charac- $3.5 per person per session, and the cost was affordable for terized by activation and relaxation related to the agonist most participants. In Taiwan, a formal Tai Chi training course and antagonist muscle groups during a specific activity.
for novice participants usually costs $20–40 per month. In a Coactivation of muscle groups is a common strategy adopted recent review to evaluate the strategies to prevent falls among to reduce strain and shear forces at the joint [8].
older people [12], Tai Chi was the most cost-effectiveness Age may affect the characteristics of Tai Chi performance.
strategy to prevent falls.
The elderly people practice Tai Chi in a higher posturebecause of muscle weakness or degeneration of knee joints 3. Tai Chi for Health Promotion
[9]. Tai Chi gait has an increased shear force and frontal planetorque at lower extremity joints than normal gait, but the 3.1. Aerobic Capacity. The peak oxygen uptake is the best shear force at lower extremity joints during TCG is lower in indicator for aerobic capacity and is the strongest predictor the elderly subjects than in the young adults [10].
of the risk of death among normal subjects and patientswith cardiovascular diseases [13]. In cross-sectional studies, 2.3. Cost. Tai Chi is a low-cost exercise because equipment Lan and colleagues [14] have reported that elderly Tai Chi and facility are not needed. In the Chinese community, most practitioners showed 18%-19% higher in ̇ VO2peak than their of the instructors are volunteer, and participants only need to sedentary counterparts. Furthermore, long-term Tai Chi Evidence-Based Complementary and Alternative Medicine practitioners displayed slower age-related decline of aerobic termed "sensory organization" [26]. The sensory organization capacity than sedentary individuals. In a five-year follow up testing (SOT) can be used to identify problems with postural study [15], the annual decrease of ̇ control by assessing the subject's ability to make effective use peak in the Tai Chi group was about 40% slower than in the sedentary control of visual, vestibular, and proprioceptive information.
group. Lan and colleagues [16] also reported that the ̇ During the performance of Tai Chi, weight shifting, increased 16.1% and 21.3% after one year of Tai Chi training body rotation, and single-leg standing in different positions in older men and women, respectively. According to a recent are frequently practiced. Delicate joint control with muscle meta-analysis [17], practice of Tai Chi may significantly coordination is required during motions, and hence balance improve aerobic capacity. Middle-aged and older women and function may benefit from long-term practice of Tai Chi.
men benefit the most, with greater gains seen among those In studies using simple balance tests (e.g., time duration in single-leg standing with eyes open or closed), older Tai Chipractitioners showed better postural control than sedentary 3.2. Muscular Strength. Tai Chi is performed in the semisquat subjects [27, 28]. In a study using computerized balance position, and various degrees of concentric and eccentric system, Tai Chi practitioners showed no difference compared contractions are demanded in this unique posture. In the to control group in simple conditions (such as postural Frailty and Injuries: Cooperative Studies of Intervention sway in standing with eyes open or close) [29]. By contrast, Techniques (FICSIT) study [18], Tai Chi program might pre- Tai Chi participants showed better performance in complex serve the strength gains from a 3-month strength training conditions, such as eyes closed with sway surface, sway vision program using instruments, and significant gains persisted with sway surface, and forward-backward weight shifting test after 6 months of Tai Chi.
[29]. Many studies have demonstrated the advantages of Tai Twelve to 24 weeks of Tai Chi exercise appears to be Chi on visual, proprioceptive, and vestibular functions, and beneficial to muscular strength of lower extremities. Jacobson they are described briefly below.
and colleagues [19] reported that the 12 subjects aging 20–45years who performed 108-form Tai Chi three times per week 3.3.1. Visual System. In elderly people, Tai Chi participants for 12 weeks significantly increased the muscular strength had better postural stability at the more challenging condition of their knee extensors. Lan and colleagues [20] found that of sway-referenced vision and support than the control group Tai Chi exercise enhanced strength of knee extensors at [29]. Tsang and colleagues [30] investigated elderly Tai Chi various angles. After 6 months of Yang Tai Chi training, practitioners using the SOT and found that their visual ratio men increased 13.5–24.2% of isokinetic strength in concentric was higher than that of nonpractitioners, and even compara- contractions and increased 15.1%–23.8% in eccentric con- ble with that of the young subjects. The results implied that tractions. Wu and colleagues [21] also reported that Tai Chi long-term practice of Tai Chi improved balance control in participants had higher concentric and eccentric strengths the elderly population, and there was an increased reliance of knee extensors and smaller foot center of pressure excur- on the visual system during stance. Additionally, elderly Tai sions in both eyes-open and eyes-closed conditions than Chi practitioners attained the same level of balance control the controls. The degree of knee flexion during single-leg as young subjects when standing in reduced or conflicting stance of Tai Chi may be a key element for improving leg sensory conditions. In a recent study, Chen and colleagues muscle strength [22]. In a recent study, Lu and colleagues [31] investigated the effects of Tai Chi for elderly persons [23] measured muscular strength of knee by isokinetic testing with visual impairment and found that the Tai Chi group at 30∘/s. The Tai Chi group demonstrated greater eccentric showed significant improvements in visual and vestibular muscular strength in both knee extensors and flexors than the ratios compared with the control group.
control group.
In elderly individuals, Li and colleagues [24] reported 3.3.2. Proprioceptive System. Tai Chi training puts a great that a 16-week Tai Chi program increased 19.9% of muscular emphasis on exact joint positions, and it may improve the strength of the knee flexors, and there was a significant sense of position of lower extremities. Wong et al. [32] and decrease in latency of semitendinosus muscle in the Tai Chi Tsang and Hui-Chan [33] examined the knee proprioception group. The prevention of falls depends on the timely initiation in elderly subjects by using the passive knee joint reposition of an appropriate postural response. Tai Chi intervention test and found that Tai Chi practitioners had better knee significantly hastened the reaction time of the semitendi- joint proprioceptive acuity than control subjects. In another nosus muscle, which may help older people maintain postural study, Tsang and Hui-Chan [34] reported that both Tai Chi control. In a recent randomized trial, a 16-week Tai Chi practitioners and golfers had better knee joint proprioceptive program three sessions per week also induced a significant acuity than the elderly control subjects, and it was similar increase in eccentric knee extensor strength in senior female to that of the young subjects. Similarly, Xu and colleagues subjects [25].
[35] reported that Tai Chi participants not only showedbetter proprioception at the ankle and knee joints than the 3.3. Balance and Motor Control. Standing balance is a com- controls, but they also showed better ankle kinesthesis than plex process that depends on the integration of mechanical, sensory, and motor processing strategies. The visual, propri- Training duration of Tai Chi may influence the accuracy oceptive, and vestibular systems are three sources of afferent of joint position sense. Fong and Ng [27] have compared long- information to influence the control of balance, which is term (practice for 1–3 years) and short-term (practice for 3 Evidence-Based Complementary and Alternative Medicine months) Tai Chi training for middle-aged and older individ- the education group, and the Tai Chi group reduced the risk uals. The results showed that both long-term and short-term of multiple falls by 47.5%.
Tai Chi training improved joint position sense, but only long- Li and colleagues [43] randomly assigned 256 sedentary term practice could enhance dynamic standing balance.
community-dwelling elderly people to a Tai Chi group or a Tai Chi also improves proprioceptive function of upper stretching control group. After 6 months of training, the Tai extremities. Tai Chi practitioners focus specific mental atten- Chi group showed significantly fewer falls, lower proportions tion on the body and upper extremities, which may facilitate of fallers, and fewer injurious falls than the control group. The tactile acuity and perceptual function. Previous study showed risk for multiple falls in the Tai Chi group was 55% lower than that Tai Chi training could increase shoulder kinesthetic that in the control group. In another study, Voukelatos and sense and reduce movement force variability in manual aim- colleagues [44] reported that 702 community-dwelling olderpeople participated in a Tai Chi class for 16 weeks. The Tai ing tasks. Recent study also found that Tai Chi practitioners Chi group showed less falls than the control group, and the attained significantly better eye-hand coordination in finger hazard ratios of falls for the Tai Chi group were 0.72 and 0.67 pointing than control subjects [36].
at 16 weeks and 24 weeks, respectively.
Tai Chi and conventional balance training appear to 3.3.3. Vestibular System. Elderly Tai Chi practitioners had have similar effects in falls prevention. Huang and colleagues better maximal stability and average velocity than the con- [45] assigned 163 older adults to three interventions groups trols under the condition of eyes closed and sway-referenced (education, Tai Chi, and education plus Tai Chi) and one support (ECSS), which indicated improvement of balance control group. Over a five-month intervention, the education function through vestibular mechanism [32, 37]. Practicing plus Tai Chi group showed a significant reduction in falls Tai Chi involves head movements and thus stimulates the and the risk factors of falls. After a one-year follow up, vestibular system. Therefore, the elderly Tai Chi practitioners participants who were receiving any one of the interventions could attain a higher vestibular ratio than the controls under showed a reduction in falls compared with the control group.
the condition of ECSS.
In a recent study, Tousignant and colleagues [46] randomly Patients with dizziness and balance disorders may get assigned 152 elderly subjects to a 15-week Tai Chi exercise benefits from Tai Chi training. Hain and colleagues [38] or conventional physical therapy, and the results showed that reported that patients with dizziness who practiced 8 Tai Chi both interventions were effective in falls prevention, but Tai movements every day for at least 30 min showed significant Chi showed a better protective effect compared with physical improvements in the SOT and the Dizziness Handicap therapy. In a recent randomized trial [47], 684 community- Inventory scores. McGibbon and colleagues [39] found that dwelling older adults were assigned to 3 groups: Tai Chi once both Tai Chi and vestibular rehabilitation improved balance a week, Tai Chi twice a week, or a low-level exercise program in patients with vestibulopathy, but through different mech- control group for 20 weeks. Over the 17-month period, the anisms. Gaze stability is most improved in those who receive rate of falls reduced similarly among the 3 groups (mean vestibular rehabilitation, but Tai Chi training improves reduction of 58%). The results implied that multiple interven- whole-body stability and footfall stability without improving tions could be used to prevent falls among older adults.
gaze stability. In a subsequent study [40], 36 older adults Although many studies have reported favorable effects of with vestibulopathy were assigned to a 10-week program of Tai Chi on balance and falls prevention, some studies did not vestibular rehabilitation or Tai Chi exercise. The improve- find positive evidence. Woo and colleagues [48] randomized ments of the Tai Chi group were associated with reorga- 90 men and 90 women into 3 groups (Tai Chi, resistance nized neuromuscular pattern in lower extremities, while the training, and control), and found no significant changes in vestibular rehabilitation group only had better control of balance, muscle strength, and flexibility for either exercise upper body motion to minimize loss of balance. In a recent group compared with controls. Logghe and colleagues [49] study, MacIaszek and Osinski [41] assigned 42 older people applied Tai Chi to 269 community-dwelling elderly people with dizziness to either a Tai Chi group or a control group. The with a high risk of falling. The intervention group received Tai Tai Chi group practiced a 45-minute exercise twice weekly Chi training one hour twice weekly for 13 weeks; the control for 18 weeks and showed significant improvement in up to group received usual care. After 12 months, the Tai Chi group and go test, forward deflection, backward deflection, and the did not display lower risk of falls than the control group.
maximum sway area.
A meta-analysis including 9 trials (2203 participants) reported that Tai Chi participants had significant improve- 3.3.4. Prevention of Falls. Balance function begins to decline ments in fall rates (2 trials included) and static balance (2 from middle age, deteriorates in older age, and increases the trials included) compared with exercise controls [50]. Com- risk of fall and injury. Suitable exercise training may improve pared with nonexercise controls, however, no improvement balance function and prevent accidental falls. Recent studies was found for Tai Chi participants in fall rates (5 trials) found that Tai Chi has favorable effects on balance function or static balance (2 trials), but a significant improvement and falls prevention in the elderly. In the Atlanta subgroup was found for fear of falling. In a recent meta-analysis, of the clinical trial of FICSIT [42], a total of 200 participants Leung and colleagues [51] reported that Tai Chi was effective were divided into three groups: Tai Chi, balance training, in improving balance of older adults, but it may not be and education. After 15 weeks of training, the fear of falling superior to other interventions. Although many Tai Chi responses were reduced in the Tai Chi group compared with studies reported positive effects on balance function, the Evidence-Based Complementary and Alternative Medicine training protocols varied among these studies. In future might provide health benefits to psychological function.
studies, large randomized trials using a standardized Tai Chi In those studies, 9 out of 11 studies confirmed significant program are required to prove the effect of falls prevention.
improvements in mood and depressive symptoms, 7 out of8 studies showed reduction in anger and tension, and 6 out of 3.4. Self-Report Physical Function and Quality of Life. Older 10 studies displayed improvements in anxiety reduction.
Tai Chi participants report higher physical function than Tai Chi can be applied in patients with depression. In a their sedentary counterparts. Li and colleagues [11] randomly recent study, Yeung and colleagues [60] randomly assigned 39 assigned 94 elderly subjects to either a 6-month Tai Chi group patients with major depressive disorders to a 12-week Tai Chi (60 min exercise twice weekly) or a wait-list control group.
intervention or a wait-list control group. Compared with the After training, the Tai Chi group experienced significant control group, the results showed trends toward improvement improvements in all aspects of physical functioning. The Tai in positive treatment-response rate and remission rate in the Chi group showed improvement in all 6 functional status Tai Chi group.
measures ranging from daily activities such as walking andlifting to moderate-vigorous activities such as running. The 4. Application of Tai Chi in Medicine
results showed that Tai Chi might improve self-reportedphysical functioning limitations among physically inactive An optimal exercise program for adults should address the older individuals. In the Atlanta subgroup of the clinical trial health-related physical fitness components of cardiorespira- of FICSIT [52], elderly subjects were randomly assigned to tory (aerobic) fitness, muscular strength and endurance, flex- three groups (Tai Chi, balance training, or exercise educa- ibility, body composition, and neuromotor fitness [61]. Previ- tion). After 4 months of training, only Tai Chi participants ous research suggests that Tai Chi may improve health-related reported improvement in daily activities and overall life.
fitness and psychosocial function. Additionally, Tai Chi Tai Chi exercise programs can slow down the decline in includes the warm-up and cool-down, stretching exercises, health-related quality of life (ADL) among elderly persons.
and gradual progression of volume and intensity, and it seems Dechamps and colleagues [53] randomly assigned 160 insti- to be helpful to reduce muscular injury and complications.
tutionalized elderly persons to a Tai Chi program (30 min, 4 The discussion below will focus on the clinical application in times/wk), a cognition-action program (30–45 min, 2 times/ patients with neurological diseases, rheumatological diseases, wk), or a usual-care control group. After 12 months, the Tai orthopedic diseases, cardiopumonary diseases and cancers.
Chi and cognition-action groups showed a lesser decline inADL than the control group. Walking ability and continence 5. Tai Chi for Neurological Disease
were maintained better in the intervention groups than inthe control group. The total Neuropsychiatric Inventory 5.1. Stroke. It is estimated that 15 million people experience score worsened significantly in the control group, while it a stroke worldwide each year. In the United States, about was unchanged or improved in the intervention groups.
795,000 people experience a new or a recurrent stroke(ischemic or hemorrhagic) each year [62]. Stroke results in 3.5. Psychological Well-Being. Jin [54] reported that Tai Chi a significant decrease in quality of life, which is determined practitioners had increased noradrenaline excretion in urine not only by the neurological deficits but also by impairment and decreased salivary cortisol concentration. The increase in of cognitive function. In a recent meta-analysis, Stoller and urine noradrenaline indicated that the sympathetic nervous colleagues [63] reported that stroke patients benefited from system is moderately activated during the Tai Chi practice.
exercise by improving peak oxygen uptake and walking The decrease in salivary cortisol concentration denoted that distance. Stroke patients usually have impaired balance and Tai Chi is a low-intensity exercise and has similar effects of motor function; thus, Tai Chi exercise may have potential meditation. The results implied that Tai Chi could reduce ten- benefits in stroke rehabilitation.
sion, depression, and anxiety, and the stress-reduction effect Hart and colleagues [64] assigned 18 community-dwell- of Tai Chi was similar to walking at speed of 6 km/hr [55]. It ing stroke patients to a Tai Chi group or a control group. The is also reported that a 16-week Tai Chi program could reduce study group practiced Tai Chi one hour twice weekly for mood disturbance and improve general mood in women [56].
12 weeks, while the control group received conventional For subjects with cardiovascular risk factors, Taylor-Piliae physical therapy. After training, the Tai Chi group showed and colleagues [57] have reported that a 60-minute Tai Chi improvement in social and general functioning, whereas the class 3 times weekly for 12 weeks might improve mood state, control group showed improvement in balance and speed of reduction in anxiety, anger-tension, and perceived stress.
walking. The results implied that physical therapy should be Wang and colleagues [58] reviewed the effect of Tai Chi served as a main treatment program for stroke patients, but on psychological profile in 40 studies including 3817 subjects.
Tai Chi can be used as an alternative exercise program.
Twenty-one of 33 randomized and nonrandomized trials Balance and motor skills in everyday life may benefit reported that regular practice of Tai Chi improved psycho- when stroke survivors do Tai Chi exercises. Au-Yeung and logical well-being including reduction of stress, anxiety, and colleagues [65] randomly assigned 136 stroke patients to a Tai depression and enhanced mood. Seven observational studies Chi group or a control group practicing general exercises. The also demonstrated beneficial effects on psychological health.
Tai Chi group practiced 12 short forms of Tai Chi for 12 weeks.
Jimenez and colleagues [59] reviewed 35 Tai Chi intervention After training, the Tai Chi group showed greater excursion articles in various populations and reported that Tai Chi in the center of gravity (COG) amplitude in leaning forward, Evidence-Based Complementary and Alternative Medicine backward, and toward the affected and nonaffected sides, as Tai Chi could reduce balance impairments in patients with well as faster reaction time in moving the COG toward the PD, with improved functional capacity and reduced falls. Tai nonaffected side. The result indicated that Tai Chi training Chi appears to be a safe and effective exercise for patients improved standing balance in patients with stroke.
with mild-to-moderate PD.
Tai Chi also shows benefits to the psychological function.
Wang and colleagues [66] randomly assigned 34 patients with 5.3. Traumatic Brain Injury. Traumatic brain injury (TBI) is stroke to Tai Chi exercise or conventional rehabilitation in a common disease in the young male population. However, group sessions once a week for 12 weeks. After training, the the outcome is disappointing in severely injured patients.
Tai Chi group had improvement for sleep quality, general Exercise therapy for patients with TBI may improve the motor health score, anxiety/insomnia score, and depression score.
function and independence.
In a recent study, Taylor-Piliae and Coull [67] recruited Shapira and colleagues [72] reported the application of 28 stroke patients to participate in a community-based long-term Tai Chi training in 3 patients with severe TBI.
Yang Tai Chi training program. Patients practiced Tai Chi After 2 to 4 years of training, all patients can walk without ≥150 minutes/week for 12 weeks. The results showed good assistance, rarely fall, and feel more secure while walking. One satisfaction, and the adherence rates were high (≥92%). There patient can lead independent daily activities and even return were no falls or other adverse events in the training period.
to car driving.
Tai Chi appears to be safe and can be considered as a To explore the effects of short-term Tai Chi training in community-based exercise program for stroke patients.
patients with TBI, Gemmell and Leathem [73] assigned 18patients with TBI to a Tai Chi group (a 6-week course) or 5.2. Parkinson's Disease. Impaired mobility is common a control group. The results showed that Tai Chi was asso- among patients with Parkinson's disease (PD). Normal senso- ciated with significant improvement on all Visual Analogue rimotor agility and dynamic control are required to maintain Mood Scales scores with decreases in sadness, confusion, balance during motor and cognitive tasks. Gait changes anger, tension, and fear and with increases in energy and include difficulty in initiating steps, shuffling, and freezing happiness. However, there were no significant between-group of gait and they are common in patients with PD. Balance differences in the Medical Outcome Study 36-Item Short- difficulties are also prominent during turning and backward Form Health Survey (SF-36) and Rosenberg Self-Esteem walking, and thus patients with PD have high risk of falls Scale. Recently, Blake and Batson [74] examined the effects [68]. Tai Chi can improve balance, kinesthetic sense, and of a short-term (eight weeks) Tai Chi Qigong program on 20 strength, and hence it may be prescribed as a sensorimotor patients with TBI. Intervention participants attended a Tai agility program for patients with PD.
Chi Qigong program for one hour per week, while control Li and colleagues [69] designed a Tai Chi program participants engaged in nonexercise-based social and leisure for 17 community-dwelling patients with mild-to-moderate activities. After the intervention, mood and self-esteem were idiopathic PD. Patients participated in a 5-day, 90 min/day improved in the Tai Chi group when compared with controls.
training program. At the end of this intervention, the pro- There were no significant differences in physical functioning gram was well received by all participants with respect to between groups.
participant satisfaction, enjoyment, and intentions to con-tinue. Furthermore, a significant improvement was observed 5.4. Multiple Sclerosis. Husted and colleagues [75] reported in 50 ft speed walk, timed up-and-go, and functional reach.
that 19 patients with multiple sclerosis participated in an The results of this pilot study suggested that even a 5-day Tai 8-week Tai Chi program. After training, walking speed Chi program was effective for improving physical function in increased in 21%, and hamstring flexibility increased in 28%.
patients with PD.
The results may be attributed to the effect of neuromuscular In another study [70], 33 patients with PD were randomly facilitation during Tai Chi practice.
assigned to a Tai Chi group or a control group. The Tai Chigroup participated in 20 training sessions within 10–13 6. Tai Chi for Rheumatological Disease
weeks. After training, the Tai Chi group improved more thanthe control group on the Berg Balance Scale, the Unified There are more than 21% of adults in the United States Parkinson's Disease Rating Scale, the timed up-and-go, the living with rheumatological diseases, conditions that affect tandem stance test, the 6-minute walk, and the backward the joints and bones and cause chronic joint pain, swelling, walking. In a recent study, Li and colleagues [71] randomly and stiffness [76]. Studies have shown that patients with assigned 195 patients with PD to one of three groups: Tai Chi, rheumatological diseases can benefit from Tai Chi exercise.
resistance training, or stretching. All patients participated Although Tai Chi is performed in a semisquat posture, joint in 60-minute exercise sessions twice weekly for 24 weeks.
pain can be prevented because most motions of Tai Chi are After training, the Tai Chi group performed better than the performed in a closed kinematic chain and in very slow speed other two groups in maximum excursion and in directional [20]. However, patients with arthropathy should perform control. The Tai Chi group also performed better in strength, Tai Chi in high-squat posture to prevent excessive stress on functional reach, timed up-and-go, motor scores, and lower extremities. In a recent review, Tai Chi may modulate number of falls than the stretching group. Additionally, the complex factors and improve health outcomes in patients Tai Chi group outperformed the resistance-training group in with rheumatologic conditions. Tai Chi can be recommended stride length and functional reach. This study revealed that to patients with rheumatoid arthritis, osteoarthritis, and Evidence-Based Complementary and Alternative Medicine fibromyalgia, as an alternative approach to improve patient's study proved that patients with fibromyalgia benefited from well-being [77].
Tai Chi training, with no adverse effects.
Jones and colleagues [84] conducted a randomized con- 6.1. Rheumatoid Arthritis. Rheumatoid arthritis (RA) is a trolled trial and assigned 101 patients with fibromyalgia chronic, inflammatory, and systemic disease which affects to Tai Chi or education group. The Tai Chi participants the musculoskeletal system. In a Cochrane database systemic practiced modified 8-form Yang-style Tai Chi 90 minutes review including 4 trials and 206 patients with RA [78], Tai twice weekly for over 12 weeks. After training, the Tai Chi Chi does not exacerbate symptoms of RA. In addition, Tai Chi group demonstrated significant improvements in FIQ scores, has significant benefits to lower extremity range of motion for pain severity, pain interference, sleep, and self-efficacy forpain control compared with the education group. Functional patients with RA.
mobility variables including timed up-and-go, static balance, Recently, two studies reported the benefits of Tai Chi for and dynamic balance were also improved in the Tai Chi patients with RA. Wang [79] randomly assigned 20 patients group. Tai Chi appears to be a safe and acceptable exercise with functional class I or II RA to Tai Chi or attention control modality for patients with fibromyalgia.
group. After 12 weeks of training, half of patients in the Tai In a recent study, Romero-Zurita and colleagues [85] Chi group achieved a 20% response of the American College reported the effects of Tai Chi training in women with fibro- of Rheumatology, but no patient in the control group showed myalgia. Thirty-two women with fibromyalgia attended Tai improvement. The Tai Chi group had greater improvement in Chi intervention 3 sessions weekly for 28 weeks. After train- the disability index, the vitality subscale of the SF-36, and the ing, patients improved in pain threshold, total number of depression index. Similar trends to improvement for disease tender points, and algometer score. Patients also showed activity, functional capacity and health-related quality of life improvement in the 6 min walk, back scratching, handgrip were also observed. In another study [80], 15 patients with strength, chair stand, chair sit & reach, 8-feet up-and-go, RA were instructed on Tai Chi exercise twice weekly for 12 and blind flamingo tests. Additionally, the Tai Chi group weeks. The result showed that the Tai Chi group improved improved in the total score and six subscales of FIQ: stiffness, lower-limb muscle function at the end of the training and pain, fatigue, morning tiredness, anxiety, and depression.
at 12 weeks of follow up. Patients also experienced improved Finally, patients also showed improvement in six subscales physical condition, confidence in moving, balance, and less in SF-36: bodily pain, vitality, physical functioning, physical pain during exercise and in daily life. Others experienced role, general health, and mental health.
stress reduction, increased body awareness, and confidencein moving. These studies indicated that Tai Chi was a feasible 7. Tai Chi for Orthopedic Disease
exercise modality for patients with RA.
7.1. Osteoarthritis. Patients with osteoarthritis (OA) show 6.2. Ankylosing Spondylitis. Ankylosing spondylitis (AS) is benefits from 6–20 weeks of Tai Chi training. The first ran- a chronic inflammatory disease of the axial skeleton with domized trial of Tai Chi and osteoarthritis was conducted by variable involvement of peripheral joints and nonarticular Hartman and colleagues [86]. In this study, 33 older patients structures. In a recent study [81], Lee and colleagues assigned with lower extremity OA were assigned to Tai Chi or control 40 patients with AS to Tai Chi or control group. The Tai Chi group. Tai Chi training included two 1-hour Tai Chi classes group performed 60 min of Tai Chi twice weekly for eight per week for 12 weeks. After training, Tai Chi participants weeks followed by 8 weeks of home-based Tai Chi. After experienced significant improvements in self-efficacy for training, the Tai Chi group showed significant improvement arthritis symptoms, total arthritis self-efficacy, level of ten- in disease activity and flexibility compared with the control sion, and satisfaction with general health status.
group, and no adverse effects associated with the practice of Song and colleagues [87] randomly assigned 72 patients Tai Chi were reported by the participants.
with OA to a Tai Chi group or a control group. The TaiChi group practiced Sun-style Tai Chi for 12 weeks. After 6.3. Fibromyalgia. Fibromyalgia syndrome is a chronic con- training, the Tai Chi group perceived significantly less joint dition characterized by widespread pain, multiple tender pain and stiffness and reported fewer perceived difficulties points, nonrestorative sleep, fatigue, cognitive dysfunction, in physical functioning, while the control group showed no complex somatic symptoms, and poor quality of life [82].
change or even deterioration in physical functioning. The Tai Exercise showed some benefits in the treatment of patients Chi group also displayed significant improvement in balance with fibromyalgia. An important study of Tai Chi on fibromy- and abdominal muscle strength. In a subsequent study, Song algia was reported by Wang and colleagues [83]. In this trial, and colleagues [88] reported that Tai Chi could improve knee 66 patients with fibromyalgia were randomly assigned to a extensor endurance, bone mineral density in the neck of the Tai Chi group or a group that attended wellness education proximal femur, Ward's triangle, and trochanter and reduce and stretching program. Each session lasted for 60 minutes fear of falling in women with OA.
twice weekly for 12 weeks. After training, the Tai Chi Brism´ee and colleagues [89] reported a randomized group displayed improvements in the Fibromyalgia Impact controlled trial including 41 elderly patients with OA. Patients Questionnaire (FIQ) total score and SF-36. The SF-36 phys- were assigned to a Tai Chi or an attention control group.
ical component scores and mental component scores were The Tai Chi group participated in six-week Tai Chi sessions, significantly improved compared with the control group. This 40 min/session, three times a week, followed by another six Evidence-Based Complementary and Alternative Medicine weeks of home-based Tai Chi training, and then a six-week the ultradistal tibia. The follow up measurements showed follow up detraining period. Subjects in the attention control generalized bone loss in both groups, but the quantitative group attended six weeks of health lectures, followed by 12 computed tomography revealed significantly reduced rate of weeks of no activity. After six weeks of training, the Tai Chi bone loss in trabecular BMD of the ultradistal tibia and of the group showed significant improvements in overall knee pain, cortical BMD of the distal tibial diaphysis. In a subsequent maximum knee pain, and the Western Ontario and McMaster study, Chan and colleagues [96] randomly assigned 132 Universities Osteoarthritis Index (WOMAC) subscales of healthy postmenopausal women to Tai Chi or sedentary con- physical function and stiffness compared with the baseline.
trol group. The Tai Chi group practiced Tai Chi 45 minutes a The Tai Chi group reported lower overall pain and better day, 5 days a week for 12 months. At 12 months of training, WOMAC physical function than the attention control group, BMD measurements revealed a general bone loss in both Tai but all improvements disappeared after detraining. The result Chi and control subjects at lumbar spine, proximal femur, and implies that a short-term Tai Chi program is beneficial distal tibia, but with a slower rate in the Tai Chi group. A for patients with OA, but long-term practice is needed to significant 2.6- to 3.6-fold retardation of bone loss was found maintain the therapeutic effect.
in both trabecular and cortical compartments of the distal Fransen and colleagues [90] randomly assigned 152 older tibia in the Tai Chi group as compared with the controls.
persons with chronic hip or knee OA to hydrotherapy classes, In a recent trial, Wayne and colleagues [97] reported Tai Chi classes, or a wait-list control group. After 12 weeks of the application of Tai Chi in 86 postmenopausal osteopenic training, both the hydrotherapy group and the Tai Chi group women aging 45–70 years. Women were assigned to either demonstrated improvements for pain, and physical function 9 months of Tai Chi training plus usual care or usual care scores and achieved improvements in the 12-Item Short From alone. Protocol analyses of femoral neck BMD changes were Health Survey (SF-12) physical component summary score.
significantly different between Tai Chi and usual care-group.
This study revealed that Tai Chi and hydrotherapy can pro- Changes in bone formation markers and physical domains of vide similar benefits to patients with chronic hip or knee OA.
quality of life were more favorable in the Tai Chi group.
In a randomized controlled trial conducted by Wang and colleagues [91], 40 patients with OA were assigned to Tai 7.3. Low-Back Pain. Chronic low-back pain (LBP) is preva- Chi group or attention control group. The Tai Chi group lent in the general population, and exercise therapy is among practiced 10 modified Yang Tai Chi postures twice weekly the effective interventions showing small-to-moderate effects for 12 weeks. After training, the Tai Chi group significantly for patients with LBP. In a recent randomized trial [98], 160 improved in WOMAC pain, WOMAC physical function, volunteers with chronic LBP were assigned either to a Tai patient and physician global visual analog scale, chair stand Chi group or to a wait-list control group. The Tai Chi group time, Center for Epidemiologic Studies Depression Scale, participated in 18 training sessions (40 minutes per session self-efficacy score, and SF-36 physical component summary.
over a 10-week period), and the wait-list control group con- The result showed that Tai Chi reduces pain and improves tinued with usual healthcare. After training, the Tai Chi group physical function, self-efficacy, depression and health-related reduced bothersomeness of back symptoms by 1.7 points on a quality of life for patients with knee OA.
0–10 scale, reduced pain intensity by 1.3 points on a 0–10 scale, In a recent randomized controlled study [92], 58 commu- and improved self-report disability by 2.6 points on the 0– nity-dwelling elderly patients with knee OA and cognitive 24 Roland-Morris Disability Questionnaire scale. Though the impairment were assigned to a Tai Chi (20-week program) improvements were modest and most of the patients were not or a control group. After training, the Tai Chi group showed "completely recovered", the results showed that a 10-week Tai significant improvement in WOMAC pain, physical function, Chi program provides benefits for pain reduction considered and stiffness score than the control group. The result showed clinically worthwhile for those experiencing chronic LBP.
that practicing Tai Chi was effective in reducing pain andstiffness in patients with knee OA and cognitive impairment.
7.4. Musculoskeletal Disorder. Musculoskeletal disorder is a Tai Chi is also beneficial to gait kinematics for the elderly leading cause of work disability and productivity losses in with knee OA. Shen and colleagues [93] applied Tai Chi on industrialized nations. Tai Chi can be used as a simple, 40 patients with knee OA. Patients participated in 6-week Tai convenient workplace intervention that may promote mus- Chi training (1 hour/session, 2 sessions/week). After 6 weeks culoskeletal health without special equipment. A recent study of Tai Chi exercise, patient's stride length, stride frequency, applied Tai Chi to female computer users [99], and 52 subjects and gait speed were significantly increased, and knee pain was participated in a 50-minute Tai Chi class per week for 12 weeks. The results showed significant improvement in heartrate, waist circumference, and hand-grip strength. It implied 7.2. Osteoporosis. Osteoporosis is the most common meta- that Tai Chi was effective in improving musculoskeletal bolic bone disorder, and it is estimated that 44 million individuals in the United States over the age of 50 years have In chronic muscular pain, such as tension headache, Tai osteoporosis or low bone mass [94]. Exercise is an effective Chi also shows some benefits. Abbott and colleagues [100] therapy to prevent or delay the development of osteoporosis.
randomly assigned 47 patients with tension headache to Qin and colleagues [95] reported that Tai Chi participants either a 15-week Tai Chi program or a wait-list control group.
had significantly higher bone mineral density (BMD) than The SF-36 and headache status were obtained at baseline and the controls in the lumbar spine, the proximal femur, and at 5, 10, and 15 weeks during the intervention period. After Evidence-Based Complementary and Alternative Medicine training, the results revealed significant improvements in Da Qing Diabetes Prevention Study [113] for people with favor of Tai Chi intervention for the headache status score and impaired glucose tolerance, lifestyle intervention groups (diet the subsets of health-related quality of life, including pain, and exercise) displayed a 43% lower incidence of diabetes energy/fatigue, social functioning, emotional well-being, and than the control group over the 20-year follow up period.
mental health summary scores.
Several studies have shown the benefits of Tai Chi for diabetic patients. In a pilot study for 12 patients with diabetes, 8. Tai Chi for Cardiovascular Disease
Wang [114] reported that an 8-week Tai Chi program coulddecrease blood glucose. Additionally, high- and low-affinity In the United States, the relative rate of death attributable to insulin receptor numbers and low-affinity insulin receptor- cardiovascular disease (CVD) declined by 32.7% from 1999 to binding capacity were increased. For obese diabetic patients, 2009; however, CVD still accounted for 32.3% of all deaths in Chen and colleagues reported that 12 weeks of Chen Tai 2009 [62]. Exercise training is the core component of cardiac Chi training induced significant improvement in body mass rehabilitation (CR) for patients with coronary heart disease index, triglyceride (TG), and high-density lipoprotein choles- (CHD). Tai Chi may be used in CR programs because its terol (HDL-C) [115]. In addition, serum malondialdehyde exercise intensity is low to moderate, and it can be easily (oxidative stress indicator) and C-reactive protein (inflam- implemented in communities. In a recent study, Taylor-Piliae mation indicator) decreased significantly.
and colleagues [101] reported a study that included 51 cardiac In diabetic patients complicated with peripheral neuropa- patients who participated in an outpatient CR program.
thy, Ahn and Song reported that Tai Chi training one hour Patients were assigned to attend a group practicing Tai Chi twice per week for 12 weeks improved glucose control, bal- plus CR or a group to attend CR only. After rehabilitation, ance, neuropathic symptoms, and some dimensions of quality subjects attending Tai Chi plus CR had better balance,perceived physical health, and Tai Chi self-efficacy compared of life [116]. A recent study reported that a 12-week Tai Chi with those attending CR only.
program for diabetic patients obtained significant benefits inquality of life [117]. After training, the Tai Chi group revealed 8.1. Cardiovascular Risk Factors significant improvements in the SF-36 subscales of physicalfunctioning, role physical, bodily pain, and vitality.
8.1.1. Hypertension. Hypertension is the most prevalent formof CVD affecting approximately 1 billion patients worldwide.
8.1.3. Dyslipidemia. Dyslipidemia, or abnormalities in blood In the United States, about one in three adults has hyperten- lipid and lipoprotein, is a major risk factor of cardiovascular sion [62]. Hypertension is a major risk factor for coronary disease. In the United States, 26.0% of adults had hypercholes- artery disease, heart failure, stroke, and peripheral vascular terolemia during the period from 1999 to 2006, and approx- disease. Regular exercise and lifestyle change are the core of imately 27% of adults had a triglyceride level ≥150 mg/dL current recommendations for prevention and treatment of during 2007 to 2010 [62]. The prevalence of dyslipidemia hypertension. Systemic review of randomized clinical trials increases with age and westernized lifestyle, but regular indicated that aerobic exercise significantly reduced BP, and exercise may ameliorate the trend toward abnormal blood the reduction appears to be more pronounced in hypertensive lipid profile. A meta-analysis of 31 randomized controlled subjects [102, 103].
trials with exercise training reported a significant decrease Previous studies have shown that 6- to 12-week Tai in total cholesterol (TC), low-density lipoprotein cholesterol Chi training programs might decrease systolic and dias- (LDL-C), and triglyceride, and an increase in HDL-C [118].
tolic BP at rest or after exercise, and hypertensive patients Tsai and colleagues [107] randomly assigned 88 patients to exhibit the most favorable improvement [104–108]. In a Tai Chi or sedentary control group. After 12 weeks of classical recent systemic review, Yeh and colleagues [109] analyzed Yang Tai Chi training, TC, TG, and LDL-C decreased by 15.2, 26 studies and found positive effect of Tai Chi on blood 23.8, and 19.7 mg/dL, respectively, and HDL-C increased by pressure. In patients with hypertension, studies showed that 4.7 mg/dL. By contrast, Thomas and colleagues [119] reported Tai Chi training might decrease systolic BP (range: −7 to no significant change in TC, TG, LDL-C, and HDL-C after −32 mm Hg) and diastolic BP (−2.4 to −18 mm Hg). In studies 12 months of Tai Chi training. This may be attributed to for noncardiovascular populations or healthy patients, the differences in baseline lipid concentrations, training amount decreases ranged from −4 to −18 mm Hg in systolic BP and and intensity, changes in body composition, or the adjunctive from −2.3 to −7.5 mm Hg in diastolic BP. For patients with interventions such as diet or lipid-lowering agents.
acute myocardial infarction (AMI), both Tai Chi and aerobic In a recent study, Lan and colleagues [120] assigned 70 exercise were associated with significant reductions in systolic dyslipidemic patients to a 12-month Yang Tai Chi training BP, but diastolic BP was decreased in the Tai Chi group only.
group or the usual-care group. After training, the Tai Chigroup showed a significant decrease of 26.3% in TG (from 8.1.2. Diabetes Mellitus. Diabetes mellitus is a fast growing 224.5 ± 216.5 to 165.9 ± 147.8 mg/dL), 7.3% in TC (from risk factor for cardiovascular disease. Estimated 19.7 million 228.0 ± 41.0 to 211.4 ± 46.5 mg/dL), and 11.9% in LDL-C American adults have diabetes, and the prevalence of pre- (from 134.3 ± 40.3 to 118.3 ± 41.3 mg/dL), whereas the HDL- diabetes in the US adult population is 38% [62]. Previous C did not increase significantly. In addition, the Tai Chi studies have shown that exercise has benefits for those who group also showed a significant decrease in fasting insulin have diabetes or impaired glucose tolerance [110–112]. In the and a decrease in homeostasis model assessment of insulin Evidence-Based Complementary and Alternative Medicine failure was the underlying cause in 56,410 of those deaths in the United States [62]. Exercise training improves functionalcapacity and symptoms in patients with CHF, and the increase in exercise tolerance may be attributed to increased skeletal muscle oxidative enzymes and mitochondrial density. Previ- ous studies have shown that low-intensity Tai Chi training benefited patients with CHF [123–128]. In a study by Barrowand colleagues [123], 52 patients with CHF were randomized to Tai Chi or standard medical care group. The Tai Chi group practiced Tai Chi twice a week for 16 weeks. After training, the Tai Chi group did not show significant increase in exercisetolerance, but they had improvement in symptom scores of heart failure and depression scores compared with the control group. Yeh and colleagues [124, 125] also reported that a Figure 4: Changes of peak ̇ VO2 and cardiovascular risk factors after 12-week Tai Chi training in patients with CHF improved 1 year of training in patients with dyslipidemia (Tai Chi group versus quality of life, sleep quality, and 6-minute walking distance usual-care group).
and decreased serum B-type natriuretic peptide (BNP). BNPis produced by ventricular cardiomyocytes and is correlatedwith left ventricular dysfunction. In a recent study, Yeh and resistance (HOMA) index, which is suggestive of improved colleagues [126] randomized 100 patients with systolic heart insulin resistance (Figure 4).
failure into a Tai Chi group or a control group. Tai Chi partic-ipants practiced 5 basic simplified Yang Tai Chi movements 8.2. Acute Myocardial Infarction. Acute myocardial infarc- twice weekly, while the control group participated in an edu- tion is the most common cause of mortality in patients with cation program. After 12 weeks of training, the Tai Chi group cardiovascular disease, but exercise can significantly reduce displayed greater improvements in quality of life, exercise the mortality rate in patients with AMI. A recent Cochrane self-efficacy, and mood. For patients with CHF, low-intensity review [121] involved in 47 studies randomizing 10,794 exercise such as simplified Tai Chi may increase the accep- patients with AMI to exercise-based cardiac rehabilitation or tance. Interval training protocol by using selected Tai Chi usual care. Patients receiving exercise training reduced a 13% movements is suitable for patients with very low endurance.
of risk for total mortality, a 26% of risk for cardiovascular Tai Chi can combine endurance exercise to improve mortality, and a 31% of risk for hospital admissions. Channer functional capacity. Caminiti and colleagues [127] enrolled and colleagues [104] randomized 126 patients with AMI to Tai 60 patients with CHF and randomized them into a combined Chi, aerobic exercise, or nonexercise support group. The Tai training group performing Tai Chi plus endurance training, Chi and the aerobic exercise group participated in an 8-week and an endurance training group. After 12 weeks of training, training program, attended twice weekly for three weeks, and 6-minute walking distance increased in both groups, but then once weekly for five weeks. The results displayed that Tai the combined training group showed more improvement Chi was effective for reducing systolic and diastolic BP and than the endurance training group. Systolic BP and BNP that it was safe for patients after AMI.
decreased in the combined training group compared withthe endurance training group. Additionally, the combined 8.3. Coronary Artery Bypass Grafting. Lan and colleagues training group had a greater improvement in physical per- [122] assigned 20 patients after coronary artery bypass graft- ception and peak torque of knee extensor compared with the ing surgery (CABG) to classical Yang Tai Chi program or endurance training group.
maintenance home exercise. After 12 months of training, the The left ventricle ejection fraction is found to be preserved Tai Chi group showed significant improvements of oxygen in about half of all cases of heart failure. Patients with heart uptake at the peak exercise and the ventilatory threshold. At failure with preserved ejection fraction (HFPEF) appear to the peak exercise, the Tai Chi group showed 10.3% increase in be older and are more likely to be females, have a history ̇VO2, while the control group did not show any improvement.
of hypertension, and have less coronary artery diseases Furthermore, the Tai Chi group increased 17.6% in ̇ [128]. Yeh and colleagues [129] recently used Tai Chi in ventilatory threshold, while the control group did not display the treatment of patients with HFPEF, and 16 patients were significant change. The result showed that Tai Chi was safe randomized into 12-week Tai Chi or aerobic exercise. Change and had benefits in improving functional capacity for patients VO2peak was similar between groups, but 6-minute walking distance increased more in the Tai Chi group. Both groupshad improved Minnesota Living With Heart Failure scores 8.4. Congestive Heart Failure. Congestive heart failure (CHF) and self-efficacy, but the Tai Chi group showed a decrease is characterized by the inability of the heart to deliver in depression scores in contrast to an increase in the aerobic sufficient oxygenated blood to tissue. CHF results in abnor- exercise group. In patients with HFPEF, the Tai Chi group malities in skeletal muscle metabolism, neurohormonal displayed similar improvement as the aerobic exercise group responses, vascular and pulmonary functions. In 2009, heart despite a lower aerobic training workload.
Evidence-Based Complementary and Alternative Medicine 9. Tai Chi for Pulmonary Disease
improve QOL by regulating inflammatory responses andother biomarkers associated with side effects from cancer Chronic obstructive pulmonary disease (COPD) is the fourth and its treatments. By contrast, a recent meta-analysis did leading cause of mortality in the United States. Patients with not show convincing evidence that Tai Chi is effective for COPD are at risk for low levels of physical activity, leading supportive breast cancer care [143]. Most Tai Chi studies are to increased morbidity and mortality [130]. The effectiveness focused on QOL of breast cancer survivors; however, the pos- of exercise training in people with COPD is well established.
itive results must be interpreted cautiously because most trials However, alternative methods of training such as Tai Chi have suffered from methodological flaws such as a small-sample not been widely evaluated.
size and inadequate study design. Further research involving Chan and colleagues [131] have evaluated the effectiveness large number of participants is required to determine optimal of a 3-month Tai Chi Qigong (TCQ) program in patients with effects of Tai Chi exercise for cancer patients.
COPD. 206 patients with COPD were randomly assignedto three groups (TCQ, exercise, and control). Patients in 11. Future Research of Tai Chi
the TCQ group participated in a TCQ program, includingtwo 60-minute sessions each week for 3 months; patients The training effect of an exercise program depends on its in the exercise group practiced breathing exercise combined exercise mode, intensity, frequency, and duration. Although with walking. After training, the TCQ group showed greater previous studies have shown that Tai Chi has potential bene- improvements in the symptom and activity domains. In fits, most of the studies have limitations in study design, such addition, the forced vital capacity, forced expiratory volume as (1) a small-sample size, (2) nonrandomized trials, (3) lack in the first second, walking distance, and exacerbation rate of training intensity measurement, and (4) significant differ- were improved in the TCQ group [132].
ences in training protocols. In future research, a randomized In a pilot study conducted by Yeh and colleagues [133], 10 controlled trial with standardized training protocol should be patients with moderate-to-severe COPD were randomized to utilized according to the principles of exercise prescription.
12 weeks of Tai Chi plus usual care or usual care alone. After Tai Chi participants usually need 12 weeks of training to training, there was significant improvement in Chronic Res-piratory Questionnaire score in the Tai Chi group compared familiarize the movements. During the familiarization phase, with the usual-care group. There were nonsignificant trends the exercise intensity and amount of training are inconsistent.
toward improvement in 6-minute walk distance, depression Therefore, a suitable training program should take at least scale, and shortness of breath score.
6 months of training. Additionally, heart rate monitoring in In a recent study, Leung and colleagues [134] examined selected individuals is recommended to determine the exer- the effect of short-form Sun-style Tai Chi training in people cise intensity of Tai Chi, and the suitable duration of training with COPD. Forty-two participants were randomly allocated is 40 to 60 minutes including warm-up and cool-down.
to Tai Chi or usual-care control group. Participants in the TaiChi group trained twice weekly for 12 week, and the exercise intensity of Tai Chi was 53% ± 18% of oxygen uptake reserve.
Compared with the control, Tai Chi significantly increased Tai Chi is a Chinese traditional conditioning exercise that endurance shuttle walk time, reduced medial-lateral body integrated breathing exercise into body movements. This sway in semitandem stand, and increased total score on the literature paper reveals that Tai Chi has benefits in health Chronic Respiratory Disease Questionnaire.
promotion and has potential role as an alternative therapyin neurological, rheumatological, orthopedic, and cardiopul- 10. Tai Chi for Cancer
monary diseases. There are several reasons to recommend TaiChi as an exercise program for healthy people and patients Cancer is a leading cause of death worldwide. Exercise with chronic diseases. First, Tai Chi does not need special therapy is a safe adjunct therapy that can mitigate common facility or expensive equipment, and it can be practiced treatment-related side effects among cancer patients [135].
anytime and anywhere. Second, Tai Chi is effective in enhanc- Additionally, exercise has beneficial effects on certain ing aerobic capacity, muscular strength, and balance and in domains of health-related quality of life (QOL) including improving cardiovascular risk factors. Third, Tai Chi is a low- physical functioning, role functioning, social functioning, cost, low- technology exercise, and it can be easily imple- and fatigue [136]. Tai Chi has been reported to be beneficial mented in the community. It is concluded that Tai Chi is for physical, emotional, and neuropsychological functions in effective in promoting health, and it can be prescribed as an patients with breast cancer [137–140], lung cancer [141], and alternative exercise program for patients with certain chronic gastric cancer [142].
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