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Chow SL, Bozkurt B, Baker WL, Bleske BE, Breathett K, Fonarow GC, Greenberg B, Khazanie P, Leclerc J, Morris AA, Reza N, Yancy CW. Complementary and Alternative Medicines in the Management of Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2023; 147:e4-e30. [PMID: 36475715 DOI: 10.1161/cir.0000000000001110] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Complementary and alternative medicines (CAM) are commonly used across the world by diverse populations and ethnicities but remain largely unregulated. Although many CAM agents are purported to be efficacious and safe by the public, clinical evidence supporting the use of CAM in heart failure remains limited and controversial. Furthermore, health care professionals rarely inquire or document use of CAM as part of the medical record, and patients infrequently disclose their use without further prompting. The goal of this scientific statement is to summarize published efficacy and safety data for CAM and adjunctive interventional wellness approaches in heart failure. Furthermore, other important considerations such as adverse effects and drug interactions that could influence the safety of patients with heart failure are reviewed and discussed.
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Leung LYL, Tam HL, Ho JKM. Effectiveness of Tai Chi on older adults: A systematic review of systematic reviews with re-meta-analysis. Arch Gerontol Geriatr 2022; 103:104796. [PMID: 36058045 DOI: 10.1016/j.archger.2022.104796] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/14/2022] [Accepted: 08/24/2022] [Indexed: 11/22/2022]
Abstract
This overview study examined and synthesized the effect of Tai Chi (TC) on the physical conditions, psychological conditions, cognitive abilities, and quality of life (QoL) of older adults. This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Using Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, PubMed, Scopus, and Web of Science, English-language systematic reviews (SRs) published within the latest decade (2010-2020) were included. SRs with meta-analysis were selected if TC was the examined intervention and older adults was the targeted population. A total of 16 SRs covering 89 original studies were included. A number of the pooled results of the included SRs were inconclusive. Taking into consideration of the new meta-analyses of this study, TC significantly improved most outcomes, including the mobility, pain level, physical function, psychological distress, depressive symptoms, anxiety, global cognitive function, mental speed and attention, learning ability, verbal fluency, executive function, and QoL of older adults. TC can be an effective intervention for older adults for improving physical and psychological conditions, cognitive abilities, and QoL. Additional high-quality studies with larger samples investigating the effectiveness of TC in older adults are warranted.
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Affiliation(s)
- Leona Yuen Ling Leung
- The Ronin Institute, Montclair, NJ 07043-2314, USA; Canadian Academy of Independent Scholar, Vancouver, Canada
| | - Hon Lon Tam
- Kiang Wu Nursing College of Macau, Macau; The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
| | - Jonathan Ka Ming Ho
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong
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Hui J, Wang Y, Zhao J, Cong W, Xu F. Effects of Tai Chi on health status in adults with chronic heart failure: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:953657. [PMID: 36158796 PMCID: PMC9500215 DOI: 10.3389/fcvm.2022.953657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Chronic heart failure (CHF) is among the top causes of cardiovascular morbidity, and most patients with CHF have poor health status. Tai Chi, a mind-body exercise that originated in China, is beneficial for health status. This study was conducted to evaluate the effects of Tai Chi on health status in adults with CHF. Methods The Cochrane Library, PubMed, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Database, and Chinese Scientific Journal Database were searched from the inception to 22 October 2021. This meta-analysis was performed using the fixed- or random-effects model. Continuous outcomes were carried out using mean difference (MD) or standardized mean difference (SMD) with 95% confidence interval (CI). Dichotomous outcomes were determined using risk ratio (RR) with 95%CI. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE)pro Guideline Development Tool (GDT) online software was used to present outcome-specific information regarding overall certainty of evidence from studies. Results In total, 15 studies including 1,236 participants were finally included. Compared with usual care alone, Tai Chi combined with usual care achieved efficacy in improving Minnesota Living with Heart Failure Questionnaire (MD = -8.51; 95% CI: -10.32 to -6.70; p < 0.00001), 6-min walk test (MD = 43.47; 95% CI: 33.38 to 54.10; p < 0.00001), left ventricular ejection fraction (MD = 6.07; 95% CI: 3.44 to 8.70; p < 0.00001), B-type natriuretic peptide/N-terminal fragment of pro-BNP (SMD = -1.12; 95% CI: -1.70 to -0.54; p = 0.0002), Hamilton Depression Rating Scale (MD = -2.89; 95% CI: -4.87 to -0.91; p = 0.004), Pittsburgh Sleep Quality Index (MD = -2.25; 95% CI: -3.88 to -0.61; p = 0.007), timed up and go test (MD = -1.34; 95% CI: -2.50 to -0.19; p = 0.02), and reduced the risk of heart failure hospitalization (RR = 0.47; 95% CI: 0.25 to 0.88; p = 0.02). However, there was no difference in the outcome of peak oxygen uptake (MD = 1.38; 95% CI: -1.51 to 4.28; p = 0.35). All-cause mortality or cardiovascular death could not be evaluated due to insufficient data. The certainty of evidence ranged from very low to moderate due to the risk of bias, inconsistency, imprecision, and publication bias. Conclusion Tai Chi might be safe and showed beneficial effects on health status in patients with CHF. However, more high-quality and long-term studies are still needed to further evaluate the effects of Tai Chi.
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Affiliation(s)
- Jiaqi Hui
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Institute of Geriatrics, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Ya Wang
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Institute of Geriatrics, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Junnan Zhao
- Institute of Geriatrics, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Weihong Cong
- Laboratory of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Fengqin Xu
- Institute of Geriatrics, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
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Yang G, Li W, Klupp N, Cao H, Liu J, Bensoussan A, Kiat H, Karamacoska D, Chang D. Does tai chi improve psychological well-being and quality of life in patients with cardiovascular disease and/or cardiovascular risk factors? A systematic review. BMC Complement Med Ther 2022; 22:3. [PMID: 34983493 PMCID: PMC8725570 DOI: 10.1186/s12906-021-03482-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 12/08/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Psychological risk factors have been recognised as potential, modifiable risk factors in the development and progression of cardiovascular disease (CVD). Tai Chi, a mind-body exercise, has the potential to improve psychological well-being and quality of life. We aim to assess the effects and safety of Tai Chi on psychological well-being and quality of life in people with CVD and/or cardiovascular risk factors. METHODS We searched for randomised controlled trials evaluating Tai Chi for psychological well-being and quality of life in people with CVD and cardiovascular risk factors, from major English and Chinese databases until 30 July 2021. Two authors independently conducted study selection and data extraction. Methodological quality was evaluated using the Cochrane Risk of Bias tool. Review Manager software was used for meta-analysis. RESULTS We included 37 studies (38 reports) involving 3525 participants in this review. The methodological quality of the included studies was generally poor. Positive effects of Tai Chi on stress, self-efficacy, and mood were found in several individual studies. Meta-analyses demonstrated favourable effects of Tai Chi plus usual care in reducing anxiety (SMD - 2.13, 95% confidence interval (CI): - 2.55, - 1.70, 3 studies, I2 = 60%) and depression (SMD -0.86, 95% CI: - 1.35, - 0.37, 6 studies, I2 = 88%), and improving mental health (MD 7.86, 95% CI: 5.20, 10.52, 11 studies, I2 = 71%) and bodily pain (MD 6.76, 95% CI: 4.13, 9.39, 11 studies, I2 = 75%) domains of the 36-Item Short Form Survey (scale from 0 to 100), compared with usual care alone. Tai Chi did not increase adverse events (RR 0.50, 95% CI: 0.21, 1.20, 5 RCTs, I2 = 0%), compared with control group. However, less than 30% of included studies reported safety information. CONCLUSIONS Tai Chi seems to be beneficial in the management of anxiety, depression, and quality of life, and safe to practice in people with CVD and/or cardiovascular risk factors. Monitoring and reporting of safety information are highly recommended for future research. More well-designed studies are warranted to determine the effects and safety of Tai Chi on psychological well-being and quality of life in this population. SYSTEMATIC REVIEW REGISTRATION International Prospective Register for Systematic Reviews (PROSPERO), CRD42016042905. Registered on 26 August 2016.
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Affiliation(s)
- Guoyan Yang
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Wenyuan Li
- Hospital of Traditional Chinese Medicine Affiliated to Chengdu University of Traditional Chinese Medicine, Chengdu, 610036, Sichuan, China
| | - Nerida Klupp
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
- School of Health Sciences, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Huijuan Cao
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Jianping Liu
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Alan Bensoussan
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Hosen Kiat
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia
- Cardiac Health Institute, Sydney, NSW, 2122, Australia
| | - Diana Karamacoska
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Dennis Chang
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
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Perloff J, Thomas CP, Macklin E, Gagnon P, Tsai T, Isaza I, Wayne PM, Lipsitz L. The Impact of Tai Chi Exercise on Health Care Utilization and Imputed Cost in Residents of Low-Income Senior Housing. Glob Adv Health Med 2021; 10:2164956120985479. [PMID: 33598365 PMCID: PMC7841657 DOI: 10.1177/2164956120985479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study was designed to test the impact of Tai Chi (TC) on healthcare utilization and cost in older adults living in low-income senior housing. We hypothesized that TC would improve overall health enough to reduce the use of emergency department (ED) and inpatient services. DESIGN Cluster randomized controlled trial with randomization at the housing site level. SETTING Greater Boston, Massachusetts. PARTICIPANTS The study includes 6 sites with 75 individuals in the TC treatment condition and 6 sites with 67 individuals in the health education control condition. INTERVENTION Members of the treatment group received up to a year-long intervention with twice weekly, in-person TC exercise sessions along with video-directed exercises that could be done independently at home. The comparison group received monthly, in-person healthy aging education classes (HE). Study recruitment took place between August, 2015 and October, 2017. Key outcomes included acute care utilization (inpatient stays, observation stays and emergency department visits). In addition, the cost of utilization was estimated using the age, sex and race adjusted allowed amount from Medicare claims for a geographically similar population aged ≥ 65. RESULTS The results suggested a possible reduction in the rate of ED visits in the TC group vs. controls (rate ratio = 0.476, p-value = 0.06), but no findings achieved statistical significance. Adjusted estimates of imputed costs of ED and hospital care were similar between TC and HE, averaging approximately $3,000 in each group. CONCLUSION ED utilization tended to be lower over 6 to 12 months of TC exercises compared to HE in older adults living in low-income housing, although estimated costs of care were similar.
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Affiliation(s)
- Jennifer Perloff
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Cindy Parks Thomas
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Eric Macklin
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Peggy Gagnon
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts
| | - Timothy Tsai
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts
| | - Ilean Isaza
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts
| | - Peter M Wayne
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Lewis Lipsitz
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Beth Israel Deaconess Medical Center Division of Gerontology, Boston, Massachusetts
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Chen X, Savarese G, Cai Y, Ma L, Lundborg CS, Jiang W, Wen Z, Lu W, Marrone G. Tai Chi and Qigong Practices for Chronic Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:2034625. [PMID: 33381195 PMCID: PMC7755480 DOI: 10.1155/2020/2034625] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Several randomized controlled trials (RCTs) have assessed the role of Tai Chi and Qigong Practices (TQPs) in managing chronic heart failure (CHF). They have included broad variations in comparators, sample sizes, and results. This study evaluates existing RCTs for evidence of TQPs rehabilitation effects for CHF. METHODS Both English and Chinese databases were searched from their inception to October 23, 2019. RCTs were included if they compared the addition of TQPs into routine managements (RMs) to RMs alone or compared TQPs to general exercise, with RMs as a consistent cointervention in both groups. Data were screened and extracted independently using predesigned forms. RCT quality was assessed with the Cochrane tool. The primary outcomes were peak oxygen consumption (VO2peak), 6-minute walking distance (6MWD), and Minnesota Living with Heart Failure Questionnaire (MLHFQ). Mean differences (MDs) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed with an I 2 statistic. RESULTS A total of 33 RCTs with 2,465 patients were included in the systematic review. Compared to the RMs alone, TQPs plus RMs improved VO2peak (MD: 1.24 mL/kg/min, 95% CI, 0.91 to 1.57; I 2 = 0%), 6MWD (MD: 59.63 meters, 95% CI, 43.35 to 75.90 I 2 = 88%), and MLHFQ (MD: -8.63 scores; 95% CI, -10.60 to -6.67; I 2 = 94%). Compared to general exercise, superior improvements were found in the TQP group; they were significant in MLHFQ (MD: -9.18 scores; 95% CI, -17.95 to -0.41; I 2 = 86%), but not in VO2peak or 6MWD. Evidence was also found of TQPs' safety and high adherence. CONCLUSIONS Considering that there are low costs, multiple physical benefits, and no equipment required, TQPs are a promising rehabilitation therapy, as an adjunct to routine pharmacotherapies or as an alternative to conventional exercises, especially in home-based settings.
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Affiliation(s)
- Xiankun Chen
- Department of Global Public Health, Health Systems and Policy, Karolinska Institute, 17177 Stockholm, Sweden
- Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, 510120 Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Gianluigi Savarese
- Department of Medicine, Cardiology, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Yiyi Cai
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
- Department of Cardiology, Guangdong Provincial Hospital of Chinese Medicine, 510120 Guangzhou, China
| | - Liuling Ma
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
- Department of Cardiology, Guangdong Provincial Hospital of Chinese Medicine, 510120 Guangzhou, China
| | - Cecilia Stålsby Lundborg
- Department of Global Public Health, Health Systems and Policy, Karolinska Institute, 17177 Stockholm, Sweden
| | - Wei Jiang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
- Department of Cardiology, Guangdong Provincial Hospital of Chinese Medicine, 510120 Guangzhou, China
| | - Zehuai Wen
- Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, 510120 Guangzhou, China
- National Centre for Design Measurement and Evaluation in Clinical Research, Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Weihui Lu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
- Department of Cardiology, Guangdong Provincial Hospital of Chinese Medicine, 510120 Guangzhou, China
- Heart Failure Center/Department of Cardiology, Guangdong Provincial Hospital of Chinese Medicine, 510120 Guangzhou, China
| | - Gaetano Marrone
- Department of Global Public Health, Health Systems and Policy, Karolinska Institute, 17177 Stockholm, Sweden
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Lo OY, Conboy LA, Rukhadze A, Georgetti C, Gagnon MM, Manor B, Lachman ME, Lipsitz LA, Wayne PM. In the Eyes of Those Who Were Randomized: Perceptions of Disadvantaged Older Adults in a Tai Chi Trial. THE GERONTOLOGIST 2020; 60:672-682. [PMID: 30544227 DOI: 10.1093/geront/gny165] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Older adults living in subsidized housing have typically been excluded from exercise intervention studies. We conducted a qualitative study to explore the perceived physical, psychological, social, and economic factors that influenced participation in and adherence to a year-long Tai Chi intervention within an ongoing cluster-randomized controlled trial (RCT) for older adults living within subsidized housing facilities. RESEARCH DESIGN AND METHODS Focus groups were held with participants of the RCT who were allocated to the trial's Tai Chi intervention. Individual phone interviews were conducted with those allocated to Tai Chi who had low adherence or who had withdrawn their participation from the study. Emergent themes were extracted using grounded-theory methods. RESULTS In this qualitative study, we enrolled 41 participants who were allocated to the RCT's Tai Chi intervention: 38 completed and 3 withdrew from the study. Average Tai Chi class attendance was 64.3%. Pragmatic factors that led to higher adherence and retention included: locating classes within each facility; providing programs at no cost; and deployment of a skilled research support team. In addition, the use of an accessible, simplified Tai Chi program improved confidence, social support, self-efficacy, and self-reported improvements in physical and psychological well-being. DISCUSSION AND IMPLICATIONS Perceived physical, psychological, social benefits, and self-efficacy likely enhance adherence and retention to research-based Tai Chi interventions for older adults. Delivering an on-site, no cost, and supportive program appears critical to overcoming financial and environmental barriers to participation for those living within subsidized housing.
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Affiliation(s)
- On-Yee Lo
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Lisa A Conboy
- New England School of Acupuncture, Newton, Massachusetts
| | | | - Caroline Georgetti
- New England School of Acupuncture at Massachusetts College of Pharmacy and Health Sciences, Worcester, Massachusetts
| | - Margaret M Gagnon
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, Massachusetts
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Margie E Lachman
- Department of Psychology, Brandeis University, Waltham, Massachusetts
| | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Peter M Wayne
- Harvard Medical School, Boston, Massachusetts.,Osher Center for Integrative Medicine at Brigham and Women's Hospital, Boston, Massachusetts
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Tai Chi Improves Coronary Heart Disease Risk by Inactivating MAPK/ERK Pathway through Serum miR-126. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:4565438. [PMID: 32382289 PMCID: PMC7199556 DOI: 10.1155/2020/4565438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/29/2020] [Accepted: 04/04/2020] [Indexed: 01/20/2023]
Abstract
Background Tai Chi is effective in preventing heart disease (CHD) risk, but the molecular mechanism remains unclear. Mitogen-activated protein kinase (MAPK) signaling plays a critical role in the pathogenesis of CHD and can be activated by miR-126. Tai Chi may exert its protective function through the miR-126-modulated MAPK pathway. Methods The CHD patients after PCI were randomized into the CG group (CG) (n = 19, normal care) and Tai Chi group (TG) (Tai Chi intervention, n = 17). Epicardial adipose tissue volume (EATV) (one main adverse cardiovascular event of CHD), HR (heart rate), QoL (quality of life) scores, and balance performance were measured in the two groups. The body fat content, abdominal subcutaneous fat, and visceral fat were measured to reflect the improvement of adipose tissue dysfunction. The levels of miR-126 and MAPK-associated molecules were measured in peripheral blood leukocytes. Meanwhile, the effects of miR-126 silence and mimic on MAPK-associated molecules were also explored in cardiac cell H9C2. Results After the 3-month intervention, Tai Chi reduced EATV and HR and increased QoL scores and balance performance, respectively (P < 0.05). The fat percentage, body fat mass, and BMI were also significantly reduced after Tai Chi intervention (P < 0.05). The levels of miR-126, MAPK, JNK, and ERK in the TG group were lower than those in the CG group (P < 0.05). The miR-126 levels had a strong relationship with the values of EATV, HR, and QoL scores (P < 0.05). miR-126 silence or mimic inactivated or activated MAPK-associated molecules in the cardiac cell lines. Conclusions Tai Chi improved CHD risk by inactivating the MAPK/ERK pathway via serum miR-126.
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Wang MH, Yeh ML. Respiratory training interventions improve health status of heart failure patients: A systematic review and network meta-analysis of randomized controlled trials. World J Clin Cases 2019; 7:2760-2775. [PMID: 31616691 PMCID: PMC6789387 DOI: 10.12998/wjcc.v7.i18.2760] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/04/2019] [Accepted: 07/27/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Prior studies indicate that doing breathing exercises improves physical performance and quality of life (QoL) in heart failure patients. However, these effects remain unclear and contradictory.
AIM To determine the effects of machine-assisted and non-machine-assisted respiratory training on physical performance and QoL in heart failure patients.
METHODS This was a systematic review and network meta-analysis study. A literature search of electronic databases was conducted for randomized controlled trials (RCTs) on heart failure. Respiratory training interventions were grouped as seven categories: IMT_Pn (inspiratory muscle training without pressure or < 10% maximal inspiratory pressure, MIP), IMT_Pl (inspiratory muscle training with low pressure, 10%-15% MIP), IMT_Pm (inspiratory muscle training with medium pressure, 30%-40% MIP), IMT_Ph (inspiratory muscle training with high pressure, 60% MIP or MIP plus aerobics), Aerobics (aerobic exercise or weight training), Qi_Ex (tai chi, yoga, and breathing exercise), and none. The four outcomes were heart rate, peak oxygen uptake (VO2 peak), 6-min walking distance test (6MWT), and Minnesota Living with Heart Failure QoL. The random-effects model, side-splitting model, and the surface under the cumulative ranking curve (SUCRA) were used to test and analyze the data.
RESULTS A total of 1499 subjects from 31 RCT studies were included. IMT_Ph had the highest effect sizes for VO2 peak and 6MWT, IMT_Pm highest for QoL, and Qi_Ex highest for heart rate. Aerobics had the second highest for VO2 peak, Qi_Ex second highest for 6MWT, and IMT_Ph second highest for heart rate and QoL.
CONCLUSION This study supports that high- and medium-intensity machine-assisted training improves exercise capacity and QoL in hospital-based heart failure patients. After hospital discharge, non-machine-assisted training continuously improves cardiac function.
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Affiliation(s)
- Mei-Hua Wang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
| | - Mei-Ling Yeh
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
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10
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Conboy L, Krol J, Tomas J, Yeh GY, Wayne P, Salmoirago-Blotcher E. Tai Chi for heart attack survivors: qualitative insights. BMJ Support Palliat Care 2019; 10:e44. [PMID: 30948446 DOI: 10.1136/bmjspcare-2018-001685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/18/2019] [Accepted: 03/06/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Cardiac rehabilitation (CR) programmes are standard of care for patients following a coronary event. While such exercise-based secondary prevention programme do offer benefits, they are used by less than 30% of eligible patients and attrition within these programmes is high. This project is a nested qualitative assessment of a pilot programme considering Tai Chi (TC) as an alternative to CR. We hypothesised that TC may overcome several key barriers to CR. METHODS A semistructured focus group agenda was used to assess three key domains of feasibility: (1) patients' experiences, (2) reasons/barriers for not having attended CR and (3) any improvements in physical activity and other secondary outcomes (quality of life, weight, sleep). A thematic analysis was used to better understand the key concepts. RESULTS This high-risk group of patients reported that they enjoyed TC exercise, and felt confident and safe doing it. TC practice was reported to support other types of physical activity allowing for a generalisation of positive effects. DISCUSSION This analysis is consistent with published reports of TC practice improving mood and psychological well-being. Qualitative methods allowed us to find emergent experiential reports of behaviour change factors found in established behaviour change theories.
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Affiliation(s)
- Lisa Conboy
- Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA .,New England School of Acupuncture, Massachusetts College of Pharmacy and Health Sciences, Worcester, Massachusetts, USA
| | - Julie Krol
- Miriam Hospital, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Jose Tomas
- Miriam Hospital, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Gloria Y Yeh
- Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Wayne
- Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Pearson MJ, King N, Smart NA. Effect of exercise therapy on established and emerging circulating biomarkers in patients with heart failure: a systematic review and meta-analysis. Open Heart 2018; 5:e000819. [PMID: 30018779 PMCID: PMC6045761 DOI: 10.1136/openhrt-2018-000819] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/04/2018] [Accepted: 05/24/2018] [Indexed: 12/23/2022] Open
Abstract
Background Biomarkers are important in the diagnosis, risk stratification and management of patients with heart failure (HF). The established biomarkers of myocardial stretch, brain natriuretic peptide (BNP) and amino (N) portion of BNP (NT-proBNP) have been extensively studied, and early analyses have demonstrated response to exercise training. Several other biomarkers have been identified over the last decade and may provide valuable and complementary information which may guide treatment strategies, including exercise therapy. Methods A systematic search of PubMed, EMBASE and Cochrane Trials Register to 31 October 2017 was conducted for exercise-based rehabilitation trials in HF. Randomised and controlled trials that reported biomarkers, BNP, NT-proBNP, soluble ST2, galectin-3, mid-regional atrial natriuretic peptide, mid-regional adrenomedullin and copeptin, were included. Results Forty-three studies were included in the systematic review, with 27 studies suitable for meta-analyses. Data pooling was only possible for NT-proBNP and BNP. Meta-analyses of conventional training studies demonstrated a statistically significant improvement in NT-proBNP (pmol/L); mean difference (MD) −32.80 (95% CI −56.19 to −9.42), p=0.006 and in BNP (pmol/L); MD −17.17 (95% CI −29.56 to −4.78), p=0.007. Pooled data of non-conventional training failed to demonstrate any statistically significant improvements. Conclusion Pooled data indicated a favourable effect of conventional exercise therapy on the established biomarkers, NT-proBNP and BNP; however, this was in contrast to a number of studies that could not be pooled. Limited evidence exists as to the effect of exercise training on emerging biomarkers.
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Affiliation(s)
- Melissa J Pearson
- School of Science and Technology, University of New England, Armidale, New South Wales, Australia
| | - Nicola King
- School of Biomedical and Healthcare Sciences, University of Plymouth, Plymouth, UK
| | - Neil A Smart
- School of Science and Technology, University of New England, Armidale, New South Wales, Australia
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12
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Ren X, Li Y, Yang X, Li J, Li H, Yuan Z, Sun Y, Shang H, Xing Y, Gao Y. The Effects of Tai Chi Training in Patients with Heart Failure: A Systematic Review and Meta-Analysis. Front Physiol 2017; 8:989. [PMID: 29375390 PMCID: PMC5770613 DOI: 10.3389/fphys.2017.00989] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/17/2017] [Indexed: 12/12/2022] Open
Abstract
Heart Failure (HF) is associated with significantly high morbidity and mortality. We performed a meta-analysis and updated new evidences from randomized controlled trials (RCTs) to determine the effects of Tai Chi (TC) in patients with HF. Electronic literature search of Medline, PubMed, EMBASE, the Cochrane Library, China national knowledge infrastructure (CNKI), and Wan Fang Database was conducted from inception of their establishment until 2017. And we also searched Clinical Trials Registries (https://clinicaltrials.gov/ and www.controlled-trials.com) for on-going studies. A total of 11 trials with 656 patients were available for analysis. The results suggested that TC was associated with an obviously improved 6-min walk distance [6MWD, weighted mean difference (WMD) 65.29 m; 95% CI 32.55–98.04] and quality of life (Qol, WMD −11.52 points; 95% CI −16.5 to −6.98) and left ventricular ejection fraction (LVEF, WMD 9.94%; 95% CI 6.95 to 12.93). TC was shown to reduce serum B-type natriuretic peptide [BNP, standard mean difference (SMD) −1.08 pg/mL; 95% CI −1.91 to −0.26] and heart rate (HR, WMD −2.52 bpm; 95% CI −3.49 to −1.55). In summary, our meta-analysis demonstrated the clinical evidence about TC for HF is inconclusive. TC could improve 6MWD, Qol and LVEF in patients with HF and may reduce BNP and HR. However, there is a lack of evidence to support TC altering other important long-term clinical outcomes so far. Further larger and more sustainable RCTs are urgently needed to investigate the effects of TC.
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Affiliation(s)
- Xiaomeng Ren
- Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China.,Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Yanda Li
- Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China.,Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xinyu Yang
- Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China.,Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Jie Li
- Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China.,Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Huilong Li
- Department of Surgery, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Zhengzhong Yuan
- Department of Traditional Chinese Medicine, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yikun Sun
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Hongcai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Yanwei Xing
- Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China
| | - Yonghong Gao
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
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13
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Salmoirago-Blotcher E, Wayne PM, Dunsiger S, Krol J, Breault C, Bock BC, Wu WC, Yeh GY. Tai Chi Is a Promising Exercise Option for Patients With Coronary Heart Disease Declining Cardiac Rehabilitation. J Am Heart Assoc 2017; 6:e006603. [PMID: 29021268 PMCID: PMC5721863 DOI: 10.1161/jaha.117.006603] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/15/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND More than 60% of patients decline participation in cardiac rehabilitation after a myocardial infarction. Options to improve physical activity (PA) and other risk factors in these high-risk individuals are limited. We conducted a phase 2 randomized controlled trial to determine feasibility, safety, acceptability, and estimates of effect of tai chi on PA, fitness, weight, and quality of life. METHODS AND RESULTS Patients with coronary heart disease declining cardiac rehabilitation enrollment were randomized to a "LITE" (2 sessions/week for 12 weeks) or to a "PLUS" (3 sessions/week for 12 weeks, then maintenance classes for 12 additional weeks) condition. PA (accelerometry), weight, and quality of life (Health Survey Short Form) were measured at baseline and 3, 6, and 9 months after baseline; aerobic fitness (stress test) was measured at 3 months. Twenty-nine participants (13 PLUS and 16 LITE) were enrolled. Retention at 9 months was 90% (LITE) and 88% (PLUS). No serious tai chi-related adverse events occurred. Significant mean between group differences in favor of the PLUS group were observed at 3 and 6 months for moderate-to-vigorous PA (100.33 min/week [95% confidence interval, 15.70-184.95 min/week] and 111.62 min/week; [95% confidence interval, 26.17-197.07 min/week], respectively, with a trend toward significance at 9 months), percentage change in weight, and quality of life. No changes in aerobic fitness were observed within and between groups. CONCLUSIONS In this community sample of patients with coronary heart disease declining enrollment in cardiac rehabilitation, a 6-month tai chi program was safe and improved PA, weight, and quality of life compared with a 3-month intervention. Tai chi could be an effective option to improve PA in this high-risk population. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02165254.
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Affiliation(s)
| | - Peter M Wayne
- Osher Center for Integrative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Shira Dunsiger
- The Miriam Hospital and The Warren Alpert Medical School of Brown University, Providence, RI
| | | | | | - Beth C Bock
- The Miriam Hospital and The Warren Alpert Medical School of Brown University, Providence, RI
| | - Wen-Chih Wu
- The Miriam Hospital and The Warren Alpert Medical School of Brown University, Providence, RI
| | - Gloria Y Yeh
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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14
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Wayne PM, Gagnon MM, Macklin EA, Travison TG, Manor B, Lachman M, Thomas CP, Lipsitz LA. The Mind Body-Wellness in Supportive Housing (Mi-WiSH) study: Design and rationale of a cluster randomized controlled trial of Tai Chi in senior housing. Contemp Clin Trials 2017; 60:96-104. [PMID: 28694204 PMCID: PMC5639896 DOI: 10.1016/j.cct.2017.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/28/2017] [Accepted: 07/03/2017] [Indexed: 02/08/2023]
Abstract
Supporting the health of growing numbers of frail older adults living in subsidized housing requires interventions that can combat frailty, improve residents' functional abilities, and reduce their health care costs. Tai Chi is an increasingly popular multimodal mind-body exercise that incorporates physical, cognitive, social, and meditative components in the same activity and offers a promising intervention for ameliorating many of the conditions that lead to poor health and excessive health care utilization. The Mind Body-Wellness in Supportive Housing (Mi-WiSH) study is an ongoing two-arm cluster randomized, attention-controlled trial designed to examine the impact of Tai Chi on functional indicators of health and health care utilization. We are enrolling participants from 16 urban subsidized housing facilities (n=320 participants), conducting the Tai Chi intervention or education classes and social calls (attention control) in consenting subjects within the facilities for one year, and assessing these subjects at baseline, 6months, and 1year. Physical function (quantified by the Short Physical Performance Battery), and health care utilization (emergency visits, hospitalizations, skilled nursing and nursing home admissions), assessed at 12months are co-primary outcomes. Our discussion highlights our strategy to balance pragmatic and explanatory features into the study design, describes efforts to enhance site recruitment and participant adherence, and summarizes our broader goal of post study dissemination if effectiveness and cost-effectiveness are demonstrated, by preparing training and protocol manuals for use in housing facilities across the U.S.
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Affiliation(s)
- Peter M Wayne
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, United States.
| | - Margaret M Gagnon
- Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, United States.
| | - Eric A Macklin
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
| | - Thomas G Travison
- Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, United States.
| | - Bradley Manor
- Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, United States.
| | - Margie Lachman
- Department of Psychology, Brandeis University, Waltham, MA, United States.
| | - Cindy P Thomas
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States.
| | - Lewis A Lipsitz
- Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, United States.
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15
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Wang Y, Shan W, Li Q, Yang N, Shan W. Tai Chi Exercise for the Quality of Life in a Perimenopausal Women Organization: A Systematic Review. Worldviews Evid Based Nurs 2017; 14:294-305. [PMID: 28742289 DOI: 10.1111/wvn.12234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Improvement of the quality of life in perimenopausal women has recently become an important global health issue. Extensive research reports provide evidence of Tai Chi for the quality of life, but no systematic review has individually investigated Tai Chi as a main intervention on the quality of life in perimenopausal women. OBJECTIVE To assess clinical evidence of Tai Chi for the quality of life in perimenopausal women. METHODS Studies related to the effect of Tai Chi on the quality of life in perimenopausal women in the databases of China and abroad were searched. RevMan version 5.2 software was used, and the Medical Outcomes Study 36-item short form health survey (SF-36) and bone mineral density (BMD) were selected as evaluation indices. RESULTS Five trials were included. The results of this study showed that Tai Chi had a significant effect on bodily pain, general health, vitality, mental health of SF-36, and the spine dimension of BMD, as supported by the following data: bodily pain (Standard Mean Difference [SMD] = -3.63; 95% confidence interval [CI] [-6.62, -0.64]; p = .02); general health (SMD = -5.08; 95% CI [-7.60, -2.56]; p < .0001); vitality (SMD = -5.67; 95% CI [-8.54, -2.81], p = .0001); mental health (SMD = -2.51; 95% CI [-4.82, -0.20], p = .03); and spine dimension of BMD (SMD = -0.06; 95% CI [-0.10, -0.01]; p = .01). However, Tai Chi had no effect on physical function, emotional health, social function, role-physical of SF-36, and the hip dimension of BMD, as supported by the following data: physical function (SMD = -1.79; 95% CI [-5.15, 1.57]; p = .30); emotional health (SMD = -2.90; 95% CI [-7.23, 1.43], p = .19]; social function (SMD = -2.23, 95% CI [-5.08, 0.61], p = .12; role-physical (SMD = - 1.18; 95% CI [-4.84, 2.47], p = .53; and hip dimension of BMD (SMD = -0.01; 95% CI [-0.03, 0.01]; p = .31). LINKING EVIDENCE TO ACTION This systematic review found significant evidence for Tai Chi improving bodily pain, general health, vitality, mental health of SF-36, and the spine dimension of BMD in patients with perimenopausal syndrome. Findings suggest that Tai Chi might be recommended as effective and safe adjuvant treatment for patients with perimenopausal syndrome. More high-quality randomized controlled trials are urgently needed to confirm these results.
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Affiliation(s)
- Ying Wang
- Nurse Practitioner, Nursing School of Chengde Medical University, Chengde City, Hebei Province, China
| | - Weichao Shan
- Associate Professor, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, China
| | - Qing Li
- Lecturer, Nursing School of Chengde Medical University, Chengde City, Hebei Province, China
| | - Na Yang
- Teaching Assistant, Nursing School of Chengde Medical University, Chengde City, Hebei Province, China
| | - Weiying Shan
- Professor, Science and Technology Department of Chengde Medical University, Chengde City, Hebei Province, China
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16
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Wang YT, Li Z, Yang Y, Zhong Y, Lee SY, Chen S, Chen YP. Effects of wheelchair Tai Chi on physical and mental health among elderly with disability. Res Sports Med 2016; 24:157-70. [PMID: 27248716 DOI: 10.1080/15438627.2016.1191487] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A 12-week Wheelchair Tai Chi 10 Form (WTC10) intervention was conducted among elderly with disability to examine the effect of this WTC10 intervention on selected physical and mental health variables. Thirteen (age 87.23 ± 6.71) in the WTC10 intervention group and 15 (age 89.73 ± 6.31) in the control group completed the study. Independent t-tests and paired t-tests were employed to examine the differences between groups and within groups, respectively, at pretest and post-test. The WTC10 intervention group showed significant improvements in systolic and diastolic blood pressure, shoulder external rotation, left trunk rotation and total trunk rotation after the intervention. A 12-week WTC10 intervention had positive effects on blood pressure, range of motion at the shoulder and trunk, physical activity, and mental health among the elderly with disability. WTC10 is a feasible and safe exercise for the elderly with disability.
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Affiliation(s)
- Yong Tai Wang
- a The School of Nursing, The University of Texas at Tyler , Tyler , TX , USA
| | - Zhanghua Li
- b Orthopaedics , Wuhan University , Wuhan , China
| | - Yi Yang
- c Health Sciences , Wuhan Sport University , Wuhan , China
| | - Yaping Zhong
- c Health Sciences , Wuhan Sport University , Wuhan , China
| | - Shih-Yu Lee
- d Nursing , Hungkaung University , Taichung , Taiwan
| | - Shihui Chen
- e Physical Education Center , WPEO BNU-HKBU United International College (UIC), Zhuhai, China
| | - Yu-Ping Chen
- f Physical Therapy , Georgia State University , Atlanta , GA , USA
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17
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Wang XQ, Pi YL, Chen PJ, Liu Y, Wang R, Li X, Chen BL, Zhu Y, Yang YJ, Niu ZB. Traditional Chinese Exercise for Cardiovascular Diseases: Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc 2016; 5:e002562. [PMID: 26961239 PMCID: PMC4943241 DOI: 10.1161/jaha.115.002562] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Traditional Chinese exercise (TCE) has widespread use for the prevention and treatment of cardiovascular disease; however, there appears to be no consensus about the benefits of TCE for patients with cardiovascular disease. The objective of this systematic review was to determine the effects of TCE for patients with cardiovascular disease. Methods and Results Relevant studies were searched by PubMed, Embase, Web of Science, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, and the China National Knowledge Infrastructure. We covered only published articles with randomized controlled trials. The outcome measures included physiological outcomes, biochemical outcomes, physical function, quality of life, and depression. A total of 35 articles with 2249 cardiovascular disease patients satisfied the inclusion criteria. The pooling revealed that TCE could decrease systolic blood pressure by 9.12 mm Hg (95% CI −16.38 to −1.86, P=0.01) and diastolic blood pressure by 5.12 mm Hg (95% CI −7.71 to −2.52, P<0.001). Patients performing TCE also found benefits compared with those in the control group in terms of triglyceride (standardized mean difference −0.33, 95% CI −0.56 to −0.09, P=0.006), 6‐minute walk test (mean difference 59.58 m, 95% CI −153.13 to 269.93, P=0.03), Minnesota Living With Heart Failure Questionnaire results (mean difference −17.08, 95% CI −23.74 to −10.41, P<0.001), 36‐Item Short Form physical function scale (mean difference 0.82, 95% CI 0.32–1.33, P=0.001), and Profile of Mood States depression scale (mean difference −3.02, 95% CI −3.50 to −2.53, P<0.001). Conclusions This study demonstrated that TCE can effectively improve physiological outcomes, biochemical outcomes, physical function, quality of life, and depression among patients with cardiovascular disease. More high‐quality randomized controlled trials on this topic are warranted.
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Affiliation(s)
- Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China
| | - Yan-Ling Pi
- Department of Rehabilitation Medicine, Shanghai Punan Hospital, Shanghai, China
| | - Pei-Jie Chen
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yu Liu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Ru Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Xin Li
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Bing-Lin Chen
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yi Zhu
- Rehabilitation Therapy Center, Hainan Province Nongken General Hospital, Haikou, China
| | - Yu-Jie Yang
- Second School of Clinical Medical, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhan-Bin Niu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
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Salmoirago-Blotcher E, Wayne P, Bock BC, Dunsiger S, Wu WC, Stabile L, Yeh G. Design and methods of the Gentle Cardiac Rehabilitation Study--A behavioral study of tai chi exercise for patients not attending cardiac rehabilitation. Contemp Clin Trials 2015; 43:243-51. [PMID: 26115880 DOI: 10.1016/j.cct.2015.06.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/18/2015] [Accepted: 06/20/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Cardiac rehabilitation (CR) programs reduce overall and cardiovascular mortality in patients with a history of acute coronary events or revascularization procedures, but only 30% of patients enroll in CR and attrition rates reach up to 60%. Tai chi, a mind-body practice based on light/moderate aerobic exercise accompanied by meditative components could be a possible exercise option for patients who do not attend CR. METHODS/DESIGN Sixty patients will be randomized to a "LITE" condition (one tai chi session twice weekly for 12 weeks) or to a "PLUS" condition (one tai chi session 3 times weekly for 12 weeks, followed by maintenance classes 1-2 times weekly for an additional 12 weeks). Measurements will be conducted at baseline, 3-, 6-, and 9 months after enrollment. The primary outcome is to determine the feasibility, acceptability and safety of each dose. Secondary outcomes include estimates of effect size of each dose on accelerometry-assessed physical activity; the proportion of patients meeting current recommendations for physical activity; and measures of fitness, quality of life, body weight, and sleep. In addition, we will collect exploratory information on possible mediators (exercise self-efficacy, perceived social support, resilience, mindfulness, and depression). CONCLUSIONS Findings from this pilot study will provide preliminary indications about the usefulness of tai chi as an exercise option for patients not attending traditional CR programs. Results will also shed light on the possible mechanisms by which tai chi practice may improve overall physical activity among patients with atherosclerotic coronary heart disease.
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Affiliation(s)
| | - Peter Wayne
- Osher Center for Integrative Medicine, Brigham and Women Hospital, Harvard Medical School, United States
| | - Beth C Bock
- The Miriam Hospital, The Warren Alpert Medical School of Brown University, United States
| | - Shira Dunsiger
- The Miriam Hospital, The Warren Alpert Medical School of Brown University, United States
| | - Wen-Chih Wu
- The Miriam Hospital, The Warren Alpert Medical School of Brown University, United States
| | | | - Gloria Yeh
- Beth Israel Deaconess Medical Center, Harvard Medical School, United States
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Efficacy and safety of Tai Chi for Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials. PLoS One 2014; 9:e99377. [PMID: 24927169 PMCID: PMC4057148 DOI: 10.1371/journal.pone.0099377] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/13/2014] [Indexed: 12/02/2022] Open
Abstract
Background and Objective In Parkinson's disease (PD), wearing off and side effects of long-term medication and complications pose challenges for neurologists. Although Tai Chi is beneficial for many illnesses, its efficacy for PD remains uncertain. The purpose of this review was to evaluate the efficacy and safety of Tai Chi for PD. Methods Randomized controlled trials (RCTs) of Tai Chi for PD were electronically searched by the end of December 2013 and identified by two independent reviewers. The tool from the Cochrane Handbook 5.1 was used to assess the risk of bias. A standard meta-analysis was performed using RevMan 5.2 software. Results Ten trials with PD of mild-to-moderate severity were included in the review, and nine trials (n = 409) were included in the meta-analysis. The risk of bias was generally high in the blinding of participants and personnel. Improvements in the Unified Parkinson's Disease Rating Scale Part III (mean difference (MD) −4.34, 95% confidence interval (CI) −6.67–−2.01), Berg Balance Scale (MD: 4.25, 95% CI: 2.83–5.66), functional reach test (MD: 3.89, 95% CI: 1.73–6.04), Timed Up and Go test (MD: −0.75, 95% CI: −1.30–−0.21), stride length (standardized MD: 0.56, 95% CI: 0.03–1.09), health-related quality of life (standardized MD: −1.10, 95% CI: −1.81–−0.39) and reduction of falls were greater after interventions with Tai Chi plus medication. Satisfaction and safety were high. Intervention with Tai Chi alone was more effective for only a few balance and mobility outcomes. Conclusions Tai Chi performed with medication resulted in promising gains in mobility and balance, and it was safe and popular among PD patients at an early stage of the disease. This provides a new evidence for PD management. More RCTs with larger sample size that carefully address blinding and prudently select outcomes are needed. PROSPERO registration number CRD42013004989.
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Wayne PM, Berkowitz DL, Litrownik DE, Buring JE, Yeh GY. What do we really know about the safety of tai chi?: A systematic review of adverse event reports in randomized trials. Arch Phys Med Rehabil 2014; 95:2470-83. [PMID: 24878398 DOI: 10.1016/j.apmr.2014.05.005] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 05/02/2014] [Accepted: 05/05/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To systematically review the frequency and quality of adverse event (AE) reports in randomized controlled trials (RCTs) of tai chi (TC). DATA SOURCES Electronic searches of PubMed/MEDLINE and additional databases from inception through March 2013 of English-language RCTs. Search terms included tai chi, taiji, and tai chi chuan. Data were independently extracted by 2 investigators. STUDY SELECTION We included all available RCTs that were published in English and used TC as an intervention. Inclusion and exclusion criteria of studies were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA EXTRACTION Eligible RCTs were categorized with respect to AE reporting: no mention of protocol for monitoring AEs or reports of AEs, and reports of AEs either with or without explicit protocol for monitoring AEs. DATA SYNTHESIS There were 153 eligible RCTs identified; most targeted older adults. Only 50 eligible trials (33%) included reporting of AEs; of these, only 18 trials (12% overall) also reported an explicit AE monitoring protocol. Protocols varied with respect to the rigor of systematic monitoring in both the TC and comparison groups. Reported AEs were typically minor and expected and primarily musculoskeletal related (eg, knee and back pain); no intervention-related serious AEs were reported. CONCLUSIONS TC is unlikely to result in serious AEs, but it may be associated with minor musculoskeletal aches and pains. However, poor and inconsistent reporting of AEs greatly limits the conclusions that can be drawn regarding the safety of TC.
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Affiliation(s)
- Peter M Wayne
- Osher Center for Integrative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Harvard Medical School, Boston, MA; Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA.
| | - Danielle L Berkowitz
- Osher Center for Integrative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA
| | - Daniel E Litrownik
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Julie E Buring
- Harvard Medical School, Boston, MA; Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA
| | - Gloria Y Yeh
- Harvard Medical School, Boston, MA; Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Winters-Stone K. Tai Ji Quan for the aging cancer survivor: Mitigating the accelerated development of disability, falls, and cardiovascular disease from cancer treatment. JOURNAL OF SPORT AND HEALTH SCIENCE 2014; 3:52-57. [PMID: 25285233 PMCID: PMC4180213 DOI: 10.1016/j.jshs.2013.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Currently there are more than 13.7 million cancer survivors living in the U.S., and that figure is projected to increase by 31% in the next decade, adding another 4 million cancer survivors into the healthcare system. Cancer is largely a disease of aging, and the aging of the population will sharply raise the proportion of older cancer survivors, many of whom will be long-term survivors (5+ years post diagnosis). This review will address the potential utility of exercise to address three health problems that are of particular concern for the aging cancer survivor and the healthcare system, i.e., disability, falls, and cardiovascular disease, because the development of these age-related problems may be accelerated by cancer treatment. While there are many different modes of exercise that each produce specific adaptations, Tai Ji Quan may be a particularly suitable strategy to mitigate the development of age- and cancer-treatment-related problems. Based on studies in older adults without cancer, Tai Ji Quan produces musculoskeletal and cardiometabolic adaptations and is more easily performed by older adults due to its low energy cost and slower movement patterns. Since cancer survivors are mostly older, inactive, and often physically limited by the lingering side effects of treatment, they need to engage in safe, practical, and effective modes of exercise. The dearth of published controlled trials examining the efficacy of Tai Ji Quan to mitigate cancer-treatment-related musculoskeletal and cardiovascular side effects points to ample research opportunities to explore the application of this non-Western exercise modality to improve long-term outcomes for aging cancer survivors.
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Affiliation(s)
- Kerri Winters-Stone
- School of Nursing and Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
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Tai chi chuan exercise for patients with cardiovascular disease. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:983208. [PMID: 24348732 PMCID: PMC3855938 DOI: 10.1155/2013/983208] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 08/19/2013] [Accepted: 09/23/2013] [Indexed: 01/19/2023]
Abstract
Exercise training is the cornerstone of rehabilitation for patients with cardiovascular disease (CVD). Although high-intensity exercise has significant cardiovascular benefits, light-to-moderate intensity aerobic exercise also offers health benefits. With lower-intensity workouts, patients may be able to exercise for longer periods of time and increase the acceptance of exercise, particularly in unfit and elderly patients. Tai Chi Chuan (Tai Chi) is a traditional Chinese mind-body exercise. The exercise intensity of Tai Chi is light to moderate, depending on its training style, posture, and duration. Previous research has shown that Tai Chi enhances aerobic capacity, muscular strength, balance, and psychological well-being. Additionally, Tai Chi training has significant benefits for common cardiovascular risk factors, such as hypertension, diabetes mellitus, dyslipidemia, poor exercise capacity, endothelial dysfunction, and depression. Tai Chi is safe and effective in patients with acute myocardial infarction (AMI), coronary artery bypass grafting (CABG) surgery, congestive heart failure (HF), and stroke. In conclusion, Tai Chi has significant benefits to patients with cardiovascular disease, and it may be prescribed as an alternative exercise program for selected patients with CVD.
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Tai chi chuan in medicine and health promotion. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:502131. [PMID: 24159346 PMCID: PMC3789446 DOI: 10.1155/2013/502131] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 06/29/2013] [Indexed: 12/28/2022]
Abstract
Tai Chi Chuan (Tai Chi) is a Chinese traditional mind-body exercise and recently, it becomes popular worldwide. During the practice of Tai Chi, deep diaphragmatic breathing is integrated into body motions to achieve a harmonious balance between body and mind and to facilitate the flow of internal energy (Qi). Participants can choose to perform a complete set of Tai Chi or selected movements according to their needs. Previous research substantiates that Tai Chi has significant benefits to health promotion, 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-back pain, and musculoskeletal disorder), cardiovascular diseases (e.g., acute myocardial infarction, coronary artery bypass grafting surgery, 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 Chi and introduces its health-promotion effect and the potential clinical applications.
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Ding M, Zhang W, Li K, Chen X. Effectiveness of t'ai chi and qigong on chronic obstructive pulmonary disease: a systematic review and meta-analysis. J Altern Complement Med 2013; 20:79-86. [PMID: 23961940 DOI: 10.1089/acm.2013.0087] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The purpose of this study is to determine the effects of Chinese traditional exercise such as t'ai chi and qigong (TCQ) on patients with chronic obstructive pulmonary disease (COPD). METHODS All prospective, randomized, controlled clinical trials, published in English or Chinese and involving the use of TCQ by patients with COPD, were searched in 10 electronic databases from their respective inceptions to July 2012. The methodological quality of all studies was assessed using the Jadad score. The selection of studies, data extraction, and quality assessment were performed independently by two raters. RESULTS In the results, 10 trials met the inclusion criteria and were reviewed. The meta-analysis demonstrated that compared with no exercise, TCQ had significant effects on 6-minute walk distance, forced expiratory volume in 1 second (FEV1), predicted FEV1 percentage, and St. George's Respiratory Questionnaire score. There were no significant differences in all outcomes between TCQ and other exercise training except 6-minute walk distance. CONCLUSIONS In conclusion, TCQ might be beneficial with respect to physical performance, lung function, remission of dyspnea, and quality of life in patients with COPD; however, caution is needed to draw a firm conclusion because of the low methodological quality of the included trials.
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Affiliation(s)
- Meng Ding
- 1 College of Physical Education, Shandong Normal University , Jinan, China
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Stan DL, Collins NM, Olsen MM, Croghan I, Pruthi S. The evolution of mindfulness-based physical interventions in breast cancer survivors. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2012; 2012:758641. [PMID: 22997532 PMCID: PMC3446749 DOI: 10.1155/2012/758641] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 06/27/2012] [Indexed: 02/05/2023]
Abstract
Survivors of breast cancer are faced with a multitude of medical and psychological impairments during and after treatment and throughout their lifespan. Physical exercise has been shown to improve survival and recurrence in this population. Mind-body interventions combine a light-moderate intensity physical exercise with mindfulness, thus having the potential to improve both physical and psychological sequelae of breast cancer treatments. We conducted a review of mindfulness-based physical exercise interventions which included yoga, tai chi chuan, Pilates, and qigong, in breast cancer survivors. Among the mindfulness-based interventions, yoga was significantly more studied in this population as compared to tai chi chuan, Pilates, and qigong. The participants and the outcomes of the majority of the studies reviewed were heterogeneous, and the population included was generally not selected for symptoms. Yoga was shown to improve fatigue in a few methodologically strong studies, providing reasonable evidence for benefit in this population. Improvements were also seen in sleep, anxiety, depression, distress, quality of life, and postchemotherapy nausea and vomiting in the yoga studies. Tai chi chuan, Pilates, and qigong were not studied sufficiently in breast cancer survivors in order to be implemented in clinical practice.
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Affiliation(s)
- Daniela L. Stan
- Department of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Nerissa M. Collins
- Department of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Molly M. Olsen
- Department of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Ivana Croghan
- Nicotine Research Program, Primary Care Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Sandhya Pruthi
- Department of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Nguyen MH, Kruse A. The effects of Tai Chi training on physical fitness, perceived health, and blood pressure in elderly Vietnamese. Open Access J Sports Med 2012; 3:7-16. [PMID: 24198581 PMCID: PMC3781893 DOI: 10.2147/oajsm.s27329] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective Evaluating the effects of Tai Chi exercise on physical fitness, blood pressure, and perceived health in community-dwelling elderly. Design A randomized controlled trial. Setting Community-dwelling elderly in Vinh city, Vietnam. Participants Ninety-six community-dwelling participants aged 60 to 79 years (68.9 ± 5.1 years) were recruited. Intervention Subjects were divided randomly into two groups: Tai Chi and Control groups. Participants in the Tai Chi group (aged 69.02 ± 5.16 years) attended a 60-minute Tai Chi practice session twice a week for 6 months. The session consisted of a 15-minute warm-up and a 15-minute cool-down period. The Control group (aged 68.72 ± 4.94 years) maintained routine daily activities. Outcome measures The Senior Fitness Test and Short-Form 36® (SF-36®) are primary outcome measures. Results After 24 weeks of the Tai Chi training program, the intervention group showed significant decrease in systole of 12 mmHg and heart rate 6.46 bpm. Body mass index and waist–hip ratio were also reduced by 1.23 and 0.04, respectively. The Senior Fitness Test and SF-36 showed significant improvement. Conclusion In this randomized controlled trial study, Tai Chi is beneficial to improve systole blood pressure, heart rate, body mass index, waist–hip ratio, perceived health, and physical fitness. Assessment of the effects of Tai Chi may be focused more on chronic disease with a long-term training program in the future.
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Affiliation(s)
- Manh Hung Nguyen
- Institute of Gerontology, Heidelberg University, Heidelberg, Germany
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