Challenges inherent to t'ai chi research: part I--t'ai chi as a complex multicomponent intervention

Comparative Effectiveness of Tai Chi Versus Physical Therapy for Knee Osteoarthritis: A Randomized Trial

BACKGROUND

Few remedies effectively treat long-term pain and disability from knee osteoarthritis. Studies suggest that Tai Chi alleviates symptoms, but no trials have directly compared Tai Chi with standard therapies for osteoarthritis.

OBJECTIVE

To compare Tai Chi with standard physical therapy for patients with knee osteoarthritis.

DESIGN

Randomized, 52-week, single-blind comparative effectiveness trial. (ClinicalTrials.gov: NCT01258985).

SETTING

An urban tertiary care academic hospital.

PATIENTS

204 participants with symptomatic knee osteoarthritis (mean age, 60 years; 70% women; 53% white).

INTERVENTION

Tai Chi (2 times per week for 12 weeks) or standard physical therapy (2 times per week for 6 weeks, followed by 6 weeks of monitored home exercise).

MEASUREMENTS

The primary outcome was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 12 weeks. Secondary outcomes included physical function, depression, medication use, and quality of life.

RESULTS

At 12 weeks, the WOMAC score was substantially reduced in both groups (Tai Chi, 167 points [95% CI, 145 to 190 points]; physical therapy, 143 points [CI, 119 to 167 points]). The between-group difference was not significant (24 points [CI, -10 to 58 points]). Both groups also showed similar clinically significant improvement in most secondary outcomes, and the benefits were maintained up to 52 weeks. Of note, the Tai Chi group had significantly greater improvements in depression and the physical component of quality of life. The benefit of Tai Chi was consistent across instructors. No serious adverse events occurred.

LIMITATION

Patients were aware of their treatment group assignment, and the generalizability of the findings to other settings remains undetermined.

CONCLUSION

Tai Chi produced beneficial effects similar to those of a standard course of physical therapy in the treatment of knee osteoarthritis.

PRIMARY FUNDING SOURCE

National Center for Complementary and Integrative Health of the National Institutes of Health.

Mind-Body Exercises for Nurses with Chronic Low Back Pain: An Evidence-Based Review

Background. Chronic low back pain (CLBP) among nurses is a growing health concern. The multimodal nature of mind-body exercises has potential to impact physiological and psychological processes associated with chronic pain, affording possible advantages over conventional unimodal therapies. This paper summarizes the prevalence of and risk factors for CLBP among nurses, reviews the effectiveness in treating pain and disability of mind-body exercises (yoga and tai chi) for CLBP among the general and nursing population, and describes implications. Methods. Articles, published during or prior to 2015, were systematically identified through the PubMed/MEDLINE, Web of Science, and ScienceDirect databases using the following search terms: nurses, mind-body, integrative, biopsychosocial, yoga, tai chi, back pain, and/or risk factors. Results. Prevalence estimates of CLBP among nurses ranged from 50% to 80%. Associated risk factors for CLBP included lifestyle and physical, psychological, psychosocial, and occupational factors. No published studies were identified that evaluated yoga or tai chi for nurses with CLBP. Studies in the general population suggested that these interventions are effective in reducing pain and disability and may improve factors/processes predictive of CLBP. Conclusion. This review suggests that evaluating the impact of multimodal interventions such as yoga and tai chi for nurses with CLBP warrants investigation.

Does T'ai Chi Gait Reduce External Knee Adduction Moment?

INTRODUCTION

T'ai chi chuan is a beneficial exercise of improving health and function. Biomechanical insights of t'ai chi chuan are less understood.

OBJECTIVES

To study t'ai chi gait (TCG), a common form of t'ai chi chuan in order to quantify external knee adduction moment (EKAM) as a key indicator of mechanical loading of the medial compartment of the knee compared with normal walking (NW).

DESIGN

A quantitative biomechanics approach to determine peak EKAM for NW and TCG.

RESULTS

There were a tri-modal pattern of EKAM during TCG and a bimodal pattern of EKAM during normal walking. In addition, subsequent analysis showed a 25%-47% reduction in peak EKAM during double support phases of TCG compared with NW; the peak EKAM of TCG during single-limb support phase showed significantly higher magnitude than the other two double-support phases.

CONCLUSION

These results indicate that t'ai chi chuan might be a beneficial intervention for reducing the medial mechanical load at the knee joint, particularly during the first double-support phases of TCG, but the special consideration of higher peak EKAM of single-limb support phase is needed during regular t'ai chi chuan practice.

The Impact of Tai Chi Exercise on Self-Efficacy, Social Support, and Empowerment in Heart Failure: Insights from a Qualitative Sub-Study from a Randomized Controlled Trial

OBJECTIVE

To qualitatively explore perceived physical and psychosocial effects and overall patient experience associated with a 12-week tai chi (TC) intervention and an education group in a clinical trial of patients with chronic heart failure (HF).

SUBJECTS AND METHODS

We randomized 100 patients with chronic systolic HF (NYHA Class 1-3, ejection fraction≤40%) to a 12-week group TC program or an education control. At 12-weeks, semi-structured interviews were conducted on a random subset (n = 32; n = 17 in TC, n = 15 in control), audiorecorded and transcribed verbatim. Two independent reviewers extracted information using grounded-theory methods for emergent themes. We explored similarities and differences in themes/sub-themes between the groups, and examined qualitative association with changes from baseline to post-intervention in previously reported quantitative measures (e.g., Minnesota Living with HF, Cardiac Exercise Self Efficacy and Profile of Mood States).

RESULTS

The mean age (±SD) of participants was 68±9 years, baseline ejection fraction 29±7%, and median New York Heart Association class 2 HF. We idenitifed themes related to the patient's experience of illness, perceptions of self, and relationship to others. Specific psychosocial and physical benefits were described. Common themes emerged from both groups including: social support and self-efficacy related to activity/exercise and diet. The tai chi group, however, also exhibited a more global empowerment and perceived control. Additional themes in TC included mindfulness/self-awareness, decreased stress reactivity, and renewed social role. These themes mirrored improvements in previously reported quantitative measures (quality-of-life, self-efficacy, and mood) in TC compared to control. Patients in TC also reported physical benefits (e.g., decreased pain, improved energy, endurance, flexibility).

CONCLUSION

Positive themes emerged from both groups, although there were qualitative differences in concepts of self-efficacy and perceived control between groups. Those in tai chi reported not only self efficacy and social support, but overall empowerment with additional gains such as internal locus of control, self-awareness and stress management. Future studies of mind-body exercise might further examine perceived control, self-efficacy, and locus-of-control as potential mediators of effect.

Changes in self-reported symptoms of depression and physical well-being in healthy individuals following a Taiji beginner course - Results of a randomized controlled trial

BACKGROUND

Taiji is a mind-body practice being increasingly investigated for its therapeutic benefits in a broad range of mental and physical conditions. The aim of this study was to investigate the potential preventive effects of Taiji practice in healthy individuals with regard to their depressive symptomatology and physical well-being.

METHODS

Seventy healthy Taiji novices were randomly assigned to a Taiji intervention group, that is, Taiji beginner course (Yang-Style Taiji, 2 h per week, 12 weeks) or a control group comprised of the waiting list for the course. Self-reported symptoms of depression (CES-D) and physical well-being (FEW-16) were assessed at baseline, at the end of the intervention, as well as 2 months later.

RESULTS

The included participants had a mean age of 35.5 years. Physical well-being in the Taiji group significantly increased when comparing baseline to follow-up (FEW-16 sum score T(27) = 3.94, P = 0.001, 95% CI 0.17 to 0.55). Pearson's correlation coefficients displayed a strong negative relationship between self-reported symptoms of depression and physical well-being (P's < 0.001, r's ≥ -0.54).

CONCLUSION

In this randomized controlled trial, we found significant evidence that a Taiji beginner course of 3 months duration elicits positive effects with respect to physical well-being in healthy individuals, with improvements pronouncing over time. Physical well-being was shown to have a strong relationship with depressive symptoms. Based on these results, the consideration of Taiji as one therapeutic option in the development of multimodal approaches in the prevention of depression seems justifiable.

Cognitive Benefits of Social Dancing and Walking in Old Age: The Dancing Mind Randomized Controlled Trial

Background

A physically active lifestyle has the potential to prevent cognitive decline and dementia, yet the optimal type of physical activity/exercise remains unclear. Dance is of special interest as it complex sensorimotor rhythmic activity with additional cognitive, social, and affective dimensions.

Objectives

To determine whether dance benefits executive function more than walking, an activity that is simple and functional.

Methods

Two-arm randomized controlled trial among community-dwelling older adults. The intervention group received 1 h of ballroom dancing twice weekly over 8 months (~69 sessions) in local community dance studios. The control group received a combination of a home walking program with a pedometer and optional biweekly group-based walking in local community park to facilitate socialization.

Main outcomes

Executive function tests: processing speed and task shift by the Trail Making Tests, response inhibition by the Stroop Color-Word Test, working memory by the Digit Span Backwards test, immediate and delayed verbal recall by the Rey Auditory Verbal Learning Test, and visuospatial recall by the Brief Visuospatial Memory Test (BVST).

Results

One hundred and fifteen adults (mean 69.5 years, SD 6.4) completed baseline and delayed baseline (3 weeks apart) before being randomized to either dance (n = 60) or walking (n = 55). Of those randomized, 79 (68%) completed the follow-up measurements (32 weeks from baseline). In the dance group only, “non-completers” had significantly lower baseline scores on all executive function tests than those who completed the full program. Intention-to-treat analyses showed no group effect. In a random effects model including participants who completed all measurements, adjusted for baseline score and covariates (age, education, estimated verbal intelligence, and community), a between-group effect in favor of dance was noted only for BVST total learning (Cohen’s D Effect size 0.29, p = 0.07) and delayed recall (Cohen’s D Effect size = 0.34, p = 0.06).

Conclusion

The superior potential of dance over walking on executive functions of cognitively healthy and active older adults was not supported. Dance improved one of the cognitive domains (spatial memory) important for learning dance. Controlled trials targeting inactive older adults and of a higher dose may produce stronger effects, particularly for novice dancers.

Trial registration

Australian and New Zealand Clinical Trials Register (ACTRN12613000782730).

Design, methodology and baseline characteristics of Tai Chi and its protective effect against ischaemic stroke risk in an elderly community population with risk factors for ischaemic stroke: a randomised controlled trial

INTRODUCTION

Controlling risk factors with regular exercise is effective and cost-effective for the primary prevention of ischaemic stroke. As a traditional Chinese form of exercise, Tai Chi might be beneficial in decreasing ischaemic stroke, but the evidence remains insufficient. We hypothesise that elderly community adults with risk factors for ischaemic stroke will decrease their ischaemic stroke risk by improving cerebral haemodynamic parameters, cardiopulmonary function, motor function, plasma risk indices, physical parameters or psychological outcomes after receiving 12 weeks of regular Tai Chi training compared with those who maintained their original physical activities. Therefore, we designed a randomised controlled trial that will systematically evaluate the protective effects of Tai Chi exercise on ischaemic stroke risk in an elderly community population with risk factors for ischaemic stroke.

METHODS AND ANALYSIS

A total of 170 eligible participants were randomly allocated into either the Tai Chi training group or the usual physical activity group. This paper reports on the design, intervention development and baseline characteristics of the participants. There were no significant differences between comparison groups in demographic characteristics or the baseline data of primary or secondary outcomes. Participants in the Tai Chi training group will receive 12 weeks of Tai Chi training with a frequency of 5 days/week and 60 min/day, while those in the usual physical activities group will maintain their original activities. Primary and secondary outcomes will be measured at the 12-week and 24-week follow-ups.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Medical Ethics Committee of The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine (number 2013-020-02). The findings of this study will be communicated to healthcare professionals, participants and the public through peer-reviewed publications or scientific conferences.

TRIAL REGISTRATION NUMBER

ChiCTR-TRC-13003601; Pre-results.

Effect of traditional Chinese exercise on the quality of life and depression for chronic diseases: a meta-analysis of randomised trials

Traditional Chinese exercise (TCE) has many uses in the prevention and treatment of chronic diseases. However, there is no consensus regarding the benefit of TCE for chronic diseases. Our objective is to examine the effect of TCE on the quality of life and depression for chronic diseases by performing a meta-analysis of randomized controlled trials (RCTs). We only cover published RCTs. The outcome measures included quality of life and depression. Sixty articles with a total of 4311 patients were included. The pooling revealed that TCE could improve the SF-36 physical function subscale in the short term [SMD (95% CI) = 0.35 (0.13, 0.56), P = 0.002] and mid-term [SMD (95% CI) = 0.49 (0.12, 0.85), P = 0.009], GHQ [SMD (95% CI) = −0.68 (−1.26, −0.09), P = 0.02], the Center for Epidemiologic Studies depression scale in the short term [SMD (95% CI) = −0.86 (−1.42, −0.31), P = 0.002] and mid-term [SMD (95% CI) = −0.41 (−0.64, −0.18), P < 0.001]. The meta-analysis of RCT demonstrates that TCE can significantly improve the quality of life and depression of patients with chronic diseases. These findings provide useful information for patients with chronic diseases as well as for medical staff.

Disease Prevention and Health Promotion: How Integrative Medicine Fits

As a discipline, preventive medicine has traditionally been described to encompass primary, secondary, and tertiary prevention. The fields of preventive medicine and public health share the objectives of promoting general health, preventing disease, and applying epidemiologic techniques to these goals. This paper discusses a conceptual approach between the overlap and potential synergies of integrative medicine principles and practices with preventive medicine in the context of these levels of prevention, acknowledging the relative deficiency of research on the effectiveness of practice-based integrative care. One goal of integrative medicine is to make the widest array of appropriate options available to patients, ultimately blurring the boundaries between conventional and complementary medicine. Both disciplines should be subject to rigorous scientific inquiry so that interventions that are efficacious and effective are systematically distinguished from those that are not. Furthermore, principles of preventive medicine can be infused into prevalent practices in complementary and integrative medicine, promoting public health in the context of more responsible practices. The case is made that an integrative preventive approach involves the responsible use of science with responsiveness to the needs of patients that persist when conclusive data are exhausted, providing a framework to make clinical decisions among integrative therapies.

Mindful movement and skilled attention

Bodily movement has long been employed as a foundation for cultivating mental skills such as attention, self-control or mindfulness, with recent studies documenting the positive impacts of mindful movement training, such as yoga and tai chi. A parallel “mind-body connection” has also been observed in many developmental disorders. We elaborate a spectrum of mindfulness by considering ADHD, in which deficient motor control correlates with impaired (disinhibited) behavioral control contributing to defining features of excessive distractibility and impulsivity. These data provide evidence for an important axis of variation for wellbeing, in which skillful cognitive control covaries with a capacity for skillful movement. We review empirical and theoretical literature on attention, cognitive control, mind wandering, mindfulness and skill learning, endorsing a model of skilled attention in which motor plans, attention, and executive goals are seen as mutually co-defining aspects of skilled behavior that are linked by reciprocal inhibitory and excitatory connections. Thus, any movement training should engage “higher-order” inhibition and selection and develop a repertoire of rehearsed procedures that coordinate goals, attention and motor plans. However, we propose that mindful movement practice may improve the functional quality of rehearsed procedures, cultivating a transferrable skill of attention. We adopt Langer’s spectrum of mindful learning that spans from “mindlessness” to engagement with the details of the present task and contrast this with the mental attitudes cultivated in standard mindfulness meditation. We particularly follow Feldenkrais’ suggestion that mindful learning of skills for organizing the body in movement might transfer to other forms of mental activity. The results of mindful movement training should be observed in multiple complementary measures, and may have tremendous potential benefit for individuals with ADHD and other populations.

Use of pragmatic community-based interventions to enhance recruitment and adherence in a randomized trial of Tai Chi for women with osteopenia: insights from a qualitative substudy

OBJECTIVE

This study aims to qualitatively evaluate the feasibility of using a pragmatic network of community-based Tai Chi schools to deliver 9-month exercise interventions to women with osteopenia and to explore the impact of this design feature on facilitators and barriers to trial recruitment and participant adherence during and after the trial.

METHODS

In a randomized trial comparing 9 months of Tai Chi plus usual care with usual care alone for postmenopausal women with moderately low bone mass, exit interviews were conducted with 43 participants randomized to the pragmatically delivered Tai Chi intervention. Transcripts were digitially recorded, transcribed, and imported into NVivo, a computer-assisted qualitative data analysis software. Qualitative content analysis was used to code the data. Patterns emerging from among the codes were further examined and clustered into themes.

RESULTS

Analyses revealed features of pragmatically delivered Tai Chi programs that both facilitated and impeded study participation and/or posttrial adherence. Direct facilitators included convenience of class locations and times, alternative learning modalities, quality of teaching, community and social support, and perceived health benefits. Barriers consisted primarily of time-related issues. A possible causal mechanism (self-efficacy) was also identified.

CONCLUSIONS

Factors related to the use of pragmatically delivered interventions are beneficial for fostering both study participation and posttrial adherence to the Tai Chi programs. This qualitative substudy is valuable for identifying these factors and a possible causal mechanism. These findings will assist in the design and conduct of future studies exploring the use of Tai Chi in fracture prevention and health-related quality of life in postmenopausal women.

Evaluation of Tai Chi Yunshou exercises on community-based stroke patients with balance dysfunction: a study protocol of a cluster randomized controlled trial

BACKGROUND

Balance dysfunction after stroke limits patients' general function and participation in daily life. Previous researches have suggested that Tai Chi exercise could offer a positive improvement in older individuals' balance function and reduce the risk of falls. But convincing evidence for the effectiveness of enhancing balance function after stroke with Tai Chi exercise is still inadequate. Considering the difficulties for stroke patients to complete the whole exercise, the current trial evaluates the benefit of Tai Chi Yunshou exercise for patients with balance dysfunction after stroke through a cluster randomization, parallel-controlled design.

METHODS/DESIGN

A single-blind, cluster-randomized, parallel-controlled trial will be conducted. A total of 10 community health centers (5 per arm) will be selected and randomly allocated into Tai Chi Yunshou exercise group or balance rehabilitation training group. Each community health centers will be asked to enroll 25 eligible patients into the trial. 60 minutes per each session, 1 session per day, 5 times per week and the total training round is 12 weeks. Primary and secondary outcomes will be measured at baseline and 4-weeks, 8-weeks, 12-weeks, 6-week follow-up, 12-week follow-up after randomization. Safety and economic evaluation will also be assessed.

DISCUSSION

This protocol aims to evaluate the effectiveness of Tai Chi Yunshou exercise for the balance function of patients after stroke. If the outcome is positive, this project will provide an appropriate and economic balance rehabilitation technology for community-based stroke patients.

TRIAL REGISTRATION

Chinese Clinical Trial Registry: ChiCTR-TRC-13003641. Registration date: 22 August, 2013 http://www.chictr.org/usercenter/project/listbycreater.aspx .

Complexity-Based Measures Inform Effects of Tai Chi Training on Standing Postural Control: Cross-Sectional and Randomized Trial Studies

Background

Diminished control of standing balance, traditionally indicated by greater postural sway magnitude and speed, is associated with falls in older adults. Tai Chi (TC) is a multisystem intervention that reduces fall risk, yet its impact on sway measures vary considerably. We hypothesized that TC improves the integrated function of multiple control systems influencing balance, quantifiable by the multi-scale “complexity” of postural sway fluctuations.

Objectives

To evaluate both traditional and complexity-based measures of sway to characterize the short- and potential long-term effects of TC training on postural control and the relationships between sway measures and physical function in healthy older adults.

Methods

A cross-sectional comparison of standing postural sway in healthy TC-naïve and TC-expert (24.5±12 yrs experience) adults. TC-naïve participants then completed a 6-month, two-arm, wait-list randomized clinical trial of TC training. Postural sway was assessed before and after the training during standing on a force-plate with eyes-open (EO) and eyes-closed (EC). Anterior-posterior (AP) and medio-lateral (ML) sway speed, magnitude, and complexity (quantified by multiscale entropy) were calculated. Single-legged standing time and Timed-Up–and-Go tests characterized physical function.

Results

At baseline, compared to TC-naïve adults (n = 60, age 64.5±7.5 yrs), TC-experts (n = 27, age 62.8±7.5 yrs) exhibited greater complexity of sway in the AP EC (P = 0.023), ML EO (P<0.001), and ML EC (P<0.001) conditions. Traditional measures of sway speed and magnitude were not significantly lower among TC-experts. Intention-to-treat analyses indicated no significant effects of short-term TC training; however, increases in AP EC and ML EC complexity amongst those randomized to TC were positively correlated with practice hours (P = 0.044, P = 0.018). Long- and short-term TC training were positively associated with physical function.

Conclusion

Multiscale entropy offers a complementary approach to traditional COP measures for characterizing sway during quiet standing, and may be more sensitive to the effects of TC in healthy adults.

Trial Registration

ClinicalTrials.gov NCT01340365

Qigong and fibromyalgia: randomized controlled trials and beyond

Introduction. Qigong is currently considered as meditative movement, mindful exercise, or complementary exercise and is being explored for relief of symptoms in fibromyalgia. Aim. This narrative review summarizes randomized controlled trials, as well as additional studies, of qigong published to the end of 2013 and discusses relevant methodological issues. Results. Controlled trials indicate regular qigong practice (daily, 6–8 weeks) produces improvements in core domains for fibromyalgia (pain, sleep, impact, and physical and mental function) that are maintained at 4–6 months compared to wait-list subjects or baselines. Comparisons with active controls show little difference, but compared to baseline there are significant and comparable effects in both groups. Open-label studies provide information that supports benefit but remain exploratory. An extension trial and case studies involving extended practice (daily, 6–12 months) indicate marked benefits but are limited by the number of participants. Benefit appears to be related to amount of practice. Conclusions. There is considerable potential for qigong to be a useful complementary practice for the management of fibromyalgia. However, there are unique methodological challenges, and exploration of its clinical potential will need to focus on pragmatic issues and consider a spectrum of trial designs. Mechanistic considerations need to consider both system-wide and more specific effects.

The benefits of endurance exercise and Tai Chi Chuan for the task-switching aspect of executive function in older adults: an ERP study

This study was designed to determine the relationship between physical activity and the task-switching aspect of executive function by investigating the modulating roles of age, modality of physical activity, and type of cognitive function using behavioral and event-related potential (ERP) assessments. Sixty-four participants were assigned to one of four groups based on age and history of physical activity: older adults performing endurance exercise (OEE), older adults practicing Tai Chi Chuan (OTC), older adults with a sedentary lifestyle (OSL), and young adults (YA). Study participants completed a task-switching task under homogeneous and heterogeneous conditions while ERPs were recorded. The results revealed that YA had shortest reaction times compared with the three older adults groups, with OSL exhibiting the longest reaction time. YA also exhibited shorter P3 latency than OSL. No differences were observed in P3 amplitude between YA, OEE, and OTC; however, all three groups had significantly larger P3 amplitude compared with OSL in both task conditions. In conclusion, age and participation in physical activity influence the relationship between physical activity and task-switching, and a positive relationship was observed regardless of the modality of physical activity and type of cognitive function. Our ERP findings support the model of the scaffolding theory of aging and cognition (STAC) and suggest that regular participation in endurance exercise and Tai Chi Chuan may have equivalent beneficial effects on cognition at the behavioral and neuroelectric levels.

Functional benefits of tai chi training in senior housing facilities

OBJECTIVES

To determine the effects of tai chi training on functional performance and walking with and without the addition of the performance of a cognitive task, in older adults living in supportive housing facilities.

DESIGN

Secondary data analysis comparing a single-blind, randomized controlled trial of tai chi training with an attention-matched educational control intervention with crossover to tai chi.

SETTING

Two supportive housing facilities.

PARTICIPANTS

Sixty-six men and women living in supportive housing facilities entered the study, and 57 aged 87±7 completed all study procedures.

INTERVENTION

Interventions consisted of two 1-hour-long instructor-led group sessions per week for 12 weeks. Tai chi training consisted of movements based upon the Yang-style short form. Educational sessions consisted of lectures and discussions of age-related health topics.

MEASUREMENTS

Subjects were tested for physical function (Short Physical Performance Battery, SPPB), balance (Berg Balance Scale, BBS), mobility (timed up-and-go, TUG), and walking speed under normal and cognitive dual-task conditions.

RESULTS

The tai chi group exhibited greater improvement in SPPB scores (baseline 8.1±2.9, follow-up 9.0±2.6) than controls (baseline 8.2±2.6, follow-up 8.2±2.6) (P=.005). Tai chi also increased normal and dual-task walking speed (P<.001) yet did not affect BBS (P=.02) or TUG (P=.02) after accounting for multiple comparisons. The dual-task cost (percentage change) to walking speed was unaffected. After the crossover tai chi intervention, the control group improved performance in the SPPB, BBS, and TUG, and increased walking speed under normal and dual-task conditions (P=.008).

CONCLUSION

Tai chi training may be a safe and effective therapy to help improve physical function and dual-task walking in very old adults living in supportive housing facilities.

Tai chi mind-body exercise in patients with COPD: study protocol for a randomized controlled trial

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a chronic, progressively debilitating condition that is prevalent in the US and worldwide. Patients suffer from progressive dyspnea and exercise intolerance. Physical exercise is beneficial, but conventional pulmonary rehabilitation programs are underutilized. There remains a need for novel interventions that improve symptoms, quality-of-life, and functional capacity. Tai chi is an increasingly popular mind-body exercise that includes physical exercise, breathing training, mindful awareness, and stress management--components that are essential to the self-management of COPD. There are, however, limited data on the effectiveness of tai chi as a therapeutic intervention in this population.

METHODS/DESIGN

The Primary Aims are to evaluate the efficacy, safety, and feasibility of a 12-week tai chi program for patients with COPD. We utilize a randomized controlled trial design, with participants assigned in a 2:1 ratio to either a group tai chi program (N = 63) or a time/attention-matched education control (N = 31). Our primary outcomes are COPD-specific quality-of-life and exercise capacity. Secondary outcomes include dyspnea, mood, functional status, self-efficacy, and lung function. Cardiopulmonary exercise testing is done in a subset of patients (N = 50). To explore optimal training duration, a subgroup of patients in tai chi are randomly assigned to complete an additional 12 weeks training (total 24 weeks) (Exploratory Aim 1). To explore the impact of a simplified seated intervention including only a subset of tai chi's training components, a third randomly assigned group (N = 31) receives a 12- week mind-body breathing program (N = 31) (Exploratory Aim 2).

DISCUSSION

Results of the BEAM study (Breathing, Education, Awareness, Movement) will provide preliminary evidence regarding the value of tai chi for improving quality of life and exercise capacity in patients with COPD, including information regarding optimal duration. They will also inform the feasibility and potential benefit of an alternative mind-body breathing intervention, and provide insight regarding how isolated mind-body exercise components contribute to the overall effects of tai chi. Should the results be positive, tai chi and related mind-body practices may offer a novel exercise option that is potentially accessible to a large proportion of patients with COPD.

TRIAL REGISTRATION

This trial is registered in Clinical Trials.gov, ID number NCT01551953. Date of Registration March 1 2012.

Mindfulness-based interventions in multiple sclerosis: beneficial effects of Tai Chi on balance, coordination, fatigue and depression

Background

Patients suffering from Multiple Sclerosis (MS) experience a wide array of symptoms, including balance problems, mobility impairment, fatigue and depression. Physical exercise has recently been acknowledged as a treatment option complementary to medication. However, information regarding putative effects of structured exercise programs on neurological symptoms is sparse. Tai Chi, a Chinese martial art incorporating physical exercise and mindfulness training, has been shown to yield health benefits in various neurological groups. It seems particularly suitable for patients with motoric deficits as it challenges coordination and balance. The purpose of the current study was to explore the therapeutic value of structured Tai Chi training for coordination, balance, fatigue and depression in mildly disabled MS patients.

Methods

A sample of 32 MS patients (Expanded Disability Status Scale, EDSS < 5) was examined. A structured Tai Chi course was devised and a Tai Chi group participated in two weekly sessions of 90 minutes duration for six months, while a comparison group received treatment as usual (TAU). Both groups were examined prior to and following the six-months interval with regards to balance and coordination performance as well as measures of fatigue, depression and life satisfaction.

Results

Following the intervention, the Tai Chi group showed significant, consistent improvements in balance, coordination, and depression, relative to the TAU group (range of effect-sizes: partial η² = 0.16 – 0.20). Additionally, life satisfaction improved (partial η² = 0.31). Fatigue deteriorated in the comparison group, whereas it remained relatively stable in the Tai Chi group (partial η² = 0.24).

Conclusions

The consistent pattern of results confirms that Tai Chi holds therapeutic potential for MS patients. Further research is needed to determine underlying working mechanisms, and to verify the results in a larger sample and different MS subgroups.

Qualitative analysis of a controlled trial of qigong for fibromyalgia: advancing understanding of an emerging health practice

OBJECTIVES

A randomized controlled trial (RCT) and an extension trial of qigong (Chaoyi Fanhuan qigong [CFQ]) in patients with fibromyalgia were recently completed. In the present study, a qualitative analysis of comments from the RCT was undertaken using motivation and amount of practice to determine whether initial experiences provided information relevant to outcomes.

INTERVENTION

Participants in the RCT received instruction in qigong (level 1 CFQ), practiced 45 min/day for 8 weeks and continued practice to 6 months; open-ended qualitative comments on experiences were invited at 8 weeks and 4 and 6 months. Extension trial participants received further instruction (level 2 CFQ) and practiced regularly for 8 weeks-6 months. Comments from the original RCT were considered as narratives for the extension trial subgroup (n=20) and thematically, according to amount of practice, for all participants who completed the RCT (n=73).

RESULTS

Narrative comments from the RCT for those who completed the extension trial (n=13) and those who withdrew from that trial (n=7) were considered separately. Participants reporting benefits within the first 8 weeks were more likely to maintain practice and report continued benefits at 4-6 months than those who withdrew from the trial. Thematic comments for all who completed the RCT (n=73) were considered in relation to amount of practice (per protocol, intermediate, minimal). Participants who practiced per protocol during the initial 8 weeks (≥5 hours/wk) were more likely to maintain practice over 4-6 months and to report beneficial health effects from qigong.

CONCLUSIONS

This retrospective qualitative analysis of information collected in an RCT of qigong for fibromyalgia indicates that favorable initial experiences with the practice over 8 weeks predispose to continued practice and more health effects. Future individual trials and meta-analyses of qigong will need to attend to the amount, and potentially quality, of practice undertaken in considering trial outcomes.

Efficacy and safety of Tai Chi for Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials

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.

Exercise mode heterogeneity among reported studies of the qigong practice Baduanjin

There has not been a uniform method for the practice of Baduanjin, and most published research reports involving this set of traditional Chinese exercise have provided incomplete descriptions of the movements used for those studies. This paper reviews elements of past research methodologies of Baduanjin intervention studies and provides considerations for future research. Ambiguities and inconsistencies in the descriptions of the movements, along with some implications which arise from this are discussed.

Rating of Perceived Exertion and Affective Responses during Tai Chi Chuan

Ratings of perceived exertion (RPE) and affective responses were assessed during Tai Chi Chuan. A total of 16 women ( M age = 61.2 yr., SD = 8.8) participated in this study. Individuals practiced Tai Chi Chuan three times / week during seven weeks, and were assessed session-by-session (21 Wu Tai Chi Chuan sessions) in three moments (15, 30, and 45 min.) using Borg's scale (CR 0–10) and the Feeling Scale (+5/–5). With regard to RPE, there was a difference between 15 and 30 min. and between 15 and 45 min. The same pattern of differences was observed for the affective response. The RPE during the seven weeks ranged from “fairly light” to “moderate” and the affective response from “good” to “very good.” Thus, Tai Chi Chuan was perceived as a low-moderate intensity and pleasurable (positive affect) exercise by middle-aged and elderly women.

Movement-based embodied contemplative practices: definitions and paradigms

Over the past decades, cognitive neuroscience has witnessed a shift from predominantly disembodied and computational views of the mind, to more embodied and situated views of the mind. These postulate that mental functions cannot be fully understood without reference to the physical body and the environment in which they are experienced. Within the field of contemplative science, the directing of attention to bodily sensations has so far mainly been studied in the context of seated meditation and mindfulness practices. However, the cultivation of interoceptive, proprioceptive and kinesthetic awareness is also said to lie at the core of many movement-based contemplative practices such as Yoga, Qigong, and Tai Chi. In addition, it likely plays a key role in the efficacy of modern somatic therapeutic techniques such as the Feldenkrais Method and the Alexander Technique. In the current paper we examine how these practices are grounded in the concepts of embodiment, movement and contemplation, as we look at them primarily through the lens of an enactive approach to cognition. Throughout, we point to a series of challenges that arise when Western scientists study practices that are based on a non-dualistic view of mind and body.

Key issues in clinical and epidemiological research in complementary and alternative medicine--a systematic literature review

BACKGROUND

In the last 2 decades there has been a large increase in publications on complementary and alternative medicine (CAM). However, CAM research methodology was heterogeneous and often of low quality. The aim of this systematic review was to investigate scientific publications with regards to general issues, concepts and strategies. We also looked at research priorities and methods employed to evaluate the clinical and epidemiological research of CAM in the past to identify the basis for consensus-based research strategies.

METHODS

We performed a systematic literature search for papers published between 1990 and 2010 in 7 electronic databases (Medline, Web of Science, PsychArticles, PsycInfo, CINAHL, EMBASE and Cochrane Library) on December 16 and 17, 2010. In addition, experts were asked to nominate relevant papers. Inclusion criteria were publications dealing with research methodology, priorities or complexities in the scientific evaluation of CAM. All references were assessed in a multistage process to identify relevant papers.

RESULTS

From the 3,279 references derived from the search and 98 references contributed by CAM experts, 170 papers fulfilled the criteria and were included in the analysis. The following key issues were identified: difficulties in past CAM research (e.g., randomisation, blinding), utility of quantitative and qualitative research methods in CAM, priority setting in CAM research and specific issues regarding various CAM modalities.

CONCLUSIONS

Most authors vote for the use of commonly accepted research methods to evaluate CAM. There was broad consensus that a mixed methods approach is the most suitable for gathering conclusive knowledge about CAM.

Preventing falls with Tai Ji Quan: A public health perspective

Falls among people aged 65 and older are a significant public health problem and one that is expected to increase as the population ages. Randomized controlled trials have demonstrated that Tai Ji Quan can reduce falls and associated injuries among older adults. In this paper, we describe how Tai Ji Quan community programs are being utilized by public health and aging services organizations to reduce older adult falls. We conclude that, to have a population-level impact on reducing falls and improving the health of older adults, Tai Ji Quan interventions must be translated into community programs that meet the needs and abilities of older adults. These programs must be adapted to fit into existing community structures, disseminated through multiple delivery channels, adopted and implemented broadly by organizations, and institutionalized to ensure sustainability.

Effect of tai chi on musculoskeletal health-related fitness and self-reported physical health changes in low income, multiple ethnicity mid to older adults

Background

Tai Chi (TC) has proven to be effective at improving musculoskeletal fitness by increasing upper and lower body strength, low back flexibility and overall physical health. The objectives of this study were to examine changes in musculoskeletal health-related fitness and self-reported physical health after a 16 week TC program in a low income multiple ethnicity mid to older adult population.

Methods

Two hundred and nine ethnically diverse mid to older community dwelling Canadian adults residing in low income neighbourhoods were enrolled in a 16 week Yang style TC program. Body Mass Index and select musculoskeletal fitness measures including upper and lower body strength, low back flexibility and self-reported physical health measured by SF 36 were collected pre and post the TC program. Determinants of health such as age, sex, marital status, education, income, ethnicity of origin, multi-morbidity conditions, weekly physical activity, previous TC experience as well as program adherence were examined as possible musculoskeletal health-related fitness change predictors.

Results

Using paired sample t-tests significant improvements were found in both upper and lower body strength, low back flexibility, and the SF 36 physical health scores (p < 0.05). Based on multiple linear regression analyses, no common health determinants explained a significant portion of the variation in percent changes of the musculoskeletal fitness and SF 36 measures.

Conclusions

These results reveal that TC has the potential of having a beneficial influence on musculoskeletal health-related fitness and self-reported physical health in a mid to older low socioeconomic, ethnically diverse sample.

Effects of Tai Chi on cognitive function in community-dwelling older adults: a review

As the population of the United States ages, activities to maintain or improve cognitive function will become increasingly important to preserve functional ability, independence and health-related quality of life. This article is a review of recent research on Tai Chi and cognitive function in community-dwelling older adults. Of the 12 studies reviewed, 10 reported improvement in measures of executive function, language, learning, and/or memory. Several design features make comparisons across studies challenging. As a moderate-intensity, low-impact form of exercise, Tai Chi is appropriate for older adults and seems to offer positive cognitive benefits. Recommendations for future research are provided.

Investigating short- and long-term transfer effects of a Taiji beginner course in participants' daily life

OBJECTIVE

In recent years research investigating various health benefits of Taiji practice has markedly increased. Despite this growing scientific interest, essential questions such as to what extent a Taiji course may exert noticeable effects in participants' everyday life, what these effects are, and how and where potential transfer effects occur, have hardly been considered. The aim of our study was to explore transfer effects from a Taiji course into participants' daily lives.

METHODS

We conducted a longitudinal observational study in 45 healthy participants at the end of their three-month Taiji beginner course (tp1) and at two months (tp2) as well as one year after course completion (tp3). Participants were asked to report their Taiji practice behavior at all time points, as well as to rate and describe perceived transfer effects of Taiji course contents on their daily life at tp1 and tp3.

RESULTS

Transfer effects were reported by 91.1% of all respondents after course completion (tp1) and persisted in 73.3% at the one-year follow-up assessment (tp3), counting "increase of self-efficacy", "improvement of stress management", and "increase of body awareness" as the most frequently mentioned effects. Transfer effects predominantly occurred in participants' work and social environments, as well as during everyday activities in public areas. While self-reliant Taiji practice frequency significantly decreased from 82.2% at tp1 to 55.6% at tp3 (P < 0.001), the magnitude of self-reported transfer effects did not (P = 0.35). As explorative analyses revealed, regular Taiji course attendance was highly correlated with stronger transfer effects at tp1 (r = 0.51; P < 0.001) and tp3 (r = 0.35; P = 0.020). Participants reporting high self-reliant Taiji practice frequency at tp2 were likely to maintain a regular practice routine at tp3 (r = 0.42; P < 0.004), whereas self-reliant practice frequency and transfer effects at tp1 were positively correlated with self-reliant practice frequency at tp3 on a trend level (r < 0.27; P > 0.08).

CONCLUSION

Our data underline the importance of regular course participation for pronounced and long lasting transfer effects into participants' everyday life. We discuss that several context and process-related aspects of a Taiji intervention are potentially relevant factors for enhancement of transfer effect.

Extension trial of qigong for fibromyalgia: a quantitative and qualitative study

This extension trial is an open-label observational trial of 20 subjects with fibromyalgia who undertook level 2 Chaoyi Fanhuan Qigong (CFQ) training following an earlier controlled trial of level 1 CFQ. Subjects practiced 60 min/day for 8 weeks and continued some daily practice for 6 months. Quantitative measures, assessed at baseline, 8 weeks, 4 and 6 months, were of pain, impact, sleep, physical and mental functions, and practice time. Qualitative comments also were recorded. Compared to baselines, CFQ practice led to significant improvements in pain, impact, sleep, and physical function in the 13 subjects (65%) who completed the trial; changes were present at 8 weeks and were maintained for the 6-month trial duration. A highly motivated subgroup of N = 5, who practiced the most, had the best outcomes in terms of end symptomology, and qualitative comments indicated health benefits in other domains as well. Qualitative comments by the remaining N = 8 trial completers and N = 7 withdrawals indicate different experiences with the practice. This extension trial indicates that diligent CFQ practice over time produces significant health gains in fibromyalgia in a subset of individuals. Future studies will need to address factors that might predispose to favourable outcomes.

Tai Chi’s Effects on Health-Related Fitness of Low-Income Older Adults

On a démontré que le Tai Chi peut influer positivement sur la condition physique liée à la santé (CLPS) des participants âgés, en leur offrant un moyen d’accoître la force musculo-squelettique. L’objectif de cette étude était d’examiner les effets de l’intervention de Tai Chi sur la forme physique, et de découvrir si ethnies culturellement étrangères au Tai Chi constituaient un obstacle à la participation à un programme communautaire pour les aînés à faible revenu. Soixante-dix-huit aînés d’origine mixte (55 ans et plus), qui n’étaient pas culturellement affiliés au Tai Chi, ont été recrutés pour cette étude. Les mesures de la condition liée à la santé ont été prises avant et après un programme de Tai Chi d’une durée de 16 semaines, avec sept séances par semaine. Des améliorations significatives en résultaient dans l’aptitude supérieur et inférieur musculo-squelettique ainsi que dans la flexion partielle parmi ceux qui pratiquaient le Tai Chi. Ces résultats suggèrent que le Tai Chi peut être efficace pour améliorer la CLPS, et que les ethnies non pas liées culturellement au Tai Chi n’éprouviaent pas un obstacle à la participation d’un échantillon de population âgée à un niveau socio-économique faible.

Physiologic complexity and aging: implications for physical function and rehabilitation

The dynamics of most healthy physiological processes are complex, in that they are comprised of fluctuations with information-rich structure correlated over multiple temporospatial scales. Lipsitz and Goldberger (1992) first proposed that the aging process may be characterized by a progressive loss of physiologic complexity. We contend that this loss of complexity results in functional decline of the organism by diminishing the range of available, adaptive responses to the innumerable stressors of everyday life. From this relationship, it follows that rehabilitative interventions may be optimized by targeting the complex dynamics of human physiology, and by quantifying their effects using tools derived from complex systems theory. Here, we first discuss several caveats that one must consider when examining the functional and rehabilitative implications of physiologic complexity. We then review available evidence regarding the relationship between physiologic complexity and system functionality, as well as the potential for interventions to restore the complex dynamics that characterize healthy physiological function.

Temporary practice pause then resumption (TPPR) study design: an extension of the withdrawal study design to complementary and alternative medicine mind and body interventions (CAM-MABI)

Study of complementary and alternative medicine's mind and body interventions (CAM-MABI) is hindered not only by the inability to mask participants and their teachers to the study intervention but also by the major practical hurdles of long-term study of practices that can be lifelong. Two other important methodological problems are that study of newly trained practitioners cannot directly address long-term practice, and that long-term practitioners likely self-select in ways that make finding appropriate controls (or a comparison group) challenging. The temporary practice pause then resumption study design (TPPR) introduced here is a new tool that extends the withdrawal study design, established in the field of drug evaluation, to the field of CAM-MABI. With the exception of the inability to mask, TPPR can address the other methodological problems noted above. Of great interest to investigators will likely be measures in practitioners of CAM-MABI that change with temporary pausing of CAM-MABI practice, followed by return of the measures to pre-pause levels with resumption of practice; this would suggest a link of the practice to measured changes. Such findings using this tool may enhance our insight into fundamental biological processes, leading to beneficial practical applications.

Can social dancing prevent falls in older adults? a protocol of the Dance, Aging, Cognition, Economics (DAnCE) fall prevention randomised controlled trial

BACKGROUND

Falls are one of the most common health problems among older people and pose a major economic burden on health care systems. Exercise is an accepted stand-alone fall prevention strategy particularly if it is balance training or regular participation in Tai chi. Dance shares the 'holistic' approach of practices such as Tai chi. It is a complex sensorimotor rhythmic activity integrating multiple physical, cognitive and social elements. Small-scale randomised controlled trials have indicated that diverse dance styles can improve measures of balance and mobility in older people, but none of these studies has examined the effect of dance on falls or cognition. This study aims to determine whether participation in social dancing: i) reduces the number of falls; and ii) improves cognitive functions associated with fall risk in older people.

METHODS/DESIGN

A single-blind, cluster randomised controlled trial of 12 months duration will be conducted. Approximately 450 participants will be recruited from 24 self-care retirement villages that house at least 60 residents each in Sydney, Australia. Village residents without cognitive impairment and obtain medical clearance will be eligible. After comprehensive baseline measurements including physiological and cognitive tests and self-completed questionnaires, villages will be randomised to intervention sites (ballroom or folk dance) or to a wait-listed control using a computer randomisation method that minimises imbalances between villages based on two baseline fall risk measures. Main outcome measures are falls, prospectively measured, and the Trail Making cognitive function test. Cost-effectiveness and cost-utility analyses will be performed.

DISCUSSION

This study offers a novel approach to balance training for older people. As a community-based approach to fall prevention, dance offers older people an opportunity for greater social engagement, thereby making a major contribution to healthy ageing. Providing diversity in exercise programs targeting seniors recognises the heterogeneity of multicultural populations and may further increase the number of taking part in exercise.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12612000889853The trial is now in progress with 12 villages already have been randomised.

Feasibility and acceptability of a Tai Chi Chih randomized controlled trial in senior female cancer survivors

OBJECTIVE

The purpose of this randomized controlled trial (RCT) was to examine the feasibility and acceptability of a Tai Chi Chih (TCC) intervention in senior female cancer survivors with physical functioning limitations, and its effects on health-related quality of life (QOL).

DESIGN

This was a two-armed, parallel group, RCT with 12-weeks of Tai Chi Chih or Health Education Control.

METHODS

Sixty-three senior (M age = 67 years, SD = 7.15) female cancer survivors (83% breast cancer, stages I-III) with physical functioning limitations (SF-12 Health Survey role-physical & physical functioning subscales) were randomized to 12-weeks of TCC or Health Education control (HEC). Primary outcomes were feasibility and acceptability. Secondary outcomes included health-related QOL (SF-36 Health Survey), and participants' qualitative feedback on the intervention.

RESULTS

Retention (TCC = 91%; HEC = 81%) and class attendance (TCC = 79%; HEC = 83%) rates, and satisfaction levels for both study arms were high, but did not significantly differ from one another. At one-week post-intervention, none of the SF-36 scores differed between the TCC and HEC groups. Within-group analyses revealed significant improvements in the mental component summary score in TCC (p = 0.01), but not in HEC. Qualitative analyses indicated that the TCC group felt they received mental and physical benefits, whereas HEC group reported on social support benefits and information received.

CONCLUSION

The TCC intervention was found to be a feasible and acceptable modality for senior female cancer survivors. Future, larger definitive trials are needed to clarify TCC dosage effects on QOL in this vulnerable population.

Mediators of yoga and stretching for chronic low back pain

Although yoga is an effective treatment for chronic low back pain, little is known about the mechanisms responsible for its benefits. In a trial comparing yoga to intensive stretching and self-care, we explored whether physical (hours of back exercise/week), cognitive (fear avoidance, body awareness, and self-efficacy), affective (psychological distress, perceived stress, positive states of mind, and sleep), and physiological factors (cortisol, DHEA) mediated the effects of yoga or stretching on back-related dysfunction (Roland-Morris Disability Scale (RDQ)). For yoga, 36% of the effect on 12-week RDQ was mediated by increased self-efficacy, 18% by sleep disturbance, 9% by hours of back exercise, and 61% by the best combination of all possible mediators (6 mediators). For stretching, 23% of the effect was mediated by increased self-efficacy, 14% by days of back exercise, and 50% by the best combination of all possible mediators (7 mediators). In open-ended questions, ≥20% of participants noted the following treatment benefits: learning new exercises (both groups), relaxation, increased awareness, and the benefits of breathing (yoga), benefits of regular practice (stretching). Although both self-efficacy and hours of back exercise were the strongest mediators for each intervention, compared to self-care, qualitative data suggest that they may exert their benefits through partially distinct mechanisms.

Complexity-based measures inform Tai Chi's impact on standing postural control in older adults with peripheral neuropathy

BACKGROUND

Tai Chi training enhances physical function and may reduce falls in older adults with and without balance disorders, yet its effect on postural control as quantified by the magnitude or speed of center-of-pressure (COP) excursions beneath the feet is less clear. We hypothesized that COP metrics derived from complex systems theory may better capture the multi-component stimulus that Tai Chi has on the postural control system, as compared with traditional COP measures.

METHODS

We performed a secondary analysis of a pilot, non-controlled intervention study that examined the effects of Tai Chi on standing COP dynamics, plantar sensation, and physical function in 25 older adults with peripheral neuropathy. Tai Chi training was based on the Yang style and consisted of three, one-hour group sessions per week for 24 weeks. Standing postural control was assessed with a force platform at baseline, 6, 12, 18, and 24 weeks. The degree of COP complexity, as defined by the presence of fluctuations existing over multiple timescales, was calculated using multiscale entropy analysis. Traditional measures of COP speed and area were also calculated. Foot sole sensation, six-minute walk (6MW) and timed up-and-go (TUG) were also measured at each assessment.

RESULTS

Traditional measures of postural control did not change from baseline. The COP complexity index (mean ± SD) increased from baseline (4.1 ± 0.5) to week 6 (4.5 ± 0.4), and from week 6 to week 24 (4.7 ± 0.4) (p=0.02). Increases in COP complexity-from baseline to week 24-correlated with improvements in foot sole sensation (p=0.01), the 6MW (p=0.001) and TUG (p=0.01).

CONCLUSIONS

Subjects of the Tai Chi program exhibited increased complexity of standing COP dynamics. These increases were associated with improved plantar sensation and physical function. Although more research is needed, results of this non-controlled pilot study suggest that complexity-based COP measures may inform the study of complex mind-body interventions, like Tai Chi, on postural control in those with peripheral neuropathy or other age-related balance disorders.

Feasibility and effectiveness of a Chen-style Tai Chi programme for stress reduction in junior secondary school students

Stress is common in junior secondary school students (JSSS). This study aimed to determine the feasibility and effectiveness of a Chen-style Tai Chi programme for stress reduction in JSSS. A non-equivalent pre-test/post-test control group design was adopted, and a convenience sample of 69 JSSS was recruited. The experimental group (n = 32) joined a Chen-style Tai Chi programme, which included 10 sessions of 80-minute Tai Chi training (one session per week). The control group (n = 37) proceeded with self-study. Participants' stress levels were assessed using the Perceived Stress Scale. Feasibility was determined as the percentage of participants completing and attending the programme. Effectiveness was measured as the significant difference in changes in stress levels before and after the intervention between the two groups. Results preliminarily supported that the programme was feasible for JSSS. Completion rate was 100%, and attendance rate was 90%. However, no significant difference was noted in changes in stress levels before and after the intervention between the two groups. The potential health benefits of Tai Chi could not be detected owing to the restrictions imposed by the research setting and study limitations. The present study represents initial efforts in this direction and serves as reference for future study.

A systems biology approach to studying Tai Chi, physiological complexity and healthy aging: design and rationale of a pragmatic randomized controlled trial

INTRODUCTION

Aging is typically associated with progressive multi-system impairment that leads to decreased physical and cognitive function and reduced adaptability to stress. Due to its capacity to characterize complex dynamics within and between physiological systems, the emerging field of complex systems biology and its array of quantitative tools show great promise for improving our understanding of aging, monitoring senescence, and providing biomarkers for evaluating novel interventions, including promising mind-body exercises, that treat age-related disease and promote healthy aging.

MATERIAL AND METHODS

An ongoing, two-arm randomized clinical trial is evaluating the potential of Tai Chi mind-body exercise to attenuate age-related loss of complexity. A total of 60 Tai Chi-naïve healthy older adults (aged 50-79) are being randomized to either six months of Tai Chi training (n=30), or to a waitlist control receiving unaltered usual medical care (n=30). Our primary outcomes are complexity-based measures of heart rate, standing postural sway and gait stride interval dynamics assessed at 3 and 6months. Multiscale entropy and detrended fluctuation analysis are used as entropy- and fractal-based measures of complexity, respectively. Secondary outcomes include measures of physical and psychological function and tests of physiological adaptability also assessed at 3 and 6months.

DISCUSSION

Results of this study may lead to novel biomarkers that help us monitor and understand the physiological processes of aging and explore the potential benefits of Tai Chi and related mind-body exercises for healthy aging.

Meditative movement for depression and anxiety

This review focuses on Meditative Movement (MM) and its effects on anxiety, depression, and other affective states. MM is a term identifying forms of exercise that use movement in conjunction with meditative attention to body sensations, including proprioception, interoception, and kinesthesis. MM includes the traditional Chinese methods of Qigong (Chi Kung) and Taijiquan (Tai Chi), some forms of Yoga, and other Asian practices, as well as Western Somatic practices; however this review focuses primarily on Qigong and Taijiquan. We clarify the differences between MM and conventional exercise, present descriptions of several of the key methodologies of MM, and suggest how research into these practices may be approached in a systematic way. We also present evidence for possible mechanisms of the effects of MM on affective states, including the roles of posture, rhythm, coherent breathing, and the involvement of specific cortical and subcortical structures. We survey research outcomes summarized in reviews published since 2007. Results suggest that MM may be at least as effective as conventional exercise or other interventions in ameliorating anxiety and depression; however, study quality is generally poor and there are many confounding factors. This makes it difficult to draw definitive conclusions at this time. We suggest, however, that more research is warranted, and we offer specific suggestions for ensuring high-quality and productive future studies.

Efeito da prática do Tai Chi Chuan sobre a resistência aeróbia de idosas sedentárias

OBJETIVO: Investigar o efeito da prática do Tai Chi Chuan (TCC) sobre a resistência aeróbia de idosas sedentárias. Métodos: Fizeram parte do estudo 11 idosas sedentárias (67,9 ± 6,8 anos; 25,9 ± 2,8 kg/m²), as quais foram submetidas aos testes de marcha estacionária de dois minutos e teste de caminhada de seis minutos pré e pós-intervenção de 12 semanas de TCC. RESULTADOS: Houve aumento da resistência aeróbia das idosas analisadas após 12 semanas de prática de TCC, demonstrado tanto por meio do teste de caminhada de seis minutos (510 ± 64 vs. 536 ± 63 metros; p = 0,006) quanto no teste de marcha estacionária de dois minutos (83 ± 20 vs. 110 ± 19 execuções; p = 0,001). CONCLUSÃO: De acordo com os resultados obtidos, é possível concluir que a prática do TCC é capaz de promover aumento da resistência aeróbia de idosas sedentárias.

Getting started with taiji: investigating students expectations and teachers appraisals of taiji beginners courses

In recent years, Taiji has been frequently investigated and considered as a stress management intervention. Although health care providers' appraisals and consumers' expectations are regarded as essential for treatment outcome, little attention has been drawn to this issue in Taiji research. In our study we have conducted two surveys to explore beginners' (n = 74) expectations and teachers' (n = 136) appraisals of their Taiji courses in general as well as more particularly related to stress management. Qualitative data analysis revealed that beginners mainly expected to learn a new method that is applicable in their daily life to foster peace of mind and to enhance their stress management. Congruently moderate-to-high improvements in stress management have also been found in quantitative analysis, whereby a lower educational level predicted higher expectations (P = 0.016). Taiji-teachers stated body- and mind-related benefits most frequently and appraised moderate-to-high improvements in stress management. Higher appraisals were predicted by a shorter teaching experience (P = 0.024). Our results inform about beginners' expectations and teachers' appraisals related to a Taiji-beginners course and highlight the role of educational background and teaching experience in shaping stress-management-related beginners' expectations and teachers' appraisals.