Tai Chi and Qi Gong therapies as a complementary treatment in Parkinson's disease - a systematic review

Physical exercise and its effects on people with Parkinson's disease: Umbrella review

INTRODUCTION

Parkinson's disease is neurodegenerative, complex and progressive, manifesting in a slow and irreversible way. Physical exercise has been proposed as therapeutic alternative to people with Parkinson´s disease.

OBJECTIVE

To synthesize knowledge about the effects of physical exercise on people with Parkinson´s Disease as presented by published systematic reviews.

METHODS

Nine electronic databases and two grey literature databases were searched for systematic reviews reporting the effects of physical exercises on people with Parkinson´s Disease. Searches involved a two-phase process, by, at least, two independent reviewers. Methodological quality of the included systematic reviews was assessed using AMSTAR-2.

RESULTS

From 2,122 systematic reviews, 139 were included. Motor outcomes were assessed in 91% of the studies, with balance being the most studied. Non-motor outcomes were assessed in 68% of the studies, with emphasis on quality of life. Physical exercises were classified into five categories: aerobic exercises, strength, combined, sensorimotor activities and other activity protocols. Findings of the systematic reviews suggest that all exercise categories can be prescribed to improve balance and mobility, while combined exercises, strength, and specific activities improve both motor and non-motor outcomes, and aerobic exercise and sensorimotor activities improve motor outcomes.

CONCLUSION

Current evidence from systematic reviews suggests that physical exercises impacts both motor and non-motor outcomes in people with Parkinson´s Disease. Limits in evidence provided by the systematic reviews were related to methodological issues and to the description of the interventions and must be considered to improve decision-making and clinical application.

Promoting whole person health: Exploring the role of traditional Chinese medicine in Polish healthcare

Poland has a unique history of traditional Chinese medicine (TCM) dating back to the 17th century when Polish missionary Michael (Michał) Boym was a pioneer in the field. In the 20th century, his successor, Professor Zbigniew Garnuszewski, reintroduced acupuncture to medical practice in Poland. However, other methods of TCM and its holistic approach to patient care have not found their place in modern medicine in Poland. At present, the legal status of TCM in Poland remains unregulated, with TCM included in the broad spectrum of complementary and alternative medicine (CAM) practices. Few reports are available on the use of TCM methods among the Polish population. Integrative medicine combines conventional medicine with evidence-based CAM interventions and considers all aspects of a patient's health, including physical, emotional, mental, social, and environmental factors. An integrative healthcare model that incorporates TCM modalities and lifestyle recommendations as well as a whole person approach may provide a more sustainable solution for the constantly underfinanced Polish healthcare system, which faces challenges of multimorbidity in an aging society and limited access to care. The coronavirus disease 2019 pandemic, war in Ukraine, and ongoing climate crisis have underscored the need to strengthen the resilience of the Polish healthcare system and search for new solutions. A model of care that blends the best of biomedicine and TCM healing approaches may be a better option for both patients and the healthcare system in Poland. Please cite this article as: Rybicka M, Zhao J, Piotrowicz K, Ptasnik S, Mitka K, Kocot-Kępska M, Hui KK. Promoting whole person health: Exploring the role of traditional Chinese medicine in Polish healthcare. J Integr Med. 2023; 21(6): 509-517.

Updates in Parkinson's Disease Integrative Therapies: an Evidence-Based Review

PURPOSE OF REVIEW

This review summarizes recent evidence-based integrative therapies for Parkinson's disease (PD) that may improve motor and non-motor symptoms, enhance quality of life, and alter disease progression.

RECENT FINDINGS

Imaging studies have demonstrated that aerobic exercise changes brain structure and function, while strength training improves posture and balance. Loneliness is associated with worsening PD severity, but social prescribing and cognitive behavioral therapy may effectively foster connections. Ayurvedic and traditional Chinese medicine practices including yoga, meditation, tai chi, and acupuncture may help improve mobility, mood, sleep, and quality of life. Art therapy enhances visuospatial skills, whereas music and dance therapy can alleviate freezing of gait. Several studies demonstrate successful use of these integrative strategies virtually, thereby improving patient accessibility and participation. PD management has broadened to include integrative approaches combining conventional and complementary therapies. Potential benefits of movement, nutrition, sleep, socialization, and mind-body practices have been confirmed with several recent randomized controlled trials.

Participant Perspectives on Community Qigong for People with Multiple Sclerosis

Introduction

Multiple sclerosis (MS) is a progressive neurodegenerative disorder affecting motor and nonmotor function including physical and cognitive decline, fatigue, anxiety, and depression. Qigong is a mind-body self-care practice with the potential to address MS symptoms. Publicly available community qigong classes may provide opportunities for people with MS to access qigong, but little is known about the risks and benefits. A mixed methods study of community qigong was conducted for people with MS. In this article, the results of this qualitative analysis to identify benefits and challenges faced by people with MS attending community qigong classes were presented.

Methods

Qualitative data were collected from an exit survey of 14 study participants with MS who enrolled in a pragmatic trial of community qigong classes for 10 weeks. Participants were new to community-based classes offered but some had experience with qigong/tai chi/other martial arts or yoga. Data were analyzed using reflexive thematic analysis.

Results and Discussion

Seven common themes were identified from this analysis: (1) physical function, (2) motivation/energy, (3) learning, (4) dedicating time for self, (5) meditation/centering/focus, (6) relaxation/stress relief, and (7) psychological/psychosocial. These themes reflected both positive and negative experiences with community qigong classes and home practice. Self-reported benefits centered around improved flexibility, endurance, energy, and focus; stress relief; and psychological/psychosocial benefits. Challenges included physical discomfort including short-term pain, balance difficulty, and heat intolerance.

Conclusion

The qualitative findings provide evidence to support qigong as a self-care practice that may benefit people with MS. The challenges identified in the study will help to inform future clinical trials of qigong for MS.

Trial Registration

ClinicalTrials.gov (CTR#: NCT04585659).

Benefits of Tai Chi Quan on neurodegenerative diseases: A systematic review

BACKGROUND

Neurodegenerative diseases have become an important concern with the accelerated aging process. Tai Chi Quan (TCQ) has positive benefits for brain health and chronic diseases. The aim of this study was to summarize the protective effects of TCQ for motor function, cognition, quality of life, and mood in patients with neurodegenerative diseases.

METHODS

A systematic search was conducted via PubMed database and the Web of Science core collection database until August 20, 2021. The available English systematic reviews, meta-analyses, and clinical trials were included. Two reviewers completed the screening and assessment process independently.

RESULTS

A total of 28 studies on Parkinson's disease, 21 on cognitive impairment, and 9 on multiple sclerosis met the included criteria. The study found that TCQ remarkably improved general motor function and balance, and prevented falls for Parkinson's disease. TCQ significantly improved global cognitive function for cognitive impairment. TCQ was likely safe and beneficial for multiple sclerosis as result of heterogeneous outcomes and small samples.

CONCLUSION

TCQ exercise can effectively improve the motor function, global cognitive function, and falls in patients with neurodegenerative diseases. However, the positive effects of TCQ on the quality of life and mood of patients with neurodegenerative diseases need further evidence.

Home-Based Exercise to Improve Motor Functions, Cognitive Functions, and Quality of Life in People with Huntington's Disease: A Systematic Review and Meta-Analysis

Exercise in different settings has become a fundamental part of Huntington's disease (HD) management. The aim of this systematic review and meta-analysis was to investigate the effectiveness of home-based exercises (HBE) in HD. Randomized controlled trials (RCTs) investigating the effect of HBE on motor, cognitive, or health-related quality of life (QoL) outcomes in HD were included. Standardized mean difference (SMD), the 95% confidence interval, and p-values were calculated by comparing the outcomes change between HBE and control groups. Seven RCTs met the inclusion criteria. The included RCTs prescribed different types of HBEs, i.e., aerobic strengthening, walking, balance, and fine motor exercises. The HBE protocol length was between 6 and 36 weeks. The meta-analyses showed a significant effect of HBE intervention on motor function measure by Unified Huntington Disease Rating and overall QoL measure by Short Form-36 post-treatment respectively, [SMD = 0.481, p = 0.048], [SMD = 0.378, p = 0.003]. The pooled analysis did not detect significant changes in cognition, gait characteristics, or functional balance scales. The current study shows the positive effect of HBE in HD, especially on motor function and QoL. No significant adverse events were reported. The current results support the clinical effect of HBE intervention on motor function and QoL in HD patients. However, these results should be taken with caution due to the limited available evidence. Well-designed clinical studies that consider the disease severity and stages are required in the future.

Which type of mind-body exercise is most effective in improving functional performance and quality of life in patients with Parkinson's disease? A systematic review with network meta-analysis

BACKGROUND

Several studies have investigated the effect of mind-body exercise (MBE) on functional performance and health-related quality of life (HRQoL) in Parkinson's disease (PD), but it is still very difficult for clinicians to make informed decision on the best mind-body exercise for PD.

PURPOSE

We analyzed the relative efficacy of MBE (yoga, Tai-Chi, Pilates, Qigong, and dance) in improving functional performance and HRQoL in patients with PD.

METHODS

A systematic review of randomized controlled trials (RCTs) was performed using network meta-analysis (NMA), searching the following databases: Cochrane, Web of Science, and PubMed using specific keywords until December 28, 2021, assessing the effects of MBE on functional performance and HRQoL in patients with PD.

RESULTS

This review included 60 RCTs with 2037 participants. A ranking of MBE for modifying various aspects of functional performance and HRQoL was achieved. Pairwise NMA showed Pilates to be the most effective in improving functional mobility (MD: - 3.81; 95% CI (- 1.55, - 6.07) and balance performance (SMD: 2.83; 95% CI (1.87, 3.78). Yoga (MD: - 5.95; 95% CI (- 8.73, - 3.16) and dance (MD: - 5.87; 95% CI (- 8.73, - 3.01) to be the most effective in improving motor function, whereas Qigong (MD: 0.32; 95% CI (0.00, 0.64) was most effective in improving gait speed. Considering HRQoL, dance was found to be the most effective (SMD: - 0.36; 95% CI (- 0.70, -0.01).

CONCLUSION

MBE should be considered an effective strategy for improving functional performance and HRQoL in patients with PD. The most effective MBE intervention varied with the functional performance domain. Dance was an effective exercise for improving HRQoL among people with PD.

PROSPERO REGISTRATION ID

CRD42022301030.

The effect of expertise on postural control in elite sport ju-jitsu athletes

Background

Due to the high postural control demands of sport ju-jitsu, it is likely that long-term sport ju-jitsu training may induce sport-specific adaptations in postural control, especially in positions directly related to combat. The aim of the study was to assess the differences in postural control between elite sport ju-jitsu athletes and untrained controls in non-ecological and ecological conditions and to investigate the relative contribution of spinal and supraspinal mechanisms to postural control in expert athletes.

Methods

The study was conducted on eleven male elite ju-jitsu athletes and ten non-athletes. The data was collected with the use of a force plate under two conditions: quiet standing and ju-jitsu combat stance. Apart from the standard analysis of the spatial–temporal parameters of center of foot pressure, non-linear measures were used, namely rambling-trembling and sample entropy. The non-parametric Mann–Whitney U test was used to compare both groups.

Results

The main findings of the study showed that in quiet standing, elite ju-jitsu athletes and non-athletes had comparable postural control in both the anterior–posterior and mediolateral planes. In contrast, in the combat stance, elite athletes had lower values of postural sway and rambling component (range and rms) and higher values of sample entropy in comparison to the non-athletes (p < 0.05). No differences were found in the trembling component of sway between groups in the combat stance (p < 0.05).

Conclusions

Smaller postural sway and its rambling component in sport ju-jitsu athletes may indicate the more precise control of center of foot pressure and improved ability in estimating its position. The sample entropy results confirmed that the displacement of center of foot pressure for sport ju-jitsu athletes was more irregular, which demonstrates greater automatization in postural control. The results also confirm the importance of ecological validity in investigating postural adaptations associated with sports expertise.

The effect of Tai Chi on functional mobility, balance and falls in Parkinson's disease: A systematic review and meta-analysis of systematic reviews

BACKGROUND

The aim of the study was to evaluate the effect of Tai Chi on functional mobility, balance and falls in Parkinson's disease.

MATERIALS AND METHODS

A comprehensive literature search was conducted to identify the systematic reviews and meta-analyses up to the end of October 2021. 601 studies were identified, and 16 of them were included in our study.

RESULTS

According to our meta-analysis; there was a significant effect of Tai Chi on balance (SMD, -0.777 95% CI -0.921 to -0.633; p = 0.000), functional mobility (SMD, -0.719 95% CI -0.944 to -0.494; p = 0.000), and falls (SMD, -0.456 95% CI -0.668 to -0.245; p = 0.000) in PD.

CONCLUSION

Our systematic review and meta-analysis found significant effects of Tai Chi on functional mobility, balance and falls in patients with PD.

Mind-Body Therapies From Traditional Chinese Medicine: Evidence Map

Background: The mind-body therapies of traditional Chinese medicine include several intervention types and combine physical poses with conscious relaxation and breathing techniques. The purpose of this Evidence Map is to describe these different interventions and report related health outcomes. Methods: This evidence map is based on the 3iE Evidence Gap Map methodology. We searched seven electronic databases (BVS, PUBMED, EMBASE, PEDro, ScienceDirect, Web of Sciences, and PschyInfo) from inception to November 2019 and included systematic reviews only. Systematic reviews were analyzed based on AMSTAR 2. We used Tableau to graphically display quality assessment, the number of reviews, outcomes, and effects. Results: The map is based on 116 systematic reviews and 44 meta-analyses. Most of the reviews were published in the last 5 years. The most researched interventions were Tai Chi and Qi Gong. The reviews presented the following quality assessment: 80 high, 43 moderate, 23 low, and 14 critically low. Every 680 distinct outcome effect was classified: 421 as potential positive; 237 as positive; 21 as inconclusive/mixed; one potential negative and none no effect. Positive effects were related to chronic diseases; mental indicators and disorders; vitality, well-being, and quality of life. Potential positive effects were related to balance, mobility, Parkinson's disease, hypertension, joint pain, cognitive performance, and sleep quality. Inconclusive/mixed-effects justify further research, especially in the following areas: Acupressure as Shiatsu and Tuiná for nausea and vomiting; Tai Chi and Qi Gong for acute diseases, prevention of stroke, stroke risk factors, and schizophrenia. Conclusions: The mind-body therapies from traditional Chinese medicine have been applied in different areas and this Evidence Map provides a visualization of valuable information for patients, professionals, and policymakers, to promote evidence-based complementary therapies.

Baduanjin Qigong Intervention by Telerehabilitation (TeleParkinson): A Proof-of-Concept Study in Parkinson's Disease

Many people living with Parkinson’s Disease (PD) face issues with healthcare services, including delays in diagnosis and treatment, as well as limited access to specialized care, including rehabilitation programs. Non-motor and motor signs and symptoms typically observed in people with PD, such as tremor, rigidity, postural instability, bradykinesia, and freezing are particularly disabling and have been associated with falls, fractures, hospitalizations, and a worse quality of life. Baduanjin Qigong (BDJ) programs have been proven potentially effective in improving physical outcomes and reducing the incidence of falls in PD. The aim of this case report, proof-of-concept, study was to explore the adherence, feasibility, acceptability, and potential efficacy of a BDJ program offered via telerehabilitation in people with PD living in the community. Two participants performed semi-supervised exercise sessions at home, twice a week (over eight weeks) using the TeraPlus platform. Adherence, adverse events, and feasibility (technical implementability), acceptability (patient satisfaction), patient-reported, self-reported, and performance outcomes were measured. Results were based on single-subject descriptive data, minimal detectable change, and anchor-based minimally important difference. Our findings suggest that the intervention seems feasible with no major technical issues or adverse events, and high adherence; acceptable (patient satisfaction); and potentially effective to improve markers of walking performance (gait speed, balance), and quality of life (activities of daily living, mobility).