Two-year trends in cardiorespiratory function among older Tai Chi Chuan practitioners and sedentary subjects

Assessment of fall-associated risk factors in the Muslim community-dwelling older adults of Peshawar, Khyber Pakhtunkhwa, Pakistan

BACKGROUND

Falls are the third-leading cause of disability among the elderly population worldwide. It is multifactorial, and the occurrence of falls depends on different factors, which can be different from context to context, and individual to individual. Therefore, regular assessment of fall risk factors is required to develop a strategy for fall prevention. The study aimed to identify fall-related risk factors in Pakistani healthy older adults at risk of developing physical disabilities. It also aimed to create a risk-predictive model for fall occurrence, offering evidence for preventive strategies.

METHODS

Data were collected from 140 Muslim older adults from two residential areas of Peshawar, Khyber Pakhtunkhwa, from July 2022 to August 25, 2022, after obtaining permission from the Zhengzhou University Ethical Review Board (ZZUIRB #202,254), and the District Health Department Office (DHO #14,207). Participants were informed, and consent was obtained before data collection. Data were collected using the Time Up and Go Test (TUGT) checklist, the Cognitive Screening Scores (CS-10) checklist, interviews regarding the prayer practice, fall history in the last six months, visual equity questions, and demographic variables.

RESULTS

Factors associated with falls were; age, gender, education, cognitive status, poor walking speed, lack of physical activity, poor vision, and history of falls in the last six months, with a significant P value of (P. < 0.05) in the Pearson correlation coefficient test. Poor cognition, low visual equity, poor walking speed, and lack of exercise increase the risk of falling in the future, with a prediction value of (P < 0.005) in Omnibus, Lemeshow score of (0.77).

CONCLUSION

Hence, our study provides a road map for future risk assessment of falls by adding the four mentioned risk factors in the proposed model to facilitate timely action to prevent fall-related infirmities in Pakistani healthy older adults.

A Systematic Review and Meta-Analysis of Tai Chi Training in Cardiorespiratory Fitness of Elderly People

Objectives

The purpose of this study was to investigate the influence of Tai Chi on cardiorespiratory fitness (CRF) in elderly people using meta-analysis.

Methods

This study used seven electronic databases and data retrieved from randomized controlled trials (RCTs) investigating the role of Tai Chi on CRF in the elderly. All these 24 RCTs were screened and selected from 7 literature databases. The Stata 11.2 software (StataCorp, USA) was used for the meta-analysis, subgroup analysis, and bias test, while the Cochrane Collaboration's tool was used for the assessment of the risk of bias (RoB). 4 researchers independently participated in sample selection, data extraction, and RoB assessment.

Results

Following the inclusion criteria, 24 eligible studies were included in our analysis. The meta-analysis indicated that Tai Chi practice significantly increased the maximum rate of oxygen consumption (VO_{2 max}) (weighted mean difference (WMD)  = 3.76, 95% CI: 1.25 to 6.26, P < 0.1), leading to an overall reduction in the heart rate (HR) (WMD  = −1.84, 95% CI: −2.04 to −1.63, P  ≤ 0.001) and an increase in the O_{2 pulse} (WMD = 0.94, 95% CI: 0.60 to 1.28, P ≤ 0.001) in individuals who practiced Tai Chi regularly compared with those who did not. The subgroup analysis suggested that overall in those who practiced Tai Chi, males (WMD = 1.48, 95% CI: 0.85 to 2.12, P ≤ 0.001) had higher O_{2 pulse} than females (WMD = 0.73, 95% CI: 0.33 to 1.12, P ≤ 0.001). The subgroup analysis also showed an increase in the vital capacity (VC) (WMD = 316.05, 95% CI: 239.74 to 392.35, P ≤ 0.001) in individuals practicing Tai Chi. When the samples were further stratified by Tai Chi practicing time, the subgroup analysis suggested that individuals practicing Tai Chi over a period of 24 weeks showed no significant difference in VC (WMD = 82.95, 95% CI: -98.34 to 264.23, P=0.370), while those practicing Tai Chi over a period of 48 weeks showed a significant increase (WMD = 416.62, 95% CI: 280.68 to 552.56, P ≤ 0.001). Furthermore, the subgroup analysis demonstrated that the increase in VC is significantly correlated with the Tai Chi practicing time (WMD = 344.97, 95% CI: 227.88 to 442.06, P ≤ 0.001).

Conclusion

Regular Tai Chi practice could improve the CRF in the elderly, as indicated by significant improvement in indicators including VO_2max, O_2pulse, VC, and HR. However, gender and practice time might influence the overall beneficial outcomes.

Effects of Tai-Chi and Running Exercises on Cardiorespiratory Fitness and Biomarkers in Sedentary Middle-Aged Males: A 24-Week Supervised Training Study

This study examined the effectiveness of Tai-Chi and running exercises on cardiorespiratory fitness and biomarkers in sedentary middle-aged adults under 24 weeks of supervised training. Methods Thirty-six healthy middle-aged adults (55.6 ± 5.3 yr) were randomly assigned into Tai-Chi, running and control groups. During a 24-week training period, the Tai-Chi and running groups were asked to perform exercises for 60 min/day and 5 days/week, which were supervised by Tai-Chi and running instructors throughout. Resting heart rate, lean mass, blood pressure and blood lipids were measured, and cardiorespiratory fitness (VO2max, Vmax and Peak heart rate) was assessed at the baseline and the 12- and 24-week interventions. Results Compared to the no-exercise control group, both the Tai-Chi and running groups significantly decreased resting heart rate, diastolic blood pressure and cardiorespiratory fitness and increased lean mass across the training session (p < 0.05). Compared to the Tai-Chi group, the running group showed greater improvement in VO2max and Vmax (p < 0.05) and reduced triglyceride and low-density lipoprotein cholesterol (p < 0.05). Conclusion Both Tai-Chi and running exercise showed beneficial effects on cardiorespiratory fitness and enhanced health-related outcomes in middle-aged adults. Although Tai-Chi exercises were less effective in VO2max than running, Tai-Chi may be considered as a plausible alternative to running exercises that can be achieved in the indoor-based setting.

Effects of Tai-Chi Chuan Practice on Patterns and Stability of Lower Limb Inter-Joint Coordination During Obstructed Gait in the Elderly

Losing balance or tripping during obstacle-crossing is one of the most frequent causes of falls in the elderly. As a low speed, low impact exercise, Tai Chi Chuan (TCC) can be promising in helping the elderly develop strategies for improved balance, inter-joint coordination, and end-point control during obstacle-crossing. This study investigates the effects of TCC training on the patterns and variability of the lower-limb inter-joint coordination during obstacle-crossing in the elderly. Fifteen older TCC practitioners and 15 healthy controls crossed obstacles of three different heights, while sagittal angles (x) and angular velocities (x′) of the hips, knees and ankles were measured and their phase angles obtained. The continuous relative phases (CRP) of the hip-knee and knee-ankle coordination were also calculated. The standard deviations of the CRP curve points were averaged to obtain deviation phase (DP) values for the stance and swing phases. The TCC group was found to cross obstacles with increased leading and trailing toe-clearances with unaltered CRP values when the swing toe was above the obstacle. Long-term TCC training altered the patterns and magnitudes of the CRPs primarily over double-limb support and significantly reduced the variabilities of leading knee-ankle and trailing hip-knee and knee-ankle CRP curves over the crossing cycle, regardless of obstacle height. The current results suggest that long-term TCC practice was helpful for a crossing strategy with significantly increased foot-obstacle clearances and reduced variability of the way the motions of the lower limb joints are coordinated during obstacle-crossing. These benefits may be explained by the long-lasting effects of continuous practice of the slow movement patterns emphasizing between-limb transfer of body weight in TCC.

An investigation to study the effects of Tai Chi on human gait dynamics using classical machine learning

Tai Chi has been proven effective in preventing falls in older adults, improving the joint function of knee osteoarthritis patients, and improving the balance of stroke survivors. However, the effect of Tai Chi on human gait dynamics is still less understood. Studies conducted in this domain only relied on statistical and clinical measurements on the time-series gait data. In recent years machine learning has proven its ability in recognizing complex patterns from time-series data. In this research work, we have evaluated the performance of several machine learning algorithms in classifying the walking gait of Tai Chi masters (people expert on Tai Chi) from the normal subjects. The study is designed in a longitudinal manner where the Tai Chi naive subjects received 6 months of Tai Chi training and the data was recorded during the initial and follow-up sessions. A total of 57 subjects participated in the experiment among which 27 were Tai Chi masters. We have introduced a gender, BMI-based scaling of the features to mitigate their effects from the gait parameters. A hybrid feature ranking technique has also been proposed for selecting the best features for classification. The research reports 88.17% accuracy and 93.10% ROC AUC values from subject-wise 5-fold cross-validation for the Tai Chi masters' vs normal subjects' walking gait classification for the "Single-task" walking scenarios. We have also got fairly good accuracy for the "Dual-task" walking scenarios (82.62% accuracy and 84.11% ROC AUC values). The results indicate that Tai Chi clearly has an effect on the walking gait dynamics. The findings and methodology of this study could provide preliminary guidance for applying machine learning-based approaches to similar gait kinematics analyses.

Best-Compromise Control Strategy Between Mechanical Energy Expenditure and Foot Clearance for Obstacle-Crossing in Older Adults: Effects of Tai-Chi Chuan Practice

Background: Obstacle-crossing increases the risk of falls in older people. This study aimed to identify the effects of long-term Tai-Chi Chuan (TCC) practice on the control strategies for obstacle-crossing in older people.

Methods: A multi-objective optimal control technique with measured gait data was used to identify the control strategies adopted by 15 long-term TCC practitioners and 15 healthy controls when crossing obstacles of different heights, in terms of the best-compromise weighting sets for the conflicting objectives of minimizing energy expenditure and maximizing the toe-obstacle and heel-obstacle clearances.

Results and Conclusions: The long-term TCC older practitioners adopted a best-compromise control strategy similar to those adopted by young adults, with greater weightings on the minimization of the mechanical energy expenditure and smaller weightings on foot-clearance as compared to non-TCC controls (TCC: 0.72, 0.14, 0.14; Control: 0.55, 0.225, 0.225). This strategy enabled the long-term TCC older practitioners to cross obstacles with significantly greater leading-toe clearances but with relatively less mechanical energy expenditure. With the current approach, further simulations of obstacle-crossing mechanics with a given weighting set will be useful for answering clinically relevant what-if questions, such as what abilities would be needed if the non-TCC older people were to cross obstacles using the crossing strategy of the TCC people.

Bibliometric Evaluation of Global Tai Chi Research from 1980-2020

While studies on the health benefits of Tai Chi have sprung up over the past four decades, few have engaged in collecting global data, estimating the developing trends, and conducting reviews from the perspective of visualization and bibliometric analysis. This study aimed to provide a summary of the global scientific outputs on Tai Chi research from 1980 to 2020, explore the frontiers, identify cooperation networks, track research trends and highlight emerging hotspots. Relevant publications were downloaded from the Web of Science Core Collection (WoSCC) database between 1980 and 2020. Bibliometric visualization and comparative analysis of authors, cited authors, journals, co-cited journals, institutions, countries, references, and keywords were systematically conducted using CiteSpace software. A total of 1078 publications satisfied the search criteria, and the trend of annual related publications was generally in an upward trend, although with some fluctuations. China (503) and Harvard University (74) were the most prolific country and institution, respectively. Most of the related researches were published in the journals with a focus on sport sciences, alternative medicine, geriatrics gerontology, and rehabilitation. Our results indicated that the current concerns and difficulties of Tai Chi research are “Intervention method”, “Targeted therapy”, “Applicable population”, “Risk factors”, and “Research quality”. The frontiers and promising domains of Tai Chi exercise in the health science field are preventions and rehabilitations of “Fall risk”, “Cardiorespiratory related disease”, “Stroke”, “Parkinson’s disease”, and “Depression”, which should receive more attention in the future.

Research on Function and Mechanism of Tai Chi on Cardiac Rehabilitation

With the increasing number of cardiovascular patients, more and more people are living with diseases. Cardiac rehabilitation (CR) is an effective treatment and prevention measure for cardiovascular disease (CVD), which aims to relieve both psychological and physiological stress of CVD, reduce risk of death from CVD, improve cardiovascular function and patients' quality of life. Tai Chi is popular in China and mainly used as a daily leisure activity for the elderly to strengthen their bodies. This review discusses whether Tai Chi could be taken as a positive intervention in CR and what is the exact role and its mechanisms as exercise therapy for CVD. The authors detail the role of Tai Chi on CR from the aspects of exercise capacity, risk factors of CVD and psychological factors, etc., as well as highlight the limitation of Tai Chi research at present.

The importance of physical function as a clinical outcome: Assessment and enhancement

The burgeoning population of older adults is intrinsically prone to cardiovascular disease (CVD) in a context of multimorbidity and geriatric syndromes. Risks include high susceptibility to functional decline, with many older adults tipping towards patterns of sedentary behavior and to downstream effects of frailty, falls, disability, poor quality of life, as well as increased morbidity and mortality even if the incident CVD was treated perfectly. While physical activity has been shown to moderate these patterns both as primary or secondary preventive medical care, the majority of older adults fail to meet physical activity recommendations. Clinicians of all specialities, including CVD medicine, can benefit from greater proficiency in functional assessments for their older adults, as well as from insights how to initiate effective functional enhancing approaches even in older adults who may be frail, deconditioned, and medically complex. Pertinent functional assessments include traditional cardiovascular metrics of cardiorespiratory fitness, as well as strength and balance. This review summarizes the components of a wide-ranging functional assessment that can be used to enhance care for older adults with CVD, as well as interventions to improve physical function.

Never Too Old for Cardiac Rehabilitation

Prevalence of cardiovascular disease (CVD) increases with age and is endemic in the burgeoning population of older adults. Older adults with CVD are susceptible not only to high mortality but also to increased likelihood of disability, dependency, functional decline, and poor quality of life. Cardiac rehabilitation (CR) is a multidimensional and comprehensive treatment program that can potentially address many of the distinctive challenges of older adults with CVD. In this review, the wide range of potential benefits of CR for older adults with CVD is summarized.

Tai Chi Chuan in postsurgical non-small cell lung cancer patients: study protocol for a randomized controlled trial

Background

Impairment of exercise capacity remains a common adverse effect of non-small cell lung cancer (NSCLC) survivors after surgery. Previous research has suggested that Tai Chi Chuan (TCC) offers an exercise capacity benefit in several types of cancers. This is a randomized trial to investigate the efficacy and safety of TCC in postoperative NSCLC patients over an observation period of 3 months and a 9-month follow-up.

Methods/design

Using a prospective, one center and randomized design, 120 subjects with histologically confirmed stage I–IIIA NSCLC following complete surgical resection will potentially be eligible for this trial. Following baseline assessments, eligible participants will be randomly assigned to one of two conditions: (1) TCC training, or (2) placebo control. The training sessions for both groups will last 60 min and take place three times a week for 3 months. The sessions will be supervised with target intensity of 60–80% of work capacity, dyspnea, and heart rate management. The primary study endpoint is peak oxygen consumption (VO_2peak), and the secondary endpoints include: 6-min walk distance (6MWD), health-related quality of life (HRQoL), lung function, immunity function, and the state of depression and anxiety. All endpoints will be assessed at the baseline and postintervention (3 months). A follow-up period of 9 months will be included. The main time points for the evaluation of clinical efficacy and safety will be months 3, 6, 9, and 12 after enrollment.

Discussion

This study will assess the effect of group TCC in postsurgery NSCLC survivors on VO_2peak, lung function, and other aspects. The results of this study will eventually provide clinical proof of the application of TCC as one kind of exercise training for patients across the entire NSCLC continuum, as well as information on the safety and feasibility of exercise.

Trial Registration

Chinese Clinical Trial Registry: ChiCTR-IOR-15006548. Registered on 12 June 2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2320-x) contains supplementary material, which is available to authorized users.

Application of Traditional Chinese Medicine in Treatment of Atrial Fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia, which is related to many cardiac and cerebral vascular diseases, especially stroke. It can therefore increase cardiovascular mortality and all-cause death. The current treatments of AF remain to be western drugs and radiofrequency ablation which are limited by the tolerance of patients, adverse side effects, and high recurrence rate, especially for the elderly. On the contrary, traditional Chinese medicine (TCM) with long history of use involves various treatment methods, including Chinese herbal medicines (CHMs) or bioactive ingredients, Chinese patent medicines, acupuncture, Qigong, and Tai Chi Chuan. With more and more researches reported, the active roles of TCM in AF management have been discovered. Then it is likely that TCM would be effective preventive means and valuable additional remedy for AF. The potential mechanisms further found by numerous experimental studies showed the distinct characteristics of TCM. Some CHMs or bioactive ingredients are atrial-selective, while others are multichannel and multifunctional. Therefore, in this review we summarized the treatment strategies reported in TCM, with the purpose of providing novel ideas and directions for AF management.

Tai-chi-chuan and yoga onpostexercise hypotension: comparison to aerobic and resistance exercise

Abstract Introduction: Tai-Chi-Chuan and Yoga have becoming popular practices. However is unclear the cardiovascular effects, and if they present similar behavior to aerobic and resistance sessions. Objective: To evaluate the cardiovascular responses during the session and post-exercise hypotension (PEH) of Tai Chi Chuan (TS) and Yoga (YS) in comparison to aerobic (AS) and resistance (SR) exercises. Methods: Fourteen young women (22.3 ± 2 years) apparently healthy performed four sessions (AS, RS, TS and YS). The heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP) were recorded at resting, during (every 10 minutes) and until 50 minutes of recovery. Results: AS, RS, TS e YS showed significant increase in HR compared to resting.AS at 10, 30 e 50 minutes in relation to RS, TS e YS. The RS in relation to TS and YS at 10, 30 and 50 minutes. No significant difference between TS and YS. SBP was significantly increased in AS, RS, TS e YS at 10, 30 e 50 minutes during the session, in relation to rest. AS was significantly higher at 30 e 50 minutes than RS and higher than TS and YS at 10, 30 e 50 minutes. No significant difference in DBP. For PEH, AS, RS and TS significantly reduced at 10, 30 and 50 minutes. YS reduced at 50 minutes. No significant diastolic PEH. Conclusion: TS and YS showed as safe alternatives of exercising in the normotensive young adult woman, despite having lower values, they promote similar hemodynamic behavior to AS and RS.

Measurement Properties of Tai Chi Exercise Self-Efficacy among Ethnic Chinese with Coronary Heart Disease Risk Factors: A Pilot Study

BACKGROUND

Improvement in aerobic capacity and reduction in blood pressure after Tai Chi exercise programs in persons with coronary heart disease (CHD) or with CHD risk factors have been reported. Self-efficacy has been shown to be a consistent predictor of behavioral outcomes, now being applied to Tai Chi exercise.

AIM

To assess the utility and appropriateness of existing tools measuring aspects of Tai Chi exercise self-efficacy (TCSE) in a new population, ethnic Chinese with CHD risk factors. Specific objectives were: (1) examine acceptability and feasibility; (2) determine score distributions; (3) assess the reliability and known-groups validity; (4) translate tool into an equivalent Chinese version and determine if there were any differences between ethnic Chinese and non-Chinese.

METHODS

Following a review of the literature, two existing tools used with Caucasians were found and modified; a 9-item exercise self-efficacy tool developed by Resnick and Jenkins [Resnick B, Jenkins LS, Testing the reliability and validity of the Self-Efficacy for Exercise scale. Nurs. Res. 49(3) (2000) 154-159], and a 3-item tool developed by Li et al. [Li F, McAuley E, Harmer P, Duncan TE, Chaumeton NR, Tai Chi enhances self-efficacy and exercise behavior in older adults. J. Aging Phys. Act. 9 (2001) 161-171] to assess gradations of the challenge to perform Tai Chi among elderly populations. The modified TCSE tool was translated into Chinese and back-translated. A pilot study was conducted to pre-test the modified 14-item TCSE tool in ethnic Chinese and non-Chinese.

RESULTS

A total of 18 subjects (mean age = 60 years, S.D. = 18.4) participated. Seven subjects (39%) identified themselves as ethnic Chinese. Ten subjects (56%) had experience performing Tai Chi, ranging from 3 months to 17 years (mean = 5.0 years, S.D.=5.0). Half of the subjects reported having a history of hypertension (n = 9, 50%), while nearly one-third reported having high cholesterol (n = 5, 28%). No significant difference in TCSE mean scores was found between ethnic Chinese and non-Chinese (p > 0.05). Internal consistency estimates were very high (TCSE Barriers, r = 0.95; TCSE Performance, r = 0.97). A statistically significant difference was found in the TCSE mean scores between Tai Chi practitioners and non-practitioners (TCSE Barriers, t = -3.3, p = 0.01; TCSE Performance, t = -2.7, p = 0.03), with Tai Chi practitioners reporting higher self-efficacy; thus providing initial evidence of known-groups validity.

CONCLUSIONS

Measurement of self-efficacy to overcome barriers to Tai Chi exercise (TCSE Barriers) and self-efficacy to perform Tai Chi (TCSE Performance) functioned well in this sample. The acceptability and feasibility of this tool was established and known-groups validity was confirmed. Further research using this tool among ethnic Chinese with CHD or CHD risk factors, including those with less than high school education or low literacy, is recommended as the next step in development of TCSE.

Tai Chi for chronic obstructive pulmonary disease (COPD)

BACKGROUND

Tai Chi, a systematic callisthenic exercise first developed in ancient China, involves a series of slow and rhythmic circular motions. It emphasises use of 'mind' or concentration to control breathing and circular body motions to facilitate flow of internal energy (i.e. 'qi') within the body. Normal flow of 'qi' is believed to be essential to sustain body homeostasis, ultimately leading to longevity. The effect of Tai Chi on balance and muscle strength in the elderly population has been reported; however, the effect of Tai Chi on dyspnoea, exercise capacity, pulmonary function and psychosocial status among people with chronic obstructive pulmonary disease (COPD) remains unclear.

OBJECTIVES

• To explore the effectiveness of Tai Chi in reducing dyspnoea and improving exercise capacity in people with COPD.• To determine the influence of Tai Chi on physiological and psychosocial functions among people with COPD.

SEARCH METHODS

We searched the Cochrane Airways Group Specialised Register of trials (which included the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Allied and Complementary Medicine Database (AMED) and PsycINFO); handsearched respiratory journals and meeting abstracts; and searched Chinese medical databases including Wanfang Data, Chinese Medical Current Contents (CMCC), Chinese Biomedical Database (CBM), China Journal Net (CJN) and China Medical Academic Conference (CMAC), from inception to September 2015. We checked the reference lists of all primary studies and review articles for relevant additional references.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) comparing Tai Chi (Tai Chi alone or Tai Chi in addition to another intervention) versus control (usual care or another intervention identical to that used in the Tai Chi group) in people with COPD. Two independent review authors screened and selected studies.

DATA COLLECTION AND ANALYSIS

Two independent review authors extracted data from included studies and assessed risk of bias on the basis of suggested criteria listed in the Cochrane Handbook for Systematic Reviews of Interventions. We extracted post-programme data and entered them into RevMan software (version 5.3) for data synthesis and analysis.

MAIN RESULTS

We included a total of 984 participants from 12 studies (23 references) in this analysis. We included only those involved in Tai Chi and the control group (i.e. 811 participants) in the final analysis. Study sample size ranged from 10 to 206, and mean age ranged from 61 to 74 years. Programmes lasted for six weeks to one year. All included studies were RCTs; three studies used allocation concealment, six reported blinded outcome assessors and three studies adopted an intention-to-treat approach to statistical analysis. No adverse events were reported. Quality of evidence of the outcomes ranged from very low to moderate.Analysis was split into three comparisons: (1) Tai Chi versus usual care; (2) Tai Chi and breathing exercise versus breathing exercise alone; and (3) Tai Chi and exercise versus exercise alone.Comparison of Tai Chi versus usual care revealed that Tai Chi demonstrated a longer six-minute walk distance (mean difference (MD) 29.64 metres, 95% confidence interval (CI) 10.52 to 48.77 metres; participants = 318; I(2) = 59%) and better pulmonary function (i.e. forced expiratory volume in one second, MD 0.11 L, 95% CI 0.02 to 0.20 L; participants = 258; I(2) = 0%) in post-programme data. However, the effects of Tai Chi in reducing dyspnoea level and improving quality of life remain inconclusive. Data are currently insufficient for evaluating the impact of Tai Chi on maximal exercise capacity, balance and muscle strength in people with COPD. Comparison of Tai Chi and other interventions (i.e. breathing exercise or exercise) versus other interventions shows no superiority and no additional effects on symptom improvement nor on physical and psychosocial outcomes with Tai Chi.

AUTHORS' CONCLUSIONS

No adverse events were reported, implying that Tai Chi is safe to practise in people with COPD. Evidence of very low to moderate quality suggests better functional capacity and pulmonary function in post-programme data for Tai Chi versus usual care. When Tai Chi in addition to other interventions was compared with other interventions alone, Tai Chi did not show superiority and showed no additional effects on symptoms nor on physical and psychosocial function improvement in people with COPD. With the diverse style and number of forms being adopted in different studies, the most beneficial protocol of Tai Chi style and number of forms could not be commented upon. Hence, future studies are warranted to address these topics.

Acute Effects of T'ai Chi Chuan Exercise on Blood Pressure and Heart Rate in Peripheral Artery Disease Patients

OBJECTIVE

To investigate the acute effect of a t'ai chi chuan session on blood pressure and heart rate in patients with peripheral artery disease (PAD).

DESIGN

Randomized crossover intervention study.

SETTING

Outpatient therapy center.

PARTICIPANTS

Seven patients with PAD, aged 50-79 years, not using β-blockers, calcium-channel blockers, or nondihidropiridinic vasodilators.

INTERVENTION

T'ai chi chuan and control session (both sessions lasted 40 minutes).

OUTCOME MEASURES

Systolic and diastolic blood pressure and heart rate, which were evaluated before and after the intervention (10, 30, and 50 minutes).

RESULTS

T'ai chi chuan exercise acutely decreased systolic blood pressure at 30 minutes after exercise (p = 0.042) and increased diastolic blood pressure at 50 minutes after exercise (p = 0.041). Heart rate did not change after t'ai chi chuan exercise.

CONCLUSION

T'ai chi chuan acutely decreases systolic blood pressure in patients with PAD.

Increased first and second pulse harmonics in Tai Chi Chuan practitioners

Background

Tai Chi Chuan (TCC) is known to be a good calisthenics for people. This study examined the relationship between pulse harmonics and autonomic nervous modulation in TCC practitioners.

Methods

Power spectral measures of right pulse wave and heart rate variability (HRV) measures were compared between TCC practitioners and control subjects. Correlation analyses between pulse harmonics and HRV measures were performed using linear regression analysis.

Results

At baseline, the total power of pulse (TPp), powers of all individual pulse harmonics, normalized power of the 1^st harmonics (nPh1) of TCC practitioners were greater, while the normalized power of the 4^th pulse harmonics (nPh4) of TCC practitioners was smaller, than those of the controls. Similarly, the baseline standard deviation (SD_RR), coefficient of variation (CV_RR), and normalized high-frequency power (nHFP) of RR intervals were smaller, while the normalized very low-frequency power (nVLFP) and low-/high- frequency power ratio (LHR) were larger in the TCC practitioners. The TCC age correlated significantly and negatively with nPh1, and nearly significantly and negatively with nPh2 in the TCC practitioners. Thirty min after TCC exercise, the percentage changes in mRRI, SD_RR, TP, VLFP were decreased, while the percentage changes in HR, ULFP, nLFP, and Ph2 were increased, relative to the controls. Correlation analysis shows that the %Ph2 correlates significantly and negatively with %mRRI and significantly and positively with %HR.

Conclusion

The TCC practitioners had increased baseline total power of pulse and the 1^st and 2^nd pulse harmonics, and decreased power of the 4^th pulse harmonics, along with decreased vagal modulation and increased sympathetic modulation. After TCC exercise, the power of the 2^nd harmonics of TCC practitioners was increased which might be related to the increase in HR due to decreased vascular resistance after TCC exercise.

The beneficial effects of Tai Chi exercise on endothelial function and arterial stiffness in elderly women with rheumatoid arthritis

Background

Rheumatoid arthritis (RA) has been known to be associated with increased risk of cardiovascular disease (CVD). The aim of this study was to investigate the effects of Tai Chi exercise on CVD risk in elderly women with RA.

Method

In total, 56 female patients with RA were assigned to either a Tai Chi exercise group (29 patients) receiving a 3-month exercise intervention once a week or a control group (27 patients) receiving general information about the benefits of exercise. All participants were assessed at baseline and at 3 months for RA disease activity (Disease Activity Score 28 and Routine Assessment of Patient Index Data 3), functional disability (Health Assessment Questionnaire), CVD risk factors (blood pressure, lipids profile, body composition, and smoking), and three atherosclerotic measurements: carotid intima-media thickness, flow-mediated dilatation (FMD), and brachial-ankle pulse wave velocity (baPWV).

Results

FMD, representative of endothelial function, significantly increased in the Tai Chi exercise group (initial 5.85 ± 2.05 versus 3 months 7.75 ± 2.53 %) compared with the control group (initial 6.31 ± 2.12 versus 3 months 5.78 ± 2.13 %) (P = 1.76 × 10⁻³). Moreover, baPWV, representative of arterial stiffness, significantly decreased in the Tai Chi exercise group (initial 1693.7 ± 348.3 versus 3 months 1600.1 ± 291.0 cm/s) compared with the control group (initial 1740.3 ± 185.3 versus 3 months 1792.8 ± 326.1 cm/s) (P = 1.57 × 10⁻²). In addition, total cholesterol decreased significantly in the Tai Chi exercise group compared with the control group (−7.8 ± 15.5 versus 2.9 ± 12.2 mg/dl, P = 2.72 × 10⁻²); other changes in RA-related characteristics were not significantly different between the two groups. Tai Chi exercise remained significantly associated with improved endothelial function (FMD; P = 4.32 × 10⁻³) and arterial stiffness (baPWV; P = 2.22 × 10⁻²) after adjustment for improvement in total cholesterol level.

Conclusion

Tai Chi exercise improved endothelial dysfunction and arterial stiffness in elderly women with RA, suggesting that it can be a useful behavioral strategy for CVD prevention in patients with RA.

Electronic supplementary material

The online version of this article (doi:10.1186/s13075-015-0893-x) contains supplementary material, which is available to authorized users.

Long-term Exercise After Pulmonary Rehabilitation (LEAP): Design and rationale of a randomized controlled trial of Tai Chi

BACKGROUND

Persons with chronic obstructive pulmonary disease (COPD) have reduced exercise capacity and levels of physical activity. Supervised, facility-based pulmonary rehabilitation programs improve exercise capacity and reduce dyspnea, but novel long-term strategies are needed to maintain the benefits gained. Mind-body modalities such as Tai Chi which combine aerobic activity, coordination of breathing, and cognitive techniques that alleviate the physical inactivity, dyspnea, and anxiety and depression that are the hallmarks of COPD are promising strategies.

METHODS/DESIGN

We have designed a randomized controlled study to examine whether Tai Chi will maintain exercise capacity in persons with COPD who have recently completed a supervised pulmonary rehabilitation program, compared to standard care. The primary outcome is 6-min walk test distance at 6 months. Secondary outcomes include health-related quality of life, dyspnea, mood, occurrence of acute exacerbations, engagement in physical activity, exercise self-efficacy, and exercise adherence. Simultaneously, we are conducting a pilot study of group walking. We will enroll 90 persons who will be randomized to one of three arms in a 2:2:1 ratio: Tai Chi, standard care, or group-based walking.

DISCUSSION

The Long-term Exercise After Pulmonary Rehabilitation (LEAP) study is a novel and clinically relevant trial. We will enroll a well-characterized cohort of persons with COPD and will comprehensively assess physiological and psychosocial outcomes. Results of this study will provide the evidence base for persons with COPD to engage in Tai Chi as a low-cost, long-term modality to sustain physical activity in persons who have completed a standard short-term pulmonary rehabilitation program.

TRIAL REGISTRATION

This trial is registered in Clinical Trials.gov, with the ID number of NCT01998724.

The effect of Tai Chi training on cardiorespiratory fitness in healthy adults: a systematic review and meta-analysis

Background

Tai Chi may be efficient for healthy adults to improve the cardiorespiratory fitness, but there is no systematic evaluation for its effectiveness.

Objective

To systematically assess the effectiveness of Tai Chi on cardiorespiratory fitness in healthy adults.

Methods

Seven electronic databases were searched from their inception to October 2013. The controlled trails including randomized controlled trial (RCT), non-randomized controlled trial (NRCT), self-controlled trial (SCT), and cohort study (CS) testing Tai Chi exercise against non-intervention control conditions in healthy adults that assessed any type cardiorespiratory fitness outcome measures were considered. Two reviewers independently performed the selection of the studies according to predefined criteria. The risk of bias was assessed using Cochrane criteria. RevMan 5.2 software was applied for data analysis.

Results

Twenty studies (2 RCTs, 8 NRCTs, 3 SCTs, and 7 CSs) with 1868 participants were included, but most of them belonged to low methodological quality. The results of systematic review showed that Tai Chi exercise had positive effect on majority outcomes of cardio function (Blood pressure: n = 536, SPB SMD = -0.93, 95% CI -1.30 to -0.56, P < 0.00001; DBP SMD = -0.54, 95% CI -0.90 to -0.18, P < 0.00001; heart rate at quiet condition: n = 986, SMD = -0.72, 95% CI -1.27 to -0.18, P = 0.010; stroke volume: n = 583, SMD = 0.44, 95% CI 0.28 to 0.61, P < 0.00001; cardio output: n = 583, MD = 0.32 L/min, 95% CI 0.08 to 0.56, P = 0.009), lung capacity (FVC at quiet condition: n = 1272, MD = 359.16 mL, 95% CI 19.57 to 698.75, P = 0.04 for less than one year intervention, and MD = 442.46 mL, 95% CI 271.24 to 613.68, P<0.0001 for more than one year intervention; V·O₂peak: n = 246, SMD = 1.33, 95% CI 0.97 to 1.70, P < 0.00001), and cardiorespiratory endurance (O₂ pulse at quiet condition: n = 146, SMD = 1.04; 95% CI 0.69 to 1.39; P < 0.00001; stair test index at quiet condition: n = 679, SMD = 1.34, 95% CI 0.27 to 2.40, p = 0.01). No adverse events were reported.

Conclusions

The results are encouraging and suggest that Tai Chi may be effective in improving cardiorespiratory fitness in healthy adults. However, concerning the low methodological quality in the included studies, more larger-scale well-designed trails are needed till the specific and accurate conclusions can be perorated.

Ground reaction force characteristics of Tai Chi push hand

Push Hand is an advanced training technique for the Yang-style old frame 108 forms Tai Chi Chuan. It is performed by two practitioners. To clarify how people use forces during Push Hand training, it is important to review the ground reaction force (GRF). Here, we quantify the characteristics of the GRF during Push Hand training. Kinematic data and GRF data from 10 Tai Chi Chuan practitioners (29.9 ± 7.87 years) were synchronously recorded using a three-dimensional motion analysis system (200 frames · s(-1)) and three-dimensional force plates (1000 Hz). The resultant GRF for both feet for the 0%, 50% and 100% phases of attack and defence were compared to body weight using a paired-samples t-test. The differences in the resultant GRF between the 0%, 50% and 100% phases of attack and defence were tested by one-way repeated-measures ANOVA. The significance level was set to 0.05. The total resultant GRF was almost equal to the participant's body weight in push hand. This result was consistent throughout the entire push hand process. Our results revealed that the GRF was comparable to the body weight, implying that practitioners do not push or resist their opponents during the push hand process.

Breathing frequency-independent effect of Tai Chi Chuan on autonomic modulation

OBJECTIVE

This study investigates the breathing frequency (BF)-independent effect of Tai Chi Chuan (TCC) on autonomic nervous modulation in TCC practitioners.

METHODS

Twenty-five TCC practitioners and 25 sedentary normal controls were recruited. The stationary heart rate variability (HRV) measures of TCC practitioners and controls were compared. The same HRV measures in TCC practitioners and among the controls, TCC practitioners before TCC and TCC practitioners 30 min after TCC were compared.

RESULTS

In TCC practitioners, the BF, normalized high-frequency power (nHFP), and normalized very low-frequency power were significantly increased, while the normalized low-frequency power (nLFP) was significantly decreased 30 min after TCC. The BF correlated significantly and negatively with heart rate (HR), nHFP and nLFP, and correlated significantly and positively with mean RR interval (MnRR) before TCC in TCC practitioners. A slower BF is associated with a higher HR, a greater vagal modulation, and a greater combined sympatho-vagal modulation before TCC. To remove the effect of BF on HRV measures, new indices such as HR*BF, nHFP*BF, nLFP*BF, and MnRR/BF were introduced for comparison among the controls, TCC practitioners before TCC, and TCC practitioners 30 min after TCC. Thirty minutes after TCC, the MnRR/BF of TCC practitioner was smaller whereas HR*BF and nHFP*BF were greater than those before TCC.

INTERPRETATION

The BF-independent effects of TCC on the autonomic nervous modulation of TCC practitioners are an increase in vagal modulation and HR, and a decrease in mean RR interval. The mechanism underlying the parallel increase in HR and vagal modulation in TCC practitioners is not understood yet at present.

What is the role of alternative treatments in late-life depression?

Late-life depression remains challenging to treat. One major limitation to treatment is the concern over medication-related side effects to which the elderly are especially vulnerable. Also, because many elderly people are already taking multiple medications for medical conditions, there is the concern over drug-drug interactions. This article reviews various complementary and alternative medicine interventions for late-life depression, including natural remedies, exercise, yoga, tai chi, massage therapy, music therapy, and religion and spirituality.

Foot Forces Induced Through Tai Chi Push-Hand Exercises

The low impact forces of Tai Chi push-hand exercises may be particularly suited for older people and for those with arthritis; however, the biomechanics of push-hand exercises have not previously been reported. This paper examines the ground reaction forces (GRFs) and plantar force distributions during Tai Chi push-hand exercises in a stationary stance with and without an opponent. Ten male Tai Chi practitioners participated in the study. The GRFs of each foot were measured in three perpendicular directions using two force plates (Kistler). The plantar force distribution of each foot was measured concurrently using an insole sensor system (Novel). The results showed that the average maximum vertical GRF of each foot was not more than 88% ± 6.1% of the body weight and the sum of the vertical forces (103% ± 1.4%) generated by the two feet approximately equals the body weight at any one time. The horizontal GRFs generated by the two feet were in the opposite directions and the measured mean peak values were not more than 12% ± 2.8% and 17% ± 4.3% of the body weight in the medio-lateral and antero-posterior directions respectively. Among the nine plantar areas, the toes sustained the greatest plantar force. This study indicates that push-hand exercises generate lower vertical forces than those induced by walking, bouncing, jumping and Tai Chi gait, and that the greatest plantar force is located in the toe area, which may have an important application in balance training particularly for older adults.

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.

POSTURE CONTROL AND BALANCE DURING TAI CHI CHUAN PUSH HANDS MOVEMENTS IN A FIXED STANCE

The present study investigated the adequacy of the interaction between the center of mass (COM) and the center of pressure (COP) for maintaining dynamic stability during Tai Chi Chuan (TCC) Push Hands movements in a fixed stance. The COM of the whole body and COP were calculated. Four TCC experts, with 10.3 ± 1.7 years' experience in the Push Hands technique, and 4 TCC beginners, with 2.5 ± 1.3 years' Push Hands experience, were recruited. An Expert Vision Eagle motion analysis system collected kinematic data and 4 Kistler force plates collected the ground reaction force data. The expert group of TCC practitioners showed a significantly more vertical (P = 0.001) direction in the neutralizing circle, and significantly larger values for anterior–posterior (A–P) (P = 0.006) and vertical (P = 0.0004) displacement in the enticing circle, than the beginner group. Compared with the beginner group, the expert group demonstrated significantly greater velocity A–P (P = 0.001) and vertical (P = 0.001) COM displacements in the enticing circle. A significant extent main effect (P = 0.0028) was observed for the COPA–P excursion between the expert and beginner groups during Push Hands movements. The greater A–P force generated by both groups during the initiation of the Push Hands cycle probably reflects the more rapid and forward-oriented nature of this movement. The TCC beginners might have difficulties with movement transfers because of disruptions in the temporal sequencing of the forces. Overall, results indicated that the initial experience-related differences in COM transfers are reflected in the Push Hands movement cycle.

Tai Chi, arterial compliance, and muscle strength in older adults

BACKGROUND

Aerobic exercise can alleviate the declines in arterial compliance common in older adults. However, when combined with strength training, aerobic exercise may not reduce arterial compliance. Tai Chi practice has been found to improve muscle strength and cardiopulmonary function in older subjects, but whether or not it improves arterial compliance is not known. The primary aim of this study was to investigate whether Tai Chi practitioners have better arterial compliance and muscle strength.

DESIGN

Twenty-nine older Tai Chi practitioners (73.7 ± 4.5 years) and 36 healthy control subjects (71.4 ± 6.6 years) participated in this cross-sectional study.

METHODS

The participants were independent in their daily living activities. They were screened for apparent cardiovascular disease and underwent arterial compliance testing and isokinetic knee muscle strength testing at 30°/s.

RESULTS

Tai Chi practitioners showed significantly better haemodynamic parameters than the controls as indexed by larger and small artery compliance. They also demonstrated greater eccentric muscle strength in both knee extensors and flexors.

CONCLUSION

The findings of better muscle strength without jeopardizing arterial compliance suggests that Tai Chi could be a suitable exercise for older persons to improve both cardiovascular function and muscle strength.

The story of the evolution of a unique tai chi form: origins, philosophy, and research

The purpose of this article is to introduce a unique tai chi form that has been successfully implemented in two large randomized clinical trials. The intervention is composed of a series of tai chi movements chosen for their particular meanings, thus adding a cognitive component to the practice of a moving meditation. Over the last decade, the intervention has continued to evolve as it has been used in different populations. Most recently, medical qigong has been integrated to strengthen its potential impact on a variety of biobehavioral measures associated with cardiometabolic risk in women. Following an appraisal of the authors' process as well as the philosophy, practice, and research of tai chi and qigong, the authors share the story of their intervention to contribute to the evolving research of these safe, well-received, low-cost, and beneficial practices.

Effects of tai chi training in dynapenic and nondynapenic postmenopausal women

OBJECTIVE

The purpose of the present study was to investigate the effects of a 12-week tai chi program in type I dynapenic and nondynapenic postmenopausal women.

METHODS

Sixty-two postmenopausal women were recruited. Body composition, handgrip strength, functional capacities, cardiorespiratory functions (forced expiratory volume in 1 s and oxygen consumption per unit time peak), and quality of life (36-item Short-Form Health Survey) were measured before and after the intervention.

RESULTS

Type I dynapenic postmenopausal women showed a significant decrease in body weight (P = 0.004), fat mass percentage (P = 0.02), and skeletal muscle mass (SM; in kilograms; P = 0.02), whereas handgrip strength (in kilograms per SMkg; P = 0.04), functional capacity test scores (P ≤ 0.050), and general health perception (P = 0.01) significantly increased. In nondynapenic postmenopausal women, we observed a significantly decreased waist circumference (P = 0.04) and a significantly increased chair-stand test (P < 0.001) and one-leg stance test (P = 0.04) scores. In addition, significantly lower systolic (P ≤ 0.001) and diastolic (P ≤ 0.005) blood pressures were observed in both groups after the intervention. Finally, type I dynapenic women showed a more pronounced general health perception increase compared with nondynapenic individuals (P = 0.03).

CONCLUSIONS

Tai chi training improved body composition, muscle strength, functional capacities, and general health perception in postmenopausal women, and this last improvement was more pronounced in type I dynapenic individuals. Therefore, tai chi may be considered as an alternative physical training method in preventing the occurrence of disabilities and frailty in postmenopausal women with type I dynapenia.

Dejian mind-body intervention on depressive mood of community-dwelling adults: a randomized controlled trial

The present study evaluated the effectiveness of a short-term mind-body intervention program on improving the depressive mood of an adult community sample. Forty adult volunteers with various degrees of depressive mood were randomly assigned to the experimental group (Dejian Mind-Body Intervention, DMBI) and control group (Cognitive-Behavioral Therapy, CBT). For each group, a total of four 90-min weekly sessions were conducted. Treatment-related changes were measured using the Beck Depression Inventory (BDI-II), an electroencephalographic indicator of positive affect (i.e., prefrontal activation asymmetry), and self-report ratings on physical health. Results indicated that both the DMBI and the CBT group demonstrated significant reduction in depressive mood. However, among individuals with moderate to severe depressive mood at baseline, only those in the DMBI but not the CBT group showed significant reduction in depressive mood. Besides, only the DMBI group demonstrated a significant increase in prefrontal activation asymmetry, suggesting increase in positive affect. While most psychological therapies for depressive mood normally take several months to show treatment effect, the present findings provided initial data suggesting that the DMBI was effective in improving depressive mood of community adults after 1 month of training.

Tai chi exercise in patients with chronic heart failure: a randomized clinical trial

BACKGROUND

Preliminary evidence suggests that meditative exercise may have benefits for patients with chronic systolic heart failure (HF); this has not been rigorously tested in a large clinical sample. We sought to investigate whether tai chi, as an adjunct to standard care, improves functional capacity and quality of life in patients with HF.

METHODS

A single-blind, multisite, parallel-group, randomized controlled trial evaluated 100 outpatients with systolic HF (New York Heart Association class I-III, left ventricular ejection fraction ≤40%) who were recruited between May 1, 2005, and September 30, 2008. A group-based 12-week tai chi exercise program (n = 50) or time-matched education (n = 50, control group) was conducted. Outcome measures included exercise capacity (6- minute walk test and peak oxygen uptake) and disease-specific quality of life (Minnesota Living With Heart Failure Questionnaire).

RESULTS

Mean (SD) age of patients was 67 (11) years; baseline values were left ventricular ejection fraction, 29% (8%) and peak oxygen uptake, 13.5 mL/kg/min; the median New York Heart Association class of HF was class II. At completion of the study, there were no significant differences in change in 6-minute walk distance and peak oxygen uptake (median change [first quartile, third quartile], 35 [-2, 51] vs 2 [-7, 54] meters, P = .95; and 1.1 [-1.1, 1.5] vs -0.5 [-1.2, 1.8] mL/kg/min, P = .81) when comparing tai chi and control groups; however, patients in the tai chi group had greater improvements in quality of life (Minnesota Living With Heart Failure Questionnaire, -19 [-23, -3] vs 1 [-16, 3], P = .02). Improvements with tai chi were also seen in exercise self-efficacy (Cardiac Exercise Self-efficacy Instrument, 0.1 [0.1, 0.6] vs -0.3 [-0.5, 0.2], P < .001) and mood (Profile of Mood States total mood disturbance, -6 [-17, 1] vs -1 [-13, 10], P = .01).

CONCLUSION

Tai chi exercise may improve quality of life, mood, and exercise self-efficacy in patients with HF. Trial Registration clinicaltrials.gov Identifier: NCT00110227.

External qigong therapy for women with breast cancer prior to surgery

The majority of patients with cancer use some form of complementary or alternative medicine. External qigong treatment (EQT), classified as a bioenergy therapy, is one such approach that patients combine with conventional medicine or, in some cases, use in place of conventional medicine. This study aimed to determine whether EQT could shrink breast cancer tumors and improve quality of life (QOL) in women with pathologically confirmed breast cancer awaiting surgery. A total of 9 women with pathologically confirmed breast cancer were recruited from large cancer centers in the United States (n = 5) and China (n = 4). A single-arm pre/post design was used. Each patient underwent 5 consecutive days of EQT, with each treatment lasting from 2 to 5 minutes. All treatments were performed by the same qigong master. Tumor measurements were made before and after the EQT sessions. Tumor assessments were conducted prior to study initiation and following the last EQT. Patients underwent both an ultrasound and mammogram (United States) or an ultrasound and magnetic resonance imaging (China). All patients also underwent physical breast examinations (PBEs) and completed QOL questionnaires before and after the last EQT. No clinical changes in tumor measurements from pre- to post-EQT were noted. There was also no suggestion of change in tumor size by PBE or change in QOL. Using the current

STUDY DESIGN

EQT also does not appear to have any effect on patient QOL. Because of the small sample size and working with only one qigong practitioner, to definitively determine the efficacy or lack of efficacy of EQT, a larger study with multiple qigong practitioners would need to be conducted.

The development of a Tai Chi exercise regimen for the prevention of conditions requiring long-term care in Japan

This study was to examine an effect of such an exercise program on preventing conditions requiring long-term care in the Japanese frail elderly who participated in a Tai Chi Yuttari-exercise program. The first-intervention group underwent an intervention program by participating in a Tai Chi Yuttari-exercise session once a week for 3 months. Each session lasted 90 min including a break time. Moreover, the subjects received a video recording of the exercise, and instructions to carry out the exercise at home. The same program was administered to the second-intervention group. Physical function improved significantly in the first-intervention group, with single-leg balance (SLB) increasing, and trunk anteflexion increasing after the intervention program. Furthermore, the total score of the Motor Fitness Scale (MFS) improved significantly. On the other hand, mono- and multi-variate analyses showed no significant differences observed in the second-intervention group during the study period. A careful interpretation of the results suggests that Tai Chi Yuttari-exercise improves physical function and ability for frail elderly individuals and could reduce the need for long-term care.

Tai chi and rheumatic diseases

Tai chi is a complex multicomponent mind-body exercise. Many studies have provided evidence that tai chi benefits patients with a variety of chronic disorders. This form of mind-body exercise enhances cardiovascular fitness, muscular strength, balance, and physical function and seems to be associated with reduced stress, anxiety, and depression and improved quality of life. Thus, despite certain limitations in the evidence, tai chi can be recommended to patients with osteoarthritis, rheumatoid arthritis, and fibromyalgia as a complementary and alternative medical approach. This article overviews the current knowledge about tai chi to better inform clinical decision making for rheumatic patients.

Effects of martial arts on health status: a systematic review

OBJECTIVE

To systematically summarize the evidence for the effects of martial arts on health and fitness, to show the strengths of different types of martial arts, and to get a more complete picture of the impacts of martial arts on health, and also to provide a basis for future research on martial arts as an exercise prescription in exercise therapy.

METHOD

We searched for "martial arts""health" and "random" in eight databases (n= 5432). Randomized controlled trials and controlled clinical trials on the health effects of martial arts were included in the study.

RESULTS

The final analysis included 28 papers (one general martial arts, one kung fu, sixteen tai chi, six judo, three karate, and one taekwondo). Among the disciplines of martial arts, tai chi was the most well-studied, followed by judo, karate, and taekwondo. Research topics varied widely, and included health, injuries, competition, morals and psychology, and herbal medicine. Most found positive effects on health. Tai chi is no-contact, low-impact, soft body and mindfulness exercise, which has been widely adopted by elderly people and proven to be a beneficial health promotion exercise. Research on judo, karate, and taekwondo mainly focused on improvements to athletes' competitive abilities, rather than on health effects. We did not find any published randomized controlled trials or controlled clinical trials on aikido, kendo, sumo, kyudo, qi gong, or other disciplines.

DISCUSSION AND CONCLUSION

Since martial arts are widely practiced, their effects on physiology, morphology, immunology, and neurology should be further studied in order to help people to select the best discipline or style to accomplish their purposes. This necessitates categorizing and classifying the disciplines and styles according to their effects on different body systems and levels of contact, as well as standardizing evaluation criteria for martial arts. Martial arts as an exercise prescription can then move from an experience-based to an evidence-based treatment.

Tai Chi Chuan increases circulating myeloid dendritic cells

Dendritic cells, the most potent antigen-presenting cells linking innate and adoptive immunity, are thought to be important targets of immune modulators such as exercise. We examined the effect of Tai Chi Chuan (TCC) on dendritic cells. TCC practitioners were further divided to high-level practitioners (TCC-H) and low-level practitioners (TCC-L). The quantities of myeloid and plasmacytoid dendritic cells were estimated by flow cytometry. We examined parameters including age, body weight, body length, body fat, and serum albumin level, in the controls, TCC-H and TCC-L, which did not differ significantly. The mean peak VO(2) (volume of O(2) utilization) of the TCC-H group was greater than that of the sedentary control group. White blood cell (WBC) count in the entire TCC group was greater than that of the controls. The quantity of myeloid dendritic cells was significantly greater in the TCC group, whereas the quantity of plasmacytoid dendritic cells was similar for both groups. Among the TCC subgroups, the quantity of myeloid dendritic cells, but not plasmacytoid dendritic cells, in the TCC-H group was greater than that of TCC-L practitioners. TCC could increase the number of circulating myeloid dendritic cells, but not plasmacytoid dendritic cells, in a performance level-dependent manner.

Exercise as a Treatment to Enhance Sleep

The prevalence of sleep-related complaints and the limited efficacy of pharmacological treatments make nonpharmacological alternatives essential. Physical exercise is one such alternative that is inexpensive and affects numerous health systems simultaneously. This article reviews putative mechanisms that have guided exercise and sleep research, including exercise’s antidepressant effects, restorative functions, and circadian effects, and concludes that a number of mechanisms are plausible and likely active in explaining the effects of exercise on sleep. The empirical literature is reviewed, with special emphasis given to randomized controlled trials and experimental studies that help to inform for whom (eg, age, fitness characteristics), under what conditions (eg, light exposure, time of day), and by what means (eg, type, intensity, duration) exercise optimally affects sleep. The review also includes the emerging research using exercise as a treatment of obstructive sleep apnea and restless legs syndrome. The current literature indicates that moderate amounts of exercise, which can be obtained through a variety of means such as brisk walking and resistance training, are sufficient to improve sleep quality. Additional research is warranted in this area, particularly randomized controlled trials that target subgroups at risk for poor sleep such as older adults and persons with sleep disorders.

Influence of personal patterns of behavior on the effects of Tai Chi: a pilot study

OBJECTIVES

To investigate the influence of individual patterns of personality and behavior on the change in mood status after a brief period of Tai Chi exercise.

METHODS

The mood status in 22 healthy females was evaluated before and after a period of Tai Chi exercise using the Profile of Mood States (POMS) score. Patterns of personal behavior were also assessed by written questionnaire.

RESULTS

In the type A behavior pattern group, the score for total mood disturbance decreased significantly after a brief period (20 min) of Tai Chi exercise. No change was observed in the type B behavior pattern group.

CONCLUSIONS

These findings suggest that a brief period of Tai Chi exercise is mentally beneficial, particularly to individuals with type A characteristics.

T'ai chi and qigong for health: patterns of use in the United States

BACKGROUND

Little is known in the United States about those who practice t'ai chi and qigong, two mind-body techniques that originated in Asia.

OBJECTIVE

The objective of this study is to characterize use of t'ai chi and qigong for health with regard to sociodemographics, health status, medical conditions, perceptions of helpfulness, and disclosure of use to medical professionals.

METHODS

We analyzed associations of t'ai chi and qigong use for health using cross-sectional data from the 2002 National Health Interview Survey (NHIS) Alternative Medicine Supplement (n = 31,044). The 2002 NHIS estimated the number of t'ai chi and qigong users for health to be 2.5 and 0.5 million persons, respectively. We collapsed t'ai chi and qigong use into a single category (TCQ) for analysis, representing 2.8 million individuals.

RESULTS

We found that neither age nor sex was associated with TCQ use. TCQ users were more likely than nonusers to be Asian than white (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.30-3.15), college educated (OR 2.44, 95% CI 1.97-3.03), and less likely to live in the Midwest (OR 0.64, 95% CI 0.42-0.96) or the southern United States (OR 0.51, 95% CI 0.36-0.72) than the West. TCQ use was associated independently with higher reports of musculoskeletal conditions (OR 1.43, 95% CI 1.11-1.83), severe sprains (OR 1.65, 95% CI 1.14-2.40), and asthma (OR 1.50, 95% CI 1.08-2.10). Half of TCQ users also used yoga for health in the last 12 months. Most TCQ users reported their practice to be important to maintain health, but only a quarter of users disclosed their practice to a medical professional.

CONCLUSIONS

In the United States, TCQ is practiced for health by a diverse population, and users report benefits for maintaining health. Further research is needed to establish efficacy and safety for target populations, including those with musculoskeletal and pulmonary disease, as well as for preventive health.

A study investigating the effects of Tai Chi Chuan: Individuals with traumatic brain injury compared to controls

OBJECTIVE

To explore the effects of a 6-week course in Tai Chi associated with traumatic brain injury (TBI) symptoms.

METHOD

Eighteen participants, with TBI assigned to a control (waiting list) group (n = 9) or Tai Chi group (n = 9) completed the Medical Outcome Scale Short Form 36 (SF-36) and Rosenberg Self-Esteem Scale (RSES) before, during, immediately after and 3 weeks after completion of the Tai Chi course. The Tai Chi group completed the Visual Analogue Mood Scales (VAMS) before and after each class.

RESULTS

Tai Chi was associated with significant improvement on all VAMS scores (except fatigue) with decreases in sadness, confusion, anger, tension, fear and increases in energy and happiness. There were no significant between-group differences on the SF-36 or RSES.

CONCLUSIONS

Tai Chi provides short-term benefits after TBI, with rigorous outcome measurement needed to examine long-term benefits.

Changes of aerobic capacity, fat ratio and flexibility in older TCC practitioners: a five-year follow-up

The objective of this study was to evaluate the 5-year changes of aerobic capacity, fat ratio and flexibility in older Tai Chi Chuan (TCC) practitioners and sedentary controls. Sixty-nine community-dwelling elderly individuals (mean age: 68.6 +/- 6.3 years) completed this study. The TCC group (18 M; 17 F) had been practicing TCC regularly for 6.3 +/- 3.7 years at baseline and continued training in the study interval. The control group (16 M; 18 F) did not participate in any regular exercise program. A graded bicycle exercise testing was conducted at the baseline and at 5-year to evaluate the age-related decline in aerobic capacity. Triceps and subscapular skinfolds, and thoracolumbar flexibility were also measured. At baseline, the TCC group displayed higher peak oxygen uptake $({\dot{\rm V}}{\rm O}_{2{\rm peak}})$ and thoraolumbar flexibility, and lower fat ratio than the control group. At the 5-year follow-up, the TCC group displayed a smaller decrease in $\dot{\rm V}{\rm O}_{2{\rm peak}}$ than the sedentary group. The annual decrease of $\dot{\rm V}{\rm O}_{2{\rm peak}}$ in TCC men and women was 0.32 and 0.22 ml . kg(-1) . min(-1), respectively. In the control group, the annual decrease of $\dot{\rm V}{\rm O}_{2{\rm peak}}$ was 0.50 and 0.36 ml . kg(-1) . min(-1) in men and women, respectively. The TCC group also showed a smaller increase of body fat ratio, and a less decrease of flexibility than the control group. In conclusion, long-term practice of TCC attenuates the age-related decline of aerobic capacity, and it also reduces the increase of body fat ratio in older individuals. TCC may be prescribed as a conditioning exercise for the elderly to maintain their health fitness.

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

In this, the first of 2 companion papers, we present a framework for viewing t'ai chi as a complex, multicomponent intervention that integrates numerous physical, cognitive, and ritualistic components. We discuss how the richness and complexity of t'ai chi poses challenges related to the traditional distinction between specific versus nonspecific effects, the development and interpretation of valid sham controls, and more generally, to the reductionist causal approach of attributing observed outcomes to single, independent component factors. We also discuss parallels between t'ai chi research and the emerging field of whole systems research, and how t'ai chi research may benefit from the use of an ecologic framework. In a second, companion paper, we discuss additional challenges inherent in defining the t'ai chi intervention itself, and more comprehensively outline the benefits and limitations of commonly used clinical research designs to evaluate the efficacy and safety of t'ai chi.