Tai Chi as a Therapy of Traditional Chinese Medicine on Reducing Blood Pressure: A Systematic Review of Randomized Controlled Trials

Evidence map of traditional Chinese exercises

Objective

This study aimed to assess and visually depict the clinical evidence landscape of traditional Chinese exercises and identify any research gaps and future research needs.

Methods

We comprehensively searched seven Chinese and English databases to identify randomized controlled trials (RCTs) and systematic reviews (SRs) evaluating the effects of traditional Chinese exercises from their inception until May 2023. The quality of evidence was assessed via the GRADE approach, and the research topics, intervention effects, and strength of evidence were graphically displayed.

Results

This evidence map includes 2,017 studies, comprising 1,822 RCTs and 195 SRs. These studies were conducted globally in various countries. Among the traditional Chinese exercises, Tai Chi and Baduanjin have received the most research attention, with a growing number of publications. When traditional Chinese exercises were compared with the control groups, 88.2% of the included SRs reported significantly positive effects, 4.1% reported unclear effects, and 7.7% reported no significant differences. The findings suggested that traditional Chinese exercises could benefit patients with osteoarthritis, osteoporosis, hypertension, coronary heart disease, diabetes, chronic obstructive pulmonary disease, stroke, Parkinson's disease, anxiety, and depression. However, the overall quality of the evidence was suboptimal, with 11.3% rated as moderate, 45.6% as low, and 43.1% as critically low.

Conclusion

This evidence map visually represents valuable information on traditional Chinese exercises. While most studies have reported significant benefits, the overall quality of evidence is low.

How effective are allied health group interventions for the management of adults with long-term conditions? An umbrella review of systematic reviews and its applicability to the Australian primary health system

BACKGROUND

Group allied health interventions for people with chronic conditions may be a solution to increasing access to allied health in primary care. This umbrella review aimed to determine the effectiveness of allied health group interventions to improve health-related outcomes for adults with chronic conditions and the applicability of the findings to the Australian primary health care context.

METHODS

An umbrella review of systematic reviews conducted April-July 2022, searching eight databases. Systematic reviews were eligible if they included randomised controlled trials (RCT) or quasi-RCTs, community dwelling adults aged ≥ 18, at least one chronic condition, group intervention in scope for allied health professionals, and published in English after 2000. Studies were excluded if interventions were conducted in hospital or aged care facilities, out of scope for allied health, or unsupervised.

RESULTS

Two thousand three hundred eighty-five systematic reviews were identified: after screening and full text review 154 were included and data extracted from 90. The chronic conditions included: cancer (n = 15), cardiovascular disease (n = 6), mixed chronic conditions (n = 3), kidney disease (n = 1), low back pain (n = 12), respiratory disease (n = 8), diabetes (n = 14), heart failure (n = 9), risk of falls (n = 5), hypertension (n = 4, osteoarthritis (n = 6) and stroke (n = 8). Most group interventions included prescribed exercise and were in scope for physiotherapists and exercise physiologists. Overall, allied health group exercise programs for community dwelling adults improved health outcomes for most chronic conditions. Aggregated data from the systematic reviews suggests programs of 45-60 min per session, 2-3 times per week for 12 weeks. Lifestyle education and support for people with type-2 diabetes improved glycaemic control.

CONCLUSIONS

Prescribed group exercise delivered by allied health professionals, predominantly by exercise physiologists and physiotherapists, significantly improved health outcomes for community dwelling adults with a broad range of chronic conditions.

Acceptability and Feasibility of a Tai Chi/Qigong Intervention for Older People Living With HIV

Tai chi/qigong (TCQ) is a low impact, meditative movement with breathwork that may benefit people with HIV (PWH) over 50 years old. This study is a feasibility clinical trial of a remote TCQ intervention for older PWH. Participants (n = 48) were recruited via clinic sites and social media and randomized to a TCQ, sham qigong, or wait-list control group. The 12-week intervention included fourteen 45-60-minute sessions. Acceptability (satisfaction, attitudes, practice, attendance) and feasibility (retention rate, adverse events, remote delivery) data were surveyed. Overall retention rate was 72.9%, but 81.2% for the TCQ group. Most TCQ participants attended at least 10 sessions (62.5%) and were practicing TCQ after 2 weeks (72.7%). Over 92% of TCQ participants reported satisfaction and positive attitudes and preferred remote versus in person delivery (63.6%). Two mild intervention related adverse events occurred. Findings suggest that a remote TCQ intervention is acceptable, feasible, and safe among older PWH.

Effect of Tai Chi vs Aerobic Exercise on Blood Pressure in Patients With Prehypertension: A Randomized Clinical Trial

Importance

Prehypertension increases the risk of developing hypertension and other cardiovascular diseases. Early and effective intervention for patients with prehypertension is highly important.

Objective

To assess the efficacy of Tai Chi vs aerobic exercise in patients with prehypertension.

Design, Setting, and Participants

This prospective, single-blinded randomized clinical trial was conducted between July 25, 2019, and January 24, 2022, at 2 tertiary public hospitals in China. Participants included 342 adults aged 18 to 65 years with prehypertension, defined as systolic blood pressure (SBP) of 120 to 139 mm Hg and/or diastolic BP (DBP) of 80 to 89 mm Hg.

Interventions

Participants were randomized in a 1:1 ratio to a Tai Chi group (n = 173) or an aerobic exercise group (n = 169). Both groups performed four 60-minute supervised sessions per week for 12 months.

Main Outcomes and Measures

The primary outcome was SBP at 12 months obtained in the office setting. Secondary outcomes included SBP at 6 months and DBP at 6 and 12 months obtained in the office setting and 24-hour ambulatory BP at 12 months.

Results

Of the 1189 patients screened, 342 (mean [SD] age, 49.3 [11.9] years; 166 men [48.5%] and 176 women [51.5%]) were randomized to 1 of 2 intervention groups: 173 to Tai Chi and 169 to aerobic exercise. At 12 months, the change in office SBP was significantly different between groups by -2.40 (95% CI, -4.39 to -0.41) mm Hg (P = .02), with a mean (SD) change of -7.01 (10.12) mm Hg in the Tai Chi group vs -4.61 (8.47) mm Hg in the aerobic exercise group. The analysis of office SBP at 6 months yielded similar results (-2.31 [95% CI, -3.94 to -0.67] mm Hg; P = .006). Additionally, 24-hour ambulatory SBP (-2.16 [95% CI, -3.84 to -0.47] mm Hg; P = .01) and nighttime ambulatory SBP (-4.08 [95% CI, -6.59 to -1.57] mm Hg; P = .002) were significantly reduced in the Tai Chi group compared with the aerobic exercise group.

Conclusions and Relevance

In this study including patients with prehypertension, a 12-month Tai Chi intervention was more effective than aerobic exercise in reducing SBP. These findings suggest that Tai Chi may help promote the prevention of cardiovascular disease in populations with prehypertension.

Trial Registration

Chinese Clinical Trial Registry Identifier: ChiCTR1900024368.

Pilot study of Qigong/Tai Chi Easy acute effects of meditative movement, breath focus and "flow" on blood pressure, mood and oxytocin in older adults

BACKGROUND

Older adults are increasingly lonely and at risk for hypertension. Endogenous oxytocin levels are associated with lowering blood pressure (BP), suggesting value in increasing oxytocin. Regular practice of Tai Chi improves BP and mood; we explored a single session of Tai Chi Easy (TCE) with older adults and feasibility of measuring oxytocin as a key biomarker.

METHOD

In a single-arm pre-post design pilot study, 21 older adults (age 55-80) with mild-moderate hypertension practiced a single session (50-min) TCE. BP, psychosocial measures, and saliva samples were collected pre/post to examine feasibility of acute measures of oxytocin and explore effect sizes of outcomes. Participants (N = 21; 19 % Latinx, 76.2 % female, mean age 66.76).

RESULTS

BP systolic: 138.43-134.86; diastolic 78.48-78.00 (p > .05; Cohen's d -0.23; -0.08 respectively). Total Mood Disturbance (TMD) and Connection (CN) improved [TMD mean pre 41.891 (SD=19.60) to post 35.00 (SD=10.21), p = .01; Cohen's d - 0.67); CN mean 7.85 (SD=2.01) to post 9.05 (SD=1.00), p = .01; Cohen's d 0.70]. Baseline oxytocin was positively correlated with baseline loneliness (N = 14, r = .599); pre/post oxytocin changes were negatively correlated with baseline loneliness (N = 14, r = -.585). BP decrease was associated with characteristics of the intervention: "flow" (coef=.=0.58N = 17) and meditative/breath focus (coef=-1.78; N = 17).

DISCUSSION/CONCLUSION

Medium to large effect sizes indicating change in mood and connection were found for this single session intervention. Knowing that Tai Chi improves BP when practiced over time, this TCE intervention shows promise for planning a fully powered, randomized controlled study of BP, mood and perceptions of connection in hypertensive older adults. Feasibility of assessing acute salivary oxytocin is less promising. Increase in oxytocin levels occurred for those less lonely, but declined for lonelier participants. With different responses based on baseline loneliness scores, no mean change in oxytocin levels was found. Seemingly unstable levels (possibly related to interaction with study staff) suggests the need for further testing in more controlled study designs. Finally, BP associations with meditative/breath focus and flow could be further explored in future study designs addressing mediation.

From Ancient Patterns of Hand-to-Hand Combat to a Unique Therapy of the Future

The purpose of this publication is to provide generalized knowledge of the area of changes that took place over past centuries in relation to health, social and cultural conditions. In Greek mythology, it was necessary to nurture both body and spirit to be a perfect human being. This link between the concepts of physical beauty and goodness can be also found in later works dedicated to ancient Greek history. Particularly in Greek myths, and in Greek education in general, it was believed that both physical and spiritual excellence were necessary to raise men to achieve their true form. Some of the main forms of implementing this idea were hand-to-hand combat exercises (wrestling, boxing and pankration). Ideas characteristic of the world of ancient Greece, in a general sense, can be observed in the culture of the Far East. The main difference is the fact that these principles did not survive in Western culture as a result of transformation into a consumer society focused on the rejection of moral principles. The brutalisation of the forms of the Roman Games meant that the ideals of the ancient world were forgotten for more than 1500 years. The modern Olympic Games were resurrected in the 19th century. Inspired by the ancient Greek cult of health of body and spirit, they gave rise to a movement known as Olympism. In the Olympic Charter written by Coubertin, Olympism was called "a philosophy of life exalting and combining in a balanced whole the qualities of body, will and mind". The combat sports disciplines have had their place there since the beginning of the modern Olympic Games. The evolution of hand-to-hand combat disciplines, including numerous scientific studies indicating a very broad impact in the area of health, led to this type of physical activity being reached for as an essential element in supporting the health-promoting behaviour of society. Nowadays, physical activity in the area of exercise with elements of hand-to-hand combat, combat sports, or martial arts is an indissoluble link in the prevention and treatment of 21st century diseases. For Parkinson's disease patients, drug treatment is an essential resource for continuing to function in society, but it will not be completely effective without supporting the treatment with appropriate and attractive physical activity (e.g., "Rock Steady Boxing"). Of similar importance is the prevention of dangerous falls, which are common in this population as well as among the elderly or those affected by other diseases of civilisation. Implementing the principles and techniques of safe falling in the teaching of the young population significantly increases the likelihood of applying appropriate responses to these individuals in adulthood and old age. Actions that should be taken now for prevention can be implemented through social programmes, such as "Active today for a healthy future".

Quality of Evidence Supporting the Effects of Tai Chi Exercise on Essential Hypertension: An Overview of Systematic Reviews and Meta-Analyses

Objectives

Tai Chi (TC) is a potential complementary treatment for essential hypertension (EH). This overview systematically summarizes and evaluates the existing evidence of TC in the therapy of EH.

Methods

Systematic reviews (SRs)/meta-analyses (MAs) on TC interventions for EH were comprehensively searched in seven databases. Methodological quality, risk of bias, reporting quality, and quality of evidence were assessed by means of the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2), the Risk of Bias in Systematic (ROBIS) scale, the list of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), as well as the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

Results

Twelve published SRs/MAs were included in our study. According to the results of the AMSTAR-2, ROBIS, PRISMA, and GRADE assessment, only 1 SR/MA was assessed as high quality and only 1 SR/MA was assessed as low risk of bias. Only 2 SRs/MAs have been fully reported on the checklist. In addition to that, the quality of evidence was assessed for a total of 69 outcome indicators extracted from the SRs/MAs included in this overview, and only 3 items were assessed as high quality.

Conclusions

TC may be an effective and safe complementary treatment for EH. However, this conclusion must be approached with caution, as the quality of the evidence provided by the SRs/MAs is usually low.