Effects of fitness qigong and tai chi on middle-aged and elderly patients with type 2 diabetes mellitus

Effects of Traditional Chinese Exercises on Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Currently, most studies on the health benefits of traditional Chinese exercises on type 2 diabetes mellitus have explored the effects of a single type of traditional Chinese exercise on type 2 diabetes. Although a previous study evaluated the combined clinical effects of traditional Chinese exercises on type 2 diabetes, the studies included in that review were deficient in their study design. In addition, previous studies have not explored the ideal exercise dose that should be taken by patients with type 2 diabetes when performing traditional Chinese exercises.

OBJECTIVE

To understand whether the findings of previous systematic reviews and meta-analyses are still applicable and to try to address the deficiencies in the previous review, this review conducted a meta-analysis of existing randomized controlled trials to investigate the impact of traditional Chinese exercises on glycemic control with type 2 diabetes.

METHODS

The literature was searched in seven Chinese and English databases. Randomized controlled trials published in English and Chinese, from database inception to March 2023, were included in this review. Two reviewers independently reviewed the search results, extracted the data, and assessed the risk of bias. A meta-analysis of the included studies was conducted using Rev Man 5.4 and Stata 15.1 software. Heterogeneity was investigated using a sensitivity analysis, a subgroup analysis, and a meta-regression analysis. Pre-determined subgroups included the duration of the intervention, frequency of exercise, and duration of the single exercise session.

RESULTS

A total of 31 randomized controlled trials (2077 subjects) were selected in this review. The meta-analysis revealed that traditional Chinese exercises were more effective than control groups in lowering glycated hemoglobin (Z = 6.06; mean difference [MD] =  - 0.64, 95% confidence interval [CI] - 0.85, - 0.44; P < 0.00001), fasting blood glucose (Z = 7.81; MD =  - 0.82, 95% CI - 1.03, - 0.62; P < 0.00001), 2-h plasma glucose (Z = 5.61; MD =  - 1.03, 95% CI - 1.39, - 0.67; P < 0.00001), total cholesterol (Z = 4.23; MD =  - 0.37, 95% CI - 0.54, - 0.20; P < 0.0001), high-density lipoprotein cholesterol (Z = 5.94; MD = 0.12, 95% CI 0.08, 0.16; P < 0.00001), low-density lipoprotein cholesterol (Z = 6.20; MD =  - 0.34, 95% CI - 0.44, - 0.23; P < 0.00001), and triglyceride levels (Z = 3.74; MD =  - 0.44, 95% CI - 0.67, - 0.21; P = 0.0002) among patients with type 2 diabetes.

CONCLUSIONS

Traditional Chinese exercises can significantly improve blood glucose and lipid levels in patients with type 2 diabetes. When performing traditional Chinese exercise interventions for type 2 diabetes, it is recommended that exercise programs are designed for 30-50 min/session, 4-5 sessions/week for at least 3 months.

Twenty-Four week Taichi training improves pulmonary diffusion capacity and glycemic control in patients with Type 2 diabetes mellitus

This study evaluated the effect of 24-week Taichi training and Taichi plus resistance band training on pulmonary diffusion capacity and glycemic control in patients with Type 2 diabetes mellitus (T2DM). Forty-eight patients with T2DM were randomly divided into three groups: Group A-Taichi training: practiced Taichi 60 min/day, 6 days/week for 24 weeks; Group B-Taichi plus resistance band training: practiced 60-min Taichi 4 days/week plus 60-min resistance band training 2 days/week for 24 weeks; and Group C-controls: maintaining their daily lifestyles. Stepwise multiple regression analysis was applied to predict diffusion capacity of the lungs for carbon monoxide (DLCO) by fasting blood glucose, insulin, glycosylated hemoglobin (HbA1c), tumour necrosis factor alpha (TNF-α), von Willebrand Factor (vWF), interleukin-6 (IL-6), intercellular adhesion molecule 1 (ICAM-1), endothelial nitric oxide synthase (eNOS), nitric oxide (NO), endothelin-1 (ET-1), vascular endothelial growth factor, and prostaglandin I-2. Taichi with or without resistance band training significantly improved DLCO, increased insulin sensitivity, eNOS and NO, and reduced fasting blood glucose, insulin, HbA1c, TNF-α, vWF, IL-6, ICAM-1, and ET-1. There was no change in any of these variables in the control group. DLCO was significantly predicted (R2 = 0.82) by insulin sensitivity (standard-β = 0.415, P<0.001), eNOS (standard-β = 0.128, P = 0.017), TNF-α (standard-β = -0.259, P = 0.001), vWF (standard-β = -0.201, P = 0.007), and IL-6 (standard-β = -0.175, P = 0.032) in patients with T2DM. The impact of insulin sensitivity was the most important predictor for the variation of DLCO based on the multiple regression modeling. This study demonstrates that 24-week Taichi training and Taichi plus resistance band training effectively improve pulmonary diffusion capacity and blood glycemic control in patients with T2DM. Variation of DLCO is explained by improved insulin sensitivity and endothelial function, and reduced inflammatory markers, including TNF-α, vWF, and IL-6.

Inconsistency between physicians' attitudes and behaviors toward TCM: A questionnaire survey in Chengdu

Although Western Medicine is considered as the mainstream medicine in China, Traditional Chinese Medicine (TCM) still has its own advantages and characteristics. The attitudes and behaviors to TCM are divided, some West Medicine Doctors prefer TCM during treatment, while others consider it not effective. The objective of this study is to find out the attitudes and treatment behaviors of Chengdu physicians toward TCM, and identify factors associated with their attitude and behaviors. A representative sample of 2049 Chengdu physicians were recruited online to investigate their attitudes and behaviors toward TCM. During this research, previous Integrative Medicine Attitude Questionnaire were referred and modified, and adjusted questionnaire was made based on the actual situation of TCM in Chengdu. This questionnaire contains 3 distinct parts. The first part aimed at the attitudes of respondents toward TCM, and contains 15 questions in 3 sections, Holism, Knowledge, and Evidence. The second part tried to determine the behaviors toward TCM in terms of self-use, recommendations, as well as prescriptions. In addition, 6 modalities including Chinese Patent Medicine, Chinese Herbal Medicine, Acupuncture, Massage & Bone Setting, Qigong, and TCM diet were introduced in the behavioral part. In the third part, we aimed to collect personal, professional, and structural factors that may significantly influence TCM attitudes and behaviors. Physicians hold positive attitudes toward TCM in general, all the mean/highest possible subscales scores value of Holism (90.53%), Knowledge (63.77%), and Evidence (62.73%) domain were over 60%. On the other hand, physicians were more positive on self-use (49.40%) and recommendation (55.98%) of TCM than giving TCM prescriptions (36.60%) to patients. The attitudes and behaviors toward may not be consistent, which means physicians may not give prescriptions to patients even they have good attitudes to TCM. Education and self-use of TCM are important positive factors that influence the behaviors of physicians.

Effects of Tai Chi in diabetes patients: Insights from recent research

Tai Chi, a practice that combines elements of both exercise and mindfulness, offers a wide range of health benefits. The body of evidence concerning the impact of Tai Chi on diabetes has recently been growing. This editorial aims to provide a concise summary of the current state of evidence for Tai Chi's effects on individuals with type 2 diabetes (T2D). The review includes 3 randomized controlled trials (RCTs) and 5 systematic reviews and meta-analyses, all of which investigate the effectiveness of Tai Chi on various health outcomes in individuals with T2D. Tai Chi demonstrates a significant effect to enhance glycemic control, lower blood pressure, improve serum lipid profiles, reduce insulin resistance, positively influence obesity-related indices, and improve overall quality of life in individuals with T2D. However, it is noteworthy that recent RCTs have reported inconsistent findings regarding the effects of Tai Chi on glycemic control and insulin resistance. The author also delves into potential mechanisms by which Tai Chi may exert its influence on the human body. Finally, the editorial highlights the critical issues that warrant further exploration in the future.

ADA-EASD Consensus Report on the Management of Hyperglycaemia in Type 2 Diabetes in an Afro-Asian Context: Broadening the Perspective

The American Diabetes Association and the European Association for the Study of Diabetes consensus statement 2022 effectively captures the changing paradigm of modern diabetes care. As emphasized in the guidelines, a person-centered decision cycle focusing on preventing complications and improving quality of life is the driving principle behind modern diabetes management. Other notable features of the document are its emphasis on self-management education, therapeutic behaviour, sleep hygiene, nonalcoholic fatty liver disease and weight loss. Focus on individualization of care, social determinants of health, and ethnic variations are pertinent from an Afro-Asian perspective. The "language matters" section is a welcome addition that will help to overcome several barriers in diabetes care.

Efficacy of traditional Chinese exercises in improving anthropometric and biochemical indicators in overweight and obese subjects: A systematic review and meta-analysis

BACKGROUND

The efficacy of traditional Chinese exercise (TCE)-based intervention in the improvement of anthropometric and biochemical indicators in overweight and obese patients is controversial. In this regard, the aim of this review was to summarize the evidence of TCE interventions to evaluate their effectiveness on the anthropometric and biochemical indicators of overweight and obese patients.

METHOD

Five databases were systematically searched for relevant articles published from inception to October 2022. Randomized controlled trials examining TCE intervention in overweight and obese patients The treatment effects were estimated using a random-effect meta-analysis model with standardized mean differences (Hedges' g). The categorical and continuous variables were used to conduct moderator analyses. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (identifier CRD42022377632).

RESULT

Nine studies involving a total of 1297 participants were included in the final analysis. In the anthropometric indicators outcomes, the meta-analytic findings revealed large and significant improvements in body mass index (g = 1.44, 95% confidence interval [CI] = 1.27-1.61, P = .000, I2 = 99%), weight (g = 1.47, 95% CI = 1.25-1.68, P = .000, I2 = 95%), fat percentage (g = 1.22, 95% CI = 0.52-1.93, P = .000, I2 = 93%), and small and significant improvements in waist circumference (g = 0.38, 95% CI = 0.21-0.54, P = .000, I2 = 99%). In the biochemical indicators outcomes, the findings revealed large and significant improvements in low density lipoprotein (g = 2.08, 95% CI = 1.80-2.37, P = .000, I2 = 98%), moderate and significant improvements in triglyceride (g = 0.69, 95% CI = 0.56-0.81, P = .000, I2 = 96%), small and significant improvements in total cholesterol (g = 0.37, 95% CI = 0.19-0.54, P = .000, I2 = 77%), and high-density lipoprotein (g = -0.71, 95% CI = -0.86 to 0.57, P = .000, I2 = 99%). The moderator shows that the effects of TCE on anthropometric and biochemical indicators were moderated by frequency of exercise, exercise duration, and type of control group.

CONCLUSION

TCE intervention is a beneficial non-pharmacological approach to improving anthropometric and biochemical indicators in overweight and obese subjects, especially in body mass index, weight, fat percentage, triglyceride, and low-density lipoprotein. The clinical relevance of our findings is pending more extensive trials and more rigorous study designs to strengthen the evidence.

Effects of baduanjin exercise on blood glucose, depression and anxiety among patients with type II diabetes and emotional disorders: A meta-analysis

BACKGROUND

Diabetes mellitus (DM) is a group of metabolic disorders reflected by high blood glucose levels and lack of hormone insulin. Notably, T2DM patients are three times more likely to report depression than the general population. Conventional exercise training programs have been shown to be beneficial for T2DM, but less is known regarding the effects of Baduanjin exercise on hemoglobin A1c (HbA1c) and psychological measures among this unique group. Therefore, this systematic review and meta-analysis aimed to investigate the effects of Baduanjin exercise on HbA1c, depression, and anxiety among type 2 diabetes mellitus (T2DM) patients with emotional disorders.

METHODS

The potential literature was searched from six electronic databases (PubMed, MEDLINE, CINAHL, Scopus, Wanfang, and CNKI) from their inception to July 2022. The randomized controlled studies that investigated the effects of Baduanjin on HbA1c, depression , and anxiety in T2DM with emotional disorders were included. The effect sizes were calculated using the random-effect models with a 95% confidence interval (CI). The Physiotherapy Evidence Database (PEDro) scale was employed to assess the study quality.

RESULTS

Eleven studies involving 755 T2DM participants with emotional disorders were analyzed in this study. The pooled results showed that Baduanjin had significant improvements in HbA1c (SMD = 0.75, 95% CI 0.46 to 1.04, p < 0.001), depression (SMD = 0.69, 95% CI 0.30 to 1.08, p < 0.01) and anxiety (SMD = 0.98, 95% CI 0.44 to 1.53, p < 0.01) compared to the control group.

CONCLUSION

Findings suggest that Baduanjin exercise may effectively alleviate HbA1c, depression, and anxiety among T2DM patients with emotional disorders. However, more well-designed studies are required to further substantiate the promising findings.

Efficacy of traditional Chinese exercise for obesity: A systematic review and meta-analysis

BACKGROUND

Obesity is considered one of the biggest public health problems, especially in the background of the coronavirus disease 2019 (COVID-19) lockdown. It is urgent to find interventions to control and improve it. We performed this systematic review and meta-analysis to summarize the effect of traditional Chinese exercise on obesity.

METHODS

We searched PubMed, Embase, Cochrane Library, the China National Knowledge Infrastructure (CNKI), the Chinese Scientific Journal Database (VIP), the Chinese Biomedical Literature Database (CBM), and WanFang database for updated articles published from the inception of each database to June 2022. Randomized controlled trials (RCTs) on traditional Chinese exercise in weight reduction were included, and related data were extracted. The random-effects model was used to adjust for the heterogeneity of the included studies, and funnel plots were used to examine publication bias.

RESULTS

A total of 701 participants were included in the 10 studies. Compared with the control group, the outcome of body weight [mean difference (MD) = -6.10; 95% CI = -8.79, -3.42], body mass index (MD = -2.03; 95% CI = -2.66, -1.41), body fat mass (MD = -3.12; 95% CI = -4.49, -1.75), waist circumference (MD = -3.46; 95% CI = -4.67, -2.24), hip circumference (MD = -2.94; 95% CI = -4.75, -1.30), and waist-to-hip ratio (MD = -0.04; 95% CI = -0.06, -0.03) in the intervention group had significant differences. Egger's test and funnel plots showed that the potential publication bias of the included studies was slight (p = 0.249).

CONCLUSION

Traditional Chinese exercise is an effective treatment for obesity; people under the COVID-19 lockdown could do these exercises to control weight. However, a precise and comprehensive conclusion calls for RCTs on a larger scale with more rigorous designs considering the inferior methodological quality and limited retrieved articles.

SYSTEMATIC REVIEW REGISTRATION

www.crd.york.ac.uk/PROSPERO/, identifier CRD42021270015.

The effects of Tai Chi on glucose and lipid metabolism in patients with diabetes mellitus: A meta-analysis

OBJECTIVE

The research aims to evaluate effects of the Tai Chi exercise therapy on glucose and lipid metabolism in patients with type 2 diabetes mellitus (T2DM).

DESIGN

Systematic review and meta-analysis of existing literature were undertaken.

METHODS

Seven electronic resource databases were scanned to collect eligible studies. Two reviewers selected studies, the meta-analysis was performed with RevMan 5.3 after quality evaluation.

RESULTS

Nineteen RCT trails involved in 18 reports were included in the meta-analysis, involving 1220 research objects. The results show that the Tai Chi exercise group is better than the control group in decreasing fasting blood glucose (FBG) (MD = - 0.79, 95 %CI (- 1.73, - 0.68), p < 0.0001), glycated hemoglobin (HbA1c) (MD = - 1.10, 95 % CI (- 1.78, - 0.43), p = 0.001), triglyceride (TG) (MD = - 0.23, 95 % CI (- 0.32, - 0.15), p < 0.0001) and in increasing the concentration of high-density lipoprotein cholesterol (HDL-C) (MD = 0.15, 95 % CI (0.11, 0.20), p < 0.0001) of T2DM patients.

CONCLUSIONS

Tai Chi exercise therapy shows significant superiority in improving the FBG, HbA1c, TG, and HDL-C in T2DM patients. It can be used as one of the exercise prescriptions for prevention and treatment of T2DM patients.

Optimal modes of mind-body exercise for treating chronic non-specific low back pain: Systematic review and network meta-analysis

BACKGROUND

There were limited studies that directly compare the outcomes of various mind-body exercise (MBE) therapies on chronic non-specific low back pain (CNLBP).

OBJECTIVES

To compare the efficacy of the four most popular MBE modes [Pilates, Yoga, Tai Chi (TC), and Qigong] in clinically CNLBP patients, we conducted a systematic review and network meta-analysis (NMA).

METHODS

We searched databases for eligible randomized controlled trials (RCTs) (from origin to July 2022). RCTs were eligible if they included adults with CNLBP, and implemented one or more MBE intervention arms using Pilates, yoga, TC, and qigong. In addition, pain intensity and physical function were evaluated using validated questionnaires.

RESULTS

NMA was carried out on 36 eligible RCTs involving 3,050 participants. The effect of exercise therapy on pain was in the following rankings: Pilates [Surface under cumulative ranking (SUCRA) = 86.6%], TC (SUCRA = 77.2%), yoga (SUCRA = 67.6%), and qigong (SUCRA = 64.6%). The effect of exercise therapy on function: Pilates (SUCRA = 98.4%), qigong (SUCRA = 61.6%,), TC (SUCRA = 59.5%) and yoga (SUCRA = 59.0%).

CONCLUSION

Our NMA shows that Pilates might be the best MBE therapy for CNLBP in pain intensity and physical function. TC is second only to Pilates in improving pain in patients with CNLBP and has the value of promotion. In the future, we need more high-quality, long-term follow-up RCTs to confirm our findings.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=306905, identifier: CRD42022306905.

Complementary and alternative medicine for glycemic control of diabetes mellitus: A systematic review

The use of complementary and alternative medicine (CAM) is increasingly popular for the management of diabetes mellitus (DM). The aim of this study was to conduct systematic review of any types of complementary and alternative medicine for glycemic control of diabetes mellitus. Four databases was used in this study, the CINAHL, PUBMED, SCOPUS, and ProQUEST. The systematic review were reported according to the PRISMA guidelines. The keywords were used according to medical subject headings (MeSH) in this study were diabetes mellitus AND complementary and alternative medicine AND blood glucose levels or blood sugar or blood glucose. Articles were limited to 2015-2021 and only in English language. We obtained 231 articles from these databases: CINAHL six articles, PUBMED 85 articles, SCOPUS 66 articles, PROQUEST 74 articles. Then, the final results recorded 17 articles. The results of a systematic review showed the effectiveness of natural products as CAM for glycemic control of DM, namely Berberis aristata/Silybum marianum, fenugreek seed, bitter melon, cinnamon or whortleberry supplements, a combination of herbal plants (C. spinosa, R. canina, and S. securigera), Nigella sativa, Mulberry juice, chicory, chamomile tea, and bell pepper juice combined with an integrated approach of yoga therapy. Mind body practices such as auditory guided imagery (AGI), qigong and tai chi exercises, and relaxation. Whole system approach, such as acupressure. Health care providers consider CAM for DM management.

Utilization of Mind–Body Intervention for Integrative Health Care of COVID-19 Patients and Survivors

Recent findings suggest a correlation between COVID-19 and diabetes, although the underlying causes are still little understood. COVID-19 infection tends to induce severe symptoms in patients with underlying diabetes, increasing their mortality rate. Moreover, COVID-19 itself appears to be a diabetogenic factor. In addition, mental health conditions, such as depression due to lockdown and anxiety about infection, were found to affect glycemic control and immunity, highlighting the importance of mental health care during the pandemic. Mind–Body Intervention (MBI), which includes meditation, yoga, and qigong, has emerged as a tool for mental health management due to its effects on stress reduction and the promotion of mental and physical well-being. Here, we review the latest randomized controlled trials to determine the effects of MBI on glycemic control and the immune system and discuss the underlying mechanisms by which MBI facilitates the virtuous cycle of stress management, glycemic control, and immune modulation. Furthermore, we examine the actual utilization of MBI during the COVID-19 pandemic era through recent studies. With proper online education, non-pharmacological MBI may be more widely used as an important tool for self-health care that complements the usual treatment of COVID-19 patients and survivors.

Meta-Analysis of Tai Chi Chuan in Treating Lumbar Spondylosis and Back Pain

BACKGROUND

The effectiveness of Tai Chi Chuan in treating various ailments has been well reported; however, its effect on back pain and lumbar spondylosis remains unclear.

METHODS

We performed this meta-analysis under the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and the research-associated search was performed over the provided databases: Embase, Cochrane Library, Web of Science, PubMed, Scopus, and CINAHL in the period of 2008 to 2016, to recognize the related studies. We used the Physiotherapy Evidence Database (PEDro) scale to measure the standard of the involved randomized control trials (RCTs). The accumulated outcomes with parameters of weighted mean difference (WMD) and confidence level (CI) of 95% were evaluated to discover the influence of Tai Chi over pain as well as dysfunction among the patients suffering from pain depending on the outcome model.

RESULTS

Seven eligible studies with a total of 296 participants were identified that met inclusion criteria for the systematic review; in the forest plot analysis, it was noted that for 95% CI, the standardized mean difference found to be -1.58 (-1.79, -1.38) with the heterogeneity of 87%, thereby favoring Tai Chi over the control group; a comparison was drawn for Tai Chi with routine therapy against the routine therapy alone, where 95% CI for -1.22 [-1.47, -0.97] is observed for I 2 = 0% for the overall effect Z = 9.42 (P < 0.00001); pain intensity of Tai Chi was compared with the control group, where 95% CI for -1.62 [-2.09, -1.14] was observed for Z = 6.69 (P < 0.00001). The forest plot subgroup analysis of Tai Chi was compared with the control group for an unchanged lifestyle, where 95% CI for -2.26 [-2.61, -1.91] was observed for Z = 12.76 (P < 0.00001).

CONCLUSION

Our results indicate that Tai Chi individually or with additional treatment along with routine physical exercises might reduce the pain and functional disorders for the patients suffering from back pain.

Effects of Tai Chi on health outcomes among community-dwelling adults with or at risk of metabolic syndrome: A systematic review

OBJECTIVES

This systematic review evaluated the effects of Tai Chi on health outcomes among community-dwelling adults with or at risk of metabolic syndrome (MetS).

METHODS

Randomized controlled trials (RCTs) were searched in 10 databases. Data were statistically pooled for meta-analysis.

RESULTS

Twenty RCTs were included. One study involved adults with MetS, and the other 19 studies involved adults with at least one risk factor for MetS. Tai Chi was found to reduce waist circumference and increase high-density lipoprotein cholesterol in obese adults. Tai Chi also reduces waist circumference, body mass index, blood glucose level, insulin resistance, and increases the quality of life (QoL) in adults with elevated blood glucose/type 2 diabetes (T2DM). Among participants with hypertension, Tai Chi improves blood pressure, lipid profiles, anxiety, depression, and physical QoL.

CONCLUSIONS

Tai Chi may be effective for enhancing the physiological and psychosocial wellbeing of community-dwelling adults at risk of MetS. Further RCTs are needed to examine its effects in adults with MetS and identify optimal regimes.