The Effects of Tai Chi on Markers of Atherosclerosis, Lower-limb Physical Function, and Cognitive Ability in Adults Aged Over 60: A Randomized Controlled Trial

Impact of Taekwondo training on cognitive and physical function in elderly individuals: A comprehensive review of randomized controlled trials

BACKGROUND

Researchers have investigated the physical and psychosocial advantages of Taekwondo for older adults. However, prior studies of Taekwondo's impact on physical function and psychological well-being in this demographic have produced inconsistent findings. Thus, this systematic review aimed to assess how Taekwondo practice affects the physical function and psychological well-being of older adults.

METHODS

We systematically searched PubMed, EMBASE, CINAHL, SPORTDiscus, Scopus, Korea Education and Research Information Service, Korean Studies Information Service System, Korean National Assembly Library, Research Information Sharing Service, National Digital Science Library, and China National Knowledge Infrastructure from their inception to December 2023. Two reviewers independently selected and extracted data from each study. We calculated effect sizes using a random-effects model with a 95 % confidence interval (CI) and evaluated study quality using the Physiotherapy Evidence Database scale.

RESULTS

This review included ten studies with 227 participants aged 66.1-73.6 years. The meta-analysis revealed significant enhancements in cognitive function [Korean Version of Mini-Mental State Examination, standard mean difference (SMD) = 0.700, 95 % CI (0.364-1.037), I2 = 0 %, p < .001], blood indicators [β-amyloid, SMD = 0.613, 95 % CI (0.103-1.123), I2 = 34.920 %, p < .05; brain-derived neurotrophic factor, SMD = 0.566, 95 % CI (0.166-0.966), I2 = 0 %, p < .01; high-density lipoprotein cholesterol, SMD = 0.677, 95 % CI (0.357-0.966), I2 = 0 %, p < .001; low-density lipoprotein cholesterol, SMD = 0.809, 95 % CI (0.376-1.242), I2 = 42.621 %, p < .001; and total cholesterol, SMD = 0.979, 95 % CI (0.603-1.356), I2 = 22.221 %, p < .001], and physical function [lean body mass, SMD = 0.465, 95 % CI (0.109-0.821), I2 = 0 %, p < .05, and handgrip strength, SMD = 0.929, 95 % CI (0.194-1.663), I2 = 48.217 %, p < .05].

CONCLUSIONS

This meta-analysis indicates that Taekwondo training is a beneficial therapy with protective effects on cognitive function, physical function, and body composition in older adults. These findings highlight its potential significance in cognitive rehabilitation and physiological health promotion among this demographic population.

The effects of mind-body exercise on anxiety and depression in older adults: a systematic review and network meta-analysis

Background

Limited research directly compares the clinical effects of different types of mind-body exercises on anxiety and depression in older adults. Therefore, we conducted a systematic review and network meta-analysis of randomized controlled trials that meet the inclusion criteria to explore the intervention effects of five different types of mind-body exercises in improving anxiety and depression in older adults.

Methods

We followed the PRISMA-NMA guidelines and conducted searches in the Web of Science, PubMed, the Cochrane Library, and Embase databases up to July 28, 2023. The language was limited to English. Two independent reviewers conducted literature screening and data extraction. Review Manager 5.4 was used to perform Pairwise meta-analysis and risk assessment, while STATA version 15 software was used for network meta-analysis.

Result

A total of 42 studies, involving 2974 participants, were included. The results of the traditional meta-analysis showed that mind-body exercises were superior to the control group in alleviating anxiety (SMD: -0.87, 95% CI: -1.43, -0.31, p<0.05, I2 = 95%) and depressive (SMD: -0.52, 95% CI: -0.71, -0.34, p<0.05, I2 = 80%). In the network meta-analysis, the ranking of treatment effects for anxiety showed that Tai Chi > Qigong > Yoga > Dance > control group, while for depression, the ranking showed Tai Chi > Pilates > Yoga > Qigong > Dance > control group.

Conclusion

This study found that mind-body exercises have positive effects on improving anxiety and depression in older adults. Among the five different types of mind-body exercise interventions, Tai Chi was considered an effective approach for improving anxiety and depression. However, we encourage older adults to choose exercise modalities that suit their interests to enhance adherence.

Systematic review registration

http://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023464296.

The effect of mind-body exercise in lung cancer patients: a meta-analysis of RCTs

PURPOSE

This study aimed to evaluate the impact of mind-body exercise (yoga, tai chi, qigong, etc.) on lung cancer.

METHODS

We performed a literature search of the electronic databases PubMed, Web of Science, Cochrane Library, Embase, CNKI, CBM, WanFang Data, and VIP from their inception to 16 May 2023. The primary outcome was the 6-min walk test (6MWT), while the secondary outcomes were anxiety levels and quality of life (QoL). Two independent reviewers performed the data extraction using a predefined protocol and assessed the risk of bias using the Cochrane risk of bias (ROB) tool for randomized controlled trials, with differences agreed by consensus. Meta-analysis was performed using RevMan 5.4 and Stata 15 software to analyze the extracted data.

RESULTS

This meta-analysis included a total of 11 studies involving 897 patients. The results indicated that compared to the usual care group, lung cancer patients in the mind-body exercise group could increase the 6-min walk distance (5 studies, 346 participants, WMD: 18.83, 95% CI (7.55, 30.10) P = 0.001), reduce anxiety levels (4 studies, 362 participants, SMD: - 1.51, 95% CI (- 1.74, - 1.27), P < 0.05), and enhance the overall quality of life (6 studies, 594 participants, SMD: 0.71, 95% CI (0.10, 1.31), P = 0.02). The overall certainty of the evidence for all outcomes was low; seven studies were judged to be at low risk of bias, and four studies were judged to be at moderate risk of bias.

CONCLUSION

Mind-body exercise could improve exercise capacity in lung cancer survivors, reduce anxiety, and positively affect overall quality of life.

PROSPERO REGISTRATION NUMBER

CRD42023426800.

The influence of Tai Chi exercise on the subjective well-being in the aged: the mediating role of physical fitness and cognitive function

This study investigated the effects of Tai Chi exercise on subjective well-being in the aged. The participants were randomly assigned to an experimental group or a control group. The experimental group received 12-week Tai Chi exercise while the control group maintain their original living habits. The participants' subjective well-being, physical fitness, self-control, and executive function were measured at baseline and after 12 weeks of Tai Chi exercise. Results: (1) Tai Chi exercise can positively affect the subjective well-being of the aged (F(1,78) = 37.699, p < 0.001); (2) Tai Chi exercise could affect the subjective well-being in the aged through the independent intermediary of physical fitness (95% CI=[0.115, 0.485]) and self-control (95% CI=[0.109, 0.433]); (3) Tai Chi exercise could indirectly affect the subjective well-being in the aged through the chain mediation of executive function and self-control (95% CI=[0.009, 0.104]). This study provides valuable insights into the potential benefits of Tai Chi exercise for subjective well-being in the aged.

An RCT-reticulated meta-analysis of six MBE therapies affecting college students' negative psychology

The positive impact of mind-body movement therapy on mental health has been confirmed, but the current effect of various mind-body movement-specific therapies on improving the negative psychology of college students is controversial. This study compared the effects of six mind-body exercise (MBE) therapies on improving negative psychological symptoms in college students. The study found that Tai Chi (standardized mean difference [SMD] = -0.87, 95% confidence interval [CI] (-1.59, -0.15), p < 0.05), yoga (SMD = -0.95, 95% CI (-1.74, -0.15), p < 0.05), Yi Jin Jing (SMD = -1.15, 95% CI (-2.36, -0.05), p=<0.05), Five Animal Play (SMD = -1.1, 95% CI (-2.09, -0.02), p < 0.05), and Qigong Meditation (SMD = -1.31, 95% CI (-2.2, -0.4), p < 0.05) improved depressive symptoms in college students (p < 0.05). Tai Chi (SMD = -7.18, 95% CI (-13.18, -1.17), p = 0.019), yoga (SMD = -6.8, 95% CI (-11.79, -1.81), p = 0.008), and Yi Jin Jing (SMD = -9.21, 95% CI (-17.55, -0.87), p = 0.03) improved college students' anxiety symptoms. It shows that the six MBE therapies are effective in improving anxiety and depression in college students.

Effects of Tai Chi and Qigong on cognitive and physical functions in older adults: systematic review, meta-analysis, and meta-regression of randomized clinical trials

BACKGROUND

Older adults experience age-related declines in physical and cognitive functions due to interactions between aging and chronic diseases. Tai Chi and Qigong (TCQ) might be beneficial in improving the physical function and delaying the cognitive decline of this population. The potential underlying mechanism was explored to determine the effects of TCQ on cognitive function via direct or indirect pathways.

PURPOSE

The objective of this systematic review was to determine the effects of TCQ on cognitive and physical functions in older adults using meta-analysis, and to determine the impact of TCQ on cognitive function while controlling for physical function using a meta-regression approach.

METHODS

A systematic search of 13 electronic databases (in English, Korean, and Chinese languages) identified 10,292 potentially eligible studies published between inception and May 2022. The bias in individual studies was assessed using the Cochrane Risk of Bias (version 2.0) tool. The heterogeneity of the studies was evaluated using a 95% prediction interval, and the meta-analysis and meta-regression were implemented using the Comprehensive Meta-Analysis (version 3) software.

RESULTS

Our search identified 17 randomized studies (n = 2,365, mean age = 70.3 years). The results of the meta-analysis that used a random-effects model indicated that TCQ had significant effects on both cognitive (Hedges' g = 0.29, 95% confidence interval [CI] = 0.17 to 0.42) and physical (Hedges' g = 0.32, 95% CI = 0.19 to 0.44) functions. We used meta-regression to explore the effect size of TCQ in association with physical function level. The regression model was significant (Q = 25.01, p = .070), and 55% of the heterogeneity was explained by physical function as a moderator variable. The effects of TCQ on cognitive function remained significant in this model when controlling for the effect of physical function (β = 0.46, p = .011).

CONCLUSION

This meta-regression of 17 randomized studies strongly suggests that TCQ has beneficial effects on physical and cognitive functions in older adults. The effect of TCQ on cognitive function remained significant after taking into account the significant effects of physical function as a moderator. The findings imply the potential health benefits of TCQ by promoting cognitive function in older adults directly and indirectly through enhancing physical function. PROSPERO REGISTRATION NUMBER: *PROSPERO international prospective register of systematic reviews, registration ID CRD42023394358.

Association of walking pace and fall-related injury among Chinese older adults: Data from the SAGE survey

OBJECTIVE

Falls are an important public health issue that poses a threat to the health of senior people and reduces their ability to maintain independence, which in turn reduces poor quality of life. Several studies have demonstrated a positive relationship between physical function and fall, it remains unclear whether there is an association between gait speed and fall-related injuries among the aging population, which represent the largest proportion of older adults in China. Therefore, the aim of this study was to examine the association between gait speed and fall-related injuries among older Chinese adults.

METHODS

Data from the Global Ageing and Adult Health Survey (2007-2010) were analyzed. A stratified multi-stage cluster sampling design was used to collect the survey data. A total of 7558 Chinese adults aged 60 or older were included in this study. A 4-m walking test was used to assess gait speed. Fall-related injuries were self-reported by study participants. The binary logistic regression model was employed to examine the association between gait speed and fall-related injuries while controlling for age, sex, education years, smoking, alcohol consumption, and chronic diseases.

RESULTS

The mean age of the sample of older Chinese adults was 69.70 ± 7.10 years (females accounted for 52.6%). The results showed that a normal gait speed was negatively correlated with fall-related injury (odds ratio = 1.20) when adjusting for all covariates. Moreover, a binary regression analysis showed that a normal gait speed was only negatively correlated with fall-related injury in male participants (odds ratio = 1.32). There were no significant results in rapid gait speed and fall-related injuries.

CONCLUSION

The results suggest that a slow gait speed may predict a higher risk of fall-related injuries among older Chinese adults, especially older male adults. Further studies are needed to verify our findings.

Effects of the different Tai Chi exercise cycles on patients with essential hypertension: A systematic review and meta-analysis

Objective

The main treatment for essential hypertension at this stage is pharmacotherapy. Long-term pharmacotherapy is costly with some side effects. Tai Chi, a bright star in traditional Chinese arts, relaxes both mind and body and has been shown to relax blood vessels and lower blood pressure. This study aimed to systematically review the therapeutic effectiveness of the Tai Chi exercise cycle on blood pressure and cardiovascular risk factors of patients with essential hypertension.

Methods

Searching CNKI, VIP, CBM, PubMed, EBSCO, Embase, Cochrane Library, and Web of Science to collect randomized controlled trials about Tai Chi exercise in the treatment of patients with essential hypertension according to the inclusion and exclusion criteria. The search time ranged from the date of database construction to December 2022. The Cochrane risk-of-bias tool was used to evaluate the included trials. The meta-analysis was performed with RevMan5.3 and Stata12.0 software.

Results

According to the meta-analysis, compared with the controls, Tai Chi exercise with a cycle of more than 12 weeks may be better for the reduction of systolic blood pressure (SBP) [MD = -11.72, 95% CI (-15.52, -7.91)] and diastolic blood pressure (DBP) [MD = -4.68, 95% CI (-7.23, -2.12)], as well as increasing the content of nitric oxide (NO) [MD = 0.99, 95% CI (0.69, 1.28)]. The blood lipid metabolism ability may also be improved after more than 12 weeks of Tai Chi exercise, total cholesterol (TC) [SMD = -0.68, 95% CI (-0.89, -0.46), triglyceride (TG) [SMD = -0.84, 95% CI (-1.25, -0.43)], low-density lipoprotein cholesterol (LDL-C) [SMD = -1.58, 95% CI (-2.29, -0.86)]. However, the improvement of high-density lipoprotein cholesterol (HDL-C) [SMD = 0.54, 95% CI (0.28, 0.79)] was better with a less than 12 weeks exercise cycle. A subgroup analysis for exercise frequency and time showed that the exercise frequency should preferably be more than or equal to 5 times per week for patients with hypertension, and for patients with hypertension plus hyperlipidemia, the exercise frequency less than 5 times per week with exercise time less than 60 min each day may be more beneficial.

Conclusion

The meta-analysis indicated that a more than 12 weeks Tai Chi exercise cycle with less than 60 min each time and more than 5 times per week may be more beneficial in blood pressure reduction, NO level increasing and blood lipid metabolism improving in the comparison with the other exercise cycles. For patients with hypertension plus hyperlipidemia, exercise frequency of less than 5 times per week may be better.

Systematic Review Registration

[http://www.crd.york.ac.uk/prospero], identifier [CRD42022352035].

Concepts and Application of Tai Ji in Stroke Rehabilitation: A Narrative Review

Stroke remains a leading cause of adult disability, and it decreases the health-related quality of life due to functional disability and poor functional recovery in stroke. Tai Ji has been recently introduced to overcome disabilities. This review aims to explain the effects of Tai Ji on functional recovery in stroke patients, linking it to current approaches, concepts and therapies such as Bobath and proprioceptive neuromuscular facilitation techniques. A compilation of recent literature on Tai Ji's use in stroke rehabilitation from Google scholar and PubMed Central (2018 to 2022). The benefits of Tai Ji in stroke functional recovery were studied and explained based on its similarity in concepts to current conventional stroke rehabilitation approaches. There were few randomized controlled trials on Tai Ji in functional recovery among stroke patients. However, all literature identified Tai Ji as beneficial in stroke rehabilitation. However, there was no literature on explaining the Tai Ji movement based on current conventional stroke rehabilitation approaches. Tai Ji carries similar theories to the current neurorehabilitation approach. Tai Ji can be modified and incorporated into stroke rehabilitation programs based on patients' needs to produce promising outcomes.

Effectiveness of Taijiquan in treating insomnia: A systematic review and meta-analysis of randomized controlled studies

BACKGROUND

Sleep efficiency of <80% based on actigraphy was defined as insomnia as self-reported difficulty falling asleep or waking up at night three to four times per week. It is known that adequate sleep is very important for human wellbeing, affecting people's work and life, insomnia will seriously damage our daily life. There is no recognized non-drug treatment. Studies have found that Taijiquan has a positive effect on insomnia patients. This systematic review and meta-analysis will evaluate the effect of Taijiquan on insomnia.

METHODS

To find all randomized controlled trials exploring the effects of Taijiquan on insomnia patients in Chinese and English, eight databases (Pubmed, Embase, Cochrane library, Web of Science, CNKI, CBM, VIP, and Wanfang Data) were searched. The retrieval time is from database construction to October 2021. Searches were conducted in both English and Chinese language. A meta-analysis by mean difference (MD) and 95% confidence interval (CI) was performed with RevMan 5.3. The risk of bias for each study was accounted for according to the Cochrane Handbook. Our primary outcome was Pittsburg Sleep Quality Index. We explored sources of heterogeneity by comparing effect sizes across different types of etiology, country, control group, and intervention type. The protocol was pre-registered with PROSPERO, CRD42021284511.

RESULTS

Twenty-one RCTs published between 2004 and 2021 with 2,022 participants were included in this study. Twenty-one randomized controlled studies showed that Tai Chi significantly improved PSQI scores in patients with cancer, muscle fibrosis, and sub-health insomnia [MD = -1.16, 95% CI (-1.62, -0.71), P < 0.01]; There is insufficient evidence of improvement in patients with cerebrovascular disease [MD = -0.54, 95% CI (-1.58, 0.51), P = 0.31]; 8-form, 10-form or 24-form Yang's Taijiquan had the same effect in improving PSQI [MD = -1.33, 95% CI (-1.85, -0.81), P < 0.01]. When there is no treatment, exercise, exercise and health education as the control, taijiquan has a significant effect on insomnia treatment, and there is no difference in efficacy compared with cognitive behavioral therapy and health education (usual care) alone.

CONCLUSIONS

The results of the study showed that Taijiquan significantly improved sleep quality in healthy adults and patients with chronic diseases, which suggests that Taijiquan may be considered as an alternative behavioral therapy in the treatment of insomnia. In the future, more high-quality, well-controlled randomized trials are needed to better inform clinical decisions.

Determining Whether Tai Chi Chuan Is Related to the Updating Function in Older Adults: Differences Between Practitioners and Controls

Background

Tai Chi Chuan (TCC) is an effective method for delaying cognitive decline in older adults. However, in older adults, the association between long-term TCC practice and working memory updating has not been extensively studied.

Objective

This cross-sectional study investigated how updating function operationalized via Reaction Times (RTs) and Accuracy Rates (ARs) of N-Back tasks being measured in a laboratory setting is related to long term practice of TCC.

Methods

Twenty-six healthy elderly people participated in this experiment. According to the duration of time TCC was practiced, 13 subjects in the TCC group had more than 5 years of experience with TCC exercise, and 13 elderly subjects who had not been systematically exposed to mind-body exercise were assigned to the control group. The N-back task was administered to every participant to evaluate the updating function.

Results

The TCC group had faster RTs than the control group (p < 0.05). For the 1-back task, the TCC group showed faster RTs than the control group; for the 2-back task, the TCC group exhibited faster RTs than the control group. The TCC group had higher ARs than the control group (p < 0.05). For the 1-back task, the TCC group showed higher ARs than the control group; for the 2-back task, the TCC group exhibited higher ARs than the control group.

Conclusions

Long-term TCC practitioners exhibit a better updating function as compared to controls who did not practice TCC. Thus, our findings suggest that long-term TCC positively influences the updating function of older adults, making it, in turn, an effective mind-body exercise to maintain specific aspects of cognitive functioning.

Mind–Body Exercises for PTSD Symptoms, Depression, and Anxiety in Patients With PTSD: A Systematic Review and Meta-Analysis

Objectives

This study aims to systematically analyze the effects of mind–body exercises on post-traumatic stress disorder (PTSD) symptoms, depression, and anxiety in patients with PTSD. Furthermore, it intends to provide scientific evidence-based exercise prescriptions.

Methods

Chinese (i.e., China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, and Wanfang) and English (i.e., Web of Science, PubMed, the Cochrane Library, and EMBASE) databases were used as data sources to search for studies on the effects of mind–body exercises on symptoms associated with patients with PTSD from January 1980 to November 2020. After a rigorous screening, 16 eligible randomized controlled trials (RCTs) were included in the meta-analysis.

Results

Mind–body exercises exerted a significant effect on PTSD symptoms [standard mean difference (SMD) = −0.41, 95% confidence interval (CI) −0.64 to −0.19, p < 0.001], depression (SMD = −0.35, 95% CI: −0.55 to −0.15, p < 0.001), and anxiety (SMD = −0.31, 95% CI: −0.74 to −0.12, p < 0.001) among patients with PTSD. Subgroup analysis demonstrated that 60–150 min per session for 8–16 weeks of mindfulness was more effective in improving symptoms in patients with PTSD under 45 years of age compared with other subgroups. For depression, 150–180 min of yoga exercises once per week was effective. For anxiety, the frequency, timing, duration, and type of mind–body exercises that are most effective in relieving anxiety in patients with PTSD cannot be determined at this time due to the limited number of eligible RCTs.

Conclusions

Mind–body exercises were found to be significantly effective in improving PTSD symptoms, depression, and anxiety in patients with PTSD. Therefore, they can be used as an adjunct to intervention for symptoms of patients with PTSD. However, this conclusion requires further confirmation through additional scientific and objective RCTs.

Systematic Review Registration:

Unique Identifier: INPLASY2020120072.

A Systematic Review of the Effectiveness of Tai Chi Exercises for Improving Balance and Lower Limb Muscle Strength of the Elderly in the Community

BACKGROUND: Balance disorders are the primary cause of falls, a significant health concern for the elderly. Tai Chi (TC) improves the balance and strength of the lower limb muscles that focus on centering the mind, bodywork, and breathing exercises. AIM: A systematic review was conducted to search for evidence of the effects of Thai Chi in balancing and strengthening of lower extremities among the elderly in the community. METHODS: According to the preferred reporting items for systematic reviews and meta-analyses guidelines, a systematic review was conducted. Databases included Science Direct, ProQuest, and PubMed, from 2015 to 2020, with research articles being original studies. The quality of research articles was assessed using the Physiotherapy Evidence Database scale. Systematically analyses were used for results syntheses. RESULTS: Six articles were included in this review. TC exercises effectively improve the balance and muscle strength of the lower limbs among the elderly in the community. TC has a beneficial effect on evaluation in the short (8 weeks) and long (12 weeks) term to prevent falls among the elderly in the community. CONCLUSION: TC exercises are beneficial for improving balance and muscle strength of the lower limb among the elderly in the community with Selected TC, Traditional TC, and Modified Chen-style TC.

Effect of Tai Chi on muscle strength, physical endurance, postural balance and flexibility: a systematic review and meta-analysis

Objective

To investigate the impact of Tai Chi training on muscle strength, physical endurance, postural balance and flexibility, as measured by tests commonly used in health-related fitness or competitive sports contexts.

Design

Systematic review and meta-analysis.

Data sources

The following databases were searched up to 31 July 2020: CINAHL, Cochrane Library, MEDLINE via PubMed and SPORTDiscus.

Eligibility criteria for studies

Inclusion: (1) Randomised controlled trials published in German or English; (2) Tai Chi used as an intervention to improve physical performance; (3) Test methods commonly used in health-related fitness or competitive sports and (4) Participants aged ≥16 years (irrespective of health status). Exclusion: (1) Studies not focusing on Tai Chi or including Tai Chi mixed with other interventions and (2) Modified or less than eight Tai Chi movements.

Results

Out of 3817 records, 31 studies were included in the review, 21 of them in the meta-analysis. Significant improvements in handgrip strength (2.34 kg, 95% CI 1.53 to 3.14), walking distance during 6 min (43.37 m, 95% CI 29.12 to 57.63), standing time in single-leg-stance with open eyes (6.41 s, 95% CI 4.58 to 8.24) and thoracolumbar spine flexibility (2.33 cm, 95% CI 0.11 to 4.55) were observed.

Conclusion

Tai Chi training seems to moderately improve physical fitness when evaluated by tests used in health-related fitness or competitive sports. Moreover, thoracolumbar spine flexibility seems to be a factor in the improvement of postural balance. Further research is needed, including younger healthy participants performing a widely used, standardised form (eg, Peking-style routine) with high-intensity movements (eg, use of lower stances).

Cognitive Benefits of Activity Engagement among 12,093 Adults Aged over 65 Years

OBJECTIVE

The present study includes two aims: (1) to understand patterns of activity engagement among older Chinese adults; (2) to further investigate associations between activity engagement and cognitive abilities in this population.

METHODS

Latent class analysis was applied to answer the aforementioned research questions across different age ranges while controlling for confounding variables (age, health, socioeconomic status (SES), and living alone). Specifically, five latent classes (non-active, working-active, comprehensive-active, physical-active, and less-active) were identified. Furthermore, associations between the classes of activity engagement and cognition were examined separately in three age groups: less than 80 years (young-old group), 80-99.5 years (old-old group) and more than 100 years (oldest-old group) of age.

RESULTS

Compared with Non-active older individuals, the other classes with a higher probability of engagement in various activities generally showed higher cognitive abilities (including general cognition, orientation, calculation, recall, and language), but not all patterns of active engagement in daily life were positively associated with better cognitive status across different age ranges. In particular, differences in the individuals' cognitive abilities across the four active latent classes were especially obvious in the old-old group as follows: the Comprehensive-active class had higher general cognitive and recall abilities than the other three active classes and higher calculation and language abilities than the Working-active class. In addition, significant sex differences were observed in activity patterns, cognition, and their associations in the young-old and old-old groups. Culture-specific programs should be customized to subgroups of different ages and genders by providing different training or activity modules based on their related dimensions of cognitive decline.

The Effects of Tai Chi and Qigong on Immune Responses: A Systematic Review and Meta-Analysis

Background: Effective preventative health interventions are essential to maintain well-being among healthcare professionals and the public, especially during times of health crises. Several studies have suggested that Tai Chi and Qigong (TQ) have positive impacts on the immune system and its response to inflammation. The aim of this review is to evaluate the current evidence of the effects of TQ on these parameters. Methods: Electronic searches were conducted on databases (Medline, PubMed, Embase and ScienceDirect). Searches were performed using the following keywords: "Tai Chi or Qigong" and "immune system, immune function, immunity, Immun*, inflammation and cytokines". Studies published as full-text randomized controlled trials (RCTs) in English were included. Estimates of change in the levels of immune cells and inflammatory biomarkers were pooled using a random-effects meta-analysis where randomised comparisons were available for TQ versus active controls and TQ versus non-active controls. Results: Nineteen RCTs were selected for review with a total of 1686 participants and a range of 32 to 252 participants within the studies. Overall, a random-effects meta-analysis found that, compared with control conditions, TQ has a significant small effect of increasing the levels of immune cells (SMD, 0.28; 95% CI, 0.13 to 0.43, p = 0.00), I2 = 45%, but not a significant effect on reducing the levels of inflammation (SMD, -0.15; 95% CI, -0.39 to 0.09, p = 0.21), I2 = 85%, as measured by the systemic inflammation biomarker C-reactive protein (CRP) and cell mediated biomarker cytokines. This difference in results is due to the bidirectional regulation of cytokines. An overall risk of bias assessment found three RCTs with a low risk of bias, six RCTs with some concerns of bias, and ten RCTs with a high risk of bias. Conclusions: Current evidence indicates that practising TQ has a physiologic impact on immune system functioning and inflammatory responses. Rigorous studies are needed to guide clinical guidelines and harness the power of TQ to promote health and wellbeing.

Effectiveness of A Pilates Training Program on Cognitive and Functional Abilities in Postmenopausal Women

The purpose of this study was to determine the effects of a Pilates exercises program on the cognitive and physical functioning of older Spanish women. This study is a randomized clinical trial; a total of 110 women aged ≥60 years were initially allocated to either a Pilates group (PG, n = 55), who underwent a 12-week Pilates exercise program, or to a control group (CG, n = 55), who did not receive any intervention. Global cognitive function (Mini-Mental State Examination), verbal fluency (Isaacs test), executive function (Trail Making Test), functional flexibility (Back Scratch Test and Chair Sit-and-Reach Test), and lower-body strength (30 s Chair-Stand Test) were assessed before and immediately after the intervention period. The main findings of this study suggest that women in the PG (within-group differences) experienced improvements across all the variables examined except for global cognitive function. When compared with the CG (between-group differences), our analysis revealed significant benefits in the PG for all measures except for global cognitive function and functional flexibility (Back Scratch Test). In conclusion, our results suggest that Pilates has the potential to improve both cognitive and functional abilities among Spanish women aged 60 years and over.

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.

Correlation Between Cognition and Balance Among Middle-Aged and Older Adults Observed Through a Tai Chi Intervention Program

Background

Age-associated decline in cognition and balance may cause severe ability loss for daily living activities among middle-aged and older adults. The relationship between cognition and balance in this aging population remains to be explored.

Objective

The present study Is exploratory in nature and aimed to examine the relationship between balance (both static and dynamic components) and global cognitive function among middle-aged and older adults through Tai Chi (TC) practice as a research avenue.

Methods

A short-term (12 weeks) intervention of TC was conducted among middle-aged and older adults in the community setting. Global cognitive function (using the Chinese version of the Montreal Cognitive Assessment score (MoCA) and balance (i.e., one leg standing test score; Timed Up and Go Test score, TUGT) of all participants were assessed before and after the intervention. Age, body mass index (BMI), sex, and physical fitness variables (Chair Stand Test, CST; the 6-Meter Walk Test, 6MWT) were also collected as confounding factors.

Results

Significant moderator effects of baseline CST on the association between the dichotomized baseline MoCA score and the baseline left leg balance score (p = 0.0247), the baseline right leg balance score (p = 0.0140) and the baseline TUGT score (p = 0.0346) were found. Change score of left score balance (p = 0.0192) and change score of TUGT (p = 0.0162) were found to be significantly associated with change score of cognitive function.

Conclusion

Cognitive function and balance are interrelated in middle-aged and older adults. The association between global cognitive function and balance Is moderated by strength of lower limbs. The change scores of cognitive function and balance introduced by TC training were found to be positively correlated. Future research Is warranted to further confirm the cause-effect relationship of cognitive function and balance and its influencing factors among middle-aged and older adults utilizing intervention studies with larger sample sizes.

Tai Chi Training Evokes Significant Changes in Brain White Matter Network in Older Women

Background: Cognitive decline is age relevant and it can start as early as middle age. The decline becomes more obvious among older adults, which is highly associated with increased risk of developing dementia (e.g., Alzheimer’s disease). White matter damage was found to be related to cognitive decline through aging. The purpose of the current study was to compare the effects of Tai Chi (TC) versus walking on the brain white matter network among Chinese elderly women. Methods: A cross-sectional study was conducted where 42 healthy elderly women were included. Tai Chi practitioners (20 females, average age: 62.9 ± 2.38 years, education level 9.05 ± 1.8 years) and the matched walking participants (22 females, average age: 63.27 ± 3.58 years, educational level: 8.86 ± 2.74 years) underwent resting-state functional magnetic resonance imaging (rsfMRI) scans. Diffusion tensor imaging (DTI) and graph theory were employed to study the data, construct the white matter matrix, and compare the brain network attributes between the two groups. Results: Results from graph-based analyses showed that the small-world attributes were higher for the TC group than for the walking group (p < 0.05, Cohen’s d = 1.534). Some effects were significant (p < 0.001) with very large effect sizes. Meanwhile, the aggregation coefficient and local efficiency attributes were also higher for the TC group than for the walking group (p > 0.05). However, no significant difference was found between the two groups in node attributes and edge analysis. Conclusion: Regular TC training is more conducive to optimize the brain functioning and networking of the elderly. The results of the current study help to identify the mechanisms underlying the cognitive protective effects of TC.

Effects of mind-body exercises for osteoporosis in older adults: Protocol for systematic review and Bayesian network meta-analysis of randomized controlled trials

BACKGROUND

Osteoporosis is an important cause of bone fractures and even a cause of threaten to the lives of elderly people. Mind-body exercises are beneficial interventions for improving flexibility, controlling body balance, and reducing pain. To assess the effect of mind-body exercise on osteoporosis in aging people, we will perform this systematic review.

METHODS

Randomized controlled trials (RCTs) which carried out about mind-body exercise for osteoporosis will be included. Web of Science, PubMed, Science Direct, Medline, Cochrane Library, China National Knowledge Infrastructure, and Wanfang will be searched from inception to January 2020. The outcomes will include bone mineral density (BMD), bone mineral content (BMC), body balance, function of lower extremity, pain, fearing level, and quality of life. Trial reporting quality will be assessed by 2 reviewers independently and Review Manager 5.3 software will be used for meta-analysis. Trial registration is under PROSPERO (CRD42020165385).

RESULTS

Based on the current evidence, the potential rank of the efficacy and safety of mind-body exercises for BMD, BMC, body balance, function of lower extremity, pain, fearing level and quality of life will be assessed, and a prioritization regimen will be summarized.

CONCLUSIONS

Evidence from this systematic review could be useful for patients, clinical practitioners, and guideline-makers to select an optimum proposal of mild-body exercises for older adults with osteoporosis.

Mind-Body Exercise for Anxiety and Depression in COPD Patients: A Systematic Review and Meta-Analysis

Objectives: Mind–body exercise has been generally recognized as a beneficial strategy to improve mental health in those with Chronic Obstructive Pulmonary Disease (COPD). However, to date, no attempt has been made to collate this literature. The aim of the present study was to systematically analyze the effects of mind–body exercise for COPD patients with anxiety and depression and provide scientific evidence-based exercise prescription. Methods: both Chinese and English databases (PubMed, the Cochrane Library, EMBASE, Web of Science, Google Scholar, Chinese National Knowledge Infrastructure, Wanfang, Baidu Scholar) were used as sources of data to search randomized controlled trials (RCT) relating to mind–body exercise in COPD patients with anxiety and depression that were published between January 1982 to June 2019. 13 eligible RCT studies were finally used for meta-analysis. Results: Mind–body exercise (tai chi, health qigong, yoga) had significant benefits on COPD patients with anxiety (SMD = −0.76, 95% CI −0.91 to −0.60, p = 0.04, I² = 47.4%) and depression (SMD = −0.86, 95% CI −1.14 to −0.58, p = 0.000, I² = 71.4%). Sub-group analysis indicated that, for anxiety, 30–60 min exercise session for 24 weeks of health qigong or yoga had a significant effect on patients with COPD who are more than 70 years and have more than a 10-year disease course. For depression, 2–3 times a week, 30–60 min each time of health qigong had a significant effect on patients with COPD patients who are more than 70 years old and have less than a 10-year disease course. Conclusions: Mind–body exercise could reduce levels of anxiety and depression in those with COPD. More robust RCT are required on this topic.

The Rehabilitative Effects of Virtual Reality Games on Balance Performance among Children with Cerebral Palsy: A Meta-Analysis of Randomized Controlled Trials

This research aims to evaluate the effect of virtual reality (VR) games on balance recovery of children with cerebral palsy (CP) by quantitatively synthesizing the existing literature, and to further determine the impact of VR game intervention (the duration of each intervention, intervention frequency, intervention cycle, and total intervention time) on the balance recovery of children with CP. To this end, relevant literature up until 3 August 2019 was retrieved from Chinese databases (CNKI and Wanfang Data) and the databases in other languages (Web of Science, Pubmed, EBSCOhost, Informit, Scopus, Science Direct, and ProQuest), and bias analysis was conducted with the PEDro scale in this research. Randomized controlled trials (RCTs) were selected and underwent meta-analysis, and combined effect size was calculated with a random effects model. The results showed that VR games may improve the balance of children with CP (Hedge’s g = 0.29; 95% CI 0.10–0.48), and no significant influence of the intervention on balance of children with CP was shown in the subgroup analysis. In conclusion, VR games played a positive role in the improvement of balance of children with CP, but these results should be viewed with caution owing to current methodological defects (difference in measurement, heterogeneity of control groups, intervention combined with other treatments, etc.).

Are Mindful Exercises Safe and Beneficial for Treating Chronic Lower Back Pain? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Chronic low back pain (CLBP) is a common health issue worldwide. Tai Chi, Qigong, and Yoga, as the most widely practiced mindful exercises, have promising effects for CLBP-specific symptoms.

OBJECTIVE

We therefore conducted a comprehensive review investigating the effects of mindful exercises versus active and/or non-active controls while evaluating the safety and pain-related effects of mindful exercises in adults with CLBP.

METHODS

We searched five databases (MEDLINE, EMBASE, SCOPUS, Web of Science, and Cochrane Library) from inception to February 2019. Two investigators independently selected 17 eligible randomized controlled trials (RCT) against inclusion and exclusion criteria, followed by data extraction and study quality assessment. Standardized mean difference (SMD) was used to determine the magnitude of mindful exercises versus controls on pain- and disease-specific outcome measures.

RESULTS

As compared to control groups, we observed significantly favorable effects of mindful exercises on reducing pain intensity (SMD = -0.37, 95% CI -0.5 to -0.23, p < 0.001, I2 = 45.9 %) and disability (SMD = -0.39, 95% CI -0.49 to -0.28, p < 0.001, I2 = 0 %). When compared with active control alone, mindful exercises showed significantly reduced pain intensity (SMD = -0.40, p < 0.001). Furthermore, of the three mindful exercises, Tai Chi has a significantly superior effect on pain management (SMD= -0.75, 95% CI -1.05 to -0.46, p < 0.001), whereas Yoga-related adverse events were reported in five studies.

CONCLUSION

Findings of our systematic review suggest that mindful exercises (Tai Chi and Qigong) may be beneficial for CLBP symptomatic management. In particular, Tai Chi appears to have a superior effect in reducing pain intensity irrespective of non-control comparison or active control comparison (conventional exercises, core training, and physical therapy programs). Importantly, training in these mindful exercises should be implemented with certified instructors to ensure quality of movement and injury prevention.

Superior Effects of Modified Chen-Style Tai Chi versus 24-Style Tai Chi on Cognitive Function, Fitness, and Balance Performance in Adults over 55

BACKGROUND

Cognitive decline and balance impairment are prevalent in the aging population. Previous studies investigated the beneficial effects of 24-style Tai Chi (TC-24) on either cognitive function or balance performance of older adults. It still remains largely unknown whether modified Chen-style TC (MTC) that includes 18 complex movements is more beneficial for these age-related health outcomes, as compared to TC-24.

OBJECTIVE

We investigated if MTC would show greater effects than TC-24 on global cognitive function and balance-related outcomes among older adults.

METHODS

We conducted a randomized trial where 80 eligible adults aged over 55 were allocated into two different styles of Tai Chi (TC) arms (sixty-minute session × three times per week, 12 weeks). Outcome assessments were performed at three time periods (baseline, Week 6, and Week 12) and included the Chinese Version of the Montreal Cognitive Assessment (MoCA) for overall cognitive function, One-leg Standing Test (LST) for static balance, Timed Up and Go Test (TUGT) for dynamic balance, chair Stand Test (CST) for leg power, and the six-meter Walk Test (6MWT) for aerobic exercise capacity.

RESULTS

Compared to TC-24 arm, MTC arm demonstrated significantly greater improvements in MoCA, LST, TUGT, CST, and 6MWT (all p < 0.05).

CONCLUSIONS

Both forms of TC were effective in enhancing global cognitive function, balance, and fitness. Furthermore, MTC was more effective than TC-24 in enhancing these health-related parameters in an aging population.

Wuqinxi Qigong as an Alternative Exercise for Improving Risk Factors Associated with Metabolic Syndrome: A Meta-Analysis of Randomized Controlled Trials

Background: The improvement of living standards has led to increases in the prevalence of hypokinetic diseases. In particular, multifactorial complex diseases, such as metabolic syndrome, are becoming more prevalent. Currently, developing effective methods to combat or prevent metabolic syndrome is of critical public health importance. Thus, we conducted a systematic review to evaluate the existing literature regarding the effects of Wuqinxi exercise on reducing risk factors related to metabolic syndrome. Methods: Both English- and Chinese-language databases were searched for randomized controlled trials investigating the effects of Wuqinxi on these outcomes. Meanwhile, we extracted usable data for computing pooled effect size estimates, along with the random-effects model. Results: The synthesized results showed positive effects of Wuqinxi exercise on systolic blood pressure (SBP, SMD = 0.62, 95% CI 0.38 to 0.85, p < 0.001, I2 = 24.06%), diastolic blood pressure (DBP, SMD = 0.62, 95% CI 0.22 to 1.00, p < 0.001, I2 = 61.28%), total plasma cholesterol (TC, SMD = 0.88, 95% CI 0.41 to 1.36, p < 0.001, I2 = 78.71%), triglyceride (TG, SMD = 0.87, 95% CI 0.49 to 1.24, p < 0.001, I2 = 67.22%), low-density lipoprotein cholesterol (LDL-C, SMD = 1.24, 95% CI 0.76 to 1.72, p < 0.001, I2 = 78.27%), and high-density lipoprotein cholesterol (HDL, SMD = 0.95, 95% CI 0.43 to 1.46, p < 0.001, I2 = 82.27%). In addition, regression results showed that longer-duration Wuqinxi intervention significantly improved DBP (β = 0.00016, Q = 5.72, df = 1, p = 0.02), TC (β = -0.00010, Q = 9.03, df = 1, p = 0.01), TG (β = 0.00012, Q = 6.23, df = 1, p = 0.01), and LDL (β = 0.00011, Q = 5.52, df = 1, p = 0.02). Conclusions: Wuqinxi may be an effective intervention to alleviate the cardiovascular disease risk factors of metabolic syndrome.