Tai chi 'may help people cope better with diseases of ageing'

Behind the Headlines

Monday September 21 2015

It is thought tai chi dates back to the 12th century

Tai chi is said to improve balance and flexibility

"Tai chi can help older patients with disabling conditions," The Guardian reports after an analysis of old data found the martial art may help relieve some symptoms of four age-related diseases: cancer, heart failureosteoarthritis and chronic obstructive pulmonary disease (COPD).

Notable significant effects were seen, with improvements in walking for those who had heart failure, improved strength of the big quadriceps muscles for those with heart failure and COPD, and pain and stiffness for people with osteoarthritis. There were also trends for effects on depression and quality of life for those with heart failure and COPD.

However, this review can't prove tai chi will definitely have a positive effect for people who have these conditions. The trials were highly variable in their study population, the type of tai chi practised, the type of comparison intervention, and the outcomes examined. Despite the large collective number of studies, most of the individual results were based on only one or a few studies. 

Nevertheless, remaining active and exercising within your limits is positive in all stages of life, even for those who have a chronic disease. If you find tai chi enjoyable and it boosts your physical or mental wellbeing, that can only be a good thing.

If tai chi is not your cup of oolong, you could always try the Strength and Flex exercise plan

Where did the story come from?

The study was carried out by researchers from the University of British Columbia and the University of Toronto, and was funded by the University of British Columbia and the British Columbia Lung Association.

It was published in the peer-reviewed British Journal of Sports Medicine.

The UK media provide a generally accurate picture of the evidence. However, it would have been helpful to note that this study was limited by the highly variable studies the researchers looked at, which makes it difficult to form any definite conclusions.   

What kind of research was this?

This systematic review aimed to identify trials looking at the effectiveness of tai chi for four common chronic conditions: cancer, heart failure, COPD and osteoarthritis. The results of the identified trials were then pooled in a meta-analysis to give an overall effect.

Tai chi involves gentle flowing movements to improve strength, posture and balance, and has become an increasingly popular form of exercise, particularly among the middle-aged and elderly.

It has also been tried as a complementary healthcare approach for many different conditions, with some studies suggesting it has both physical and psychosocial benefits.

This review aimed to gather the evidence surrounding the martial art to get an overall conclusive summary of its effects. However, the results of a systematic review are only ever as good as the studies included, so there may be inherent limitations in the quality of the various studies and the methods used.   

What did the research involve?

The researchers searched four literature databases up to the end of December 2014 for randomised controlled trials published in English that compared tai chi with any other control group in people with four chronic conditions: cancer, heart failure, COPD and osteoarthritis. The studies were assessed for quality, and the outcomes were pooled for different disease-specific symptoms and outcomes.

33 studies met the inclusion criteria, but several reported data in two or more publications, giving a total of 24 individual trials. There were five studies available each for cancer, heart failure and COPD, and nine for osteoarthritis. The results of all the osteoarthritis studies, and four of the studies for each of the other conditions, were pooled in the meta-analysis.

The trials were of average quality, with most having a score of five out of 10 on the quality scale used (the PEDro scale). The sample size of the trials included ranged from 11 to 206. The average age of the participants varied, but they tended to be in their 60s and 70s. 

What were the basic results?

The studies examined different physical and psychological outcomes. The main effects were as follows.

Physical symptoms

  • Walking – tai chi gave significant improvements on the six-minute walk test in people with heart failure and COPD. One study each for cancer and osteoarthritis found no effects on walking.
  • Muscle strength – one COPD and one heart failure study found significant improvement in knee extensor strength, but there was no effect in the osteoarthritis studies.
  • Getting up and moving – the osteoarthritis studies found tai chi improved the timed get up and go test result, as well as sit to stand times. One heart failure study found no effect.
  • Chronic disease symptoms – tai chi significantly improved pain, stiffness and physical function in osteoarthritis. In COPD, there was a trend towards tai chi improving shortness of breath compared with control, but this was non-significant. No two cancer studies reported the same outcome. There was a trend for reduced fatigue in one study, but this had an extremely small sample size.
  • Other physiological effects – heart failure studies found no effect on blood pressure or respiratory function.

Psychological outcomes

  • Quality of life – tai chi had significant effects on osteoarthritis, but there were no significant effects in COPD, cancer or heart failure studies.
  • Depression – tai chi was associated with significant improvements in depression symptoms in heart failure studies, but there were non-significant trends in osteoarthritis and COPD studies. In cancer, it was the control intervention (stress management) that improved symptoms rather than tai chi.  

How did the researchers interpret the results?

The researchers concluded that, "The results demonstrated a favourable effect or tendency of tai chi to improve physical performance, and showed that this type of exercise could be performed by individuals with different chronic conditions, including COPD, heart failure and osteoarthritis." 

Conclusion

This review searched the literature to summarise the effects of tai chi on four common chronic conditions. It identified a large number of trials collectively examining many different physical and psychological outcomes in a predominantly middle-aged to elderly population. 

The notable significant effects seemed to be for improvements in walking for those with heart failure, knee extensor strength for those with heart failure and COPD, and pain and stiffness for those with osteoarthritis. There were also trends for effects on depression and quality of life for people with heart failure and COPD.

The researchers concluded that tai chi could be performed by individuals for many different chronic conditions. However, this review can't demonstrate that tai chi will definitely have a positive effect if it's tried out by someone who has one of these chronic conditions.

Overall, the systematic review is a high-quality study design. However, the evidence is only as good as the studies included. The 24 individual studies in this review were widely different, and most results are based on one to a few studies.

Variations across the studies included:

  • The type of tai chi, the overall duration of the intervention, and the frequency and duration of individual sessions.  
  • The type of disease and severity, even within the same chronic disease category – for example, most cancer studies were in breast cancer, but even these varied in their stages, while another was just in "unknown cancer survivors".
  • Osteoarthritis varied between spine, hip and knee, and the severity of pain and disability.
  • The comparison groups varied – for example, some were just usual care or waiting list, others self-help education, some spiritual or psychological-related, and others varied physical activities such as walking, aerobics or stretching programmes. 
  • As demonstrated by the results, the outcomes examined varied widely, and individual outcomes were only examined by one to four studies per condition.
  • Sample sizes varied, and some were extremely small – for example, only 11 people in one study. Sometimes within these small studies, the dropout rate from the trial was also high – for instance, 10 people dropping out from a starting size of just 31 participants.

This makes it very difficult to say whether a certain type of tai chi will help individuals with chronic conditions.

Nevertheless, the benefits of exercising within our limits are well known – even when a person has a chronic disease. If you find tai chi enjoyable, this can only be a good thing.

The Tai Chi Union for Great Britain website has information about classes available in your area. 

Analysis by Bazian. Edited by NHS Choices. Follow NHS Choices on Twitter. Join the Healthy Evidence forum.

Analysis by Bazian

Edited by NHS Choices

Links to the headlines

Tai chi can help older patients with disabling conditions – study. The Guardian, September 17 2015

Tai Chi 'could be prescribed' for illnesses. BBC News, September 18 2015

Tai Chi could help older people with cancer, heart disease and osteoarthritis. Daily Mirror, September 18 2015

Links to the science

Chen Y, Hunt MA, Campbell KL, et al. The effect of Tai Chi on four chronic conditions—cancer, osteoarthritis, heart failure and chronic obstructive pulmonary disease: a systematic review and meta-analyses. British Journal of Sports Medicine. Published online September 17 2015

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