Are You Really Studying Tai Chi and is it Effective for Stress? Part 2

4. Tai Chi for Stress-related Symptoms

Control of Hypertension

In Wang et al.’s recent review (4) of Tai Chi, four studies (two with randomized control) were discussed in terms of its effects on hypertension, and all of them reported that it significantly decreased blood pressure among hypertensive patients.

The results in (11) suggest that light activity and moderate intensity aerobic exercise have similar effects on BP in previously sedentary elderly individuals. If future trials with large sample size and a no-exercise control group confirm these results, promoting light intensity activity could have substantial public health benefits as a means to reduce BP.

This study (13) examined the effects of Tai Chi vs. aerobic exercise for victims of heart attacks, comparing them to a cardiac support group as control. Resting heart rate declined in the Tai Chi group, but curiously, not in the aerobics group in this study. Both the Tai Chi and aerobics groups showed a drop on systolic blood pressure, but only the Tai Chi group showed a drop in diastolic blood pressure.

Improvement of Cardiovascular Conditions

Wang et al. (4) reviewed 16 studies of Tai Chi in patients with cardiorespiratory
conditions and reported that its regular practice will delay the decline of cardiorespiratory function in older adults and might be prescribed as a suitable exercise .

One of the few studies to focus on serious Tai Chi practitioners, mostly people in their 60's, who had been practicing the new Yang Long form for 3-10 years, appears in (10). They practiced 3-7 times a week, with an average frequency of 5 times a week. A fairly rigorous practice: 20 minutes of warm-up exercises, 24 minutes of practicing the form paced by the Master, and 10 minutes of cool-down. This study compares these Tai Chi practitioners to a group of sedentary peers matched for age and body size, and looks at cardiorespiratory declines over a two-year period. It has some heart rate profiles that seem to indicate moderate aerobic benefit in older practitioners (this benefit has not been demonstrated in younger subjects).

In (12), changes in heart rate and electrocardiogram were recorded by telemetry in 100 volunteers who were regularly doing a Yang simplified (short) form. During the exercise , the change in heart rate was not very marked and no important electrocardiographic changes were recorded. Thus, it was speculated that the possible beneficial effect of Tai chi on the cardiovascular system cannot be attributed solely to the amount of exercise provided by Tai Chi and additional mechanisms must be sought. The author notes that "16 male and 10 female hypertensives reported a gradual normalization in blood pressure cutting the need for medication entirely or reducing the doses."

The study (18) concluded that Tai Chi was a culturally appropriate mind-body exercise for older adults with cardiovascular risk disease factors. Statistically significant psychosocial benefits were observed over 12-weeks. Further research examining Tai Chi exercise using a randomized clinical trial design with an attention-control group may reduce potential confounding effects, while exploring potential mechanisms underlying the relaxation response associated with mind-body exercise. In addition, future studies with people with other chronic illnesses in all ethnic groups are recommended to determine if similar benefits can be achieved. The authors were unaware of an earlier study (19) on the beneficial effects of Tai chi for dialysis patients.

This research (21) compared the effects of a short style of Tai Chi versus a brisk walking training program on aerobic capacity, heart rate variability (HRV), strength, flexibility, balance. They found Tai Chi to be an effective way to improve many fitness measures in elderly women over a 3-month period It was also significantly better than brisk walking in enhancing certain measures of fitness , including lower extremity strength, balance and flexibility, psychological status, and quality of life.

Twenty patients with coronary heart disease were recruited for the study (28). Ten patients practiced supervised Tai Chi training once a week and home-based Tai Chi training three times a week, together with conventional cardiac rehabilitation for one year. The control group only received the conventional cardiac rehabilitation. The patients in the Tai Chi group showed statistically significant improvement in baroreflex sensitivity. The researchers concluded that Tai Chi training is beneficial in the treatment of coronary heart disease .

Reduction of Chronic Pain Syndrome and Arthritis Symptoms

Pain and fatigue significantly decreased in the experimental group in (14). However, the improvement in daily life performance of the rheumatoid arthritis patients was not statistically significant but their sense of balance was enhanced significantly.

Sun-style Tai Chi exercise (6) was found as beneficial for women with osteoarthritis to reduce their perceived arthritic symptoms and to healthier behavior .

In the short term study (15), the beneficial outcomes for Tai Chi group and aquatic group were significantly better than the self-help group. Tai Chi may be more suitable than aquatic exercise for osteoarthritis. Further longitudinal studies are necessary to confirm these results. Similar conclusions were reached in another study (16) comparing Tai Chi and an aquatic group for rheumatoid arthritis .

The results (17) suggest Tai Chi does not exacerbate symptoms of rheumatoid arthritis . In addition, Tai Chi has statistically significant benefits on lower extremity range of motion, in particular ankle range of motion, for people with RA. The included studies did not assess the effects on patient-reported pain.

The objective of this systematic review (25) is to evaluate data from controlled clinical trials testing the effectiveness of Tai Chi for treating rheumatoid arthritis (RA). Systematic searches were conducted on Medline, Pubmed, AMED, British Nursing Index, CINAHL, EMBASE, PsycInfo, The Cochrane Library 2007, Issue 1, the UK National Research Register and ClinicalTrials.gov, Korean medical databases, Qigong and Energy Medicine Database and Chinese databases up to January 2007.
Collectively this evidence is not convincing enough to suggest that Tai Chi is an effective treatment for RA. The value of Tai Chi for this indication therefore remains unproven.

Reduction of Anxiety and Depression

In (20), significant improvements in trait anxiety , pain perception, mood, flexibility, and balance were obtained. These may have a profound effect on the incidence of falls, injuries, resulting disability, and overall quality of life.

The study (22) aimed to assess the usefulness of two interventions in a group rehabilitation medicine setting and to determine strategies and exercise guidelines for long-term care of the HIV/AIDS population with human immunodeficiency virus (HIV) and/or acquired immunodeficiency syndrome (AIDS). It concluded that that Tai Chi and exercise improve physiologic parameters, functional outcomes, and quality of life. Group intervention provides a socialization context for management of chronic HIV disease. Further long and short term studies are required.

The effects on blood pressure, lipid profile, and anxiety status on subjects in a 12-week Tai Chi Chuan exercise program were studied (23). It concluded that Tai Chi exercise training could decrease blood pressure and results in favorable lipid profile changes and improve subjects' anxiety status. Therefore, Tai Chi could be used as an alternative modality in treating patients with mild hypertension, with a promising economic effect.

Another paper on the beneficial effect of Tai Chi on depression in older individuals appears in (26).

Immunity

At rest the total number of T-lymphocytes and the number of active T-lymphocytes were increased significantly in the exercise group compared with the controls (8). Immediately after a bout of Tai Chi (88 style), a marked increase of active T-lymphocytes occurred. In conclusion, the results indicate that frequent Tai Chi exercise causes an increase of T-lymphocytes in the blood.

According to a new study (24), Tai Chi may help older adults
avoid getting shingles by increasing immunity to varicella-zoster virus
(VZV) and boosting the immune response to varicella vaccine in older
adults. Tai Chi alone was found to increase participants' immunity to varicella
as much as the vaccine typically produces in 30- to 40-year-old adults,
and Tai Chi combined with the vaccine produced a significantly higher
level of immunity, about a 40 percent increase, over that produced by
the vaccine alone. The study further showed that the Tai Chi group's rate
of increase in immunity over the course of the 25-week study was double
that of the health education (control) group. The Tai Chi and health
education groups' VCV immunity had been similar when the study began.
In addition, the Tai Chi group reported significant improvements in
physical functioning, bodily pain, vitality and mental health. Both groups
showed significant declines in the severity of depressive symptoms.

Previous studies have suggested that Tai Chi may improve immune function. This
study (27) was intended to examine whether 5 months of moderate Tai Chiand Qigong (TQ) practice could improve the immune response to influenza vaccine in older adults. It concluded that traditional TQ practice improves the antibody response to influenza vaccine in older adults. However, further study is needed to determine whether the enhanced response is sufficient to provide definitive protection from influenza infection.

References

1. Eisen, M., Qigong and Taiji application in stress management . Part 2: Qigong for stress, Qi Dao, Jan. – Feb., 2008.
2. Achiron, A., Barak, Y., Stern, Y., Noy, S. Electrical sensation during Tai-Chi practice as the first manifestation of multiple sclerosis," Clinical Neurology and Neurosurgery, 99, 280-281, 1997.
3. Sandlund, E. S., & Norlander, T. The effects of Tai Chi Chuan relaxation and exercise on stress responses and well-being: An overview of research. International Journal of Stress Management,7(2), 139–149, April 2000.
4. Wang, C. C., Collet, J. P., & Lau, J. The effect of Tai Chi on health outcomes in patients with chronic conditions. Archive of Internal Medicine, 164, 493–501, 2004.
5. Kuramoto, A. M. Therapeutic benefits of Tai Chi exercise: research review. WMI, 6, 105(7), 42-6, Oct. 2006.
6. Song, R., Lee, E.O., Lam. P. Bae, S.C. Effects of a Sun-style Tai Chi exercise on arthritic symptoms, motivation and the performance of health behaviors in women with osteoarthritis. Taehan Kanho Hakhoe Chi, 37(2),249-56, March 2007.
7. Jin, P.. Changes in heart rate, noradrenaline, cortisol and mood during Tai Chi. Journal of Psychosomatic Research, Vol. 33, No. 2, 197-206, 1989.
8. Sun, X., Xu Y., Xia Y. Determination of E-rosette-forming lymphocytes in aged subjects with Taichiquan exercise. Int J Sports med, Vol.10, No 3, 217-219, 1989.
9. Jin, P. Efficacy of Tai Chi, brisk walking , meditation , and reading in reducing mental and emotional stress. Journal of Psychosomatic Research, Vol. 36, No. 4, 361-370, 1992.
10. Lai, J., Lan, C., Wong, M., and Teng, S. Two-year trends in cardiorespiratory function among older Tai Chi Chuan practitioners and sedentary subjects. Journal of the American Geriatric Society, Vol. 43: 1222-1227, 1995.
11. Young, D.R., Appel, L.J., Jee, S. The effects of aerobic exercise and T'ai Chi on blood pressure in the elderly,", Circulation v. 97(#8), 54-P54, March 3, 1998.
12. Gong, L, Qian J., Zhang J., Yang Q., Jiang J., and Tao Q. Changes in heart rate and electrocardiogram during Taijiquan exercise; analysis by telemetry in 100 subjects. Chinese Medical Journal 94(9), 589-592, 1981.
13. Channer, K.S., Barrow, D., Barrow, R., Osborne, M., and Ives, G. Changes in haemodynamic parameters following Tai Chi Chuan and aerobic exercise in patients recovering from acute myocardial infarction. Postgraduate Medical Journal, 349-351, 1990.
14. Lee, K.Y. and Jeong, O. Y. The effect of Tai Chi movement in patients with rheumatoid arthritis. Taehan Kanho Hakhoe Chi, 36(2),278-85, 2006.
15. Lee, H.Y. Comparison of effects among Tai-Chi exercise, aquatic exercise, and a self-help program for patients with knee osteoarthritis. Taehan Kanho Hakhoe Chi, 36(3), 571-80, 2006.
16. Kirsteins, A.E.; Dietz, F.; Hwang, S.M. Evaluating the safety and potential use of a weight-bearing exercise, Tai-Chi Chuan, for rheumatoid arthritis patients. Am. J. Phys. Med. Rehabil., 70(3), 136-41, 1991.
17. Han, A., Robinson, V., Judd, M., Taixiang, W., Wells G.; Tugwell, P. Tai Chi for treating rheumatoid arthritis. Cochtane Database Syst. Rev., (3), CD004859, 2004.
18. Taylor-Piliae, R.E., Haskell, W.L., Waters, C.M.; Froelicher, E.S. J. Adv. Nurs., 54(3), 313-29, 2006.
19. Mustata, S., Cooper, L., Langrick, N., Simon, N., Jassal, S.V,; Oreopoulos, D.G. The effect of a Tai Chi exercise program on quality of life in patients on peritoneal dialysis: a pilot study. Perit. Dial. Int., 25(3), 291 – 4, 2005.
20. Ross, M.C., Bohannon, A.S., Davis, D.C.; Gurchiek, L. The effects of a short-term exercise program on movement, pain, and mood in the elderly. Results of a pilot study. J. Holist. Nurs., Jun;17(2):139-47, 1999.
21 Audette, J.F., Jin, Y.S. , Newcomer, R., Stein, L. Duncan G., Duncan, G.; frontera, W.R. Tai Chi versus brisk walking in elderly women. Age Aging . Jul;35(4),388-93, 2006.
22. Galantino, M.L., Shepard, K., Krafft, L., Laperriere, A., Ducette, J., Sorbello, A., Barnish, M., Condoluci, D.; Farrar JT. The effect of group aerobic exercise and t'ai chi on functional outcomes and quality of life for persons living with acquired immunodeficiency syndrome. J. Altern. Complement. Med. Dec;11(6),1085-9, 2005.
23. Tsai JC, Wang WH, Chan P, Lin LJ, Wang CH, Tomlinson B, Hsieh MH, Yang HY, Liu JC. The beneficial effects of Tai Chi Chuan on blood pressure and lipid profile and anxiety status in a randomized controlled trial. J Altern Complement Med. Oct;9(5):747-54, 2003.
24. Irwin, M.R., et al. Augmenting immune responses to varicella
zoster virus in older adults: A randomized, controlled trial of Tai Chi. Journal of the American Geriatrics Society, Volume 55,4, 511–517, April 2007.
25. Lee et al. Tai chi for rheumatoid arthritis: systematic review. Rheumatology (Oxford), Nov., 46(11),1648-51, 2007..
26. Chou, K.L., Lee, P.W., Yu, E.C., Macfarlane, D., Cheng, Y.H., Chan, S.S.; Chi, I.
Effect of Tai Chi on depressive symptoms amongst Chinese older patients with depressive disorders: a randomized clinical trial. Int J Geriatr Psychiatry, Nov;19(11):1105-7, 2004.
27. Yang Y, et al. Effects of a Taiji and Qigong intervention on
the antibody response to influenza vaccine in older adults. Am J
Chin Med. 35(4), 597-607, 2007.
28. Sato, S., et al., Effect of Tai Chi training on baroreflex sensitivity and heart rate variability in patients with coronary heart disease . Int. Heart J., 51(4): 238-41, July 2010. .