The effect of Tai Chi on cardiorespiratory function in patients with coronary artery bypass surgery

Comparison of the effects of Tai Chi Chuan and Wai Tan Kung exercises on autonomic nervous system modulation and on hemodynamics in elder adults

The health of the middle-aged and elderly people is a major concern given the rapid aging population and rising costs of medical care. Low-impact exercise on a regular basis is ideal for maintaining the well-being of an aging population. Tai Chi Chuan (TCC) is the most well-known and most widely practiced form of low-impact martial arts therapy and has been shown to have positive health effects. A lesser-known form of martial arts therapy is Wai Tan Kung (WTK), which our previous study found to have positive health effects as well. The present study compares the effects of TCC and WTK on autonomic nervous system modulation and on hemodynamics in adults among non-exercising control (30), TCC practitioners (30) and WTK practitioners (30). Our study found that in a short-term, WTK and TCC exercises enhanced the vagal modulation, lowered the sympathetic modulation and lowered arterial blood pressures in the practitioners. It was also observed that the forced vital capacity of TCC practitioners was significantly higher than that of WTK practitioners before exercise. There were no significant differences in the percentage changes in HRV measures and hemodynamics between WTK and TCC practitioners 30 and 60 min after exercise, indicating that the effects of WTK and TCC were similar in magnitude. In conclusion, TCC and WTK are comparable to each other in terms of their effects on autonomic nervous system modulation and hemodynamics, thus suggesting that WTK can be just as beneficial as TCC as a form of low-impact exercise for elderly adults.

Functional Capacity After Traditional Chinese Medicine (Qi Gong) Training in Patients With Chronic Atrial Fibrillation: A Randomized Controlled Trial

Evidence indicates that low energy expenditure protocols derived from traditional Chinese medicine may benefit patients with cardiac impairment; therefore, the authors carried out a randomized controlled trial to test a 16-week medically assisted qi gong training program for the physical rehabilitation of patients with stable chronic atrial fibrillation and preserved left ventricular function. Functional capacity variation was evaluated using the 6-minute walk test, which was performed at baseline, at the end of the intervention, and after 16 weeks. Thirty men and 13 women (mean age, 68+/-8 years) were randomized to the intervention protocol or to a wait-list control group. Qi gong training was well tolerated and, compared with baseline, trained patients walked an average 114 meters more (27%) at the end of treatment (P<.001) and 57 meters more (13.7%) 16 weeks later (P=.008). Control subjects showed no variation in functional capacity. These results seem promising and deserve confirmation with further research.

Tai Chi Chih Acutely Decreases Sympathetic Nervous System Activity in Older Adults

BACKGROUND

Aging is associated with increases of sympathetic nervous system activation implicated in the onset of hypertension and cardiovascular disease. The purpose of this study was to examine whether the practice of Tai Chi Chih (TCC), a movement-based relaxation practice, would acutely promote decreases of sympathetic activity in elderly persons.

METHOD

The sample included two groups of older men and women (age > or = 60 years): TCC practitioners (n = 19) and TCC-naïve participants (n = 13). Participants were recruited after completing a 25-week randomized trial of TCC or health education. TCC practitioners performed TCC for 20 minutes, and TCC-naïve participants passively rested. Preejection period, blood pressure, and heart rate were measured before and after the task. A subsample (n = 8) returned for a second evaluation and performed videotape-guided stretching for 20 minutes to evaluate the effects of slow-moving physical activity on sympathetic activity.

RESULTS

Results showed that TCC performance significantly decreased sympathetic activity as indexed by preejection period (p =.01). In contrast, there was no change in preejection period following passive rest or slow-moving physical activity. Neither blood pressure nor heart rate changed after TCC performance.

DISCUSSION

This study is the first to our knowledge to assess the acute effects of TCC practice on sympathetic activity in older adults. TCC performance led to acute decreases in sympathetic activity, which could not be explained by physical activity alone. Further study is needed to determine whether the acute salutary effects of TCC on autonomic functioning are sustained with ongoing practice in older adults.

Change in perceived psychosocial status following a 12-week Tai Chi exercise programme

AIM

This paper reports a study to examine change in psychosocial status following a 12-week Tai Chi exercise intervention among ethnic Chinese people with cardiovascular disease risk factors living in the United States of America.

BACKGROUND

Regular participation in physical activity is associated with protection against cardioavascular disease, and improvements in physical and psychological health. Increasing amounts of scientific evidence suggests that mind-body exercise, such as Tai Chi, are related to improvements in mental health, emotional well-being, and stress reduction. No prior study has examined the effect of a Tai Chi exercise intervention on psychosocial status among people with cardiovascular disease risk factors.

METHODS

This was a quasi-experimental study. Participants attended a 60-minute Tai Chi exercise class three times per week for 12 weeks. Data were collected at baseline, 6 and 12 weeks following the intervention. Psychosocial status was assessed using Chinese versions of Cohen's Perceived Stress Scale, Profile of Mood States, Multidimensional Scale of Perceived Social Support, and Tai Chi exercise self-efficacy.

RESULTS

A total of 39 participants, on average 66-year-old (+/-8.3), married (85%), Cantonese-speaking (97%), immigrants participated. The majority were women (69%), with < or =12 years education (87%). Statistically significant improvements in all measures of psychosocial status were found (P < or = 0.05) following the intervention. Improvement in mood state (eta2 = 0.12), and reduction in perceived stress (eta2 = 0.13) were found. In addition, Tai Chi exercise statistically significantly increased self-efficacy to overcome barriers to Tai Chi (eta2 = 0.19), confidence to perform Tai Chi (eta2 = 0.27), and perceived social support (eta2 = 0.12).

CONCLUSIONS

Tai Chi was a culturally appropriate mind-body exercise for these older adults, with statistically significant psychosocial benefits 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.

Tai Chi versus brisk walking in elderly women

PURPOSE

to compare the effects of a short style of Tai Chi versus brisk walking training programme on aerobic capacity, heart rate variability (HRV), strength, flexibility, balance, psychological status and quality of life in elderly women.

METHODS

nineteen community-dwelling, sedentary women (aged 71.4 +/- 4.5 years) were randomly assigned to Tai Chi Chuan (TCC; n = 11) or brisk walking group (BWG; n = 8). A separate group of elderly women was recruited from the same population to act as a sedentary comparison group (SCG; n = 8). The exercise groups met for 1 h, three days per week for 12 weeks. Outcomes measured before and after training included estimated VO2max, spectral analysis of HRV (high-frequency, low-frequency power as well as high- and low-frequency power in normalised units) as a measure of autonomic control of the heart, isometric knee extension and handgrip muscle strength, single-leg stance time, the State Trait Anxiety Inventory (STAI), Profile of Mood States (POMS) and Short Form-36 (SF-36) questionnaires.

RESULTS

significant improvement was seen in estimated VO(2)max in the TCC group (TCC versus SCG P = 0.003, TCC versus BWG P = 0.08). The mean within-person change of high-frequency power in normalised units (HFnu) increased [8.2 (0.14-16.3)], representing increased parasympathetic activity, and low-frequency power in normalised units (LFnu) decreased [-8.7 (-16.8-0.5)], representing decreased sympathetic activity, in the TCC group only. Significant gains were also seen in the non-dominant knee extensor strength and single-leg stance time (TCC versus BWG P < 0.05).

CONCLUSIONS

a short style of TCC was found to be an effective way to improve many fitness measures in elderly women over a 3-month period. TCC was also found to be significantly better than brisk walking in enhancing certain measures of fitness including lower extremity strength, balance and flexibility.

Cardiopulmonary Rehabilitation and Cancer Rehabilitation. 1. Cardiac Rehabilitation Review

Cardiac rehabilitation includes not only the rehabilitation of people with ischemic heart disease but also those with congestive heart failure, heart transplantation, congenital heart disease, and other conditions. New advances in medical treatment have arisen, and there are new approaches in treatment, including alternative medicine and complementary care. New surgical approaches that help restore cardiac function have also been introduced, and rehabilitation professionals must be aware of these advances and be able to incorporate this knowledge into the practice of rehabilitation medicine.

OVERALL ARTICLE OBJECTIVES

(a) To identify major categories of cardiac disease, (b) to elucidate appropriate interventions and support for patients with coronary artery disease, (c) to describe the new interventions available for the treatment of cardiac disease, and (d) to describe the appropriate role of cardiac rehabilitation for people with various forms of cardiac disease.

The role of complementary and alternative therapies in cardiac rehabilitation: a systematic evaluation

BACKGROUND

Presently, complementary and alternative medicine, including both therapies and herbal/oral supplements, is used globally. Few studies have examined the use of specific therapies, separate from herbal/oral supplements, in cardiac rehabilitation. This paper presents a systematic evaluation of current research evidence related to use of specific complementary and alternative medicine therapies in secondary prevention of cardiovascular disease, with a view to making recommendations for cardiac rehabilitation.

DESIGN AND METHODS

A literature search was conducted using complementary and alternative medicine websites, Medline, Allied and Complementary Medicine, CINAHL, Cochrane databases, EMBASE, SportDiscus, Clinical Evidence, and Evidence-Based Practice to locate research-based scientific evidence related to the use of complementary and alternative medicine in cardiac rehabilitation. Search keywords included heart, cardiac, cardiovascular, coronary, myocardial and rehabilitation, combined with particular therapies. Herbal/oral supplements were not included in this evaluation.

RESULTS

Some complementary and alternative medicine therapies may be useful to patients by themselves or coupled with traditional cardiac rehabilitation. Tai chi, as a complement to existing exercise interventions, can be utilized for low and intermediate risk patients. transcendental meditation may be used as a stress reduction technique. There was insufficient evidence found for the use of acupuncture or chelation therapy in cardiac rehabilitation or secondary prevention.

CONCLUSIONS

Some complementary and alternative medicine therapies hold promise for patients in cardiac rehabilitation. Further research is essential, however, in all areas of complementary and alternative medicine to confirm its usefulness as an adjunct to cardiac rehabilitation.

Hemodynamic responses to a community-based Tai Chi exercise intervention in ethnic Chinese adults with cardiovascular disease risk factors

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death among older adults worldwide, including Europe, Asia, and North America. In the United States (US), CVD is also the leading cause of death among Asian-Americans. Physical activity has been shown to reduce CVD risk factors. Reduction in blood pressure (BP) in response to Tai Chi (TC) exercise in persons with CVD risk factors have been reported, though not in ethnic Chinese living in the US.

AIM

Hemodynamic responses to a 12-week community-based TC exercise intervention among ethnic Chinese with CVD risk factors were examined.

METHODS

Quasi-experimental design. Ethnic Chinese > 45 years old with at least 1 major CVD risk factor, living in the San Francisco Bay Area, attended a TC intervention three times a week for 12 weeks. A 2-min step-in-place test assessed aerobic endurance. BP and heart rate were measured at rest, and within 1-min after the step-test. Data were collected at baseline, 6 and 12 weeks.

RESULTS

A total of 39 subjects (69% women), 66 +/- 8.3 years old, with hypertension (92%), hypercholesteremia (49%), and/or diabetes (21%), and 1 current smoker participated. Adherence to the intervention was high (87%). Subjects were sedentary at baseline, though had a statistically significant improvement in aerobic endurance over-time (eta2 = 0.39). At baseline, the average BP at rest was 150/86, while BP in response to the step-test was 178/99. Clinically and statistically significant reductions in BP at rest (131/77), and in response to the step-test (164/82) were found over 12 weeks of TC (p < 0.01). No significant change in heart rate was observed.

CONCLUSIONS

This innovative, culturally relevant, community-based 12-week TC exercise intervention, appealed to Chinese adults with CVD risk factors, with significant reductions in BP and improvement in aerobic endurance. Given the number of persons estimated to have HTN and other CVD risk factors, the identification of new approaches to improve health, combined with risk factor reduction is needed. This is particularly important, given the rise in HTN among adults in the US and the associated public health burden of HTN. TC has the potential to reduce expenditures associated with CVD by facilitating a lifestyle that promotes physical activity, while remaining a low-tech, low-cost alternative to exercise.

Application of a Virtual Reality–Enhanced Exercise Protocol in Patients After Coronary Bypass

OBJECTIVE

To determine whether, by using training enhanced by virtual reality (VR) displays, patients who had undergone coronary artery bypass graft (CABG) surgery could more effectively attain long-term cardiopulmonary results than those not using VR technology.

DESIGN

Randomized controlled trial.

SETTING

Exercise testing laboratory in a medical center.

PARTICIPANTS

Consecutive sample of 32 patients who had undergone CABG surgery.

INTERVENTIONS

All subjects were randomly assigned to 1 of 2 submaximal endurance programs, with or without simulated training. In all other respects, the 2 programs were identical. Each section lasted for 30 minutes and was conducted twice a week for about 3 months. Graded exercise tests, conducted before and after training, evaluated cardiorespiratory changes.

MAIN OUTCOME MEASURES

The cardiorespiratory and hemodynamic parameters were evaluated at both peak and submaximal exertion.

RESULTS

At the follow-up exercise tests (performed at 5.4 mo after surgical intervention), the VR group achieved significantly higher value in peak oxygen consumption (VO2peak), peak metabolic equivalents (METS), and amount of VO2 at anaerobic threshold than the non-VR group. Significant gain was attained in VO2peak and peak MET value accrued to those who participated in simulation-based aerobic training.

CONCLUSIONS

Our study outcomes clearly support the perceived benefits of rehabilitation programs that incorporate VR to augment patients' recovery of their physical capacity.

Reduction in fear of falling through intense tai chi exercise training in older, transitionally frail adults

OBJECTIVES

To determine whether an intense tai chi exercise program could reduce fear of falling better than a wellness education (WE) program in older adults who had fallen previously and meet criteria for transitioning to frailty.

DESIGN

Cluster-randomized, controlled trial of 48 weeks' duration.

SETTING

Ten matched pairs of congregate living facilities in the greater Atlanta area.

PARTICIPANTS

Sample of 291 women and 20 men, aged 70 to 97.

MEASUREMENTS

Activity-related fear of falling using the Activities-Specific Balance Confidence Scale (ABC) and the Fall Efficacy Scale at baseline and every 4 months for 1 year. Demographics, time to first fall and all subsequent falls, functional measures, Centers for Epidemiologic Studies Depression Scale, medication use, level of physical activity, comorbidities, and adherence to interventions.

RESULTS

Mean ABC was similar in both cohort groups at the time of randomization but became significantly higher (decreased fear) in the tai chi cohort at 8 months (57.9 vs 49.0, P<.001) and at study end (59.2 vs 47.9, P<.001). After adjusting for covariates, the mean ABC after 12 months of intervention was significantly greater in the tai chi group than in the WE group, with the differences increasing with time (mean difference at 12 months=9.5 points, 95% confidence interval=4.8-14.2, P<.001).

CONCLUSION

Tai chi led to a significantly greater reduction in fear of falling than a WE program in transitionally frail older adults. The mean percentage change in ABC scores widened between tai chi and WE participants over the trial period. Tai chi should be considered in any program designed to reduce falling and fear of falling in transitionally frail older adults.

Effects of Sun-style Tai Chi exercise on physical fitness and fall prevention in fall-prone older adults

AIM

This paper reports a study to determine changes in the physical fitness (knee and ankle muscle strength, balance, flexibility, and mobility), fall avoidance efficacy, and fall episodes of institutionalized older adults after participating in a 12-week Sun-style Tai Chi exercise programme.

BACKGROUND

Fall prevention has a high priority in health promotion for older people because a fall is associated with serious morbidity in this population. Regular exercise is effective in fall prevention for older adults because of improvements in strength and balance. Tai Chi exercise is considered to offer great potential for health promotion and rehabilitation, particularly in the maintenance of good mental and physical condition in older people.

METHODS

A quasi-experimental design with a non-equivalent control group was used. Data were collected from September 2001 to January 2002. A total of 68 fall-prone older adults with a mean age of 77.8 years participated in the study, and 29 people in the Tai Chi group and 30 controls completed the post-test measures. The Tai Chi exercise programme was provided three times a week for 12 weeks in the experimental group. Data were analysed for group differences using t-tests.

RESULTS

At post-test, the experimental group showed significantly improved muscle strength in knee and ankle flexors (P < 0.001) and extensors (P < 0.01), and improved flexibility (P < 0.01) and mobility (P < 0.001) compared with the control group. There was no significant group difference in fall episodes, but the relative risk ratio for the Tai Chi exercise group compared with the control group was 0.62. The experimental group reported significantly more confidence in fall avoidance than did the control group.

CONCLUSION

The findings reveal that Tai Chi exercise programmes can safely improve physical strength and reduce fall risk for fall-prone older adults in residential care facilities.

Shingles Immunity and Health Functioning in the Elderly: Tai Chi Chih as a Behavioral Treatment

Both the incidence and severity of herpes zoster (HZ) or shingles increase markedly with increasing age in association with a decline in varicella zoster virus (VZV)-specific immunity. Considerable evidence shows that behavioral stressors, prevalent in older adults, correlate with impairments of cellular immunity. Moreover, the presence of depressive symptoms in older adults is associated with declines in VZV-responder cell frequency (VZV-RCF), an immunological marker of shingles risk. In this review, we discuss recent findings that administration of a relaxation response-based intervention, tai chi chih (TCC), results in improvements in health functioning and immunity to VZV in older adults as compared with a control group. TCC is a slow moving meditation consisting of 20 separate standardized movements which can be readily used in elderly and medically compromised individuals. TCC offers standardized training and practice schedules, lending an important advantage over prior relaxation response-based therapies. Focus on older adults at increased risk for HZ and assay of VZV-specific immunity have implications for understanding the impact of behavioral factors and a behavioral intervention on a clinically relevant end-point and on the response of the immune system to infectious pathogens.

Effects of tai chi mind-body movement therapy on functional status and exercise capacity in patients with chronic heart failure: a randomized controlled trial

PURPOSE

To examine the effects of a 12-week tai chi program on quality of life and exercise capacity in patients with heart failure.

METHODS

Thirty patients with chronic stable heart failure and left ventricular ejection fraction < or =40% (mean [+/- SD] age, 64 +/- 13 years; mean baseline ejection fraction, 23% +/- 7%; median New York Heart Association class, 2 [range, 1 to 4]) were randomly assigned to receive usual care (n = 15), which included pharmacologic therapy and dietary and exercise counseling, or 12 weeks of tai chi training (n = 15) in addition to usual care. Tai chi training consisted of a 1-hour class held twice weekly. Primary outcomes included quality of life and exercise capacity. Secondary outcomes included serum B-type natriuretic peptide and plasma catecholamine levels. For 3 control patients with missing data items at 12 weeks, previous values were carried forward.

RESULTS

At 12 weeks, patients in the tai chi group showed improved quality-of-life scores (mean between-group difference in change, -25 points, P = 0.001), increased distance walked in 6 minutes (135 meters, P = 0.001), and decreased serum B-type natriuretic peptide levels (-138 pg/mL, P = 0.03) compared with patients in the control group. A trend towards improvement was seen in peak oxygen uptake. No differences were detected in catecholamine levels.

CONCLUSION

Tai chi may be a beneficial adjunctive treatment that enhances quality of life and functional capacity in patients with chronic heart failure who are already receiving standard medical therapy.

The influence of Tai Chi training on the center of pressure trajectory during gait initiation in older adults11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated

OBJECTIVE

To determine if a program of intense Tai Chi exercise that has been shown to reduce the risk of falling in older adults improves postural control by altering the center of pressure (COP) trajectory during gait initiation.

DESIGN

Before-after trial.

SETTING

Biomechanics research laboratory.

PARTICIPANTS

Twenty-eight older adults transitioning to frailty who participated in either a 48-week intervention of intense Tai Chi training or a wellness education (WE) program.

INTERVENTIONS

Eight Tai Chi forms emphasizing trunk rotation, weight shifting, coordination, and narrowing of lower-extremity stance were taught twice weekly. WE program participants met once a week and received lectures focused on health. Main outcome measures The COP was recorded during gait initiation both before and after the 48-week intervention by using a forceplate sampling at 300 Hz. The COP trajectory was divided into 3 periods (S1, S2, S3) by identifying 2 landmark events. Displacement and average velocity of the COP trace in the anteroposterior (x) and mediolateral (y) directions, as well as smoothness, were calculated.

RESULTS

Tai Chi training increased the posterior displacement of the COP during S1 and improved the smoothness of the COP during S2.

CONCLUSIONS

Tai Chi improved the mechanism by which forward momentum is generated and improved coordination during gait initiation, suggesting improvements in postural control.

Comprehensive Therapeutic Benefits of Taiji

This literature review offers physical rehabilitation professionals an update on the current breadth and strength of research evidence regarding comprehensive therapeutic benefits of Taiji practice. A critical analysis distinguishes between what is known from controlled clinical research and what is suggested in preliminary research. Of >200 published reports examined, 17 controlled clinical trials were judged to meet a high standard of methodological rigor. Controlled research evidence was found to confirm therapeutic benefits of Taiji practice with regard to improving quality of life, physical function including activity tolerance and cardiovascular function, pain management, balance and risk of falls reduction, enhancing immune response, and improving flexibility, strength, and kinesthetic sense. Preliminary research on implementation feasibility of Taiji programming exists for a variety of clinical populations. Further controlled clinical study is justified for a wide variety of clinical contexts.

A randomized, prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women 11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated

OBJECTIVE

To evaluate the potential benefits of programmed Tai Chi Chun (TCC) exercise on the weight-bearing bones of early postmenopausal women.

DESIGN

Age-matched and randomized prospective intervention.

SETTING

University medical school.

PARTICIPANTS

One hundred thirty-two healthy postmenopausal women (mean age, 54.0+/-3.5y) within 10 years of menopause onset were recruited and randomized into the TCC exercise group (n=67) or the sedentary control group (n=65).

INTERVENTION

Supervised TCC exercise was performed by the TCC group for 45 minutes a day, 5 days a week, for 12 months; control subjects retained a sedentary life style. Main outcome measures Bone mineral density (BMD) was measured in the lumbar spine and proximal femur by using dual-energy x-ray absorptiometry and in the distal tibia by using multislice peripheral quantitative computed tomography (pQCT). All BMD measurements were repeated after 12 months in both groups. Fracture rate was also documented.

RESULTS

Baseline measurements showed homogeneity in age, anthropometric variables, and menstruation status between the TCC and control groups. Exactly 81.6% of the subjects in the TCC group and 83.1% of subjects in the control group completed the 12-month follow-up study. BMD measurements revealed a general bone loss in both TCC and sedentary control subjects at all measured skeletal sites, but with a reportedly slower rate in the TCC group. A significant 2.6- to 3.6-fold retardation of bone loss (P<.01) was found in both trabecular and cortical compartments of the distal tibia in the TCC group as compared with the controls, as measured by pQCT. A total of 4 fracture cases were documented during follow-up, including 3 subjects in the control group and 1 in the TCC group.

CONCLUSIONS

This is the first prospective and randomized study to show that a programmed TCC exercise intervention is beneficial for retarding bone loss in weight-bearing bones in early postmenopausal women. Long-term follow-up is needed to substantiate the role of TCC exercise in the prevention of osteoporosis and its related fracture.

The effect of Tai Chi Chuan on the autonomic nervous modulation in older persons

PURPOSE

This study evaluated the effect of Tai Chi Chuan (TCC) on the autonomic nervous modulation in older persons.

METHODS

Twenty TCC practitioners and 20 normal controls were included in this study. The stationary state spectral heart rate variability (HRV) measures between TCC practitioners and normal controls, and the sequential changes in HRV measures after classical Yang's TCC were compared.

RESULTS

The total power, very low-frequency power, low-frequency power, normalized low-frequency power, and low-/high-frequency power ratios in TCC practitioners were all significantly higher than those of normal controls, whereas the heart rate and systolic and diastolic blood pressures were not different between these two groups of subjects. After TCC, the normalized high-frequency power increased significantly from 22.8 +/- 14.6 normalized units (nu) before TCC to 28.2 +/- 16.1 nu 30 min after TCC and to 30.6 +/- 18.4 nu 60 min after TCC. In contrast, the low-/high-frequency power ratio decreased significantly from 2.5 +/- 2.4 before TCC to 1.8 +/- 1.4 30 min after TCC and to 2.2 +/- 2.9 60 min after TCC. The heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, and pulse pressure also decreased sequentially after TCC.

CONCLUSION

The short-term effect of TCC was to enhance the vagal modulation and tilt the sympathovagal balance toward deceased sympathetic modulation in older persons. TCC might be good health-promoting calisthenics for older persons.

Can Tai Chi improve vestibulopathic postural control?

OBJECTIVES

To evaluate the rationale and scientific support for Tai Chi as an intervention for vestibulopathy and to offer recommendations for future studies.

DATA SOURCES

A computer-aided search, including MEDLINE and Science Citation Index, to identify original Tai Chi studies published in English; relevant references cited in the retrieved articles were also included.

STUDY SELECTION

A preliminary screening selected all randomized controlled trials (RCTs), non-RCTs, case-control studies, and case series that included Tai Chi as an intervention and had at least 1 outcome variable relevant to postural stability.

DATA EXTRACTION

Authors critically reviewed studies and summarized study designs and outcomes in a summary table.

DATA SYNTHESIS

Twenty-four Tai Chi studies met screening criteria. No studies specifically studying Tai Chi for vestibulopathy were found. Collectively, the 24 studies provide sometimes contradictory but generally supportive evidence that Tai Chi may have beneficial effects for balance and postural impairments, especially those associated with aging. Ten RCTs were found, of which 8 provide support that Tai Chi practiced alone, or in combination with other therapies, can reduce risk of falls, and/or impact factors associated with postural control, including improved balance and dynamic stability, increased musculoskeletal strength and flexibility, improved performance of activities of daily living (ADLs), reduced fear of falling, and general improvement in psychologic well-being. Studies using other designs support the results observed in RCTs.

CONCLUSIONS

At present, few data exist to support the contention that Tai Chi specifically targets the impairments, functional limitations, disability, and quality of life associated with peripheral vestibulopathy. There are, however, compelling reasons to further investigate Tai Chi for vestibulopathy, in part because Tai Chi appears useful for a variety of nonvestibulopathy etiologic balance disorders, and is safe. Especially needed are studies that integrate measures of balance relevant to ADLs with other psychologic and cognitive measures; these might help identify specific mechanisms whereby Tai Chi can remedy balance disorders.

Intense tai chi exercise training and fall occurrences in older, transitionally frail adults: a randomized, controlled trial

OBJECTIVES

To determine whether an intense tai chi (TC) exercise program could reduce the risk of falls more than a wellness education (WE) program in older adults meeting criteria for transitioning to frailty.

DESIGN

Randomized, controlled trial of 48 weeks duration.

SETTING

Twenty congregate living facilities in the greater Atlanta area.

PARTICIPANTS

Sample of 291 women and 20 men aged 70 to 97.

MEASUREMENTS

Demographics, time to first fall and all subsequent falls, functional measures, Sickness Impact Profile, Centers for Epidemiologic Studies-Depression Scale, Activities-specific Balance Confidence Scale, Falls Efficacy Scales, and adherence to interventions.

RESULTS

The risk ratio (RR) of falling was not statistically different in the TC group and the WE group (RR=0.75, 95% confidence interval (CI)=0.52-1.08), P=.13). Over the 48 weeks of intervention, 46% (n=132) of the participants did not fall; the percentage of participants that fell at least once was 47.6% for the TC group and 60.3% for the WE group.

CONCLUSION

TC did not reduce the RR of falling in transitionally frail, older adults, but the direction of effect observed in this study, together with positive findings seen previously in more-robust older adults, suggests that TC may be clinically important and should be evaluated further in this high-risk population.

The Effectiveness of Tai Chi Exercise in Improving Aerobic Capacity

PURPOSE

Meta-analysis involves the integration of several studies with small sample sizes, enabling the investigator to summarize research results into useful clinical information. Tai Chi exercise has recently gained the attention of Western researchers as a potential form of aerobic exercise. A goal of this meta-analysis was to estimate the effect of Tai Chi exercise on aerobic capacity.

METHODS

A computerized search of 7 databases was done using key words and all languages. Sixteen study elements were critically appraised to determine study quality. D-STAT software was used to calculate the standardized mean differences (ESsm) and the 95% confidence intervals (CI), using means and standard deviations (SD) reported on aerobic capacity expressed as peak oxygen uptake (VO2peak) (mL x kg(-1) x min(-1)).

RESULTS

Of 441 citations obtained, only 7 focused on aerobic capacity in response to Tai Chi exercise (4 experimental and 3 cross-sectional). Older adults including those with heart disease participated (n = 344 subjects); on average men were aged 55.7 years (SD = 12.7) and women 60.7 years (SD = 6.2). Study quality scores ranged from 22 to 28 (mean = 25.1, SD = 2.0). Average effect size for the cross-sectional studies was large and statistically significant (ESsm = 1.01; CI = +0.37, +1.66), while in the experimental studies the average effect size was small and not significant (ESsm = 0.33; CI = -0.41, +1.07). Effect sizes of aerobic capacity in women (ESsm = 0.83; CI = -0.43, +2.09) were greater than those for men (ESsm = 0.65; CI = -0.04, +1.34), though not statistically significant. Aerobic capacity was higher in subjects performing classical Yang style (108 postures) Tai Chi (ESsm = 1.10; CI = +0.82, +1.38), a 52-week Tai Chi exercise intervention (ESsm = 0.94; C = +0.06, +1.81), compared with sedentary subjects (ESsm = 0.80; CI = +0.19, +1.41).

CONCLUSIONS

This meta-analysis suggests that Tai Chi may be an additional form of aerobic exercise. The greatest benefit was seen from the classical Yang style of Tai Chi exercise when performed for 1-year by sedentary adults with an initial low level of physical activity habits. Recommendations for future research are provided and the effect sizes generated provide information needed for sample size calculations. Randomized clinical trials in diverse populations, including those with chronic diseases, would expand the current knowledge about the effect of Tai Chi on aerobic capacity.

Effects of a behavioral intervention, Tai Chi Chih, on varicella-zoster virus specific immunity and health functioning in older adults

OBJECTIVE

Both the incidence and severity of herpes zoster (shingles) increase markedly with increasing age in association with a decline in varicella-zoster virus (VZV) specific cell-mediated immunity (CMI). This study examined whether a behavioral intervention, Tai Chi Chih (TCC), affects VZV specific immunity and health functioning in older adults who, on average, show impairments of health status and are at risk for shingles.

METHODS

Thirty-six men and women (age > or =60 years) were assigned randomly to a 15-week program of TCC instruction (three 45 minute classes per week; N = 18) or a wait list control condition (N = 18). VZV-specific CMI was measured at baseline and at 1-week postintervention. Health functioning (Medical Outcome scale: SF-36) was assessed at baseline, and at 5, 10, and 15 weeks during the intervention, and at 1-week postintervention.

RESULTS

In the intent-to-treat sample, VZV-specific CMI increased 50% from baseline to 1-week postintervention in the TCC group (p < 0.05) but was unchanged in the wait list control group. In those who completed the study, 1-week postintervention SF-36 scale scores for role-physical (p < 0.05) and physical functioning (p < 0.05) were higher in the TCC group (N = 14) as compared with controls (N = 17). Older adults who had impairments of physical status at baseline showed the greatest increases of SF-36 role-physical (p < 0.01) and physical functioning (p < 0.001) during the TCC intervention.

CONCLUSIONS

Administration of TCC for 15 weeks led to an increase in VZV-specific CMI. Gains in health functioning were found in participants who received TCC and were most marked in those older adults who had the greatest impairments of health status.

The cardiorespiratory response and energy expenditure of Tai-Chi-Qui-Gong

The purpose of this study was to evaluate the cardiorespiratory response and energy expenditure during the practice of Tai-Chi-Qui-Gong (TCQG). Forty-seven TCQG practitioners with a mean age of 60.7 +/- 9.9 years participated in this study. The cardiorespiratory responses and energy expenditure were measured by a K4 telemetry system. TCQG has 54 motions and can be divided into 3 sets. The result indicated that the exercise intensity of each motion is about 3 metabolic equivalents (MET) and the energy expenditure of each set is about 60 Kcal. The estimated intensity of TCQG in elderly individuals approximated 50% of the maximum oxygen uptake (vO2max) for men, and 60% of the maximum oxygen uptake (vO2max) for women. The findings demonstrate that TCQG is a low intensity exercise and can be prescribed as an alternative exercise program for cardiopulmonary rehabilitation.

Qigong practice: a pathway to health and healing

Qigong is a therapeutic Chinese practice that has been used for thousands of years to optimize and restore energy (Qi) to the body, mind, and spirit. Elements of Taoist and Buddhist philosophies form the foundation of Qigong, which promotes health and vitality through gentle exercises for the breath, body, mind, and the voice. One component of Qigong is T'ai Chi, an exercise modality that uses gentle movements. Research has demonstrated that Qigong and T'ai Chi have beneficial effects on the body and that these are becoming popular holistic modalities in the United States. Nurses should understand the philosophy, concepts, and elements of Qigong and T'ai Chi so that they can guide patients to the benefits of this ancient art and science.

Tai Chi as an adjunct to cardiac rehabilitation exercise training

Heart disease is a chronic condition needing lifetime secondary prevention measures to decrease morbidity and mortality, and to improve quality of life. Cardiac rehabilitation exercise training, one aspect of cardiac recovery, traditionally includes some form of aerobic fitness and, more recently, muscle strength training to improve exercise tolerance. Tai chi, widely practiced in China for centuries, is a popular form of exercise among older Chinese persons associated with enhanced well-being and health among traditional Chinese practitioners. Recent research has reported improvement in cardiorespiratory function, balance and postural stability, fall prevention, and stress reduction. A review of the literature suggests potential benefits from tai chi exercise performed as an adjunct to cardiac rehabilitation exercise training. Tai chi is cost-effective and facilitates a lifestyle of health-related behavior practices.

Physiological Benefits of 24-style Taijiquan Exercise in Middle-aged Women

This study examined the physiological benefits of 24-style Taijiquan (24TJQ) exercises by comparing heart rate (HR), respiratory rate (RR), exercise intensity, electroencephalograph, surface electromyography and surface thermograph, as well as the results of physical fitness test in 20 middle-aged women (10 skilled participants and 10 novices). The data from the skilled participants showed greater values in sit-ups (p<0.01), side step (p<0.01) and stand trunk flexion (p<0.05), moreover, the statistic data demonstrated not only greater HR (p<0.05) or lower RR during exercise, but also higher beta%-power during the experiment, higher alpha%-power in the eye-closed period and central alpha dominant after exercise. These results suggest that 24TJQ is effective to promote physiological benefits in middle-aged women. It attracts strong interest and is helpful to induce psychological relaxation and mental concentration.

Are the 'hard' martial arts, such as the Korean martial art, TaeKwon-Do, of benefit to senior citizens?

Falls are a leading cause of death in the elderly. Associated with aging is a loss of muscular strength, flexibility, and coordination. Regular exercise is widely believed to be of benefit for the elderly. To this end, various exercise regimes have been employed to battle the associated problems of aging. One such has been the Chinese martial art, Tai Chi Chuan (TC). TC as an exercise system uses slow smooth movements to train the body in balance, endurance, and strength. For this reason, it is known as a 'soft' martial art, in that it is very non-impact oriented. There have been a variety of studies in the West examining the beneficial effects of TC. However, to date, there have been no studies with senior citizens using other martial arts, of which, TC is but one. The present study was designed to examine the appropriateness and effects of a Korean martial art known as TaeKwon-Do (TKD), a 'hard' martial art, on an elderly population measuring similar parameters reported for TC. Of those participants that attended >85% of classes, an increase was observed in the average number of push-ups, trunk flexion, and balance time on each foot. TKD proved effective at increasing one-leg balance in the population examined. Additionally, the overall dropout rate was extremely low suggesting both that the elderly are capable of participating in a hard martial art and that they have an interest in it as a viable alternative to other forms of exercise. The present study suggests that TKD as a form of exercise for an elderly population is both viable and potentially popular and warrants further study.

Delineating the impact of Tai Chi training on physical function among the elderly

BACKGROUND

Through a re-analysis of a Tai Chi intervention data set, the study objective was to determine which, if any, subgroups of the study sample evidenced differential benefits from the intervention.

METHOD

Re-analysis of a Tai Chi intervention study, a randomized controlled trial in Eugene and Springfield, Oregon. Physically inactive participants aged > or =65 years were randomly assigned to one of two groups: Tai Chi (n=49) and a wait-list control (n=45). The main outcome measure was self-reported physical function.

RESULTS

Initial latent curve analyses indicated significant Tai Chi training effects: Participants in the Tai Chi group reported significant improvements in perceived physical function compared to those in the control group. However, there was significant interindividual variability in response to Tai Chi. The overall intervention effect was further delineated by identifying two subgroups. This delineation showed that Tai Chi participants with lower levels of physical function at baseline benefited more from the Tai Chi training program than those with higher physical function scores. Inclusion of additional measures of individual characteristics at baseline, change in movement confidence, and class attendance further explained differences in treatment responses.

CONCLUSIONS

Findings from this study suggest that although an intervention may show an overall effect (or no overall effect), it may be differentially effective for subgroups of participants that differ in their pre-intervention characteristics. Examination of variability in outcome measures can provide important information for refining and tailoring appropriate interventions targeted to specific subgroups.

Heart rate responses and oxygen consumption during Tai Chi Chuan practice

Tai Chi Chuan (TCC) is a popular Chinese conditioning exercise, however, its exercise intensity remains controversial. The objective of this study was to determine the exercise intensity of Yang TCC by measuring heart rate (HR) responses and oxygen consumption (VO2) during practice. Fifteen men aged 39.9 +/- 9.5 yrs (range 26-56 yrs) participated in this study. Subjects had practiced classical Yang TCC for 5.8 +/- 2.4 years. HR responses and VO2 were measured during practice of TCC by using a K4 telemetry system. Blood lactate was measured before and immediately after TCC practice. Additionally, breath-by-breath measurement of cardiorespiratory function and sequential determination of blood lactate were performed during the incremental exercise of leg cycling. Measurements obtained during the TCC practice and exercise testing were compared to determine the exercise intensity of TCC. While performing TCC, the mean HR of subjects was 140 +/- 10 bpm, and the mean VO2 was 21.4 +/- 1.5 mL x kg(-1) min(-1). Compared with the data of the exercise test, the HR during practice was 58% of the heart rate range. Meanwhile, the VO2 during TCC practice was 55% of the VO2peak. Additionally, the level of blood lactate immediately after TCC practice was 3.8 mM, which reflected the level of lactate during TCC, approximated the onset of blood lactate accumulation (OBLA). The results demonstrate that TCC is an exercise with moderate intensity, and is aerobic in nature.

An Overview of Four Nonpharmacologic Complementary and Alternative Medicine Modalities

Objective

To provide an overview of 4 nonmedical complementary and alternative medicine (CAM) modalities with an emphasis on 1 mind-body approach (yoga), 2 alternative systems (acupuncture, tai chi), and 1 energy therapy (therapeutic touch). Support in the scientific literature for the usefulness of each technique is presented.

Data Sources

Primary articles on alternative medicine were obtained by performing a MEDLINE search. An online book search was conducted on the Ohio Library and Information Network, a consortium of 79 Ohio colleges, universities, and community colleges and the State Library of Ohio.

Data Synthesis

All 4 CAM modalities had a scientific basis and were supported in the literature. Main drawbacks to many scientific studies were in methodologic flaws such as small sample sizes, variable interventions, and the absence of controls. Many researchers are beginning to include evidence-based and scientific techniques in their studies that more closely meet established scientific standards. This will lead to more robust, valid, reliable, and uniform methodologic approaches.

Discussion

Many patients use both CAM and mainstream therapies for their medical conditions. As the quality of scientific studies improves, pharmacists can gain confidence in using the results to provide pharmaceutical care to such patients. It is the pharmacists' responsibility to educate themselves about CAM therapies.

Conclusions

Embracing a holistic approach to care may enable pharmacists to optimize the pharmaceutical care they provide to all their patients.

Tai Chi Chuan: an ancient wisdom on exercise and health promotion

Tai Chi Chuan (TCC) is a Chinese conditioning exercise and is well known for its slow and graceful movements. Recent investigations have found that TCC is beneficial to cardiorespiratory function, strength, balance, flexibility, microcirculation and psychological profile. The long-term practice of TCC can attenuate the age decline in physical function, and consequently it is a suitable exercise for the middle-aged and elderly individuals. TCC can be prescribed as an alternative exercise programme for selected patients with cardiovascular, orthopaedic, or neurological diseases, and can reduce the risk of falls in elderly individuals. The exercise intensity of TCC depends on training style, posture and duration. Participants can choose to perform a complete set of TCC or selected movements according to their needs. In conclusion, TCC has potential benefits in health promotion, and is appropriate for implementation in the community.

Tai Chi, self-efficacy, and physical function in the elderly

Using Tai Chi as an exercise mode, this study examined the association between self-efficacy and physical function. Ninety-four healthy, physically inactive older adults (M age = 72.8 years, SD = 5.1) were randomly assigned to either a 6-month, twice a week, Tai Chi condition or a wait-list control condition. Outcome variables included self-reports of movement efficacy and physical function assessed at baseline, middle, and termination of the study. Multisample latent curve analyses revealed a significant rate of change attributable to the Tai Chi intervention in both self-efficacy and physical function, with participants experiencing significant improvements over the course of the intervention. Analyses also showed a positive association between self-efficacy and physical function, indicating that improvements in older adults' self-efficacy of movement as a function of Tai Chi were related to increased levels of perceived physical capability. This study uncovered the need for further exploration of the relationship between exercise self-efficacy and physical function for enhancing health-related quality of life in older adults.

A study design to investigate the effect of intense Tai Chi in reducing falls among older adults transitioning to frailty

This paper describes the study design, methodological considerations, and baseline characteristics of a clinical trial to determine if intense (48 weeks, twice per week) Tai Chi practice can reduce the frequency of falls among older adults transitioning to frailty compared to a wellness education program. Twenty facilities will be stratified on socioeconomic status and facility type and randomly assigned to one of the two interventions. Secondary outcome measurements include variables related to function, behavior, and the biomechanics of movement. This study is unique because it represents an effort to offer a novel physical intervention to a large sample of transitional frail adults, a population that has received few formal exercise interventions. In addition to bringing the interventions into facilities, a 1-year follow-up is also included to assess rates of change in outcome measurements.

An evaluation of the effects of Tai Chi exercise on physical function among older persons: a randomized contolled trial

This study was designed to determine whether a 6-month Tai Chi exercise program can improve self-reported physical functioning limitations among healthy, physically inactive older individuals. Ninety-four community residents ages 65 to 96 (Mage = 72.8 years, SD = 5.1) volunteered to participate in the study. Participants were randomly assigned to either a 6-month experimental (Tai Chi) group (n = 49), which exercised twice per week for 60 min, or a wait-list control group (n = 45). A 6-item self-report physical functioning scale, assessing the extent of behavioral dysfunction caused by health problems, was used to evaluate change in physical functioning limitations as a result of Tai Chi intervention. Results indicated that compared to the control group, participants in the Tai Chi group experienced significant improvements in all aspects of physical functioning over the course of the 6-month intervention. Overall, the experimental group had 65% improvement across all 6 functional status measures ranging from daily activities such as walking and lifting to moderate-vigorous activities such as running. It was concluded that the 6-month Tai Chi exercise program was effective for improving functional status in healthy, physically inactive older adults. A self-paced and self-controlled activity such as Tai Chi has thepotential to be an effective, low-cost means of improving functional status in older persons.

Tai chi: physiological characteristics and beneficial effects on health

OBJECTIVES

To assess the characteristic effects of Tai Chi Chuan (TCC) exercise on metabolism and cardiorespiratory response, and to measure its effect on cardiorespiratory function, mental control, immune capacity, and the prevention of falls in elderly people.

DESIGN

A review of controlled experimental studies and clinical trials designed with one of two aims: either to assess physiological responses during the performance of TCC or to assess the impact of this exercise on general health and fitness.

MAIN OUTCOME MEASURES

Metabolic rate, heart rate, blood pressure, ventilation, maximal oxygen uptake (VO(2)MAX), immune capacity, falls, and fall related factors.

SUBJECTS

A total of 2216 men and women.

RESULTS

Under review were 31 original studies, published in Chinese or English journals, that met the criteria for inclusion. Most of the papers written in Chinese had not been introduced into the Western literature. Nine of these studies showed that TCC can be classified as moderate exercise, as its does not demand more than 55% of maximal oxygen intake. When this form of exercise and others conducted at equal intensity were compared, TCC showed a significantly lower ventilatory equivalent (VE/VO(2)MAX). Evidence provided by cross sectional and longitudinal studies suggests that TCC exercise has beneficial effects on cardiorespiratory and musculoskeletal function, posture control capacity, and the reduction of falls experienced by the elderly.

CONCLUSIONS

TCC is a moderate intensity exercise that is beneficial to cardiorespiratory function, immune capacity, mental control, flexibility, and balance control; it improves muscle strength and reduces the risk of falls in the elderly.