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

Combined effects of Tai-Chi gait with mediolateral ground support perturbation on dynamic balance control

Tai-Chi (TC) is a broadly used exercise that appeared to decrease the risk of falls. However, biomechanical mechanisms underlying the reduced fall risks following TC exercise remain unclear and hinder the ability to optimize TC intervention to target specific balance deficit disorders. In addition, combining TC gait exercise with ground support perturbation may be a viable approach to further challenge balance control compared to TC gait alone. The purpose of this study was to compare dynamic stability and limb support force production during comfortable walking speed (CWS), TC gait, and TC gait with medial (MED) and lateral (LAT) ground support perturbations in older and younger adults. Ten older adults and ten younger adults performed CWS, TC gait, LAT, and MED. Conditions involving TC gait showed decreased margin of stability (MoS) (main effect of condition, p ​< ​0.01) and increased vertical force impulse compared to CWS (p ​< ​0.01). Medial ground support perturbation induced the smallest MoS among all conditions. Older adults showed increased MoS compared to younger adults (p ​< ​0.01). These findings provided insight into how key balance control characteristics are modulated during TC exercise and indicate that combining ground support perturbation with TC may further challenge dynamic stability.

Complementary Therapies: Tai Chi in the Prevention and Management of Cardiovascular Disease

Cardiovascular disease has remained the top contributor to global mortality for decades, necessitating research into the most effective methods of its prevention and treatment. Simultaneous with an immense amount of discovery and innovation in the field of cardiology, certain therapies with traditional Chinese origins have become progressively more popular in the West in recent decades. Specifically, ancient meditative mind-body practices such as Qigong and Tai Chi may lower cardiovascular disease risk and severity through a focus on movement and meditation. Such practices are generally low-cost and modifiable, with few adverse effects. Studies have shown higher quality of life in patients with coronary artery disease and heart failure after participation in Tai Chi, as well as a positive impact on cardiovascular risk factors such as hypertension and waist circumference. Most studies in the field have various limitations, such as small sample size, lack of randomization, and inadequate control; however, these practices show potential as an adjunct in the prevention and treatment of cardiovascular disease. Patients unable or unwilling to partake in traditionally aerobic activities may benefit greatly from such mind-body therapies. Nonetheless, more studies are warranted for more definitive answers to the question of Tai Chi and Qigong's effectiveness. In this narrative review, we discuss the current evidence surrounding the effects of Qigong and Tai Chi on cardiovascular disease, in addition to the limitations and difficulties in conducting such studies.

Association between Tai Chi Yuttari Exercise and Longevity and Prevention of Long-Term Care Need: Survival Analysis in Kitakata City, Japan

This study examined whether participation in Tai Chi Yuttari exercise is associated with a delay in the death and new certification for long-term care need of older adults. Individuals who participated in Tai Chi Yuttari exercise classes in 2011-2015 (participation group) were compared with individuals from the Basic Resident Register of Kitakata City (non-participation group). Death and new certification for long-term care need were selected to evaluate the effectiveness of participation in Tai Chi Yuttari exercise classes. The periods from the start date of the observation to each person's date of occurrence of events were calculated. The Kaplan-Meier method and log-rank test were used to compare survival curves between the groups. A total of 105 and 202 individuals in the participation and non-participation groups, respectively, were observed. Survival duration (χ2 = 8.782, p = 0.003) and the period before receiving certification for long-term care (χ2 = 5.354, p = 0.021) were longer in the participation group than in the non-participation group. In the stratified analysis by sex, survival duration was longer in the participation group in men only (χ2 = 7.875, p = 0.005). Participation in Tai Chi Yuttari exercise might be effective in delaying death, especially in men, and new certification for long-term care.

The Impact of Tai Chi Exercise on Health Care Utilization and Imputed Cost in Residents of Low-Income Senior Housing

BACKGROUND/OBJECTIVES

This study was designed to test the impact of Tai Chi (TC) on healthcare utilization and cost in older adults living in low-income senior housing. We hypothesized that TC would improve overall health enough to reduce the use of emergency department (ED) and inpatient services.

DESIGN

Cluster randomized controlled trial with randomization at the housing site level.

SETTING

Greater Boston, Massachusetts.

PARTICIPANTS

The study includes 6 sites with 75 individuals in the TC treatment condition and 6 sites with 67 individuals in the health education control condition.

INTERVENTION

Members of the treatment group received up to a year-long intervention with twice weekly, in-person TC exercise sessions along with video-directed exercises that could be done independently at home. The comparison group received monthly, in-person healthy aging education classes (HE). Study recruitment took place between August, 2015 and October, 2017. Key outcomes included acute care utilization (inpatient stays, observation stays and emergency department visits). In addition, the cost of utilization was estimated using the age, sex and race adjusted allowed amount from Medicare claims for a geographically similar population aged ≥ 65.

RESULTS

The results suggested a possible reduction in the rate of ED visits in the TC group vs. controls (rate ratio = 0.476, p-value = 0.06), but no findings achieved statistical significance. Adjusted estimates of imputed costs of ED and hospital care were similar between TC and HE, averaging approximately $3,000 in each group.

CONCLUSION

ED utilization tended to be lower over 6 to 12 months of TC exercises compared to HE in older adults living in low-income housing, although estimated costs of care were similar.

Safety and effectiveness of a Tai Chi-based cardiac rehabilitation programme for chronic coronary syndrom patients: study protocol for a randomised controlled trial

INTRODUCTION

Preliminary evidence from clinical observations suggests that Tai Chi exercise may offer potential benefits for patients with chronic coronary syndrom (CCS). However, the advantages for CCS patients to practice Tai Chi exercise as rehabilitation have not been rigorously tested and there is a lack of consensus on its benefits. This study aims to develop an innovative Tai Chi Cardiac Rehabilitation Program (TCCRP) for CCS patients and to assess the efficacy, safety and acceptability of the programme.

METHODS AND ANALYSIS

We propose to conduct a multicentre randomised controlled clinical trial comprising of 150 participants with CCS. The patients will be randomly assigned in a 1:1 ratio into two groups. The intervention group will participate in a supervised TCCRP held three times a week for 3 months. The control group will receive supervised conventional exercise rehabilitation held three times a week for 3 months. The primary and secondary outcomes will be assessed at baseline, 1 month, 3 months after intervention and after an additional 3-month follow-up period. Primary outcome measures will include a score of 36-Item Short Form Survey and Chinese Perceived Stress Scale. The secondary outcome measures will include body composition, cardiopulmonary exercise test, respiratory muscle function, locomotor skills, echocardiogram, New York Heart Association classification, heart rate recovery time and laboratory examination. Other measures also include Seattle Angina Scale, Pittsburgh Sleep Quality Index, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 and Berg Balance Scale. All adverse events will be recorded and analysed.

ETHICS AND DISSEMINATION

This study conforms to the principles of the Declaration of Helsinki and relevant ethical guidelines. Ethical approval has been obtained from the Ethics Committee of Chinese People's Libration Army General Hospital (approval number: S2019-060-02). Findings from this study will be published and presented at conferences for widespread dissemination of the results.

TRIAL REGISTRATION NUMBER

NCT03936504.

Effect of Meridian Acupressure on Aerobic Performance of Healthy Young Population: A Randomized Controlled Study

OBJECTIVES

An enhancement of aerobic capacity has always been in the scope of various exercise programs. Apart from traditional, like endurance training, methods to improve aerobic performance, there is growing interest to alternative bodywork techniques, like massage, yoga, and acupuncture. This study aimed to investigate the acupressure effect on maximal aerobic capacity (VO₂max) in healthy young adult males.

DESIGN

Forty young healthy participants were randomly divided into intervention (n = 20) and control (n = 20) groups. The inferred VO₂max level in groups was assessed by the 6-min Harvard step test twice: at baseline and after acupressure session.

INTERVENTION

Three-minute finger-tip point massage of Neiguan, Juque, and Xinshu acupoints covered by 1 cm² sticky capsaicin-dressed heat plasters was applied in the intervention group, whereas in the control group, placebo acupressure was utilized.

RESULTS

The inferred VO₂max in the intervention group increased from baseline 2.38 ± 0.48 L/min to 2.57 ± 0.6 L/min (p < 0.003), whereas inferred VO₂max of the control group remained unchanged (2.46 ± 0.5 L/min at baseline and 2.47 ± 0.4 L/min after placebo acupressure, p > 0.9).

CONCLUSIONS

The results of the study demonstrated that finger-tip acupressure increases aerobic performance of young healthy males on more than 10%. Acupressure probably decreased anxiety level, which allowed better utilization of available energy sources.

The Effect of Tai Chi on Cardiorespiratory Fitness for Coronary Disease Rehabilitation: A Systematic Review and Meta-Analysis

Background: Tai Chi that originated in China as a martial art is an aerobic exercise with low-to-moderate intensity and may play a role in cardiac rehabilitation.

Aim: To systematically review the effect of Tai Chi on cardiorespiratory fitness for coronary disease rehabilitation.

Methods: We performed a search for Chinese and English studies in the following databases: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, China Knowledge Resource Integrated Database, Wanfang Data, and China Science and Technology Journal Database. The search strategy included terms relating to or describing Tai Chi and coronary disease, and there were no exclusion criteria for other types of diseases or disorders. Further, bibliographies of the related published systematic reviews were also reviewed. The searches, data extraction, and risk of bias (ROB) assessments were conducted by two independent investigators. Differences were resolved by consensus. RevMan 5.3.0 was used to analyze the study results. We used quantitative synthesis if the included studies were sufficiently homogeneous and performed subgroup analyses for studies with different control groups. To minimize bias in our findings, we used GRADEpro to grade the available evidence.

Results: Five studies were enrolled—two randomized controlled trials (RCTs) and three nonrandomized controlled trials (N-RCTs)—that included 291 patients. All patients had coronary disease. ROB assessments showed a relatively high selection and detection bias. Meta-analyses showed that compared to other types of low- or moderate-intensity exercise, Tai Chi could significantly improve VO₂max [MD = 4.71, 95% CI (3.58, 5.84), P < 0.00001], but it seemed less effective at improving VO₂max as compared to high-intensity exercise. This difference, however, was not statistically significant [MD = −1.10, 95% CI (−2.46, 0.26), P = 0.11]. The GRADEpro showed a low level of the available evidence.

Conclusion: Compared to no exercise or other types of exercise with low-to-moderate intensity, Tai Chi seems a good choice for coronary disease rehabilitation in improving cardiorespiratory fitness. However, owing to the poor methodology quality, more clinical trials with large sample size, strict randomization, and clear description about detection and reporting processes are needed to further verify the evidence.

Effects of Tai Chi-based cardiac rehabilitation on aerobic endurance, psychosocial well-being, and cardiovascular risk reduction among patients with coronary heart disease: A systematic review and meta-analysis

INTRODUCTION

Tai Chi is an attractive exercise to improve cardiovascular health. This review aimed to synthesize articles written both in Chinese and in English to evaluate the effects of Tai Chi-based cardiac rehabilitation on aerobic endurance, psychosocial well-being and cardiovascular diseases risk reduction for coronary heart diseases patients.

METHODS

PRISMA guidelines were used to search major health databases to identify randomized controlled trials or non-randomized controlled clinical trials that evaluated Tai Chi intervention compared with active or non-active control groups in coronary heart disease patients. When suitable, data were pooled using a random-effects meta-analysis model.

RESULTS

Thirteen studies met the inclusion criteria. Tai Chi groups showed a large and significant improvement in aerobic endurance compared with both active and non-active control interventions (standard mean difference (SMD) 1.12; 95% confidence interval (CI): 0.58-1.66; p <0.001). Tai Chi groups also showed a significantly lower level of anxiety (SMD=9.28; CI: 17.46-1.10; p=0.03) and depression (SMD=9.42; CI: 13.59-5.26; p <0.001), and significantly better quality of life (SMD=0.73; 95% CI: 0.39-1.08; p <0.001) compared with non-active control groups.

CONCLUSION

Significant effects of Tai Chi have been found in improving aerobic endurance and psychosocial well-being among coronary heart disease patients. Tai Chi could be a cost-effective and safe exercise option in cardiac rehabilitation. However, the effect of Tai Chi on cardiovascular disease risk reduction has not been amply investigated among coronary heart disease patients. Caution is also warranted in view of a small number of studies for this meta-analysis and potential heterogeneity in differences in the varied designs of Tai Chi intervention.

Tai Chi and Low Impact Exercise: Effects on the Physical Functioning and Psychological Well-Being of Older People

The effects of tai chi (TC) and low impact exercise (LIE) interventions on physical functioning and psychological well-being of sedentary older people were contrasted. Participants were randomized to TC, LIE, or non-exercise control groups with interventions running for 12 weeks. Post-intervention assessments with 72 participants who completed the study revealed that participants in both exercise groups improved with respect to upper body strength, balance, cardiovascular endurance, lower body strength, sleep disturbances, and anxiety. Participants in the LIE group reported better functional ability while those in the TC group reported better subjective health. Findings suggest that tai chi and low impact exercise are safe, cost-effective ways to improve both physical and psychological functioning of older people.

Measurement Properties of Tai Chi Exercise Self-Efficacy among Ethnic Chinese with Coronary Heart Disease Risk Factors: A Pilot Study

BACKGROUND

Improvement in aerobic capacity and reduction in blood pressure after Tai Chi exercise programs in persons with coronary heart disease (CHD) or with CHD risk factors have been reported. Self-efficacy has been shown to be a consistent predictor of behavioral outcomes, now being applied to Tai Chi exercise.

AIM

To assess the utility and appropriateness of existing tools measuring aspects of Tai Chi exercise self-efficacy (TCSE) in a new population, ethnic Chinese with CHD risk factors. Specific objectives were: (1) examine acceptability and feasibility; (2) determine score distributions; (3) assess the reliability and known-groups validity; (4) translate tool into an equivalent Chinese version and determine if there were any differences between ethnic Chinese and non-Chinese.

METHODS

Following a review of the literature, two existing tools used with Caucasians were found and modified; a 9-item exercise self-efficacy tool developed by Resnick and Jenkins [Resnick B, Jenkins LS, Testing the reliability and validity of the Self-Efficacy for Exercise scale. Nurs. Res. 49(3) (2000) 154-159], and a 3-item tool developed by Li et al. [Li F, McAuley E, Harmer P, Duncan TE, Chaumeton NR, Tai Chi enhances self-efficacy and exercise behavior in older adults. J. Aging Phys. Act. 9 (2001) 161-171] to assess gradations of the challenge to perform Tai Chi among elderly populations. The modified TCSE tool was translated into Chinese and back-translated. A pilot study was conducted to pre-test the modified 14-item TCSE tool in ethnic Chinese and non-Chinese.

RESULTS

A total of 18 subjects (mean age = 60 years, S.D. = 18.4) participated. Seven subjects (39%) identified themselves as ethnic Chinese. Ten subjects (56%) had experience performing Tai Chi, ranging from 3 months to 17 years (mean = 5.0 years, S.D.=5.0). Half of the subjects reported having a history of hypertension (n = 9, 50%), while nearly one-third reported having high cholesterol (n = 5, 28%). No significant difference in TCSE mean scores was found between ethnic Chinese and non-Chinese (p > 0.05). Internal consistency estimates were very high (TCSE Barriers, r = 0.95; TCSE Performance, r = 0.97). A statistically significant difference was found in the TCSE mean scores between Tai Chi practitioners and non-practitioners (TCSE Barriers, t = -3.3, p = 0.01; TCSE Performance, t = -2.7, p = 0.03), with Tai Chi practitioners reporting higher self-efficacy; thus providing initial evidence of known-groups validity.

CONCLUSIONS

Measurement of self-efficacy to overcome barriers to Tai Chi exercise (TCSE Barriers) and self-efficacy to perform Tai Chi (TCSE Performance) functioned well in this sample. The acceptability and feasibility of this tool was established and known-groups validity was confirmed. Further research using this tool among ethnic Chinese with CHD or CHD risk factors, including those with less than high school education or low literacy, is recommended as the next step in development of TCSE.

Cultural Dance Program Improves Hypertension Management for Native Hawaiians and Pacific Islanders: a Pilot Randomized Trial

Objective

Native Hawaiians and Pacific Islanders (NHPI) bear an unequal burden of hypertension and cardiovascular disease. Hula, the traditional dance of Hawaii, has shown to be a culturally meaningful form of moderate-vigorous physical activity for NHPI. A pilot study was done in Honolulu, Hawaii, to test a 12-week hula-based intervention, coupled with self-care education, on blood pressure management in NHPI with hypertension in 2013.

Method

NHPI with a systolic blood pressure (SBP) ≥140 mmHg were randomized to the intervention (n = 27) or a wait-list control (n = 28). Blood pressure, physical functioning, and eight aspects of health-related quality of life (HRQL) were assessed.

Results

The intervention resulted in a reduction in SBP compared to control (−18.3 vs. −7.6 mmHg, respectively, p ≤ 0.05) from baseline to 3-month post-intervention. Improvements in HRQL measures of bodily pain and social functioning were significantly associated with SBP improvements in both groups.

Conclusion

Using hula as the physical activity component of a hypertension intervention can serve as a culturally congruent strategy to blood pressure management in NHPI with hypertension.

Trial registration

clinicaltrials.gov Identifier: NCT01995812

Long-term Exercise After Pulmonary Rehabilitation (LEAP): Design and rationale of a randomized controlled trial of Tai Chi

BACKGROUND

Persons with chronic obstructive pulmonary disease (COPD) have reduced exercise capacity and levels of physical activity. Supervised, facility-based pulmonary rehabilitation programs improve exercise capacity and reduce dyspnea, but novel long-term strategies are needed to maintain the benefits gained. Mind-body modalities such as Tai Chi which combine aerobic activity, coordination of breathing, and cognitive techniques that alleviate the physical inactivity, dyspnea, and anxiety and depression that are the hallmarks of COPD are promising strategies.

METHODS/DESIGN

We have designed a randomized controlled study to examine whether Tai Chi will maintain exercise capacity in persons with COPD who have recently completed a supervised pulmonary rehabilitation program, compared to standard care. The primary outcome is 6-min walk test distance at 6 months. Secondary outcomes include health-related quality of life, dyspnea, mood, occurrence of acute exacerbations, engagement in physical activity, exercise self-efficacy, and exercise adherence. Simultaneously, we are conducting a pilot study of group walking. We will enroll 90 persons who will be randomized to one of three arms in a 2:2:1 ratio: Tai Chi, standard care, or group-based walking.

DISCUSSION

The Long-term Exercise After Pulmonary Rehabilitation (LEAP) study is a novel and clinically relevant trial. We will enroll a well-characterized cohort of persons with COPD and will comprehensively assess physiological and psychosocial outcomes. Results of this study will provide the evidence base for persons with COPD to engage in Tai Chi as a low-cost, long-term modality to sustain physical activity in persons who have completed a standard short-term pulmonary rehabilitation program.

TRIAL REGISTRATION

This trial is registered in Clinical Trials.gov, with the ID number of NCT01998724.

Design and methods of the Gentle Cardiac Rehabilitation Study--A behavioral study of tai chi exercise for patients not attending cardiac rehabilitation

INTRODUCTION

Cardiac rehabilitation (CR) programs reduce overall and cardiovascular mortality in patients with a history of acute coronary events or revascularization procedures, but only 30% of patients enroll in CR and attrition rates reach up to 60%. Tai chi, a mind-body practice based on light/moderate aerobic exercise accompanied by meditative components could be a possible exercise option for patients who do not attend CR.

METHODS/DESIGN

Sixty patients will be randomized to a "LITE" condition (one tai chi session twice weekly for 12 weeks) or to a "PLUS" condition (one tai chi session 3 times weekly for 12 weeks, followed by maintenance classes 1-2 times weekly for an additional 12 weeks). Measurements will be conducted at baseline, 3-, 6-, and 9 months after enrollment. The primary outcome is to determine the feasibility, acceptability and safety of each dose. Secondary outcomes include estimates of effect size of each dose on accelerometry-assessed physical activity; the proportion of patients meeting current recommendations for physical activity; and measures of fitness, quality of life, body weight, and sleep. In addition, we will collect exploratory information on possible mediators (exercise self-efficacy, perceived social support, resilience, mindfulness, and depression).

CONCLUSIONS

Findings from this pilot study will provide preliminary indications about the usefulness of tai chi as an exercise option for patients not attending traditional CR programs. Results will also shed light on the possible mechanisms by which tai chi practice may improve overall physical activity among patients with atherosclerotic coronary heart disease.

Tai Chi Chuan improves functional capacity after myocardial infarction: A randomized clinical trial

BACKGROUND

Patients with a recent myocardial infarction (MI) present a reduction in functional capacity expressed as a decrease in peak oxygen consumption (Vo2 peak). The impact of a Tai Chi Chuan (TCC) cardiac rehabilitation program for patients recovering from recent MI has yet to be assessed. Our goal is to evaluate functional capacity after a TCC-based cardiac rehabilitation program in patients with recent MI.

METHODS

A single-blind randomized clinical trial was conducted. The researchers who performed the tests were blinded to group allocation. Between the 14th and 21st days after hospital discharge, all patients performed a cardiopulmonary exercise testing and a laboratory blood workup. Mean age was similar (56±9 years in the TCC group and 60±9 years in the control group). Patients allocated to the intervention group performed 3 weekly sessions of TCC Beijin style for 12 weeks (n=31). The control group participated in 3 weekly sessions of full-body stretching exercises (n=30).

RESULTS

After the 12-week study period, participants in the TCC group experienced a significant 14% increase in Vo2 peak from baseline (21.6 ± 5.2 to 24.6 ± 5.2 mL/kg per minute), whereas control participants had a nonsignificant 5% decline in Vo2 peak (20.4 ± 5.1 to 19.4 ± 4.4 mL/kg per minute). There was a significant difference between the 2 groups (P<.0001).

CONCLUSIONS

Tai Chi Chuan practice was associated with an increase in Vo2 peak in patients with a recent MI and may constitute an effective form of cardiac rehabilitation in this patient population.

The effect of Tai Chi training on cardiorespiratory fitness in healthy adults: a systematic review and meta-analysis

Background

Tai Chi may be efficient for healthy adults to improve the cardiorespiratory fitness, but there is no systematic evaluation for its effectiveness.

Objective

To systematically assess the effectiveness of Tai Chi on cardiorespiratory fitness in healthy adults.

Methods

Seven electronic databases were searched from their inception to October 2013. The controlled trails including randomized controlled trial (RCT), non-randomized controlled trial (NRCT), self-controlled trial (SCT), and cohort study (CS) testing Tai Chi exercise against non-intervention control conditions in healthy adults that assessed any type cardiorespiratory fitness outcome measures were considered. Two reviewers independently performed the selection of the studies according to predefined criteria. The risk of bias was assessed using Cochrane criteria. RevMan 5.2 software was applied for data analysis.

Results

Twenty studies (2 RCTs, 8 NRCTs, 3 SCTs, and 7 CSs) with 1868 participants were included, but most of them belonged to low methodological quality. The results of systematic review showed that Tai Chi exercise had positive effect on majority outcomes of cardio function (Blood pressure: n = 536, SPB SMD = -0.93, 95% CI -1.30 to -0.56, P < 0.00001; DBP SMD = -0.54, 95% CI -0.90 to -0.18, P < 0.00001; heart rate at quiet condition: n = 986, SMD = -0.72, 95% CI -1.27 to -0.18, P = 0.010; stroke volume: n = 583, SMD = 0.44, 95% CI 0.28 to 0.61, P < 0.00001; cardio output: n = 583, MD = 0.32 L/min, 95% CI 0.08 to 0.56, P = 0.009), lung capacity (FVC at quiet condition: n = 1272, MD = 359.16 mL, 95% CI 19.57 to 698.75, P = 0.04 for less than one year intervention, and MD = 442.46 mL, 95% CI 271.24 to 613.68, P<0.0001 for more than one year intervention; V·O₂peak: n = 246, SMD = 1.33, 95% CI 0.97 to 1.70, P < 0.00001), and cardiorespiratory endurance (O₂ pulse at quiet condition: n = 146, SMD = 1.04; 95% CI 0.69 to 1.39; P < 0.00001; stair test index at quiet condition: n = 679, SMD = 1.34, 95% CI 0.27 to 2.40, p = 0.01). No adverse events were reported.

Conclusions

The results are encouraging and suggest that Tai Chi may be effective in improving cardiorespiratory fitness in healthy adults. However, concerning the low methodological quality in the included studies, more larger-scale well-designed trails are needed till the specific and accurate conclusions can be perorated.

Tai Chi as a form of exercise training in people with chronic obstructive pulmonary disease

Tai Chi is an ancient Chinese martial art which incorporates elements of strengthening, balance, postural alignment and concentration. The benefits of Tai Chi in the healthy population have been widely examined. In comparison, only three studies have evaluated the effects of Tai Chi in people with chronic obstructive pulmonary disease (COPD). Existing evidence suggests that the exercise intensity of Tai Chi reaches a moderate level in people with COPD. Furthermore, a short-term program of Tai Chi improves exercise capacity, health-related quality of life, balance and quadriceps strength in people with mild to moderate COPD. More studies are warranted to examine the effects of different styles of Tai Chi and the long-term benefits of Tai Chi as an exercise regimen for people with COPD.

Tai chi chuan exercise for patients with cardiovascular disease

Exercise training is the cornerstone of rehabilitation for patients with cardiovascular disease (CVD). Although high-intensity exercise has significant cardiovascular benefits, light-to-moderate intensity aerobic exercise also offers health benefits. With lower-intensity workouts, patients may be able to exercise for longer periods of time and increase the acceptance of exercise, particularly in unfit and elderly patients. Tai Chi Chuan (Tai Chi) is a traditional Chinese mind-body exercise. The exercise intensity of Tai Chi is light to moderate, depending on its training style, posture, and duration. Previous research has shown that Tai Chi enhances aerobic capacity, muscular strength, balance, and psychological well-being. Additionally, Tai Chi training has significant benefits for common cardiovascular risk factors, such as hypertension, diabetes mellitus, dyslipidemia, poor exercise capacity, endothelial dysfunction, and depression. Tai Chi is safe and effective in patients with acute myocardial infarction (AMI), coronary artery bypass grafting (CABG) surgery, congestive heart failure (HF), and stroke. In conclusion, Tai Chi has significant benefits to patients with cardiovascular disease, and it may be prescribed as an alternative exercise program for selected patients with CVD.

Tai chi chuan in medicine and health promotion

Tai Chi Chuan (Tai Chi) is a Chinese traditional mind-body exercise and recently, it becomes popular worldwide. During the practice of Tai Chi, deep diaphragmatic breathing is integrated into body motions to achieve a harmonious balance between body and mind and to facilitate the flow of internal energy (Qi). Participants can choose to perform a complete set of Tai Chi or selected movements according to their needs. Previous research substantiates that Tai Chi has significant benefits to health promotion, and regularly practicing Tai Chi improves aerobic capacity, muscular strength, balance, health-related quality of life, and psychological well-being. Recent studies also prove that Tai Chi is safe and effective for patients with neurological diseases (e.g., stroke, Parkinson's disease, traumatic brain injury, multiple sclerosis, cognitive dysfunction), rheumatological disease (e.g., rheumatoid arthritis, ankylosing spondylitis, and fibromyalgia), orthopedic diseases (e.g., osteoarthritis, osteoporosis, low-back pain, and musculoskeletal disorder), cardiovascular diseases (e.g., acute myocardial infarction, coronary artery bypass grafting surgery, and heart failure), chronic obstructive pulmonary diseases, and breast cancers. Tai Chi is an aerobic exercise with mild-to-moderate intensity and is appropriate for implementation in the community. This paper reviews the existing literature on Tai Chi and introduces its health-promotion effect and the potential clinical applications.

Tai chi in patients with heart failure with preserved ejection fraction

Although exercise is an important component of heart failure management, optimal regimens, particularly in heart failure with preserved ejection fraction (HFPEF), are uncertain. Tai chi (TC) is a mind-body exercise that may have potential benefits but has not been studied in this population. The authors randomized 16 patients with HFPEF to either 12 weeks TC or aerobic exercise. Assessments included peak oxygen uptake, 6-minute walk, quality of life, echocardiography, mood, and self-efficacy at baseline and at 12 weeks. Cardiorespiratory measures during exercise were obtained to characterize training intensities. Baseline characteristics were as follows: age 66±12 years, E/A ratio 1.3±0.7, and E/e' ratio 15.9±4.8. Overall, adherence was excellent (89% attendance). Change in peak oxygen uptake was similar between groups after 12 weeks, but 6-minute walk distance increased more after TC (69±46 m vs 10±31 m, P=.02). While both groups had improved Minnesota Living With Heart Failure scores and self-efficacy, Profile of Mood States (POMS)-Depression scores improved more with TC (-1.7±2.8 vs 1.6±3, P=.05). Cardiorespiratory assessment during TC showed lower oxygen uptake (4.3 mL/kg/min vs 9.4 mL/kg/min, P<.01), respiratory rate, and heart rate. TC is feasible and safe in HFPEF. Therepeutic endpoints appear similar with TC relative to aerobic exercise despite a lower aerobic training workload.

Tai Chi as an adjunct physical activity for adults aged 45 years and older enrolled in phase III cardiac rehabilitation

BACKGROUND

Cardiac rehabilitation improves physical, cognitive and psychosocial functioning, yet services are greatly underutilized with increasing patterns of attrition over time. Tai Chi has been suggested as a possible adjunct to cardiac rehabilitation exercise training.

AIM

To describe differences in physical, cognitive and psychosocial functioning among adults ≥ 45 years old attending phase III cardiac rehabilitation, who have or have not self-selected Tai Chi exercise as an adjunct physical activity.

METHODS

A cross-sectional design compared subjects attending group-based Wu style Tai Chi classes plus cardiac rehabilitation, with cardiac rehabilitation only. Subjects had a battery of physical and cognitive functioning tests administered to examine aerobic endurance, balance, strength, and flexibility, verbal retrieval/recall, attention, concentration and tracking. Subjects completed a health survey to ascertain cardiac event information, medical history, and psychosocial functioning (i.e. health-related quality of life, stress, depressive symptoms, social support, and Tai Chi self-efficacy).

RESULTS

A total of 51 subjects (75% married, 84% college-educated, 96% White/European-American) participated. Subjects were on average 70 (± 8) years old and had attended cardiac rehabilitation for 45 (± 37) months. Approximately 45% (n = 23) attended Tai Chi classes plus cardiac rehabilitation, while 55% (n = 28) attended cardiac rehabilitation only. Subjects attending Tai Chi plus cardiac rehabilitation had better balance, perceived physical health, and Tai Chi self-efficacy compared to those attending cardiac rehabilitation only (p ≤ 0.03).

CONCLUSION

Tai Chi can be easily implemented in any community/cardiac rehabilitation facility, and may offer adults additional options after a cardiac event.

Effectiveness of a tai-chi training and detraining on functional capacity, symptomatology and psychological outcomes in women with fibromyalgia

Background. The purpose was to analyze the effects of Tai-Chi training in women with fibromyalgia (FM). Methods. Thirty-two women with FM (mean age, 51.4 ± 6.8 years) attended to Tai-Chi intervention 3 sessions weekly for 28 weeks. The outcome measures were: tenderness, body composition, functional capacity and psychological outcomes (Fibromyalgia impact questionnaire (FIQ), Short Form Health Survey 36 (SF-36)). Results. Patients showed improvements on pain threshold, total number of tender points and algometer score (all P < 0.001). The intervention was effective on 6-min walk (P = 0.006), back scratch (P = 0.002), handgrip strength (P = 0.006), chair stand, chair sit & reach, 8 feet up & go and blind flamingo tests (all P < 0.001). Tai-Chi group improved the FIQ total score (P < 0.001) and six subscales: stiffness (P = 0.005), pain, fatigue, morning tiredness, anxiety, and depression (all P < 0.001). The intervention was also effective in six SF-36 subscales: bodily pain (P = 0.003), vitality (P = 0.018), physical functioning, physical role, general health, and mental health (all P < 0.001). Conclusions. A 28-week Tai-Chi intervention showed improvements on pain, functional capacity, symptomatology and psychological outcomes in female FM patients.

Dejian mind-body intervention on depressive mood of community-dwelling adults: a randomized controlled trial

The present study evaluated the effectiveness of a short-term mind-body intervention program on improving the depressive mood of an adult community sample. Forty adult volunteers with various degrees of depressive mood were randomly assigned to the experimental group (Dejian Mind-Body Intervention, DMBI) and control group (Cognitive-Behavioral Therapy, CBT). For each group, a total of four 90-min weekly sessions were conducted. Treatment-related changes were measured using the Beck Depression Inventory (BDI-II), an electroencephalographic indicator of positive affect (i.e., prefrontal activation asymmetry), and self-report ratings on physical health. Results indicated that both the DMBI and the CBT group demonstrated significant reduction in depressive mood. However, among individuals with moderate to severe depressive mood at baseline, only those in the DMBI but not the CBT group showed significant reduction in depressive mood. Besides, only the DMBI group demonstrated a significant increase in prefrontal activation asymmetry, suggesting increase in positive affect. While most psychological therapies for depressive mood normally take several months to show treatment effect, the present findings provided initial data suggesting that the DMBI was effective in improving depressive mood of community adults after 1 month of training.

Tai chi exercise in patients with chronic heart failure: a randomized clinical trial

BACKGROUND

Preliminary evidence suggests that meditative exercise may have benefits for patients with chronic systolic heart failure (HF); this has not been rigorously tested in a large clinical sample. We sought to investigate whether tai chi, as an adjunct to standard care, improves functional capacity and quality of life in patients with HF.

METHODS

A single-blind, multisite, parallel-group, randomized controlled trial evaluated 100 outpatients with systolic HF (New York Heart Association class I-III, left ventricular ejection fraction ≤40%) who were recruited between May 1, 2005, and September 30, 2008. A group-based 12-week tai chi exercise program (n = 50) or time-matched education (n = 50, control group) was conducted. Outcome measures included exercise capacity (6- minute walk test and peak oxygen uptake) and disease-specific quality of life (Minnesota Living With Heart Failure Questionnaire).

RESULTS

Mean (SD) age of patients was 67 (11) years; baseline values were left ventricular ejection fraction, 29% (8%) and peak oxygen uptake, 13.5 mL/kg/min; the median New York Heart Association class of HF was class II. At completion of the study, there were no significant differences in change in 6-minute walk distance and peak oxygen uptake (median change [first quartile, third quartile], 35 [-2, 51] vs 2 [-7, 54] meters, P = .95; and 1.1 [-1.1, 1.5] vs -0.5 [-1.2, 1.8] mL/kg/min, P = .81) when comparing tai chi and control groups; however, patients in the tai chi group had greater improvements in quality of life (Minnesota Living With Heart Failure Questionnaire, -19 [-23, -3] vs 1 [-16, 3], P = .02). Improvements with tai chi were also seen in exercise self-efficacy (Cardiac Exercise Self-efficacy Instrument, 0.1 [0.1, 0.6] vs -0.3 [-0.5, 0.2], P < .001) and mood (Profile of Mood States total mood disturbance, -6 [-17, 1] vs -1 [-13, 10], P = .01).

CONCLUSION

Tai chi exercise may improve quality of life, mood, and exercise self-efficacy in patients with HF. Trial Registration clinicaltrials.gov Identifier: NCT00110227.

Physical activity and cognition in older adults: the potential of Tai Chi Chuan

The purpose of this article is to review the potential of Tai Chi Chuan as a mode of physical activity that could have cognitive benefits for older adults and to provide potential directions for future research. A brief introduction to Tai Chi Chuan and its related physical benefits is provided. In addition, the empirical literature related to Tai Chi Chuan and cognition is reviewed. Potential mediators of the relationship between Tai Chi Chuan and cognition, including physical resources, disease status, and mental resources, are discussed. Based on the limitations of the extant literature, it is argued that future research in this area must provide more detailed descriptions of Tai Chi Chuan, particularly in terms of intensity and program progression. Consideration of the specific type of cognition that is expected to benefit is also encouraged, and approaches for further efforts to understand how Tai Chi Chuan affects cognition are recommended.

Tai chi and rheumatic diseases

Tai chi is a complex multicomponent mind-body exercise. Many studies have provided evidence that tai chi benefits patients with a variety of chronic disorders. This form of mind-body exercise enhances cardiovascular fitness, muscular strength, balance, and physical function and seems to be associated with reduced stress, anxiety, and depression and improved quality of life. Thus, despite certain limitations in the evidence, tai chi can be recommended to patients with osteoarthritis, rheumatoid arthritis, and fibromyalgia as a complementary and alternative medical approach. This article overviews the current knowledge about tai chi to better inform clinical decision making for rheumatic patients.

[Effects of Tai Chi exercise on physical and mental health]

Recently, Tai Chi, which is one of the Chinese traditional martial arts, has been receiving attention. The main feature of Tai Chi is its flowing movements including loosening up, relaxing, and practicing meditation with slow abdominal respiration. Tai Chi is widely taken as part of health-promotion activities or rehabilitation training, and significant mental and physical effects have been reported so far. In this review report, Tai Chi was confirmed to be beneficial not only as a rehabilitation training for old people or patients with various diseases but also as an exercise for healthy people. These findings suggest the potential of Tai Chi as a complementary and alternative therapy.

Effects of Tai Chi rehabilitation on heart rate responses in patients with coronary artery disease

The objective of the present study was to evaluate the effect of a six-month Tai Chi (TC) exercise cardiac rehabilitation program on two prognostic factors of cardiac events, rate-pressure product and rate-pressure product reserve, in patients with coronary artery disease (CAD). Patients (N = 54) with CAD were recruited from the clinics of cardiology and cardiovascular surgery at a regional hospital in Taiwan. Twenty-two of them enrolled in the TC rehabilitation program which consisted of weekly 90-min sessions of Yang's style TC for six months in addition to receiving usual care. The remaining 32 patients received usual care only. Modified Bruce treadmill exercise test was performed to evaluate their exercise test responses at baseline and at six months. The change over time was significantly different between the TC and control group in peak rate-pressure product (RPP) (interaction between group and time, p = 0.029) and in RPP reserve (interaction between group and time p = 0.009) over the six-month period, there was a decrease in peak RPP of 32.0 mmHg x bpm x 10(-2) and in RPP reserve of 37.4 mmHg x bpm x 10(-2) in the TC group. In conclusion, participating in a six-month TC exercise-based cardiac rehabilitation program was associated with improved peak RPP and RPP reserve during exercise testing in patients with CAD. TC exercise program may lead to a better prognosis for cardiac events in patients with CAD.

Influence of personal patterns of behavior on the effects of Tai Chi: a pilot study

OBJECTIVES

To investigate the influence of individual patterns of personality and behavior on the change in mood status after a brief period of Tai Chi exercise.

METHODS

The mood status in 22 healthy females was evaluated before and after a period of Tai Chi exercise using the Profile of Mood States (POMS) score. Patterns of personal behavior were also assessed by written questionnaire.

RESULTS

In the type A behavior pattern group, the score for total mood disturbance decreased significantly after a brief period (20 min) of Tai Chi exercise. No change was observed in the type B behavior pattern group.

CONCLUSIONS

These findings suggest that a brief period of Tai Chi exercise is mentally beneficial, particularly to individuals with type A characteristics.

Tai Chi for osteopenic women: design and rationale of a pragmatic randomized controlled trial

Background

Post-menopausal osteopenic women are at increased risk for skeletal fractures. Current osteopenia treatment guidelines include exercise, however, optimal exercise regimens for attenuating bone mineral density (BMD) loss, or for addressing other fracture-related risk factors (e.g. poor balance, decreased muscle strength) are not well-defined. Tai Chi is an increasingly popular weight bearing mind-body exercise that has been reported to positively impact BMD dynamics and improve postural control, however, current evidence is inconclusive. This study will determine the effectiveness of Tai Chi in reducing rates of bone turnover in post-menopausal osteopenic women, compared with standard care, and will preliminarily explore biomechanical processes that might inform how Tai Chi impacts BMD and associated fracture risks.

Methods/Design

A total of 86 post-menopausal women, aged 45-70y, T-score of the hip and/or spine -1.0 and -2.5, have been recruited from primary care clinics of a large healthcare system based in Boston. They have been randomized to a group-based 9-month Tai Chi program plus standard care or to standard care only. A unique aspect of this trial is its pragmatic design, which allows participants randomized to Tai Chi to choose from a pre-screened list of community-based Tai Chi programs. Interviewers masked to participants' treatment group assess outcomes at baseline and 3 and 9 months after randomization. Primary outcomes are serum markers of bone resorption (C-terminal cross linking telopeptide of type I collagen), bone formation (osteocalcin), and BMD of the lumbar spine and proximal femur (dual-energy X-ray absorptiometry). Secondary outcomes include health-related quality-of-life, exercise behavior, and psychological well-being. In addition, kinetic and kinematic characterization of gait, standing, and rising from a chair are assessed in subset of participants (n = 16) to explore the feasibility of modeling skeletal mechanical loads and postural control as mediators of fracture risk.

Discussion

Results of this study will provide preliminary evidence regarding the value of Tai Chi as an intervention for decreasing fracture risk in osteopenic women. They will also inform the feasibility, value and potential limitations related to the use of pragmatic designs for the study of Tai Chi and related mind-body exercise. If the results are positive, this will help focus future, more in-depth, research on the most promising potential mechanisms of action identified by this study.

Trial registration

This trial is registered in Clinical Trials.gov, with the ID number of NCT01039012.

T'ai chi and qigong for health: patterns of use in the United States

BACKGROUND

Little is known in the United States about those who practice t'ai chi and qigong, two mind-body techniques that originated in Asia.

OBJECTIVE

The objective of this study is to characterize use of t'ai chi and qigong for health with regard to sociodemographics, health status, medical conditions, perceptions of helpfulness, and disclosure of use to medical professionals.

METHODS

We analyzed associations of t'ai chi and qigong use for health using cross-sectional data from the 2002 National Health Interview Survey (NHIS) Alternative Medicine Supplement (n = 31,044). The 2002 NHIS estimated the number of t'ai chi and qigong users for health to be 2.5 and 0.5 million persons, respectively. We collapsed t'ai chi and qigong use into a single category (TCQ) for analysis, representing 2.8 million individuals.

RESULTS

We found that neither age nor sex was associated with TCQ use. TCQ users were more likely than nonusers to be Asian than white (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.30-3.15), college educated (OR 2.44, 95% CI 1.97-3.03), and less likely to live in the Midwest (OR 0.64, 95% CI 0.42-0.96) or the southern United States (OR 0.51, 95% CI 0.36-0.72) than the West. TCQ use was associated independently with higher reports of musculoskeletal conditions (OR 1.43, 95% CI 1.11-1.83), severe sprains (OR 1.65, 95% CI 1.14-2.40), and asthma (OR 1.50, 95% CI 1.08-2.10). Half of TCQ users also used yoga for health in the last 12 months. Most TCQ users reported their practice to be important to maintain health, but only a quarter of users disclosed their practice to a medical professional.

CONCLUSIONS

In the United States, TCQ is practiced for health by a diverse population, and users report benefits for maintaining health. Further research is needed to establish efficacy and safety for target populations, including those with musculoskeletal and pulmonary disease, as well as for preventive health.

Tai Chi and Meditation

The aim of this article is to review the literature on Tai Chi and meditation. A coherent construct is developed that includes a comparative analysis and conceptual synthesis of existing theories. The authors discuss a set of assumptions that justify this synthesis; they also argue that this construct would facilitate greater understanding of Tai Chi from the perspective of meditation. Such synthesis may bring “additional” benefits to Tai Chi practitioners as they could recognize that this mind—body technique holds the essence of meditation. Within the scope of this article, the evidence shows a majority of common features when concerning Tai Chi and meditation. These mutual similarities should be taken into account when performing this type of mind—body medicine by patients and/or therapists. Finally, the authors suggest that this inspiring compilation of movements and mindfulness can be used for practical purposes.

Tai chi exercise for patients with cardiovascular conditions and risk factors: A SYSTEMATIC REVIEW

PURPOSE

To conduct a systematic review of the literature evaluating tai chi exercise as an intervention for patients with cardiovascular disease (CVD) or with CVD risk factors (CVDRF).

METHODS

We searched (1) MEDLINE, CAB Alt HealthWatch, BIOSIS previews, Science Citation Index, EMBASE, and Social Science Citation Index from inception through October 2007; (2) Chinese Medical Database, China Hospital Knowledge, China National Knowledge Infrastructure, and China Traditional Chinese Medicine Database from inception through June 2005; and (3) the medical libraries of Beijing and Nanjing Universities. Clinical studies published in English and Chinese including participants with established CVD or CVDRF were included. Data were extracted in a standardized manner; 2 independent investigators assessed methodological quality, including the Jadad score for randomized controlled trials (RCTs).

RESULTS

Twenty-nine studies met inclusion criteria: 9 RCTs, 14 nonrandomized studies, and 6 observational trials. Three studies examined subjects with coronary heart disease, 5 in subjects with heart failure, and 10 in heterogeneous populations that included those with CVD. Eleven studies examined subjects with CVDRF (hypertension, dyslipidemia, impaired glucose metabolism). Study duration ranged from 8 weeks to 3 years. Most studies included fewer than 100 subjects (range, 5-207). Six of 9 RCTs were of adequate quality (Jadad >or= 3). Most studies reported improvements with tai chi, including blood pressure reductions and increases in exercise capacity. No adverse effects were reported.

CONCLUSION

Preliminary evidence suggests that tai chi exercise may be a beneficial adjunctive therapy for some patients with CVD and CVDRF. Further research is needed.

Challenges inherent to t'ai chi research: part I--t'ai chi as a complex multicomponent intervention

In this, the first of 2 companion papers, we present a framework for viewing t'ai chi as a complex, multicomponent intervention that integrates numerous physical, cognitive, and ritualistic components. We discuss how the richness and complexity of t'ai chi poses challenges related to the traditional distinction between specific versus nonspecific effects, the development and interpretation of valid sham controls, and more generally, to the reductionist causal approach of attributing observed outcomes to single, independent component factors. We also discuss parallels between t'ai chi research and the emerging field of whole systems research, and how t'ai chi research may benefit from the use of an ecologic framework. In a second, companion paper, we discuss additional challenges inherent in defining the t'ai chi intervention itself, and more comprehensively outline the benefits and limitations of commonly used clinical research designs to evaluate the efficacy and safety of t'ai chi.

Enhancement of sleep stability with Tai Chi exercise in chronic heart failure: preliminary findings using an ECG-based spectrogram method

OBJECTIVE

To assess the effects of a 12-week Tai Chi exercise program on sleep using the sleep spectrogram, a method based on a single channel electrocardiogram (ECG)-derived estimation of cardiopulmonary coupling, previously shown to identify stable and unstable sleep states.

METHODS

We retrospectively analyzed 24-h continuous ECG data obtained in a clinical trial of Tai Chi exercise in patients with heart failure. Eighteen patients with chronic stable heart failure, left ventricular ejection fraction <or= 40% (mean [+/-standard deviation] age, 59+/-14 years, mean baseline ejection fraction 24%+/-8%, mean) were randomly assigned to receive usual care (N=10), which included pharmacological therapy and dietary and exercise counseling, or 12 weeks of Tai Chi training (N=8) in addition to usual care. Using the ECG-based sleep spectrogram, we compared intervention and control groups by evaluating baseline and 12-week high (stable) and low (unstable) frequency coupling (HFC & LFC, respectively) as a percentage of estimated total sleep time (ETST).

RESULTS

At 12 weeks, those who participated in Tai Chi showed a significant increase in HFC (+0.05+/-0.10 vs. -0.06+/-0.09 % ETST, p=0.04) and significant reduction in LFC (-0.09+/-0.09 vs. +0.13+/-0.13 % ETST, p<0.01), compared to patients in the control group. Correlations were seen between improved sleep stability and better disease-specific quality of life.

CONCLUSIONS

Tai Chi exercise may enhance sleep stability in patients with chronic heart failure. This sleep effect may have a beneficial impact on blood pressure, arrhythmogenesis and quality of life.

The effects of Tai Chi on bone mineral density in postmenopausal women: a systematic review

OBJECTIVE

To evaluate the evidence for Tai Chi as an intervention to reduce rate of bone loss in postmenopausal women.

DATA SOURCES

Literature search using Medline, Science Citation Index, Cochrane databases, China Biological Medicine Database, and additional manual reference searches of retrieved articles and personal libraries.

STUDY SELECTION

Randomized controlled trials (RCTs), prospective cohort studies, and cross-sectional studies that included Tai Chi as an intervention, and had at least 1 outcome related to measurement of bone mineral density (BMD).

DATA EXTRACTION

Authors critically reviewed studies, evaluated methodologic quality, and synthesized study results in a summary table.

DATA SYNTHESIS

Six controlled studies were identified by our search. There were 2 RCTs, 2 nonrandomized prospective parallel cohort studies, and 2 cross-sectional studies. The 2 RCTs and 1 of the prospective cohort studies suggested that Tai Chi-naive women who participated in Tai Chi training exhibited reduced rates of postmenopausal declines in BMD. Cross-sectional studies suggested that long-term Tai Chi practitioners had higher BMD than age-matched sedentary controls, and had slower rates of postmenopausal BMD decline. No adverse effects related to Tai Chi were reported in any trial.

CONCLUSIONS

Conclusions on the impact of Tai Chi on BMD are limited by the quantity and quality of research to date. This limited evidence suggests Tai Chi may be an effective, safe, and practical intervention for maintaining BMD in postmenopausal women. In combination with research that indicates Tai Chi can positively impact other risk factors associated with low BMD (eg, reduced fall frequency, increased musculoskeletal strength), further methodologically sound research is warranted to better evaluate the impact of Tai Chi practice on BMD and fracture risk in postmenopausal women.