Tai Chi Exercise for Mental and Physical Well-Being in Patients with Depressive Symptoms: A Systematic Review and Meta-Analysis

Effects of chronic exercise on different central features of depression in adults with depression: A systematic review and meta-analysis of random controlled trials

BACKGROUND

Exercise is considered an effective treatment for improving central symptoms of depression. However, the antidepressant effects of exercise on specific central features in adults with depression and the optimal exercise prescription remain unclear. The present review aimed to explore the impact of exercise on emotion regulation (ER) and executive function (EF) among adults living with depression as well as the moderating effects of exercise prescription characteristics.

METHODS

Two Chinese databases and two English databases were systematically searched from January 1, 2000 to October 30, 2023 to identify relevant randomized controlled trials (RCTs). Based on the results of heterogeneity analyses, the random effects model was used for the meta-analysis of rumination (260 participants in 5 studies), inhibition (578 participants in 7 studies) and updating (832 participants in 9 studies), whereas the fixed effects model was used for the meta-analysis for shifting (802 participants in 8 studies).

RESULTS

Exercise improved rumination (standardized mean difference [SMD] = -0.59, p = 0.02); however, these benefits were observed only for moderate-intensity aerobic exercise in one or two 31-60 min sessions per week for 5-8 weeks. The results indicated significant post-exercise improvement in shifting (SMD = -0.22, p = 0.002) but not inhibition (SMD = -0.21, p = 0.18) or updating (SMD = 0.15, p = 0.14). Moreover, substantial improvements in shifting were observed only from high-intensity aerobic exercise in three or four 31-60 min sessions per week for more than 8 weeks.

CONCLUSIONS

Exercise improved ER (i.e., rumination) and EF (i.e., shifting) in adults with depression. It is important to consider symptoms when prescribing exercise to adults with depression. However, given the limited number of included RCTs, these findings are preliminary and tentative.

Non-Pharmacological Pain Management of Rheumatoid Arthritis

PURPOSE OF REVIEW

Many individuals with rheumatoid arthritis (RA) continue to suffer from pain despite treatment with disease-modifying antirheumatic drugs. In this review, we aim to summarize the evidence for non-pharmacological approaches for managing pain in RA.

RECENT FINDINGS

Few studies have examined the effect of non-pharmacological therapies on pain in patients with RA. Of these studies, many were not designed to specifically target pain and examined pain as a secondary outcome. While most studies reported within group improvements in pain, the magnitude of improvement varied, and differences between intervention and control groups often were not statistically significant. We recommend non-pharmacologic approaches for management of RA, based primarily on data for improving pain-related outcomes (e.g., physical function, overall health), as opposed to pain itself. The evidence base for non-pharmacologic interventions for pain remains poor, and there is a critical need for large RCTs designed to specifically target pain.

The Science of Tai Chi and Qigong and Whole Person Health Part I: Rationale and State of the Science

The emerging paradigm of whole person health shares many core principles with traditional complementary and integrative health frameworks, including Tai Chi and qigong (TCQ). In the Fall of 2023, the Harvard Medical School Osher Center for Integrative Health hosted the inaugural international conference on The Science of Tai Chi for Whole Person Health: Advancing the Integration of Mind-Body Practices into Contemporary Health Care held at Harvard Medical School. A two-part white paper was written to summarize key conference topics, findings, and issues. Part I presented here summarizes the rationale for the conference and synthesizes the state of evidence for TCQ as rehabilitative and preventive tools for a range of clinical conditions, including falls and balance, cognition, mental health, sleep, cardiorespiratory health, musculoskeletal health, cancer, as well as translational evidence related to the neurophysiology, brain and immune function, and biomarkers of inflammation. The state of science of TCQ, viewed through the lens of traditional East Asian health constructs, is also discussed. Part II of this white paper outlines evidence gaps and opportunities and discusses strategies to address challenges in TCQ research, dissemination, and implementation.

Effects of Tai Chi Versus General Aerobic Exercise on Depressive Symptoms and Serum Lipid Levels Among Older Persons With Depressive Symptoms: A Randomized Controlled Study

Tai Chi, a mindfulness-based aerobic exercise, may alleviate depressive symptoms and improve physiological markers in older adults. However, its distinct effects compared with general aerobic exercise remain unclear. To compare the effects of Tai Chi and general aerobic exercise on depressive symptoms and serum lipid levels in community-dwelling older adults with mild to moderate depression, a randomized controlled trial was conducted. Participants were randomly assigned to Tai Chi (n = 120) or general aerobic exercise (n = 120) for 3 months. Depressive symptoms and serum lipid levels were measured at baseline and postintervention. A generalized estimating equation was used to assess group differences over time. The Tai Chi group exhibited significantly greater reductions in depressive symptoms and improvements in serum lipid profiles compared with the general aerobic exercise group. Tai Chi's mind-body synergy may enhance its antidepressant effects, offering a promising approach to mental health and healthy aging.

Move your body, stay away from depression: a systematic review and meta-analysis of exercise-based prevention of depression in middle-aged and older adults

Objective

This study aimed to systematically assess the efficacy of exercise interventions in preventing depression among middle-aged and older adults. It further sought to dissect the impact of various intervention factors on the exercise-depression nexus within this demographic.

Methods

We conducted a comprehensive search across multiple databases including PubMed, Embase, Web of Science, and the Cochrane Library, spanning from their inception through April 2024. The initial search yielded several studies, from which 11 papers involving a total of 792 subjects were selected based on predetermined inclusion criteria.

Results

Our meta-analysis revealed a significant overall effect size (SMD = -3.64) with a 95% confidence interval of [-4.81, -2.48] and a p-value of <0.00001, underscoring the potent preventative impact of exercise on depressive symptoms in the target population. However, the studies exhibited substantial heterogeneity (I 2 = 87%).

Conclusion

Exercise interventions, particularly balance and gentle training as well as functional training, significantly reduce the risk of depression among middle-aged and older adults. The most pronounced effects were observed in group exercise settings and with exercise sessions lasting 30-40 min. Interventions of medium duration generally outperformed shorter-term interventions. Despite these promising results, the observed heterogeneity and other potential study limitations suggest a need for further research involving larger samples and more comprehensive study designs to refine and optimize exercise protocols for depression prevention in this population.

Effects of Tai Chi and Qigong on physical function and psychiatric symptoms among individuals with mental illness: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Tai Chi and Qigong (TCQ) can be a non-pharmacological intervention for individuals with mental illness, improving physical function and mental health.

PURPOSE

This meta-analysis investigated the effects of TCQ on physical function and psychiatric symptoms in adults with schizophrenia or mood disorders.

METHODS

Randomized clinical trials on the effect of TCQ on physical function or psychiatric symptoms in individuals with mental illness, published in English, Korean, or Chinese, were included. A systematic search of 17 electronic databases up to September 2024 was conducted. The risk of bias was assessed using Cochrane RoB 2.0. Data were analyzed through meta-analysis, subgroup analysis, and meta-regression.

RESULTS

Nineteen randomized studies (n = 1243, mean age 53 years) reported outcomes on physical function (k = 11) and psychiatric symptoms (k = 18). The risk of bias assessment showed that 21.1% of studies had a low risk, 73.7% had some concerns, and 5.3% had a high risk. TCQ significantly improved physical function (Hedges' g = 0.53, 95% CI, 0.26-0.81) and psychiatric symptoms (Hedges' g = 0.63, 95% CI, 0.41-0.85) in individuals with serious mental illness (SMI), regardless of intervention duration and comparison type. TCQ showed no significant effect on physical function in individuals with schizophrenia but demonstrated a significant moderate effect in those with mood disorders (Hedges' g = 0.56, 95% CI, 0.32-0.80). TCQ significantly improved psychiatric symptoms in both groups (schizophrenia: Hedges' g = 0.64, 95% CI, 0.26-1.02; mood disorders: Hedges' g = 0.64, 95% CI, 0.33-0.96). Meta-regression indicated that the effects of TCQ on physical function covaries with those on psychiatric symptoms among individuals with SMI (Q = 21.43, df = 9, P = .011).

CONCLUSIONS

TCQ effectively enhances physical function and psychiatric symptoms in individuals with schizophrenia or mood disorders. These findings support TCQ as an effective non-pharmacological intervention for individuals with SMI. Further studies should explore the underlying mechanisms by which TCQ improves psychiatric symptoms through physical function, leading to the development of targeted intervention strategies in this population.*PROSPERO international prospective register of systematic reviews, registration ID CRD42024581253.

The efficacy of exercise interventions on depressive symptoms and cognitive function in adults with depression: An umbrella review

OBJECTIVE

This umbrella review aims to consolidate the evidence concerning the influence of exercise on depressive symptoms and cognitive performance in adults diagnosed with depression.

METHODS

An umbrella review of systematic reviews with meta-analyses investigating the effect of exercise on depression and cognition was performed. Databases (PubMed, Cochrane Library, Web of Science, Embase) were searched from inception until February 2024 for reviews of randomized controlled trials. Overlap within included reviews was assessed using the corrected covered area method (CCA). A random effects model was used to calculate overall pooled effect size with sub-analyses.

RESULTS

This study included 27 reviews, encompassing 190 experiments. In patients with depression, compared to the control group, exercise demonstrated a moderate effect size in reducing depressive symptoms (SMD = -0.67; SE = 0.04; p < 0.0001), with a Number Needed to Treat (NNT) of 2.78. When analyses were limited to data from studies with a low risk of bias, the effect on depressive symptoms was smaller (SMD = -0.38; SE = 0.07; p < 0.0001; NNT = 4.72). Exercise had a small effect on cognitive functions (SMD = 0.12; SE = 0.03; p < 0.0001), with an NNT for cognitive function treatment of 14.79.

CONCLUSIONS

All forms of exercise benefit patients with depression. However, for optimal intervention outcomes, it is essential to customize the intensity and type of exercise according to the specific characteristics of the patient's depressive symptoms and cognitive functions. It is recommended to implement a phased treatment approach for patients based on the intensity of exercise.

The effect of Tai Chi on elderly depression: a systematic review and meta-analysis of randomized controlled trials

Objective

This systematic review and meta-analysis assess the impact of Tai Chi on emotional well-being and quality of life in elderly individuals with depression.

Methods

Searching six databases until October 20, 2024, including Embase, PubMed, Cochrane Library, Web of Science, SinoMed, and CNKI, for randomized controlled trials (RCTs). Participants were aged ≥60 and diagnosed with depression. Tai Chi served as the main intervention in the treatment group, with the control group receiving no exercise, or only health education. The primary outcomes focused on the improvement of depressive symptoms and quality of life. Data synthesis and meta-analysis were performed using Stata 15.1 software. The protocol of this study was registered on PROSPERO (ID: CRD42023479305).

Results

Tai Chi, as the main intervention, significantly improved depressive symptoms as measured by the Geriatric Depression Scale (WMD = -5.99, 95% CI: -10.80 to -1.19, p = 0.015) compared to no exercise or health education. Subgroup analysis favored a six-month duration of Tai Chi, showing even greater benefits (WMD = -9.79, 95% CI: -13.90 to -5.69, p < 0.001). However, Tai Chi did not demonstrate a significant advantage in improving participants' scores on the Hamilton Depression Scale (WMD = -1.04, 95% CI: -3.84 to 1.76, p = 0.468).

Conclusion

Our results indicate that Tai Chi can significantly improve depressive symptoms and quality of life in elderly individuals with depression. As a daily exercise and mind-body therapy to alleviate the mood of the elderly, it is necessary to conduct more large-sample RCTs. Further research on the details of Tai Chi, such as movements, frequency, duration, and exercise periods, is essential for a dose-response relationship, contributing to the standardized promotion of Tai Chi.

Feldenkrais method and clinical psychology: A systematic literature review exploring the potential of Feldenkrais Method in psychiatric care

BACKGROUND

In psychotherapy, physical exercise has gained recognition and extensive research attention, displaying promise in various mental health conditions. Practices such as yoga, tai chi, and the Feldenkrais Method® (FM) have also emerged as effective mental health interventions.

OBJECTIVES

This systematic literature review (SLR) explores the applicability of FM, a somatic practice, in psychiatric care and emotional regulation, as it emphasizes the interplay between bodily sensations, action patterns, and cognitive processes.

METHODS

Following PRISMA guidelines, a systematic search was conducted across selected databases from 2000 to 2022, identifying 14 articles, including randomized controlled trials, cohort studies, narrative papers, and SLRs. Thematic analysis was conducted.

RESULTS

The findings indicate global FM adoption, primarily in studies related to pain conditions, musculoskeletal disorders, and neurological disorders. Various measures were used, covering quality of life, psychological dimensions, self-image, self-efficacy, mindfulness, and interoception. However, direct application of FM in psychiatric care remains limited, with few studies addressing psychological issues. This review calls for more comprehensive investigations of FM's potential in psychiatric contexts, advocating precise measures and a dimensional approach to assessing psychological outcomes.

CONCLUSION

Further research is needed to explore the application of FM in psychiatric care. While existing research suggests potential benefits, especially in enhancing body awareness and emotional regulation, robust studies are necessary to establish its effectiveness in treating specific mental health conditions. This review serves as the foundation for future research into the potential role of FM in enhancing psychiatric care and emotional well-being.

Tai Chi Practice Buffers Aging Effects in Functional Brain Connectivity

Tai Chi (TC) practice has been shown to improve both cognitive and physical function in older adults. However, the neural mechanisms underlying the benefits of TC remain unclear. Our primary aims are to explore whether distinct age-related and TC-practice-related relationships can be identified with respect to either temporal or spatial (within/between-network connectivity) differences. This cross-sectional study examined recurrent neural network dynamics, employing an adaptive, data-driven thresholding approach to source-localized resting-state EEG data in order to identify meaningful connections across time-varying graphs, using both temporal and spatial features derived from a hidden Markov model (HMM). Mann-Whitney U tests assessed between-group differences in temporal and spatial features by age and TC practice using either healthy younger adult controls (YACs, n = 15), healthy older adult controls (OACs, n = 15), or Tai Chi older adult practitioners (TCOAs, n = 15). Our results showed that aging is associated with decreased within-network and between-network functional connectivity (FC) across most brain networks. Conversely, TC practice appears to mitigate these age-related declines, showing increased FC within and between networks in older adults who practice TC compared to non-practicing older adults. These findings suggest that TC practice may abate age-related declines in neural network efficiency and stability, highlighting its potential as a non-pharmacological intervention for promoting healthy brain aging. This study furthers the triple-network model, showing that a balancing and reorientation of attention might be engaged not only through higher-order and top-down mechanisms (i.e., FPN/DAN) but also via the coupling of bottom-up, sensory-motor (i.e., SMN/VIN) networks.

Overcoming Barriers: A Comprehensive Review of Chronic Pain Management and Accessibility Challenges in Rural America

In the United States (U.S.), chronic pain poses substantial challenges in rural areas where access to effective pain management can be limited. Our literature review examines chronic pain management in rural U.S. settings, identifying key issues and disparities. A comprehensive search of PubMed, Web of Science, and Google Scholar identified high-quality studies published between 2000 and 2024 on chronic pain management in the rural U.S. Data were categorized into thematic areas, including epidemiology, management challenges, current strategies, research gaps, and future directions. Key findings reveal that rural populations have a significantly higher prevalence of chronic pain and are more likely to experience severe pain. Economic and systemic barriers include a shortage of pain specialists, limited access to nonpharmacologic treatments, and inadequate insurance coverage. Rural patients are also less likely to engage in beneficial modalities like physical therapy and psychological support due to geographic isolation. Additionally, rural healthcare providers more often fulfill multiple medical roles, leading to burnout and decreased quality of care. Innovative approaches such as telehealth and integrated care models show the potential to improve access and outcomes. Our review highlights the need for increased telehealth utilization, enhanced provider education, and targeted interventions to address the specific pain needs of rural populations.

Mind-Body Training: A Plausible Strategy against Osteomuscular Chronic Pain-A Systematic Review with Meta-Analysis

(1) Background: Chronic pain, which affects more than one in five adults worldwide, has a negative impact on the quality of life, limiting daily activities and generating absences from work. The aim of the present review is to analyze the efficacy of mind-body therapies as therapeutic strategies for patients with chronic pain. (2) Methods: A systematic review with a meta-analysis was carried out, searching PubMed, Scopus, and Web of Science databases using specific keywords. We selected studies that included mind-body therapies as the primary intervention for older adults with chronic pain. The methodological quality of the articles was assessed using the PEDro scale. (3) Results: Of the 861 studies identified, 11 were included in this review, all of which employed different mind-body therapies as an intervention. The selected studies measured chronic pain as the main variable. (4) Conclusions: This review highlights the value of mind-body exercises in reducing chronic pain in older adults, suggesting their integration as a non-pharmacological therapeutic alternative that improves the quality of life, promoting a holistic approach to pain management.

Effects of Tai Chi on depression of middle-aged and older adults: an updated systematic review and meta-analysis

AIM

The objective of this study was to evaluate the efficacy of Tai Chi, a mind-body movement therapy originating from China, on depression in middle-aged and older adults.

METHODS

A systematic search was conducted in seven databases (Embase, Cochrane, Medline, Wanfang, SinoMed, Weipu date, CNKI) for Randomized Controlled Trials (RCTs) published until Apr 16, 2023. The quality assessment, heterogeneity analysis, subgroup analysis, and sensitivity analysis of 12 RCTs selected from the literature were performed. Meta-analyses were conducted using RevMan 5.4 software.

RESULTS

The study included 12 trials comprising 731 participants that met the inclusion criteria. The findings revealed that Tai Chi significantly improved depression in middle-aged and older adults [SMD = -1.21, 95% CI (-1.59, -0.83), I2 = 87.6%, P < 0.001]. Subgroup analysis revealed that the number of exercise weeks within the specified range, the total duration of exercise, and Tai Chi maneuvers had the greatest benefits on depression in middle-aged and elderly people. The results demonstrated that interventions lasting more than 24 weeks were more effective [SMD = -1.66, 95% CI (-2.28, -1.04), P < 0.05] than those lasting only 12 weeks [SMD = -0.73, 95% CI (-1.08, -0.38), P < 0.05]. The effect size was more significant when the total duration of the intervention was more than 2400 min [SMD = -1.31, 95% CI (-1.71, -0.92), P < 0.001], and when the 24-style Tai Chi exercise was selected [SMD = -1.06, 95% CI (-1.37, -0.75), P < 0.001], the difference was also statistically significant. Funnel plots combined with sensitivity analyses, Begg's and Egger's tests indicated no publication bias.

CONCLUSION

The study suggests that Tai Chi can be an alternative therapy for reducing depression in middle-aged and older adults. It is recommended to prolong the Tai Chi exercise period to more than 24 weeks, with a total exercise duration of more than 2400 min, and 24-style Tai Chi should be selected to achieve the best therapeutic effect in middle-aged and older adults with depression. It should be noted that there may be lower-quality studies in the RCT literature analyzed, which may limit the general applicability and credibility of the conclusions.