Does Tai Chi improve psychological well-being and quality of life in patients with cardiovascular disease and/or cardiovascular risk factors? A systematic review protocol

Effects of traditional Chinese exercises on the rehabilitation of patients with chronic heart failure: A meta-analysis

Background

With the development of rehabilitation medicine, exercise therapy has gradually become one of the methods to prevent and treat cardiovascular diseases. It is widely used in clinic because it can further reduce the mortality rate, improve clinical symptoms, restore the activity ability of the body, improve the quality of life of patients and reduce the hospitalization rate. Traditional Chinese exercises have developed rapidly in recent years, which mainly include Baduanjin, Tai Ji, etc. However, meta-analyses of all types of exercises are not well characterized.

Objectives

To evaluate the effect of traditional Chinese exercises (TCEs) on the rehabilitation of patients with chronic heart failure (CHF) using a meta-analysis.

Methods

A systematic search of randomized controlled trials (RCTs) on TCEs for patients with CHF in 13 databases (PubMed, China National Knowledge Infrastructure, etc.). Meta-analysis was performed using Review Manager software (version 5.3) after two investigators independently screened the studies, assessed the quality of the studies, and extracted the data.

Results

Meta-analysis of 21 randomized controlled trials which involved 1,665 patients with chronic heart failure showed that practicing TCEs was effective in improving patients' physiological outcomes such as VO₂max [MD = 2.14, 95% CI (1.02, 3.26), P < 0.001], AT [MD = 1.61, 95% CI (1.06, 2.16), P < 0.001], and left ventricular ejection fraction [MD = 2.60, 95% CI (1.17, 4.02), P < 0.001]. Non-physiological outcomes benefited from the application of TCEs: 6-min walking distance [MD = 38.55, 95% CI (36.67, 40.42), P < 0.001], quality of life [MD = 5.52, 95% CI (3.17, 7.88), P < 0.001], and single-item TCM symptom scores in CHF patients: tiredness and fatigue [MD = 0.78, 95% CI (0.03, 1.53), P = 0.04], shortness of breath [MD = 0.44,95% CI (0.26, 0.62), P < 0.0001], facial puffiness and limb swelling [MD = 0.44,95% CI (0.12, 0.76), P = 0.007], palpitations [MD = 0.68,95% CI (0.14, 1.21), P = 0.01] were improved.

Conclusions

TCEs improved several recovery indicators, heart failure-related clinical symptoms, quality of life, and physiological indicators in patients with CHF. It is worthwhile to expand the participants for practical application in clinical practice, but the existing evidence is insufficient and the heterogeneity of outcome is large. Therefore, more high-quality clinical trials are needed to support these results.

Systematic review registration

PROSPERO, identifier [CRD42022383246].

Does tai chi improve psychological well-being and quality of life in patients with cardiovascular disease and/or cardiovascular risk factors? A systematic review

BACKGROUND

Psychological risk factors have been recognised as potential, modifiable risk factors in the development and progression of cardiovascular disease (CVD). Tai Chi, a mind-body exercise, has the potential to improve psychological well-being and quality of life. We aim to assess the effects and safety of Tai Chi on psychological well-being and quality of life in people with CVD and/or cardiovascular risk factors.

METHODS

We searched for randomised controlled trials evaluating Tai Chi for psychological well-being and quality of life in people with CVD and cardiovascular risk factors, from major English and Chinese databases until 30 July 2021. Two authors independently conducted study selection and data extraction. Methodological quality was evaluated using the Cochrane Risk of Bias tool. Review Manager software was used for meta-analysis.

RESULTS

We included 37 studies (38 reports) involving 3525 participants in this review. The methodological quality of the included studies was generally poor. Positive effects of Tai Chi on stress, self-efficacy, and mood were found in several individual studies. Meta-analyses demonstrated favourable effects of Tai Chi plus usual care in reducing anxiety (SMD - 2.13, 95% confidence interval (CI): - 2.55, - 1.70, 3 studies, I2 = 60%) and depression (SMD -0.86, 95% CI: - 1.35, - 0.37, 6 studies, I2 = 88%), and improving mental health (MD 7.86, 95% CI: 5.20, 10.52, 11 studies, I2 = 71%) and bodily pain (MD 6.76, 95% CI: 4.13, 9.39, 11 studies, I2 = 75%) domains of the 36-Item Short Form Survey (scale from 0 to 100), compared with usual care alone. Tai Chi did not increase adverse events (RR 0.50, 95% CI: 0.21, 1.20, 5 RCTs, I2 = 0%), compared with control group. However, less than 30% of included studies reported safety information.

CONCLUSIONS

Tai Chi seems to be beneficial in the management of anxiety, depression, and quality of life, and safe to practice in people with CVD and/or cardiovascular risk factors. Monitoring and reporting of safety information are highly recommended for future research. More well-designed studies are warranted to determine the effects and safety of Tai Chi on psychological well-being and quality of life in this population.

SYSTEMATIC REVIEW REGISTRATION

International Prospective Register for Systematic Reviews (PROSPERO), CRD42016042905. Registered on 26 August 2016.

Effects of targeted community healthcare on the prevention of thrombotic adverse events in patients with coronary heart disease under the guidance of behavior change theory

OBJECTIVE

To explore the effects of targeted community healthcare on the prevention of thrombotic adverse events in patients with coronary heart disease under the guidance of behavior change theory.

METHODS

A total of 89 patients with coronary heart disease who were admitted to our hospital were selected prospectively as subjects and divided into a research group (n=45, receiving targeted community healthcare under the guidance of behavior change theory) and a control group (n=44, receiving regular community healthcare) using a random number table method. The treatment period was 6 months. Then, patient's knowledge and attitude towards coronary heart disease as well as their personal habits, glucose and lipid metabolism indicators, compliance behaviors, quality of life and the incidence of thrombotic adverse events after 1-year of follow-up were compared between the two groups.

RESULTS

The scores of patient's knowledge, attitude and personal habits, compliance behaviors and quality of life were all higher in the research group than those in the control group after intervention (all P<0.05); and the glucose and lipid metabolism indicators including fasting insulin (INS), insulin resistance index (HOMA-IR), total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) in the research group were significantly better than those in the control group after intervention (all P<0.05); after follow-up for 1 year, the total incidence of cerebral infarction, systemic embolism and myocardial infarction was significantly lower in the research group (6.67%) than that in the control group (25.00%) (P<0.05).

CONCLUSION

Targeted community healthcare under the guidance of the behavior change theory can effectively improve patient's compliance behaviors, change their knowledge, attitudes as well as their personal habits, keep their glucose and lipid metabolism indicators under control and reduce the risks of cardiovascular disease. Therefore, it is worth being applied in clinical settings.

Mind-Body Exercise for Anxiety and Depression in COPD Patients: A Systematic Review and Meta-Analysis

Objectives: Mind–body exercise has been generally recognized as a beneficial strategy to improve mental health in those with Chronic Obstructive Pulmonary Disease (COPD). However, to date, no attempt has been made to collate this literature. The aim of the present study was to systematically analyze the effects of mind–body exercise for COPD patients with anxiety and depression and provide scientific evidence-based exercise prescription. Methods: both Chinese and English databases (PubMed, the Cochrane Library, EMBASE, Web of Science, Google Scholar, Chinese National Knowledge Infrastructure, Wanfang, Baidu Scholar) were used as sources of data to search randomized controlled trials (RCT) relating to mind–body exercise in COPD patients with anxiety and depression that were published between January 1982 to June 2019. 13 eligible RCT studies were finally used for meta-analysis. Results: Mind–body exercise (tai chi, health qigong, yoga) had significant benefits on COPD patients with anxiety (SMD = −0.76, 95% CI −0.91 to −0.60, p = 0.04, I² = 47.4%) and depression (SMD = −0.86, 95% CI −1.14 to −0.58, p = 0.000, I² = 71.4%). Sub-group analysis indicated that, for anxiety, 30–60 min exercise session for 24 weeks of health qigong or yoga had a significant effect on patients with COPD who are more than 70 years and have more than a 10-year disease course. For depression, 2–3 times a week, 30–60 min each time of health qigong had a significant effect on patients with COPD patients who are more than 70 years old and have less than a 10-year disease course. Conclusions: Mind–body exercise could reduce levels of anxiety and depression in those with COPD. More robust RCT are required on this topic.

The Effect of Tai Chi Chuan on Negative Emotions in Non-Clinical Populations: A Meta-Analysis and Systematic Review

Tai Chi Chuan (TCC) as a typical mind-body practice has been investigated for its preventive role on negative emotions and has demonstrated its efficacy in healthy populations. However, the results are not consistent. We performed a meta-analysis and systematically evaluated the effect of TCC on selected negative emotions (i.e., anxiety and depression). Fourteen experimental studies from three English-and two Chinese-language databases were evaluated. The results showed that the positive effects of TCC on negative emotions were moderately to largely significant. In addition, although TCC significantly improved negative emotions in both the young adults and the older adults, old adults benefited more from TCC than young adults. These findings suggest that TCC is a worthy complementary non-pharmacological resource towards depression and anxiety and, thus, has great implications for the public health domain.

Tai Chi with music improves quality of life among community-dwelling older persons with mild to moderate depressive symptoms: A cluster randomized controlled trial

Depression leads to a poorer quality of life (QOL) which is a determinant of healthy ageing. Cost-effective solutions for enhancing QOL in the older population are much needed in China, with its rapidly ageing population. We conducted a randomized controlled trial involving 112 community-dwelling older participants with mild to moderate depression, to evaluate the effect of Tai Chi with music on QOL (57 in intervention group, 55 in control group). WHO Quality of Life-BREF was used to measure QOL at baseline and at every month for three months. Following the adjustments for sociodemographic data, the effect of intervention on QOL was assured (F = 25.145, P < 0.001, η_p²= 0.435, F = 18.696, P < 0.001, η_p²= 0.364, F = 17.473, P< 0.001, η_p²= 0.348, and F = 29.576, P < 0.001, η_p²= 0.475 for physical, psychological, social, and environment domains respectively). This intervention represents an economically viable solution to better QOL and healthy ageing in a highly populous developing nation.