Clinical Consultation: Tai Chi for COPD

Should you recommendTai Chi for yourpatients with COPD?

What evidence is there that Tai Chi can improve functional capacity in patients with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF)?

Tai Chi (also known as T'ai Chi Chuan, Taijiquan) is a form of mind-body exercise that has its roots in ancient Chinese martial arts. Throughout Asia, it is often practiced for preventive health, especially among the elderly. In recent years, Tai Chi has become popular in the West among all age groups and has been studied as a therapy for various medical conditions.

Tai Chi uses gentle physical movements, breathing techniques, and cognitive strategies such as meditation and imagery. Reported benefits in the medical literature include improving balance and decreasing risk of falls in the elderly, improving cardiorespiratory fitness and functional status in those with and without known cardiac disease, decreasing blood pressure in patients with hypertension, and improving overall mood and quality of life in patients with chronic disease.¹

Tai Chi has been suggested as an appropriate, if not ideal, form of exercise for patients with chronic cardiopulmonary disease. Because it is a low-impact form of exercise that uses slow movements, it appears to be suitable for persons across a wide range of functional capacities, including those with severe deconditioning associated with CHF or COPD.

Emphasis on efficient breathing, relaxation, and stress reduction may also make Tai Chi a good choice. It offers an advantage over conventional exercise in that it can be practiced anywhere, at any time, and in a group or alone, and it requires no equipment. The physical activity of Tai Chi is estimated to be mild-moderate aerobic exercise, at 1.6 to 4.6 metabolic equivalents and 50% to 74% maximal heart rate, depending on the person's age and the intensity of practice.^2-10

What is the evidence?

More than 20 studies on Tai Chi have measured functional capacity in various cardiac populations, as well as in persons without known cardiopulmonary disease. For example, several observational trials have found that seasoned Tai Chi practitioners had better exercise capacity (peak oxygen uptake on bicycle stress test) than age-matched controls who had never practiced Tai Chi.^11-13

Lan and associates¹⁴ reported improved maximal oxygen uptake in patients recovering from coronary bypass surgery who practiced Tai Chi for 12 months when compared with those who walked for exercise. A meta-analysis of 7 trials (4 experimental and 3 observational) suggested that Tai Chi can improve aerobic capacity.¹⁵

Two studies have specifically examined Tai Chi in patients with CHF. Yeh and associates,¹⁶ who conducted a randomized controlled trial involving 30 patients, reported improvements in functional capacity as measured by the 6-minute walk, disease-specific quality of life (Minnesota Living with Heart Failure Questionnaire [MLHFQ]), and serum B-type natriuretic peptide levels after 12 weeks of Tai Chi. Trends were also seen in improved peak oxygen uptake in the Tai Chi practitioners compared with the usual-care control group. Similarly, Fontana and associates,¹⁷ in a nonrandomized study involving 5 patients, reported improved functional capacity as measured by the 6-minute walk test, improved global and disease-specific quality-of-life (Short Form 36 Health Survey Questionnaire [SF-36] and MLHFQ), and reduced dyspnea.

No English-language studies have specifically examined Tai Chi in patients with COPD. However, 4 small studies measured related parameters of pulmonary function (such as ventilatory efficiency) in other populations. For example, Jones and colleagues¹⁸ conducted a nonrandomized study of 60 community volunteers and reported increases in peak expiratory flow rate after 12 weeks of Tai Chi. In contrast, Lan and associates⁴ reported no difference in forced vital capacity or forced expiratory volume in 1 second in 38 "healthy" elderly persons after 12 months of Tai Chi compared with age-matched controls who did not practice Tai Chi.

Safety and compliance

Most studies reported that the Tai Chi interventions were well-accepted and well-tolerated, with no adverse events. In addition, many studies reported higher compliance in the Tai Chi group than in the comparison or exercise groups. This is important to note, particularly when dealing with patients with chronic cardiac or pulmonary disease, who can be difficult to engage and sustain in conventional exercise.

Clinical bottom line

Tai Chi may be useful as an adjunct to conventional exercise or for those unable to do conventional exercise. There are many different styles of Tai Chi, and exercise benefit may vary depending on the age and condition of the patient and the relative intensity with which the exercise is performed.

Although there is a paucity of rigorous randomized, controlled trials on Tai Chi and the meditative component remains less well understood, the existing literature suggests a benefit. Further research is needed to evaluate the efficacy and safety of Tai Chi in patients with chronic cardiopulmonary disease and to explore the potential role of Tai Chi in cardiac and pulmonary rehabilitation.

References:

REFERENCES

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