Recent CME posting by Medscape (a CME site for US physicians) lists a study published in the British Journal of Sports Medicine. The authors are:
News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MS Ed
May 18, 2011 — T’ai chi may benefit the elderly population in fall prevention, psychological health, and general well-being, according to the results of an overview of systematic reviews (SRs) reported Online First May 16 in the British Journal of Sports Medicine. The practice combines deep breathing and relaxation with slow and gentle movements and is based on the Confucian and Buddhist belief that health is controlled by 2 opposing life forces, yin and yang.
“Several …SRs have assessed the effectiveness of t’ai chi for many conditions including hypertension, osteoarthritis and fall prevention; however, their conclusions have been contradictory,” write Myeong Soo Lee, from the Brain Disease Research Centre, Korea Institute of Oriental Medicine in Daejeon, South Korea, and Edzard Ernst, from Complementary Medicine, Peninsula Medical School, University of Exeter in Exeter, United Kingdom. “…Ill health is viewed as an imbalance between yin and yang, and t’ai chi can reportedly rebalance such energy disturbances. Regardless of these assumptions, the slow movements between different postures that are normally held for short periods of time represent physical stimuli, which affect the cardiovascular and muscular systems.”
The reviewers’ goal was to assess critically SRs of t’ai chi in any benefits regarding medical conditions or clinical symptoms, based on a search of English, Chinese, and Korean electronic databases. Predefined inclusion criteria were met by 35 SRs, from which data were extracted for the overview.
Medical conditions included in these SRs were cancer, aging, Parkinson’s disease, musculoskeletal pain, osteoarthritis, rheumatoid arthritis, cardiovascular disease, osteoporosis, type 2 diabetes, and other chronic conditions. Outcomes studied in these SRs included muscle strength and flexibility, improvements in aerobic capacity, cardiovascular disease risk factors, lowering of resting blood pressure, bone mineral density, psychological health, fall prevention, and improvement of balance.
The conclusions reached in these SRs were contradictory in several cases. Overall, the evidence was relatively clear supporting the efficacy of t’ai chi in older people for fall prevention, improvements in psychological health, and general health benefits. In contrast, t’ai chi seemed to be ineffective for symptomatic treatment of cancer and rheumatoid arthritis.
Limitations of this overview include high risk for bias in many of the SRs reviewed, inability to ensure that all relevant articles were identified, and risk of diluting the results of high-quality studies by including low-quality data.
“Our overview showed that t’ai chi, which combines deep breathing and relaxation with slow and gentle movements, may exert exercise-based general benefits for fall prevention and improvement of balance in older people as well as some meditative effects for improving psychological health,” the study authors conclude. “We recommend t’ai chi for older people for its various physical and psychological benefits. However, t’ai chi may not effectively treat inflammatory diseases and cardiorespiratory disorders.”
Dr. Lee was supported by KIOM. Coauthor Edzard Ernst has disclosed no relevant financial relationships.
Br J Sports Med. Published online May 16, 2011. Abstract
Related Link
The National Council on Aging’s Fall Prevention Web site provides a number of resources useful for the development of fall prevention programs.
Clinical Context
T’ai chi combines deep breathing and relaxation with slow gentle movements and has been claimed to be of benefit for a variety of conditions ranging from fall prevention in older people to cardiovascular disease such as hypertension. Different SRs have been performed to examine its efficacy.
This is a review of SRs on t’ai chi to gather information on the types of conditions for which t’ai chi may be beneficial and to review the evidence for efficacy for different conditions.
Study Highlights
- The investigators conducted electronic searches in July 2010 in the databases of MEDLINE, EMBASE, AMED, CINAHL, the Cochrane library, 6 Korean Medical Databases, and a Chinese database without restrictions.
- To be included, SRs had to specifically address t’ai chi as an intervention and include evidence from at least 2 clinical trials.
- The researchers assessed the quality of the primary trials using the Overview Quality Assessment Questionnaire.
- The search generated 55 articles, of which 35 met inclusion criteria.
- The SRs were published between 2002 and 2010.
- First authors originated from the United States (n = 10), the United Kingdom (n = 9), Korea (n = 9), France (n = 2), Australia (n = 2), the Netherlands (n = 2), Canada (n = 1), New Zealand (n = 1), Singapore (n = 1), and Sweden (n = 1).
- SRs were based on 2 to 47 primary studies.
- 10 reviews incorporated a meta-analytic approach.
- The quality of the SRs varied.
- 17 had minimal bias, 11 had major flaws, and the remaining had moderate flaws.
- The following conditions were examined: cancer, general healthcare in older adults, Parkinson’s disease, musculoskeletal disorders, muscle strength, aerobic capacity, blood pressure, osteoporosis, diabetes, balance, and other chronic conditions.
- 7 SRs concluded that data were insufficient to draw conclusions, 8 concluded that t’ai chi did not have a beneficial effect, and 20 reported that t’ai chi may be effective.
- Of 9 high-quality SRs, 1 SR arrived at a positive conclusion, and 5 arrived at a negative conclusion. In 3 SRs, no clear conclusions were drawn.
- A clear consensus was found that t’ai chi improved the general health of older persons, improved psychological health, and prevented falls.
- Of 4 SRs that investigated fall prevention, 3 showed a positive effect.
- For psychological health, 4 of 5 SRs showed a positive effect.
- All 3 SRs evaluating psychological health in older persons found a positive effect.
- The evidence for rheumatoid arthritis and cancer was clearly negative in 2 SRs.
- There was contradiction about the role of t’ai chi for improving cardiovascular function and aerobic capacity, and improving balance.
- The authors concluded that, at the present time, positive effects of t’ai chi were only shown for fall prevention and improvement of psychological health in older people.
Clinical Implications
- The benefits of t’ai chi have been investigated for many conditions including neurologic, cardiovascular, orthopaedic, and psychological conditions, but the quality of evidence varies.
- Evidence for benefit of t’ai chi is shown for psychological health and fall prevention in older people but not for cardiovascular disease, cancer, or rheumatoid arthritis.
