Research Updates

Health benefits of Tai Chi for older patients with type 2 diabetes:
the "Move It for Diabetes study"--a randomized controlled trial.
Clin Interv Aging. 2007; 2(3):429-39.
Tsang T, Orr R, Lam P, Comino EJ, Singh MF. (School of Exercise and
Sport Science, Faculty of Health Sciences, University of Sydney,
Lidcombe, NSW, Australia. ttsa6920@mail. usyd.edu. au )
Older adults with type 2 diabetes have mobility impairment and
reduced fitness. This study aimed to test the efficacy of the "Tai
Chi for Diabetes" form, developed to address health-related problems
in diabetes, including mobility and physical function. Thirty-eight
older adults with stable type 2 diabetes were randomized to Tai Chi
or sham exercise, twice a week for 16 weeks. Outcomes included gait,
balance, musculoskeletal and cardiovascular fitness, self-reported
activity and quality of life. Static and dynamic balance index (-5.8
+/- 14.2; p = 0.03) and maximal gait speed (6.2 +/- 11.6%; p = 0.005)
improved over time, with no significant group effects. There were no
changes in other measures. Non-specific effects of exercise testing
and/or study participation such as outcome expectation,
socialization, the Hawthorne effect, or unmeasured changes in health
status or compliance with medical treatment may underlie the modest
improvements in gait and balance observed in this sham-exercise-
controlled trial. This Tai Chi form, although developed specifically
for diabetes, may not have been of sufficient intensity, frequency,
or duration to effect positive changes in many aspects of physiology
or health status relevant to older people with diabetes.

An evaluation of the effects of Tai Chi Chuan and Chi Kung training
in patients with symptomatic heart failure: a randomised controlled
pilot study. Postgrad Med J. 2007 Nov; 83(985):717- 21.
Barrow DE, Bedford A, Ives G, O'Toole L, Channer KS. (Department of
Cardiology, Royal Hallamshire Hospital, Glossop Road, Sheffield S10
2JF, UK.)
OBJECTIVE: To study the effect of Tai Chi on exercise tolerance in
patients with moderate heart failure. DESIGN: Randomised parallel
group study balanced for baseline variables. SETTING: Cardiology
Department, Royal Hallamshire Hospital. PATIENTS AND METHODS: 52
patients (42 men, mean age (68.9 years), range (46-90 years), and 10
women, mean age (70.0 years), range (58-82)) with chronic heart
failure (New York Heart Association symptom class II-III) were
studied. Patients were randomised to Tai Chi Chuan twice a week for
16 weeks or to standard medical care without exercise rehabilitation.
MAIN OUTCOME MEASURES: The primary outcome measure was the change in
the distance walked in the shuttle walk test. Secondary outcome
measures were changes in symptom scores and quality of life indices.
RESULTS: Objective measures of exercise tolerance did not improve
significantly with Tai Chi, but patients having Tai Chi exercise had
an improvement in symptom scores of heart failure measured by the
Minnesota Living with Heart Failure Questionnaire (comparison of
deltas, -2.4 control vs -14.9; p = 0.01), and depression scores
measured by the SCL-90-R questionnaire (-2.9 vs -6.8; p = 0.12)
compared with those patients in the control group. CONCLUSION: In
patients with chronic heart failure, 16 weeks of Tai Chi training was
safe, with no adverse exercise related problems. It was enjoyed by
all taking part and led to significant improvements in symptoms and
quality of life.

Mind/body techniques for physiological and psychological stress
reduction: Stress management via Tai Chi training - a pilot study.
Med Sci Monit. 2007 Nov;13(11):CR488- 497.
Esch T, Duckstein J, Welke J, Braun V. (Division of Integrative
Health Promotion, Coburg University of Applied Sciences, Coburg,
Germany and Institute for Integrative Medicine and Health Research,
Potsdam, Germany.)
Background: Stress can affect health. There is a growing need for the
evaluation and application of professional stress management options,
i.e, stress reduction. Mind/body medicine serves this goal, e.g, by
integrating self-care techniques into medicine and health care. Tai
Chi (TC) can be classified as such a mind/body technique, potentially
reducing stress and affecting physical as well as mental health
parameters, which, however, has to be examined further.
Material/Methods: We conducted a prospective, longitudinal pilot
study over 18 weeks for the evaluation of subjective and objective
clinical effects of a Yang style TC intervention in young adults
(beginners) by measuring physiological (blood pressure, heart rate,
saliva cortisol) and psychological (SF-36, perceived stress,
significant events) parameters, i.e, direct or indirect indicators of
stress and stress reduction, in a non-randomised/ -controlled, yet non-
selected cohort (n=21) by pre-to-post comparison and in follow-up. SF-
36 values were also compared with the age-adjusted norm population,
serving as an external control. Additionally, we measured diurnal
cortisol profiles in a cross-sectional sub-study (n=2+2, pre-to-
post), providing an internal random control sub-sample. Results: Only
nine participants completed all measurements. Even so, we found
significant (p<0.05) reductions of saliva cortisol (post and follow-
up), which seems to be an indicator of general stress reduction. A
significant decrease in perceived mental stress (post) proved even
highly significant (p<0.01) in the follow-up, whereas physical stress
perception declined to a much lesser degree. Significant improvements
were also detected for the SF-36 dimensions general health
perception, social functioning, vitality, and mental
health/psychologica l well-being. Thus, the summarized mental health
measures all clearly improved, pointing towards a predominantly
psychological impact of TC. Conclusions: Subjective health increased,
stress decreased (objectively and subjectively) during TC practice.
Future studies should confirm this observation by rigorous
methodology and by further combining physical and psychological
measurements with basic research, thereby also gaining knowledge of
autoregulation and molecular physiology that possibly underlies
mind/body medicine.

Breathing exercises with vagal biofeedback may benefit patients with
functional dyspepsia. Scand J Gastroenterol. 2007 Sep; 42(9):1054-
62.
Hjelland IE, Svebak S, Berstad A, Flatabø G, Hausken T. (Institute of
Medicine, University of Bergen, Division of Gastroenterology, Medical
Dept, Haukeland University Hospital, Bergen, Norway.
ina.hjelland@ med.uib.no)
OBJECTIVE: Many patients with functional dyspepsia (FD) have
postprandial symptoms, impaired gastric accommodation and low vagal
tone. The aim of this study was to improve vagal tone, and thereby
also drinking capacity, intragastric volume and quality of life,
using breathing exercises with vagal biofeedback. MATERIAL AND
METHODS: Forty FD patients were randomized to either a biofeedback
group or a control group. The patients received similar information
and care. Patients in the biofeedback group were trained in breathing
exercises, 6 breaths/min, 5 min each day for 4 weeks, using specially
designed software for vagal biofeedback. Effect variables included
maximal drinking capacity using a drink test (Toro clear meat soup
100 ml/min), intragastric volume at maximal drinking capacity,
respiratory sinus arrhythmia (RSA), skin conductance (SC) and
dyspepsia-related quality of life scores. RESULTS: Drinking capacity
and quality of life improved significantly more in the biofeedback
group than in the control group (p=0.02 and p=0.01) without any
significant change in baseline autonomic activity (RSA and SC) or
intragastric volume. After the treatment period, RSA during breathing
exercises was significantly correlated to drinking capacity (r=0.6,
p=0.008). CONCLUSIONS: Breathing exercises with vagal biofeedback
increased drinking capacity and improved quality of life in FD
patients, but did not improve baseline vagal tone.

The effects of vigorous exercise training on physical function in
children with arthritis: a randomized, controlled, single-blinded
trial. Arthritis Rheum. 2007; 57(7):1202-10.
Singh-Grewal D, Schneiderman- Walker J, Wright V, Bar-Or O, Beyene J,
Selvadurai H, et al. (The Hospital for Sick Children, Toronto,
Ontario, Canada.)
OBJECTIVE: To examine the effectiveness of high-intensity aerobic
training compared with low-intensity training in terms of energy cost
of locomotion, peak oxygen uptake, peak power, and self-reported
physical function in children with juvenile idiopathic arthritis
(JIA). METHODS: Eighty children with JIA, ages 8-16 years, were
enrolled in a randomized, single-blind controlled trial. Both groups
participated in a 12-week, 3-times-weekly training program consisting
of high-intensity aerobics in the experimental group and qigong in
the control group. Subjects underwent exercise testing measuring
submaximal oxygen uptake at 3 km/hour (VO(2submax) ) as the primary
outcome, maximal oxygen uptake, and peak power at the beginning and
end of the program. Physical function was measured using the Child
Health Assessment Questionnaire (C-HAQ). RESULTS: The exercise
program was well tolerated in both groups. There was no difference in
VO(2submax) or any other exercise testing measures between the groups
through the study period and no indication of improvement. Both
groups showed significant improvements in C-HAQ with no difference
between the groups. Adherence was higher in the control group than
the experimental group. CONCLUSION: Our findings suggest that
activity programs with or without an aerobic training component are
safe and may result in an important improvement in physical function.
The intensity of aerobic training did not seem to provide any
additional benefits, but higher adherence in the qigong program may
suggest that less intensive regimens are easier for children with JIA
to comply with, and provide a degree of benefit equivalent to more
intensive programs.

Tai chi for osteoarthritis: a systematic review. Clin Rheumatol. 2007
Sep 14;
Lee MS, Pittler MH, Ernst E. (Complementary Medicine, Peninsula
Medical School, Universities of Exeter & Plymouth, 25 Victoria Park
Road, Exeter, EX2 4NT, UK, myeong.lee@pms. ac.uk.)
The aim of this study was to evaluate data from controlled clinical
trials testing the effectiveness of tai chi for treating
osteoarthritis. Systematic searches were conducted on MEDLINE, AMED,
British Nursing Index, CINAHL, EMBASE, PsycInfo, The Cochrane Library
2007, Issue 2, the UK National Research Register and
ClinicalTrials. gov, Korean medical databases, the Qigong and Energy
database and Chinese medical databases (until June 2007). Hand
searches included conference proceedings and our own files. There
were no restrictions regarding the language of publication. All
controlled trials of tai chi for patients with osteoarthritis were
considered for inclusion. Methodological quality was assessed using
the Jadad score. Five randomised clinical trials (RCTs) and seven non-
randomised controlled clinical trials (CCTs) met all inclusion
criteria. Five RCTs assessed the effectiveness of tai chi on pain of
osteoarthritis (OA). Two RCTs suggested significant pain reduction on
visual analog scale or Western Ontario and McMaster Universities
Osteoarthritis Index (WOMAC) compared to routine treatment and an
attention control program in knee OA. Three RCTs did not report
significant pain reduction on multiple sites pain. Four RCTs tested
tai chi for physical functions. Two of these RCTs suggested
improvement of physical function on activity of daily living or WOMAC
compared to routine treatment or wait-list control, whilst two other
RCTs failed to do so. In conclusion, there is some encouraging
evidence suggesting that tai chi may be effective for pain control in
patients with knee OA. However, the evidence is not convincing for
pain reduction or improvement of physical function. Future RCTs
should assess larger patient samples for longer treatment periods and
use appropriate controls.

Biopsychosocial effects of qigong as a mindful exercise for people
with anxiety disorders: a speculative review. J Altern Complement
Med. 2007 Oct; 13(8):831-9.
Chow YW, Tsang HW. (Department of Rehabilitation Sciences, The Hong
Kong Polytechnic University, Hung Hom, Hong Kong.)
In view of the inadequacies of mainstream treatments for anxiety
disorders, we suggest that qigong, an ancient oriental mindful
exercise, may be a useful adjunctive treatment. We base this on a
biopsychosocial model for health. Evidence suggests that the benefits
of exercise on personal well-being can be explained using six
theories: cognitive behaviour; distraction; social interaction;
cardiovascular fitness; amine; and endorphin theories. To date, not
much has been done to employ these theories to analyze the benefits
of mindful exercises. We try here to reorganize these theories into
psychosocial and physiologic perspectives and integrate them with
the "mind regulation," "body regulation," and "breath regulation"
components of qigong. We propose, because of its potential
therapeutic effects, that qigong can be considered as an alternative
therapy to help meet the increasing demand of nonpharmacologic
modalities in achieving biopsychosocial health for those suffering
from anxiety in the general population.