Tai Chi Helps COPD Symptoms

Posted: 8/13/2012

From MedPage Today:

A modified tai chi program proved beneficial for improving exercise capacity among patients with chronic obstructive pulmonary disease (COPD), Australian researchers found.

After 12 weeks, the mean difference on the endurance shuttle walk test between the tai chi group and a control group was 348 seconds (95% CI 186 to 510), according to Jennifer A. Alison, PhD, of the University of Sydney, and colleagues.

Peak exercise capacity as measured on the incremental shuttle walk test also was greater, with a between-group difference of 55 meters (95% CI 31 to 80), the researchers reported online in the European Respiratory Journal.

These results exceeded established minimum clinically important differences, which were 186 seconds for the endurance walk test and 47.5 meters for the incremental shuttle walk test, they noted.

Tai chi is a popular form of exercise that emphasizes circular motions, control of breathing, and postural alignment with the goal of improving balance and endurance.

One type, known as Sun-style tai chi, has been used in arthritis and includes 21 specific movements that are less demanding than some other types of the exercise.

Previous studies of tai chi among patients with COPD have had conflicting results and included small numbers of patients.

To more fully explore the possibility of utility in this patient population, the researchers enrolled 42 patients with COPD and randomized them to the 12-week program or to usual medical care.

Patients' mean age was 73, and two-thirds were men. Comorbidities included osteoarthritis in 60%, hypertension in 55%, dyslipidemia in 38%, and coronary heart disease in 33%. Three-quarters of patients had two or more comorbidities.

The program consisted of 2 hour-long sessions each week, during which participants gradually learned all the different movements, training to a moderate level of exertion.

Home practice was recommended for the other 5 days of the week.

The six patients whose exertion or breathlessness did not reach a moderate level wore 0.5 kg to 1.5 kg weights on the wrists.

Participants also were encouraged to imagine that they were pushing against resistant pressure and to focus on coordinated, rhythmic breathing.

Significant improvements were seen on multiple aspects of balance, strength, and performance, with these between-group mean differences:

  • Anterior-posterior sway in side-by-side stand, -6.3 mm (95% CI -10 to -2)
  • Medial-lateral sway in side-by-side stand, -13.4 (95% CI -20 to -7)
  • Functional reach, 5.4 cm (95% CI 3 to 8)
  • Right quadriceps strength, 24 Newton (95% CI 14.5 to 33.5)
  • Left quadriceps strength, 17.8 Newton (95% CI 6 to 29)
  • Modified Physical Performance Battery Test, -0.25 (95% CI -0.3 to -0.2)

"An important finding from our study was the significant improvement in balance and muscle strength following Sun-style tai chi training, which has the potential to reduce the risk of falls in people with COPD," the researchers commented.

There also were significant between-group mean differences for symptoms and quality of life:

  • Dyspnea, 0.9 (95% CI 0.5 to 1.3)
  • Fatigue, 0.5 (95% CI 0.1 to 1)
  • Emotional function, 0.4 (95% CI 0.02 to 0.8)
  • Anxiety, -2 (95% CI -2 to -0.5)
  • Depression, -2 (95% CI -3 to 0.02)

A total of 38 patients completed the 12-week program, and of these, 15 agreed to undergo a peak exercise test with measurement of oxygen consumption.

Among the physiologic responses seen during a 15-minute tai chi session were oxygen consumption at 0.67 L/min, carbon dioxide production at 0.57 L/min, and tidal volume at 0.97 L/min.

In addition, the session was associated with moderate exercise intensity, as shown by a 53% reserve in oxygen consumption, which reached the minimal intensity for cardiovascular benefit in COPD.

"The results of this study demonstrated that Sun-style tai chi training has highly clinically relevant effects on endurance and peak exercise capacity in people with COPD," Alison and colleagues wrote.

The effects of the program, they pointed out, were comparable to what can be achieved during conventional pulmonary rehabilitation.

The high degree of adherence with both formal and at-home training and practice suggest that the program is feasible for COPD patients, even for those with comorbidities, they noted.

A limitation of the study was the use of wrist weights, which is not a common practice in tai chi training, and limits "the ability to generalize our reported intensity of [tai chi]," the authors explained.

"This study provides compelling evidence that tai chi training achieved an appropriate training intensity and that it may be an effective alternative training modality in people with COPD," the researchers concluded.

This is the second study this week to support the use of complementary methods for managing symptoms. Canadian researchers reported that qigong may ease fibromyalgia pain.

Original here.