Tai chi benefits heart failure patients

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Adding a tai chi exercise program to standard medical care may help improve quality of life and mood among patients with heart failure (HF), data from a randomized study suggest.

“Tai chi exercise, a multicomponent mind-body training modality that is safe and has good rates of adherence, may provide value in improving daily exercise, quality of life, self-efficacy and mood in frail, deconditioned patients with systolic HF,” Gloria Yeh, MD, MPH, of Beth Israel Deaconess Medical Center and Harvard Medical School, both in Boston, and colleagues wrote in Archives of Internal Medicine.

Tai chi, “a gentle meditative exercise of flowing circular movements, balance and weight shifting, breathing techniques, visualization and focused internal awareness,” has been gaining traction in the medical community as a potential therapy for HF patients that were once considered too frail to exercise. In addition to providing mild to moderate exercise, tai chi may also help with stress management and depression associated with living with HF.

To explore these potentially beneficial properties, Yeh and colleagues enrolled patients between May 1, 2005, and September 30, 2008 and randomly assigned them to take twice weekly, hour-long tai chi classes or one of 11 education modules developed by the Heart Failure Society of America. These focused on topic ranging from adhering to low-sodium diets, to self-care and dealing with HF symptoms, to exercise and activity.

They found that patients who took tai chi experienced significant benefits on the Minnesota Living with Heart Failure Questionnaire – scores fell from 28 at baseline to 9 after 12 weeks (n=50) vs. 21 at baseline and 22 after 12 weeks among patients assigned to an education-only control group (n=50; P=0.02).

The tai chi group also experienced improvements in mood as noted on the Profile of Mood States (decreasing from 10 at baseline to 4 after 12 weeks), whereas scores in the control group remained almost same throughout the study period (decreasing from 18 to 17; P<0.001).

Most patients had New York Heart Association class II HF and were prescribed a betablocker and an angiotensin-converting enzyme inhibitor. Mean age was 67, mean left ventricular ejection fraction at study entry was 29%, and peak oxygen uptake was 13.5 mL/kg/min. Nearly one-third of patients had a history of depression and anxiety.

Although there were no differences between the groups in change in six-minute walk distance or in peak oxygen uptake, significant benefits occurred in exercise self efficacy (P<0.001) and on the vigor subscale, the tai chi group increased from 8.5 to 9, whereas the controls fell from 8 to -2 (P<0.001).

Furthermore, depression scores decreased from 2 to 0 in the tai chi group vs. an increase from 3 to 4 in the control group (P=0.004).

In an additional post hoc analysis to determine whether certain patients would benefit more from the exercise regimen than others, the researchers found that benefits were greatest among patients without implanted cardioverter-defibrillators (P=0.04), in those with class II and class III symptoms (P=0.01), and in patients whose heart failure was not ischemic (P=0.03).

Patients in the tai chi group who had greater baseline resting heart rates also experienced greater improvements in disease-specific quality of life, the researchers noted, explaining that this difference may be attributable to tai chi's ability to modulate the autonomous nervous system.

Despite these findings the researchers were unable to provide a "definitive physiological mechanism for tai chi's effects,” and pointed out that the small sample size of patients that met study inclusion criteria may have introduced selection bias.

They called for more research to determine the underlying mechanisms of tai chi's beneficial affects, as well as more studies to determine the cost effectiveness of translating these clinical observations into more widely spread community-based programs.

In an accompanying editorial, John R. Teerlink, MD, of the San Francisco Veterans Affairs Medical Center, wrote that more rigorous trials are needed “for mind-body medicine to realize it's full potential,” including much larger sample sizes and more attention to facets such as masking, control group and endpoint selection.

“Mind-body medicine holds tremendous potential to improve both functional capacity and health related quality of life in patients with HF; it is time to give these therapies the studies they deserve,” Teerlink wrote.

References

Yeh GY. Arch Intern Med. 2011;171:750-757.

Teerlink JR. Arch Intern Med. 2011;171:758-759.

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