Level 2: Mid-level evidence

Fibromyalgia can be hard to treat, and patients may suffer symptoms for years despite treatment.The American Pain Society recommends muscle-strengthening and stretching exercises as well as sleep and anti-anxiety medications as part of a multidisciplinary treatment approach. A randomized trial of 66 patients with fibromyalgia suggests that Tai Chi might be helpful for both pain and sleep disturbance symptoms (N Engl J Med. 2010;363:743-754).

Patients (mean age 50 years) were randomized to classic Yang-style tai chi vs. a control intervention (wellness education and stretching) for 60 minutes twice weekly for 12 weeks. All patients were instructed to practice activity at home for 20 minutes each day, and patients in the tai chi group were encouraged to maintain tai chi practice using an instructional DVD until follow-up at 24 weeks. The primary outcome was clinically meaningful change in symptom severity defined as an improvement of more than eight points on the 100-point Fibromyalgia Impact Questionnaire.

The Tai Chi group had a significantly higher rate of patients achieving clinically meaningful improvement (79% vs. 39%, P <0.001, NNT 3). The mean improvements from baseline were 27.8 points in the Tai Chi group vs.9.4 points for controls at 12 weeks and 28.6 vs.10.2 at 24 weeks (both P <0.001). Tai Chi was also associated with significant improvement in sleep quality, patient-reported global assessments, and both mental and physical SF-36 scores. Improvements in symptom severity were maintained in the Tai Chi group at 24-week follow-up.