Tai Chi Exercise in Patients With Chronic Heart Failure: A Randomized Clinical Trial

Study Questions:

What is the effect of tai chi, as an adjunct to standard care, on functional capacity and quality of life in patients with heart failure (HF)?

Methods:

A single-blind, multisite, parallel-group, randomized controlled trial evaluated 100 outpatients with systolic HF (New York Heart Association class I-III, left ventricular ejection fraction ≤40%), who were recruited between May 1, 2005, and September 30, 2008. A group-based 12-week tai chi exercise program (n = 50) or time-matched education (n = 50, control group) was conducted. Outcome measures included exercise capacity (6-minute walk test and peak oxygen uptake) and disease-specific quality of life (Minnesota Living With Heart Failure Questionnaire).

Results:

Mean (standard deviation [SD]) age of patients was 67 (11) years; baseline values were left ventricular ejection fraction, 29% (8%) and peak oxygen uptake, 13.5 ml/kg/min; the median New York Heart Association class of HF was class II. At completion of the study, there were no significant differences in change in 6-minute walk distance and peak oxygen uptake (median change [first quartile, third quartile], 35 [−2, 51] vs. 2 [−7, 54] meters, p = 0.95; and 1.1 [−1.1, 1.5] vs. −0.5 [−1.2, 1.8] ml/kg/min, p = 0.81) when comparing tai chi and control groups; however, patients in the tai chi group had greater improvements in quality of life (Minnesota Living With Heart Failure Questionnaire, −19 [−23, −3] vs. 1 [−16, 3], p = 0.02). Improvements with tai chi were also seen in exercise self-efficacy (Cardiac Exercise Self-Efficacy Instrument, 0.1 [0.1, 0.6] vs. −0.3 [−0.5, 0.2], p < 0.001) and mood (Profile of Mood States total mood disturbance, −6 [−17, 1] vs. −1 [−13, 10], p = 0.01).

Conclusions:

The authors concluded that tai chi exercise may improve quality of life, mood, and exercise self-efficacy in patients with HF.

Perspective:

This study suggests that tai chi, as a complement to standard medical care, has potential clinical benefits in patients with HF including enhancement in quality of life, mood, and exercise self-efficacy, despite the absence of differential improvement in peak oxygen intake and 6-minute walk test. Future studies are indicated to first of all confirm these observations, and then explore the mechanisms by which tai chi benefits patients with cardiovascular disease to better tailor these interventions to target subpopulations with specific constellations of HF symptoms.

Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Sports and Exercise Cardiology, Acute Heart Failure, Exercise

Keywords: Complement System Proteins, Self Efficacy, Outcome Assessment (Health Care), Minnesota, Quality of Life, Exercise, Heart Failure, Tai Ji, New York


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