Friday, November 12, 2010

Benefits of Tai Chi for Arthritis Pain Examined

Conference Notes Tai chi — a traditional Chinese martial art and exercise regimen characterized by slow, gentle, graceful movements — has been demonstrated as beneficial in patients with fibromyalgia and other chronic pain conditions. A newly-reported, well-designed study found tai chi significantly helps to relieve arthritis pain and improves well-being; although, ways of maximizing clinical benefits need further consideration.

In these UPDATES blogposts, we have previously described research demonstrating benefits of tai chi for fibromyalgia pain [here] and for chronic pain in general [here]. Now, in a large, community-based, randomized controlled trial, researchers from the University of North Carolina at Chapel Hill School of Medicine evaluated the effectiveness of the Arthritis Foundation’s 6-week, twice-weekly tai chi course for reducing symptoms, increasing function, and improving psychosocial status in persons with arthritis [Callahan et al. 2010]. Their study was presented November 8, 2010, at the annual scientific meeting of the American College of Rheumatology in Atlanta, Georgia.

At baseline, 332 participants at least 18 years of age with physician-diagnosed arthritis were enrolled at 20 sites in North Carolina or New Jersey and randomly assigned to treatment (172) or a delayed-treatment control group (160). All subjects were able to move independently without assistance; however, they could perform tai chi in a seated position if necessary. Participants were 85% female, 85% Caucasian and 11% African American, with an average age of 65 years (range 19–89) and body mass index of 28.5 [BMI of 25-30 is generally considered as being overweight].

All participants received baseline and 6-week followup evaluations, after which the control group received the tai chi course. Each participant completed a battery of self-report instruments to assess such factors as pain, stiffness, fatigue, sleep disturbance, physical performance, general health, and other aspects of arthritis. Roughly three-quarters of patients were available for followup assessments.

There were no significant differences between treatment and control groups at baseline. Analyses of data showed statistically significant (p<0.05) modest improvements in the treatment group for pain, fatigue, and stiffness on visual analog scales (VAS effect sizes ranging from 23%-29%). Moderate significant improvements also were seen in feelings of helplessness, self-efficacy, and sleep disturbance. However, HAQ (Health Assessment Questionnaire) measures of physical function did not indicate significant changes, and physical performance measures involving chair stands, gait speed, and single leg stance were not improved convincingly, the authors note. The ability to reach while maintaining balance improved, perhaps reflecting the nature of the tai chi training and movements.

COMMENTARY: Favorable outcomes of the study by Callahan and colleagues were statistically significant but improvements were in modest ranges, so clinical significance for individual patients needs further consideration. It is disappointing that physical performance was not improved, suggesting that a multi-modal exercise program of which tai chi is one component might be more advantageous. This study does provide a higher level of evidence than much of the earlier research on tai chi by using an adequately powered, well-controlled, and randomized design. However, it has not yet been peer reviewed, so the results and implications should be accepted cautiously at this time.

Furthermore, in their abstract the authors do not discuss the concurrent use of analgesics by study participants and how this might have influenced their performance of tai chi. It seems reasonable that arthritis sufferers would more enthusiastically participate in any exercise program if they have at least some pain relief afforded by analgesic medication at the outset; then, an expected added benefit of the program might be diminished or even discontinued analgesic use. However, this aspect was not reported.

There are various types of tai chi, and the Arthritis Foundation Tai Chi Program® used in this study followed Sun style, one of the 4 major recognized styles that include agility exercises to help improve mobility, breathing, and relaxation. The 12 movements of Sun style tai chi do not require deep bending or squatting, which makes it easier to learn and comfortable to perform. A self-instructional DVD is available from the Arthritis Foundation for about $30 (US dollars) [more info here].

REFERENCE: Callahan LF, Shreffler JH, Hackney BS, et al. Evaluation of Tai Chi Course Effectiveness for People with Arthritis. Arthritis & Rheumatism. 2010(Oct);62(10 Suppl):S288, abstract 690 [conference abstracts PDF here].