Tai chi better than aerobic exercise for managing fibromyalgia
Tai chi mind-body treatment appears to deliver similar or greater improvement in symptoms for a variety of outcomes for patients with fibromyalgia than aerobic exercise, the current most commonly prescribed nondrug treatment, according to a new study.
“Our investigation also showed that a longer duration of tai chi results in greater benefits, and patients are more likely to attend tai chi classes,” researchers said. “Therefore, this mind-body approach may be considered a therapeutic option in the multidisciplinary management of fibromyalgia.”
Participants (n=226) with fibromyalgia (as defined by the American College of Rheumatology 1990 and 2010 criteria) were randomized to either supervised aerobic exercise (24 weeks, twice weekly) or one of four classic Yang style supervised tai chi intervention (12 or 24 weeks, once or twice weekly). They were followed for 52 weeks, and adherence was strictly encouraged in person and by telephone.
The primary outcome of fibromyalgia impact questionnaire (FIQR) scores improved in all five treatment groups, but the combined tai chi groups improved statistically significantly more than the aerobic exercise group in FIQR scores at 24 weeks (difference between groups, 5.5; 95 percent CI, 0.6–10.4; p=0.03) and several secondary outcomes (patient’s global assessment, 0.9 points; 0.3–1.4; p=0.005; anxiety, 1.2 points; 0.3–2.1; p=0.006; self-efficacy, 1.0 point; 0.5–1.6; p=0.0004; and coping strategies, 2.5 points; 0.8–4.3; p=0.005). [BMJ 2018;360:k851]
Tai chi treatment compared with aerobic exercise administered with the same intensity and duration (24 weeks, twice weekly) resulted in greater improvement (between-group difference in FIQR scores, 16.2 points; 8.7–23.6; p<0.001). Tai chi for 24 weeks delivered greater benefits than for 12 weeks (difference in FIQR score, 9.6; 2.6–16.6; p=0.007). No significant increase in benefit was observed for groups who received tai chi twice weekly vs once weekly.
Attendance to tai chi training sessions was also greater than that to aerobic exercise. Moreover, there were consistent effects of tai chi across all instructors. No serious intervention-related adverse events were reported.
“The results of this trial are consistent with those of our previous attention controlled study and other small, shorter efficacy trials that showed the benefits of mind-body practices such as tai chi, qigong and yoga for pain and physical and psychological health, compared with various interventions for fibromyalgia and other chronic pain conditions,” said researchers. [Clin Rheumatol 2012;31:1205-1214; Ann Intern Med 2016;165:77-86; Pain 2010;151:530-539; Clin Psychol Rev 2013;33:763-771]
“By improving psychological wellbeing, coping and self-efficacy, tai chi mind-body exercise may help to bolster the confidence of patients with fibromyalgia to engage in behaviours that help them manage their symptoms and to persist in those behaviours,” they added. [Pain 2002;98:169-178; Support Care Cancer 2014;22:2851-2859]
A multicomponent intervention that integrates physical, psychosocial, emotional, spiritual and behavioural elements, tai chi induces effects on both body and mind that may lead to beneficial health outcomes. [Arch Intern Med 2004;164:493-501]
“More clinical trials are needed to confirm whether behavioural interventions such as mind-body exercise can improve central pain sensitization and symptom management in the fibromyalgia population,” they added.