Tai Chi may improve health status of COPD patients
Tai Chi may be equivalent to pulmonary rehabilitation (PR) in improving health status of patients with chronic obstructive pulmonary disease (COPD), a recent study shows.
Although PR has been shown to be effective in improving functional status of COPD patients, it requires specific facilities to execute, which may limit access to PR, unlike Tai Chi which requires no special equipment.
“This study demonstrates that a low-cost exercise intervention is equivalent to formal PR, and this may enable a greater number of patients to be treated,” said lead author Dr Michael Polkey from The Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK.
The study enrolled 120 treatment-naïve patients with COPD in rural China. Two weeks after initiating indacaterol 150 µg once daily, they were randomized to undergo PR thrice weekly or Tai Chi five times a week for 12 weeks. Change in health status, measured using SGRQ*, was assessed towards the end of the interventions and again 12 weeks after the conclusion of the intervention. [Chest 2018;doi:10.1016/j.chest.2018.01.053]
By the end of interventions, both the PR and Tai Chi groups saw significant improvements in their SGRQ scores compared with before starting the training (p<0.001 for both), although the difference between groups was not statistically significant (difference, -0.48; p=0.76).
However, 12 weeks after the end of interventions, the Tai Chi group continued to improve in SGRQ while the PR group did not, resulting in a 4.5-point difference in SGRQ score between groups (p<0.001). This, according to the researchers, met the minimal clinically important difference of four SGRQ points.
Other measures such as functional status by 6MWD** (difference, -22.7 m; p<0.001) and perception of dyspnoea on mMRC*** scale (difference, 0.32; p<0.001) also improved more in favour of Tai Chi at 12 weeks after the end of training.
In addition, improvement in quadricep strength was significantly greater with Tai Chi than PR (difference in maximum voluntary contraction force, 3.3 kg; p<0.001). The researchers believed that improved quadricep function is the main driver of improvements in other measures above, as quadricep weakness has been associated with impaired physical function in COPD and with dyspnoea in the general population. [Chest 2014;145:1016-1024; COPD 2013;10:40-54]
There were no differences in FEV1# between groups.
“Tai Chi is equivalent to PR and may confer more sustained benefit,” said study principal investigator Professor Yuan-Ming Luo of Guangzhou Medical University, Guangzhou, China, who noted that significant differences between groups emerged even 12 weeks after the end of training.
“[I]t is also likely that the Tai Chi group continued to some extent to practise after the end of the training period, which would have been more difficult for the PR group who lacked access to gymnasium equipment,” according to Luo and co-authors.
After the end of the 12-week interventions, participants were still encouraged to continue with Tai Chi on their own effort while those in those in the PR group were encouraged to stay physically active.
“Physical activity is key to reducing symptoms in COPD. We do recommend PR, but our study shows that Tai Chi is a viable alternative when there is no local PR service. We encourage PR providers to consider offering Tai Chi as an alternative therapy that patients would then be able to continue unsupervised in their own home,” said Polkey.