 Tai Chi Tai Chi, the Chinese low impact mind-body exercise, has been practiced for centuries for health and fitness and according to recent research is associated with improvements in psychological well-being
Laurie Barclay, MD
Désirée Lie, MD, MSEd
May 27, 2010
Tai Chi appears to
be associated with improvements in psychological well-being, although well-controlled,
longer randomized trials are needed, according to the results of a systematic
review and meta-analysis reported in the May 21 issue of BMC Complementary
and Alternative Medicine.
"Tai Chi, the Chinese low impact mind-body exercise,
has been practiced for centuries for health and fitness in the East and is
currently gaining popularity in the West," said lead author Chenchen Wang, from Tufts Medical Center, Tufts University
School of Medicine in Boston, Massachusetts, in a news release. "It is
believed to improve mood and enhance overall psychological well being, but
convincing evidence has so far been lacking."
The reviewers searched 8 English-language and 3
Chinese-language databases through March 2009 for randomized controlled trials,
nonrandomized controlled studies, and observational studies reporting at least
1 psychological health outcome. Two reviewers extracted and verified data, and a random-effects model allowed meta-analysis of
randomized trials in each subcategory of health outcomes.
Methodologic quality of each study was also evaluated.
The reviewers identified 40 studies enrolling a total of
3817 participants and reporting on a total of 29 psychological measurements. Of
33 randomized and nonrandomized trials, 21 reported significant improvements in
psychological well-being with 1 hour to 1 year of regular Tai Chi. Specific
effects in community-dwelling healthy participants and in patients with chronic
conditions were decreased stress (effect size [ES], 0.66; 95% confidence
interval [CI], 0.23 - 1.09), anxiety (ES, 0.66; 95% CI, 0.29 - 1.03), and
depression (ES, 0.56; 95% CI, 0.31 - 0.80), and improved mood (ES, 0.45; 95%
CI, 0.20 - 0.69).
"More detailed knowledge about the physiological and
psychological effects of Tai Chi exercise may lead to new approaches to promote
health, treat chronic medical conditions, better inform clinical decisions and
further explicate the mechanisms of successful mind-body medicine," Dr.
Wang said.
The beneficial association between Tai Chi practice and
psychological health was supported by 7 observational studies with relatively
large sample sizes.
"Tai Chi appears to be associated with improvements in
psychological well-being including reduced stress, anxiety, depression and mood
disturbance, and increased self-esteem. Definitive conclusions were limited due
to variation in designs, comparisons, heterogeneous outcomes and inadequate
controls. High-quality, well-controlled, longer randomized trials are needed to
better inform clinical decisions."
The study authors have disclosed no relevant financial
relationships.
BMC Complement Altern Med. 2010;10:23. Abstract
More information about the health effects of Tai Chi is
available from the National Center for Complementary and Alternative
Medicine
Clinical Context
Tai Chi is a form of low-impact mind-body exercise using
balance, flexibility, and strength. Its use has spread worldwide for the past 2
decades, and it has been reported to have beneficial psychological effects in
both healthy subjects and in those with medical conditions such as
cardiovascular disease.
This is a systematic review and meta-analysis of studies on Tai Chi to
determine its impact on psychological well-being.
Study Highlights
- The
reviewers conducted an electronic search of the medical literature using 8
English-language and 3 Chinese-language databases through March 2009.
- They also
searched reference lists of selected articles for studies.
- Included
were original studies of randomized trials, nonrandomized comparison
studies, and observational studies.
- Reviews,
conference proceedings, and case reports were excluded.
- Studies
were assessed for quality, and data were extracted for the meta-analysis
by 2 reviewers.
- The
reviewers determined ES for each outcome by pooling the ES of each study.
- An ES of 0
to 0.19 was considered negligible; 0.20 to 0.49, small; 0.50 to 0.79,
moderate; and 0.80 and above, high.
- 2579
English-language and Chinese-language articles were reviewed and 40
identified for data abstraction.
- Studies
had to include at least 10 human subjects and evaluate at least 1 outcome
of psychological health including stress, anxiety, depression, mood, and
self-esteem.
- Stress:
- For
stress, there were 5 randomized trials, 5 nonrandomized trials, and 1
observational study from 4 countries (United States, Australia, Germany,
and China) reporting effects on 870 participants aged 16 to 85 years.
- Subjective
measures were used, such as the Perceived Mental Stress Score, the Impact
of Event Scale, and the Chinese Psychological Stress Scores.
- There was
a significant improvement in stress management and psychological distress
(ES, 0.66 [moderate]).
- Tai Chi
was associated with a benefit for stress in healthy adults, those with
HIV-related distress, and elderly Chinese persons with cardiovascular
disorders.
- The
overall quality of the studies was modest to inadequate, with no controls
in most studies.
- Anxiety:
- For
anxiety, there were 5 randomized trials, 9 nonrandomized trials, and 5
observational studies examined in 1869 people from 4 countries (United
States, United Kingdom, Australia, and China).
- Scales
used included the Profile of Mood States Anxiety subscale; the
Depression, Anxiety, Stress Subscale; and the Taylor Manifest Anxiety
Scale.
- Tai Chi
practiced 2 to 4 times a week (30 - 60 minutes at a time) for 5 to 24
weeks was associated with a significant reduction in anxiety (ES, 0.66
[moderate]).
- Overall
study quality was modest.
- Depression:
- For
depression, 10 randomized trials, 6 nonrandomized trials, and 4
observational studies examined effects on 2008 patients, with Tai Chi
ranging from 1 hour to 14 years.
- Studies
used the Center for Epidemiology Studies Depression Scale, Profile of
Mood States Depression subscale, and the Beck Depression Inventory.
- Tai Chi
for 6 to 48 weeks (40 minutes to 2 hours each, 1 - 4 times a week)
resulted in reduced depression symptoms (ES, 0.56 [moderate]).
- However,
most studies were on healthy populations, with only 2 studies on
clinically depressed patients.
- Mood:
- For mood,
4 randomized trials, 8 nonrandomized trials, and 3 observational studies
with 1613 patients examined Tai Chi offered from 1 hour to 14 years (1 -
7 times a week).
- The
studies used various scales including the Profile of Mood States Scale,
Functional Assessment of HIV Infection, and Symptom Checklist-90.
- Tai Chi
significantly improved mood, with an overall ES of 0.45 (small).
- Tai Chi
was of benefit for mood in healthy adults, elderly with cardiovascular
disease risk factors, obese women, and adolescents with attention-deficit
disorder.
- Study
quality was poor overall, with inadequate controls.
- Self-esteem:
- Self-esteem
was studied in 3 randomized trials and 1 nonrandomized trial in 425
subjects.
- Tai Chi
practiced for 12 to 26 weeks (45 - 60 minutes, 2 - 3 times weekly)
improved self-esteem, as assessed by scales such as Rosenberg's 10-item
Global Self-Esteem Scale and the Body Cathexis
Score.
- There was
a positive association between Tai Chi and self-esteem, but an ES could
not be calculated because quantitative results were limited.
- The
authors concluded that the evidence supported a positive effect of Tai Chi
on reducing stress, anxiety and depression symptoms, and enhancing mood
and self-esteem, but study quality was limited and dose-response could not
be assessed.
Clinical Implications
- Tai Chi is
associated with reducing stress, anxiety, and depression symptoms and
improving self-esteem and mood in a variety of patients.
- Quality of
studies on the effects of Tai Chi is poor, and dose-response cannot be
determined.
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