Tai Chi Equals or Betters Aerobic Exercise in Fibromyalgia

MeSci

MeSci

Senior Member (Voting Rights)
from Physician's First Watch

By Joe Elia
Edited by
- Susan Sadoughi, MD, and
- Richard Saitz, MD, MPH, FACP, DFASAM

Fibromyalgia responds to tai chi as well as - or better than - it does to commonly prescribed aerobic exercises, The BMJ reports.

Researchers randomized 226 patients to one of four tai chi regimens or to aerobic exercise. Tai chi entailed once or twice weekly supervised sessions, for 12 or 24 weeks; aerobic exercise included twice weekly supervised sessions for 24 weeks. Participants were also advised to perform tai chi or aerobic exercise on their own for 30 minutes daily.

At 24 weeks, the change in fibromyalgia severity score was significantly greater in the four tai chi groups combined than in the aerobic exercise group, but the difference was not clinically meaningful. However, when the more-intense tai chi group (twice weekly for 24 weeks) was compared with aerobic exercise, a substantial clinical benefit was seen.

Link(s):
The BMJ article (Free) http://response.jwatch.org/t?ctl=3030A:5FF9B588B7CB016CE85FD7AA7BA7A434D2B71D9A95FA21D3&

The BMJ comment #1 (Free) http://response.jwatch.org/t?ctl=3030B:5FF9B588B7CB016CE85FD7AA7BA7A434D2B71D9A95FA21D3&

The BMJ comment #2 (written by study's first author) (Free) http://response.jwatch.org/t?ctl=3030C:5FF9B588B7CB016CE85FD7AA7BA7A434D2B71D9A95FA21D3&

Background: NEJM Journal Watch Neurology coverage of a 2010 study from the same group (Your NEJM Journal Watch registration required) http://response.jwatch.org/t?ctl=3030D:5FF9B588B7CB016CE85FD7AA7BA7A434D2B71D9A95FA21D3&
 
Yet more proof that although FM may be a common co-morbid condition in ME patients, they are not the same illness.

During the first year after my ME diagnosis, it was suggested Tai Chi would be a good low-intensity exercise for me (previously an extreme athlete). I signed up for a beginners' course twice weekly at our local Tai Chi organization. I thoroughly enjoyed it, and did pretty well for the first few weeks. The only observable side effect was that after every session, it was as if a blank white sheet was drawn down over my face, and I became pretty much "absent". This was actually commented on by my husband, and other participants.

The longer I attended, the more difficult it became -- both physically, and from a cognitive perspective. Initially, I was able to learn and remember a short sequence of moves at the beginning of the set. But as I continued, I couldn't even remember one small component of each move, despite the instructor demonstrating over and over again. And, I completely lost my coordination and started breaking into a sweat with minimal movement.

I tried Tai Chi three other times during the 30-year course of my illness -- each time with the same disappointing result. At one point, I even contemplated becoming an instructor for a "seated" set designed for those with illnesses and disabilities. Even this was too much for me. My ability was abysmal compared with the other participants, most of whom had MS, Parkinson's or chronic pain for various reasons.
 
I did a tai chi course weekly for about 9 years before I had ME. I really loved it. We followed a Master Lam's form and learned a miniform, short form and then the movements of the first 3 parts of a long form. During the summer we practiced in Richmond Park amongst the trees.

Each class started with a warm up, automatically rotating the knees each way while bending. Sometimes the tutor would tell us Chinese tales. Other physical massage elements would follow. Tapping on head, back etc. Many of these involved standing.

Then would come learning and practicing of the form, a series of movements following a pattern. It was a challenge physically and mentally. Not sure that it was meant to be a challenge. Maybe that is a Western concept.

I very much enjoyed it until I had a hip replacement which affected balance, and then a year later, ME struck hard. I then couldn't do the class warm up: standing was impossible so I had to go and sit down. Rotating through the 'form' became harder, more unbalanced.

Eventually I stopped. I would recommend tai chi to the fit or not orthostatically challenged unfit. Memory helps because remembering the form takes effort. I really enjoyed it but couldn't continue.

Really keen members of the class would do chi gong, to my uninformed eye, seemed to mean not moving, staying in postures. The bit I tried was hard.

We sometimes did the tai chi form at different speeds, fast or very slow. Very slow movements of the form, intense, was tough as @Jonathan Edwards said.

Wish I could do it again.
 
Tai chi is an ancient discipline involving exercise rooted in traditional Chinese medicine that originated as a martial art and has been practiced for many centuries. This complex, multicomponent mind-body intervention integrates physical, psychosocial, spiritual, and behavioral elements to promote health and fitness.20, 21
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Okay.

Looks like this did include some objective outcomes, but they haven't published these yet (unless I missed them):

"Assessments of physical function included the chair stand, six minute walk, and balance tests.55565758 Participants’ muscle strength and power were also assessed using a leg press.59 Several secondary outcomes will be reported in separate publications."
 
It's a really well written study, as far as these studies go. There's a lot of detail on things like drop out rates, adverse effects and previous studies that informed this study. It looks like they made a genuine effort to deal properly with things like missing data.

The much repeated reference to tai chi as 'the mind-body therapy' (and therefore the implication of its 'psychosocial' benefits to these fibromyalgia sufferers with their various emotional shortcomings) was annoying. So presumably aerobics in comparison was just a body therapy? My experience of tai chi was that it was similar to a very slow aerobics, with both involving physical and mental challenges and both offering an opportunity to socialise and 'be in the moment'. They suggest that tai chi has a spiritual component - I think that's a bit of a leap for westerners doing a class once or twice a week for 12 to 24 weeks. I can't say I ever noticed it.

If you aren't interested in some detail, head down to ****

They acknowledge the problem with self-reported outcomes.
First, participants were aware of their treatment group assignment, and high expectation of treatment benefit, including a placebo or nocebo response could have influenced assessments of effects.
Click to expand...


Participants assigned to tai chi attended 62% of possible classes, and participants assigned to aerobic exercise attended 40%.
Overall, 183 (81%) participants completed the 12 week evaluation, 181 (80%) completed the 24 week evaluation, and 158 (70%) completed the 52 week evaluation
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By week 52, there is no longer a statistically significant difference in FIQR score (an overall self report measure specifically for fibromyalgia) between the combined tai chi treatments and the aerobic treatment. However, there is a statistically significant difference at 52 weeks between the tai chi treatment that went for 24 weeks) with 2 classes per week and the aerobics treatment with the same length and class frequency.

There was no significant difference at 24 weeks or 52 weeks between tai chi or aerobics for the physical component of the SF36 or the 6 minute walk test.

So, there isn't really a statistically robust difference between tai chi and aerobics. (Check out Table 3).

However the changes in the self reported scales as a result of both treatments do seem to be clinically significant (although small). (i.e. there does seem to be a benefit on average from doing either tai chi or aerobic exercise for this group of fibromyalgia patients). It would be good to hear from people with more experience with the various scales as to whether the changes really do mean much.

I'm not entirely sure what they are saying here (I didn't find the appendix with the table for it)
The subgroup analysis of participants who attended at least 50% sessions in both the aerobic exercise and the tai chi groups showed similar effects as in the entire group, although statistical significance was reduced because of the smaller subgroup sample size
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If they are saying that the participants who attended more than half the sessions of the e.g. tai chi groups had similar improvements to the improvements for all of the participants in the tai chi groups, then that would be my biggest question about the study. Because that means that the participants who attended less than half the sessions did just as well as the participants who attended more than half the sessions. And that makes me think that the treatment wasn't really changing anything.

***** My takeaway from this is that, if I had fibromyalgia, I would probably choose an aerobics or tai chi class (or some other physical activity), whatever took my fancy or was nearby or had the nicest teacher, and cautiously give it a go. There didn't seem to be a lot of adverse effects. But I would not be expecting a cure or even dramatic changes. I'd be doing it mainly because being fit is good, and any small reductions in pain would just be a bonus.

My other takeaway is that physical therapies are probably not the real answer to fibromyalgia. Barely clinically significant changes aren't good enough. There needs to be more research into what is really causing the problem.

Not quite a blue cardigan JE - sort of a blue cardigan with a mystical Eastern overlay.
tai chi instructor.jpg
 
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I tried a 10 minute beginner's lesson a few years back. The next morning I couldn't even raise an arm to brush my teeth, it PM'd me quite badly. Now that my functional baseline is even lower than back then, I wouldn't dare attempt it again.
 
I successfully did a Tai Chi class early in my ME and really enjoyed it. I was not able to keep it up as I declined and no longer remember how. It was a thoroughly Western, physical form of Tai Chi. There was no spiritual/psychosocial/behavioral aspect. The movement was also equally to the right and left. Traditional Tai Chi moves to the right, as that was considered the 'good' direction by the ancient Chinese.
 
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