Improve Activity and Quality of Life in High Risk Cardiac Patients with Tai Chi
By John M. de Castro, Ph.D.
“We thought that Tai Chi might be a good option for these people because you can start very slowly and simply and, as their confidence increases, the pace and movements can be modified to increase intensity.” – Elena Salmoirago-Blotcher
Cardiovascular disease is the number one killer, claiming more lives than all forms of cancer combined. “Heart disease is the leading cause of death for both men and women. About 610,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths. Every year about 735,000 Americans have a heart attack.” (Centers for Disease Control). A myriad of treatments has been developed for heart disease including a variety of surgical procedures and medications. In addition, lifestyle changes have proved to be effective including quitting smoking, weight reduction, improved diet, physical activity, and reducing stresses. Cardiac rehabilitation programs for patients recovering from a heart attack, emphasize these lifestyle changes. Unfortunately, for a variety of reasons, 60% of cardiac patients decline participation, making these patients at high risk for another attack.
Contemplative practices, such as meditation, tai chi, and yoga, have also been shown to be helpful for heart health. In addition, mindfulness practices have also been shown to be helpful for producing the kinds of other lifestyle changes needed such as smoking cessation, weight reduction and stress reduction. Tai Chi and Qigong are ancient mindfulness practices involving slow prescribed movements. They are gentle and completely safe, can be used with the elderly and sickly, is inexpensive to administer, can be performed in groups or alone, at home or in a facility or even public park, and can be quickly learned. In addition, they can also be practiced in social groups without professional supervision. This can make it fun, improving the likelihood of long-term engagement in the practice. Since Tai Chi is both a mindfulness practice and an exercise, it may be an acceptable and effective treatment for the 60% of cardiac patients who refuse participation in more traditional cardiac rehabilitation programs.
In today’s Research News article “Tai Chi Is a Promising Exercise Option for Patients with Coronary Heart Disease Declining Cardiac Rehabilitation.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721863/ ), Salmoirago‐Blotcher and colleagues recruited cardiac patients who were physically inactive and offered them participation in group Tai Chi practices for 30 minutes per session. The participants were randomly assigned to one of two levels of practice, Lite and Plus. In the Lite condition practice occurred 2 times per week for 12 weeks. In the Plus condition practice occurred 3 times per week for 12 weeks followed by 4 weeks of twice a week practices and 8 weeks of once a week practice. Patients were measured before treatment and at 3, 6, and 9 months later. They were measured for acceptability and participation rates in the clinic and at home. They were also measured for physical activity and aerobic fitness with stress test, body size, anxiety, and depression.
Retention rates in the program were excellent with 90% of the Lite group and 84% of the Plus group still participating at the 9-month follow-up. There were no cardiac related adverse events during the study and most participants indicated that the program was acceptable and enjoyable. The Plus condition resulted in significant increases in the patients’ levels of physical activity and self-reported quality of life and decreases in body weight, but not improvement in aerobic fitness. Hence, the 6-month Plus Tai Chi program was safe and acceptable and produced measurable improvements in the patients activity levels and quality of life.
The high acceptability and retention rates are particularly important as these patients had declined participation in more traditional cardiac rehabilitation programs. They stated that they feared that the traditional programs would be too stressful and potentially harmful. But, Tai Ch practice was perceived as acceptable and not dangerous. Hence, the program was successful in getting these reluctant patients more physically active. The hope is that this would overcome their reluctance to engage in more strenuous programs and eventually lead to participation and improvement in aerobic fitness levels. This would be a breakthrough in the treatment of these very high-risk patients.
So, improve activity and quality of life in high risk cardiac patients with Tai Chi.
“Tai chi may be a useful form of exercise for cardiac rehab programs, as it’s safe for high-risk patients. Findings also suggest that tai chi alone may be beneficial for patients who are unwilling to participate in a rehab program.” – CardioSmart
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Elena Salmoirago‐Blotcher, Peter M. Wayne, Shira Dunsiger, Julie Krol, Christopher Breault, Beth C. Bock, Wen‐Chih Wu, Gloria Y. Yeh, Tai Chi Is a Promising Exercise Option for Patients With Coronary Heart Disease Declining Cardiac Rehabilitation. J Am Heart Assoc. 2017 Oct; 6(10): e006603. Published online 2017 Oct 11. doi: 10.1161/JAHA.117.006603
Clinical Perspective
What Is New?
Compared with a shorter intervention, a 6‐month tai chi exercise intervention was safe, feasible, and enjoyable and increased moderate‐to‐vigorous physical activity among deconditioned patients with coronary heart disease who had declined enrollment in cardiac rehabilitation.
Other benefits included weight loss and improvements in quality of life.
This is the first study showing that tai chi may improve exercise behaviors in this high‐risk population.
What Are the Clinical Implications?
Tai chi is a promising and safe exercise alternative for patients with coronary heart disease who are unable or unwilling to attend traditional cardiac rehabilitation.
If proved effective in larger studies, tai chi could be offered as an alternative exercise option within existing cardiac rehabilitation programs or within the context of community‐based rehabilitation programs.
Abstract
Background
More than 60% of patients decline participation in cardiac rehabilitation after a myocardial infarction. Options to improve physical activity (PA) and other risk factors in these high‐risk individuals are limited. We conducted a phase 2 randomized controlled trial to determine feasibility, safety, acceptability, and estimates of effect of tai chi on PA, fitness, weight, and quality of life.
Methods and Results
Patients with coronary heart disease declining cardiac rehabilitation enrollment were randomized to a “LITE” (2 sessions/week for 12 weeks) or to a “PLUS” (3 sessions/week for 12 weeks, then maintenance classes for 12 additional weeks) condition. PA (accelerometry), weight, and quality of life (Health Survey Short Form) were measured at baseline and 3, 6, and 9 months after baseline; aerobic fitness (stress test) was measured at 3 months. Twenty‐nine participants (13 PLUS and 16 LITE) were enrolled. Retention at 9 months was 90% (LITE) and 88% (PLUS). No serious tai chi–related adverse events occurred. Significant mean between group differences in favor of the PLUS group were observed at 3 and 6 months for moderate‐to‐vigorous PA (100.33 min/week [95% confidence interval, 15.70–184.95 min/week] and 111.62 min/week; [95% confidence interval, 26.17–197.07 min/week], respectively, with a trend toward significance at 9 months), percentage change in weight, and quality of life. No changes in aerobic fitness were observed within and between groups.
Conclusions
In this community sample of patients with coronary heart disease declining enrollment in cardiac rehabilitation, a 6‐month tai chi program was safe and improved PA, weight, and quality of life compared with a 3‐month intervention. Tai chi could be an effective option to improve PA in this high‐risk population.