Heart failure patients may experience improvements in their quality of life and mood by participating in a tai chi exercise program, a randomized study suggested.
A small, but important study of patients with chronic (long term) heart failure determined that their quality of life (measured on the Minnesota Living with Heart Failure Questionnaire) benefited those who participated in Tai Chi exercises, after to 9 at 12 weeks of participation, according to Gloria Y. Yeh, MD, of Harvard in Boston, and colleagues.
In comparison, the heart failure patients who did not participate in Tai Chi and were educated about their condition had a much lower quality of life score, that was statistically significant, according to the study reported in the April 25, 2011 Archives of Internal Medicine.
Also the Tai Chi group experienced mood improvement, after 10 and 12 weeks, compared with scores of among controls that stayed close to baseline levels at week.
Tai Chi, with its “gentle meditative exercise of flowing circular movements, balance and weight shifting, breathing techniques, visualization, and focused internal awareness,” is increasingly being adopted for use in various medical contexts, Yeh and colleagues observed.
They theorized that Tai Chi could be especially therapeutic and helpful for frail senior citizen patients experiencing debilitating heart failure, because of its multiple benefits, including mild aerobic actions, increasing strength, and extremities training.
To research this approach, the 100 patients were enrolled in the study, between May 1, 2005, and September 30, 2008. They were randomly placed in an hour-long classes twice weekly of Tai Chi or to the Heart Failure Society of America educational modules.
Their average age was 67, years, and the functioning of their left ventricle, a chamber in the heart, responsible for pumping oxygen rich blood into the body, had significantly reduced function, as measured by the ejection fraction at study entry, which was 29% at the beginning of the study. , and peak oxygen uptake was 13.5 mL/kg/min.
Most of the patients had, according to the New York Heart Association assessment had class II heart failure and were receiving a beta-blocker and an angiotensin-converting enzyme inhibitor (powerful drugs to stimulate the heart’s pumping.
Almost one-third of the patients had a history of depression and anxiety.
After 3 months, there were no differences between the groups in change in six-minute walk distance or in peak oxygen uptake.
But, the Tai Chi group did experience an increase in metabolic expenditure outside of the class in the tai chi group . They also reported mood improvement.
Those patients improved on the total mood disturbance subscale of the Profile of Mood States — consisting of 65 single-word items rated on a five-point scale to indicate recent mood in six dimensions.
The Tai Chi group participants had a decrease in their overall baseline score of 10 to a score of 4, while those in the control group had scores of 18 at baseline and 17 at week 12.
On the depression subscale of that rating tool, scores decreased from 2 to 0 in the tai chi group, and increased from 3 to 4 in the control group.
On the vigor subscale, the tai chi group increased from 8.5 to 9, while the controls fell from 8 to -2 .
Significant benefits also were seen in exercise self-efficacy.
In addition, post-hoc analyses showed benefits for tai chi in patients without implanted cardioverter-defibrillators , in those with class II and class III symptoms, and in patients whose heart failure was not ischemic (decreased oxygen primarily due to hardening of the arteries)..
Among the patients with a higher resting heart rate, there were greater improvements in disease-specific quality of life.
“One of the purported mechanisms of mind-body exercises, such as tai chi, is favorable modulation of the autonomic nervous system,” the researchers explained.
This may help explain their post-hoc finding of greater benefits in patients with high resting heart rates, “and presumably more sympathetic nervous system overdrive,” they suggested.
The researchers noted that doctors are beginning to recognize the importance and value of patient quality of life in heart failure.
“We observed large, clinically significant changes in quality of life in this study, similar to or even greater than what has been seen with cardiac resynchronization therapy,” they wrote.
The improvements in mood were “highly relevant,” they said, emphasizing the close link between heart failure and depression.
To decrease the potential disappointment among the education-only group (which could have affected scores), tai chi classes were offered at the end of the follow-up period.
The investigators were also unable to provide a “definitive physiological mechanism for tai chi’s effects.”
Nonetheless, they argue, this study provides informative data from the first large-scale clinical trial of tai chi exercise in an HF population.
Future work should address the potential mechanisms of effect as well as how programs such as this could be implemented into community practice.
In an invited commentary, John R. Teerlink, MD, of the San Francisco Veterans Affairs Medical Center echoed the call for further research into mind-body approaches such as this for heart failure.
“Mind-body medicine holds tremendous potential to improve both functional capacity and health-related quality of life in patients with [heart failure]; it is time to give these therapies the studies they deserve,” he wrote.
Primary source: Archives of Internal Medicine
Yeh G, et al “Tai chi exercise in patients with chronic heart failure: a randomized clinical trial” Arch Intern Med 2011; 171: 750-757.
Additional source: Archives of Internal Medicine
Teerlink J “Mind or body: evaluating mind-body therapy efficacy in heart failure trials” Arch Intern Med 2011;171:758-759.