Tai Chi Can Substitute for Pulmonary Rehabilitation, COPD Study Says

Can tai chi act as a substitute for pulmonary rehabilitation for patients with chronic obstructive pulmonary disease (COPD)? A study of 120 patients in the journal Chest suggests that it is a possibility.

Pulmonary rehabilitation (PR) can improve exercise capacity and quality of life for patients, but it requires trained staff and specialized facilities. However, tai chi, an ancient martial art that involves physical exertion, is gaining popularity, the researchers said, especially to help manage different conditions like pain and Parkinson's. Tai chi incorporates stretching, breathing, and coordinated movement and requires no special equipment.

The study involved 120 patients with COPD in rural China who had never used a bronchodilator. Eligible patients were aged between 40 and 80 years with post bronchodilator mean forced expiratory volume (FEV) of ≥25% and <80% of predicted and mean forced expiratory volume in 1 second (FEV₁₎/vital capacity <0.7.

After beginning daily treatment with indacaterol, subjects were randomly assigned to groups receiving traditional PR or tai chi.

Tai chi was taught as a 24-form Yang style; instruction was given 5 days per week for 1 hour for 12 weeks. Initially, patients were taught 2 to 3 movements each day and typically took 2 weeks to master them in small groups. Then the participants were able to join larger group training with a single instructor giving instructions via real-time video streaming.

At the end of the 12-week period, participants were encouraged to continue, either alone or in a group; however, no assistance was provided by the investigators.

Both the tai chi and PR groups showed similar improvements in the Saint Georges Respiratory Questionnaire (SGRQ) scores, a commonly-used tool that measures self-reported health status.

However, there was no difference in FEV₁.

With concurrent long-acting inhaled beta-agonist use, both PR and tai chi provided benefits as judged by the SGRQ and performance on a 6-minute walk distance test. Although neither training approach differed from the other by more than the minimal clinically important difference (MCID) of 4 SGRQ points, 12 weeks after the end of formal training, improvements emerged in favor of tai chi in SGRQ score, 6-minute walk distance score, dyspnea score, and quadriceps strength.

The researchers said tai chi may offer more sustained benefit than PR.

The researchers said the choice of SGRQ as the primary outcome measure was justified on the basis of it being widely used as an end point in COPD clinical trials. The efficacy of COPD treatments is often judged by change in FEV₁; however, the researchers did not expect either PR or tai chi to affect FEV based on earlier findings.

They also noted that while medication has an important role in treating COPD, cost can be an issue for some patients, especially in rural China, where the study took place.

Reference

Polkey MI, Qiu ZH, Zhou L, et al. Tai chi and pulmonary rehabilitation compared for treatment-naive patients with COPD [published online April 3, 2018]. Chest. doi: https://doi.org/10.1016/j.chest.2018.01.053.