Tai Chi as Therapy in Heart Failure

May 03, 2011

April 27, 2011 (Boston, Massachusetts) — A rare randomized trial exploring the impact of tai chi in patients with mild to moderate heart failure found that the Chinese martial art, practiced throughout China and the world in part as a form of low-intensity exercise, can significantly improve objective measures of quality of life, exercise self-efficacy, and mood state [1]. However, it saw no apparent effect of tai chi on standard functional assessments such as six-minute-walk distance or peak oxygen uptake.

"Tai chi exercise, a multicomponent mind-body training modality that is safe and has good rates of adherence, may provide value in improving daily exercise, quality of life, self-efficacy, and mood in frail, deconditioned patients with systolic heart failure," write the authors, led by Dr Gloria Y Yeh (Beth Israel Deaconess Medical Center, Boston, MA), in the April 25, 2011 issue of the Archives of Internal Medicine. "A more restricted focus on traditional measured exercise capacity may underestimate the potential benefits of integrated interventions such as tai chi."

The group's findings and conclusions are consistent with Yeh's presentation of the study at the Heart Failure Society of America 2010 Scientific Meeting, which heartwire reported at the time.

The single-blind study evenly randomized 100 patients with NYHA class 1–3 heart failure and an LVEF <40% (mean 29%) to a group-based, 12-week tai-chi program or a heart-failure education program conducted during the same period.

At 12 weeks, compared with baseline, those who had practiced tai chi showed significant improvements, compared with the education group, in results of the Minnesota Living With Heart Failure Questionnaire (MLHFQ) (p=0.02), the Cardiac Exercise Self-Efficacy Instrument (p<0.001), and the Profile of Mood States (p=0.01).

In an accompanying editorial [1], Dr John R Teerlink (San Francisco Veterans Affairs Medical Center, CA) agrees that various tests of exercise capacity and other functional measures commonly used in patients with heart failure may be limited in showing any potential benefits from interventions with a strong mind-body component, such as tai chi. He also agrees with Yeh et al that such interventions are tough to evaluate in heart-failure clinical trials as they are now conducted.

"As therapies move from a primary goal of increasing survival beyond physiological or functional surrogates to improving quality of life, a variety of other end points have emerged," Teerlink writes; among them are the MLHFQ and the Kansas City Cardiomyopathy Questionnaire.

"The criticism that these measures do not correlate with rehospitalization rates or mortality is not relevant. As long as an intervention is safe, improvements in functional capacity or health-related quality of life are independently important, although underappreciated, goals reflecting different facets of the patient’s response to therapy," according to Teerlink.

"However, for mind-body medicine to realize its potential, rigorously performed trials with sufficient attention to masking, control group, end-point selection, and sample-size determination are necessary."

The current study is an advance in this regard, he writes, but it has limitations, including its small sample size--especially compared with the >2300 patients in HF ACTION. He and Yeh et al both point out the need for exploring the mechanisms of any benefit from tai chi in heart failure.

"Mind-body medicine holds tremendous potential to improve both functional capacity and health-related quality of life in patients with HF; it is time to give these therapies the studies they deserve."

Yeh and Teerlink had no conflict-of-interest disclosures.