October 11, 2017
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Tai chi viable option for patients declining cardiac rehabilitation

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Tai chi may be a safe and effective alternative option for the improvement of physical activity among patients with CHD who decline enrollment in cardiac rehabilitation, according to data published in the Journal of the American Heart Association.

According to the study background, nearly one-quarter of patients who survive an acute coronary event will experience another CV event or are at risk for mortality in the next 5 years. Despite this, more than 60% of patients decline participation in cardiac rehabilitation after MI.

“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, MD, PhD, assistant professor of medicine at the Warren Alpert School of Medicine at Brown University, said in a press release. “Tai chi exercise can reach low- to moderate-intensity levels. The emphasis on breathing and relaxation can also help with stress reduction and psychological distress.”

Salmoirago-Blotcher and colleagues randomly assigned 29 patients with CHD declining cardiac rehabilitation (mean age, 68 years; 27% women) into two groups. The LITE patient cohort had two sessions per week for 12 weeks and the PLUS cohort had three sessions per week for 12 weeks with an additional 12 weeks of maintenance classes.

The researchers measured physical activity, quality of life and weight at baseline and again 3, 6 and 9 months after baseline. At 3 months, patients were given a stress test to measure aerobic fitness.

Physical activity benefits

At 9 months, retention rates were 90% in the LITE cohort and 88% in the PLUS cohort.

Researchers found no adverse events related to the performance of tai chi and no cardiac adverse events.

Significant mean between-group differences in moderate- to vigorous-intensity physical activity in favor of the PLUS group were observed at 3 months (100.33 minutes per week; 95% CI, 15.7-184.95; P = .04) and 6 months (111.62 minutes per week; 95% CI, 26.17-197.07). Median moderate- to vigorous-intensity physical activity was also higher in the PLUS group vs. the LITE group at 9 months (P = .03), Salmoirago-Blotcher and colleagues wrote.

Mean percentage weight loss was higher in the PLUS group (2.86 kg) vs. the LITE group (–0.45 kg).

At 3 months, quality-of-life scores were better in the PLUS group vs. the LITE group (beta = –0.69; 95% CI, –1.34 to –0.04), but the difference was not statistically significant at 6 months or 9 months, according to the researchers.

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There was no change in aerobic fitness in either group.

“On its own, tai chi wouldn’t obviously replace other components of traditional cardiac rehabilitation, such as education on risk factors, diet and adherence to needed medications,” Salmoirago-Botcher said in the release. “If proven effective in larger studies, it might be possible to offer it as an exercise option within a rehab center as a bridge to more strenuous exercise, or in a community setting with the educational components of rehab delivered outside of a medical setting.”

More research needed

According to an accompanying editorial by James P. Pirruccello, MD, from the cardiology division at Massachusetts General Hospital and Harvard Medical School, and colleagues, although tai chi as a replacement for cardiac rehabilitation may be feasible and acceptable for some patients, its ability to reduce CV morbidity and mortality in patients after a coronary event requires further research.

“Ongoing efforts to understand and address the barriers to [cardiac rehabilitation] through novel and, perhaps, alternative solutions will be important on the ‘road to increased participation’ in rehabilitative services after a coronary event, with the ultimate goal of reducing disparities in care and improving secondary cardiovascular prevention,” they wrote. – by Dave Quaile

Disclosures: One author reports he is founder and sole owner of the Tree of Life Tai Chi Center. The other authors and editorial writers report no relevant financial disclosures.