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 to 184.95 min/week) and 111.62 min/week; (95% confidence interval 26.17 to 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. CLINICAL TRIAL REGISTRATION: URL http://www.ClinicalTrials.gov. Unique identifier NCT02165254.

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