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Tai Chi exercise in patients with chronic heart failure: a randomized clinical trial
Yeh GY, McCarthy EP, Wayne PM, Stevenson LW, Wood MJ, Forman D, Davis RB, Phillips RS
Archives of Internal Medicine 2011 Apr 25;171(8):750-757
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Preliminary evidence suggests that meditative exercise may have benefits for patients with chronic systolic heart failure (HF); this has not been rigorously tested in a large clinical sample. We sought to investigate whether Tai Chi, as an adjunct to standard care, improves functional capacity and quality of life in patients with HF. METHODS: A single-blind, multisite, parallel-group, randomized controlled trial evaluated 100 outpatients with systolic HF (New York Heart Association class I to III, left ventricular ejection fraction <= 40%) who were recruited between May 1, 2005, and September 30, 2008. A group-based 12-week Tai Chi exercise program (n = 50) or time-matched education (n = 50, control group) was conducted. Outcome measures included exercise capacity (6-minute walk test and peak oxygen uptake) and disease-specific quality of life (Minnesota Living With Heart Failure Questionnaire). RESULTS: Mean (SD) age of patients was 67 (11) years; baseline values were left ventricular ejection fraction 29% (8%) and peak oxygen uptake 13.5 mL/kg/min; the median New York Heart Association class of HF was class II. At completion of the study, there were no significant differences in change in 6-minute walk distance and peak oxygen uptake (median change (first quartile to third quartile)) 35 (-2 to 51) versus 2 (-7 to 54) meters, p = 0.95; and 1.1 (-1.1 to 1.5) versus -0.5 (-1.2 to 1.8) mL/kg/min, p = 0.81) when comparing Tai Chi and control groups; however, patients in the Tai Chi group had greater improvements in quality of life (Minnesota Living With Heart Failure Questionnaire -19 (-23 to -3) versus 1 (-16 to 3), p = 0.02). Improvements with Tai Chi were also seen in exercise self-efficacy (Cardiac Exercise Self-efficacy Instrument 0.1 (0.1 to 0.6) versus -0.3 (-0.5 to 0.2), p < 0.001) and mood (Profile of Mood States total mood disturbance -6 (-17 to 1) versus -1 (-13 to 10), p = 0.01). CONCLUSION: Tai Chi exercise may improve quality of life, mood, and exercise self-efficacy in patients with HF. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT00110227.

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