Tai Chi Beats Aerobic Exercise for Fibromyalgia
Damian McNamara
Compared with
aerobic exercise, the traditional martial art of tai chi is as good as, or
better than, aerobic exercise, for improving the overall severity of
fibromyalgia symptoms, new research shows. Results of a 52-week single-blind
trial showed that in addition to fibromyalgia symptom relief, tai chi was
associated greater improvements in depression, anxiety, self-efficacy, and the
mental component of the Short-Form Health Survey (SF-36) quality-of-life
measure.
"Compared with aerobic exercise, the most commonly
prescribed non-drug treatment, tai chi appears as effective as or better for
managing fibromyalgia," the investigators, led by Chenchen Wang, MD, Tufts
University School of Medicine in Boston, Massachusetts, write. "This
mind-body approach may be considered a therapeutic option in the multidisciplinary
management of fibromyalgia."
Complex
Disorder
A complex disorder, fibromyalgia is characterized by chronic
widespread musculoskeletal pain, fatigue, sleep disturbance, and prominent
physical and psychological impairment, the investigators note. Estimates
suggest it affects 2% to 4% of the general population aged 18 to 65 years.
Aerobic
exercise is recommended as a standard treatment for fibromyalgia, but many
patients find it difficult to exercise because of fluctuations in symptoms.
Some trials have suggested that tai chi alleviates pain and improves physical
and mental health in patients with fibromyalgia but concluded that larger and
more rigorous trials are needed to confirm the results.
In addition, the duration and frequency of tai chi required to
achieve optimal benefit are unknown, as is its efficacy compared with that of
aerobic exercise in this patient population.
To find out
more, the investigators conducted a prospective, randomized, 52-week,
single-blind, comparative effectiveness trial. The study included 226 people
with fibromyalgia who were randomly assigned to receive supervised aerobic
exercise for 24 weeks, twice weekly (n = 75), or one of four Yang-style
supervised tai chi interventions, 12 or 24 weeks once or twice weekly (n =
151). Participants were followed for 52 weeks. Investigators report
adherence was "rigorously" encouraged in person and by telephone.
The study's
primary outcome was change in the revised Fibromyalgia Impact Questionnaire
(FIQR) scores at 24 weeks compared with baseline. Secondary outcomes included
changes of scores in patients' global assessment, anxiety, depression,
self-efficacy, coping strategies, physical functional performance, functional limitation, sleep,
and health-related quality of life as measured by the Short-Form Health Survey
(SF-36). The mean age of participants was 52 years, 92% were women, the
racial/ethnic composition was diverse (61% white), and mean body mass index was
30 kg/m2. The average duration of body pain was 9 years.
Participants
had poor health status at enrollment, indicated by an average SF-36 physical
score that was about 2 standard deviations below that of the general US
population. Each supervised session lasted 1 hour, and all participants were
encouraged to include at least 30 minutes of tai chi or aerobic exercise in
their daily routine during the intervention period. The researchers also asked
participants to continue their exercise routines for up to the 52-week
follow-up.
Research staff
blinded to group assignment measured body mass index, treatment expectations,
adherence, safety, and physical performance on the 6-minute walk test.
People in the tai chi groups attended 62% of classes vs 40% of
participants in the aerobic exercise group.
"Participants
assigned to the mind-body therapy maintained higher and more consistent
attendance than those assigned to aerobic exercise. Tai chi, which consists of
a gentler, low impact meditative sequence of movements with minimal side
effects, may be better embraced by patients with fibromyalgia in the long
term," the authors write.
FIQR scores
improved for participants in all groups compared to baseline at the 12-, 24-
and 52-week evaluations. Participants in all five groups demonstrated a similar
reduction in use of analgesics, antidepressants, muscle relaxants, and
antiepileptic agents over time.
A total of 183 participants (81%) completed the 24-week
evaluation. At this time point, improvement in FIQR scores in the combined tai
chi groups was significantly greater than in the aerobic exercise group (P = .03).
The duration of
tai chi mattered, with people in the 24-week groups reporting greater
improvements in FIQR scores compared with those in the 12-week groups. The
difference was statically significant (P =
.007). When the investigators looked at the frequency of tai chi, they found no
significant difference in effectiveness at 24 weeks between those who
participated in tai chi once a week and those participating twice a week,
suggesting tai chi once a week may be sufficient to see the reported
improvements.
Secondary
outcomes at 24 weeks that also significantly favored the tai chi groups
included patient global assessment (P =
.005), Hospital Anxiety and Depression Scale anxiety scores (P = .006), self-efficacy (P = .004), and coping strategies (P = .005).
A total of 154 adverse events (AEs) were reported in the study.
This included 117 AEs among 115 participants assigned to tai chi and 37 among
75 participants in the aerobic exercise group. Most were minor musculoskeletal
events, the authors noted, but 8 AEs in the tai chi group and 4 in the aerobic
exercise group were considered related to the interventions.
Rethinking
the Standard Treatment
"It may be time to rethink what type of exercise is most
effective for patients with fibromyalgia," Wang writes in an opinion piece accompanying the study.
"Despite the well-established benefits of aerobic exercise
as a core standard treatment for fibromyalgia, patients in our trial had
difficulty adhering to the aerobic exercise programme. This may not be
surprising — many patients with fibromyalgia find performing and adhering to
exercise programs hard. Complaints such as 'the floor is too
hard,' 'I cannot stand this,' 'I'm too tired,' or 'I'm in too much pain' were
common."
Three instructors taught tai chi in the study. The outcomes were
consistent across these instructors, suggesting that the "classic Yang
style tai chi can be deployed in other settings in a standardized manner for
fibromyalgia," the authors write.
In another
accompanying opinion piece, Amy Price, a trauma survivor
with chronic pain and a former neurocognitive rehabilitation consultant, notes
that her "balance was poor from brain and spinal damage, and I could only
see the depressing future of being a patient with chronic pain. I didn't expect
tai chi to work, but thought I'd give it a chance."
"Initially,
I could only do ten minutes, three times a week, with constant supervision,
because of memory and balance problems. Gradually, over about six weeks, my balance
improved and this reduced anxiety and increased strength in my broken
body," she writes. She would generally recommend tai chi for others with
fibromyalgia but recommended patients discuss the option with their physician
first, that they stop and speak up if they feel any pain, and that the quality
of the instructor matters.
The
National Institutes of Health National Center for Complementary and Integrative
Health, the National Center for Research Resources, and the National Center for
Advancing Translational Sciences funded the study. Wang has disclosed no
relevant financial relationships. Price is The BMJ Patient Editor for Research and
Evaluation and serves on the BMJ Patient
Panel. She has disclosed no relevant financial relationships.
BMJ. Published
online March 21, 2018. Abstract
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Damian McNamara on Twitter: @MedReporter
