Original articleEffectiveness of incorporating Tai Chi in a pulmonary rehabilitation program for Chronic Obstructive Pulmonary Disease (COPD) in primary care—A pilot randomized controlled trial☆
Introduction
Chronic Obstructive Pulmonary Disease (COPD) is a major public health burden characterized by both lung function impairment and disease exacerbation [1]. The disease results in a progressive deterioration in physical ability, thus, affecting quality of life and self-efficacy. Pulmonary rehabilitation is a multi-disciplinary program of care for patients with chronic respiratory impairment that is individually tailored and designed to optimize physical and social performance. Evidence from several studies has proven the benefits of pulmonary rehabilitation in improving exercise capacity, self-efficacy and health-related quality of life in patients with COPD [2]. Long term effectiveness of exercise interventions at completion of formal pulmonary rehabilitation requires exercise adherence [3].
Tai Chi, which originated from China, is an exercise characterized by posture alignment, weight shifting and circular movements that incorporate elements of muscle strengthening, balance, relaxation and breathing control. Tai Chi has been suggested as an appropriate, if not ideal, form of exercise for patients with chronic cardiopulmonary disease, such as COPD. Tai Chi has also been shown to have proven benefits in improving exercise capacity, physiological status, quality of life health related status, self-efficacy and associated with higher compliance to exercise in COPD patients [4], [5], [6]. Thus, this study hypothesized that incorporating Tai Chi elements into the exercise component in standard pulmonary rehabilitation program would have adjuvant effect on self-efficacy, quality of life parameters and exercise capacity of COPD patients in primary care setting.
Section snippets
Sample size
Previous studies suggested a medium effect size for Tai chi exercises on health related quality of life (HRQL) measured by St George respiratory questionnaire (SGRQ) for COPD [3], [4]. Given a moderate effect size, a power of 0.80, 5% significant level and potential attrition rate of 25%, a sample size of 170 participants or 85 subjects per group were needed.
Subjects
The aim was to recruit 200 subjects into the study. Subjects included were clinically diagnosed to have COPD as defined by American
Results
Initially, 192 subjects were recruited and 138 subjects completed the 6 months post-intervention assessments. Fig. 1 shows a flow diagram of recruitment, allocation, reasons for drop-out of subjects and follow-up for this study.
The mean age of subjects in PRP group and TC group were 74 years old (SD = 6.81) and 74 years old (SD = 6.46), respectively. There was a total of 175 males (91%) and 17 females (8%). The main reasons for attrition were disinterest to continue, hospital admissions, COPD
Discussion
This study was set to evaluate the adjuvant effects in self-efficacy, health status and exercise capacity by incorporating Tai Chi in pulmonary rehabilitation in COPD patients. Over a 6-month period, Tai Chi group was compared to the control group with both groups completing the 6-week intervention program. Although more favorable improvements in physiological outcomes, exercise capacity and health status were demonstrated as complementary benefits of Tai Chi incorporated to pulmonary
Conclusion
This study has shown that there is modest complementary benefit in the functional exercise performance of COPD patients by incorporating Tai Chi elements in the exercise component of conventional pulmonary rehabilitation. As Tai chi is safe, low-cost, easy to master and can be performed anywhere whether indoors or outdoors, there is enhanced exercise adherence after pulmonary rehabilitation program.
Conflict of interest
None.
Acknowledgement
This study was partially supported by Health Services Research Fund, Food and Health Bureau, Hong Kong SAR Government.
References (38)
- et al.
The COPD Self-efficacy Scale
Chest
(1991) - et al.
Reliability and validity of a Hong Kong Chinese version of the St George's respiratory questionnaire in clients with COPD
Hong Kong Physiother J
(2004) - et al.
Updated spirometric reference values for adult Chinese in Hong Kong and implications on clinical utilization
Chest
(2006) - et al.
A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain
Chest
(2001) - et al.
Tai Chi Qigong improves lung functions and activity tolerance in COPD clients: a single blind, randomized controlled trial
Complement Ther Med
(2011) - et al.
Cardiorespiratory function, flexibility, and body composition among geriatric Tai Chi Chuan practitioners
Arch Phys Med Rehabil
(1996) - et al.
Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomized controlled trial
Lancet
(2000) Clinical course of Chronic Obstructive Pulmonary Disease: review of therapeutic interventions
Am J Med
(2006)- et al.
Pulmonary rehabilitation for chronic obstructive disease (Review)
(2009) - et al.
Interventions for adherence to pulmonary rehabilitation for chronic obstructive pulmonary disease (Protocol)
(2009)
Taichi qigong exercise training in COPD
Chest
Effectiveness of a Tai chi Qigong program in promoting health-related quality of life and perceived social I supporting chronic obstructive pulmonary disease client
Qual Life Res
Short-form Sun-style Tai Chi as an exercise training modality in people with COPD
Standards for the diagnosis and management of clients with COPD
Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease
Thorax
Translation and validation of COPD CSES into Chinese CSES-Chi
HK Pract
Self-efficacy measurement and goal attainment after pulmonary rehabilitation
Int J COPD
Effects of treatment on two types of self-efficacy in people with chronic obstructive pulmonary disease
J Pain Symptom Manage
Cited by (35)
Efficacy of exercise treatments for chronic obstructive pulmonary disease: A systematic review
2024, Journal of Bodywork and Movement TherapiesEffect of different exercise programs on lung function in people with chronic obstructive pulmonary disease: A network meta-analysis of RCTs
2024, Annals of Physical and Rehabilitation MedicineTai Chi as a complementary exercise for pulmonary rehabilitation in chronic obstructive pulmonary disease: A randomised controlled trial
2023, Complementary Therapies in MedicinePulmonary rehabilitation outcomes in individuals with chronic obstructive pulmonary disease: A systematic review
2022, Annals of Physical and Rehabilitation MedicineCitation Excerpt :The agreement for 10% of the abstracts (187 records) reviewed by the 2 independent researchers was almost perfect, with Cohen's kappa 0.866 (95% confidence interval [CI] 0.76–0.97). Of the 267 included studies, 99 were observational studies [4,11–108], 87 were randomized controlled trials [109–195], 66 were quasi-experimental studies [105, 196–260], 9 had experimental designs [51, 261–268], 5 were pilot studies [269–273] and 1 was a mixed-methods study [274]. A total of 43,153 individuals with COPD were included in the studies.
Effects of the tai chi qigong programme on functional capacity, and lung function in chronic obstructive pulmonary disease patients: A ramdomised controlled trial
2020, Journal of Traditional and Complementary MedicineCitation Excerpt :TCQ training involves breathing techniques, postural control, and internal awareness,12 leading to improved gas exchange, balance and lower-limb muscle strength.28−32 The results supported previous trials in which patients with COPD received TCQ training and achieved a significant increase in 6-min walking distance.17, 33, 34 Dyspnea symptoms in the TCQ group decreased significantly after the 6th week.
Efficacy of yoga, tai chi and qi gong on the main symptoms of chronic obstructive pulmonary disease: A systematic review
2019, Respiratory Medicine and ResearchCitation Excerpt :All the results are reviewed in Table 2 and the main results are summarized hereunder by outcome. Forced expiratory volume in one second (FEV1) improved (from 40 to 420 mL) in half of the studies with statistical difference on this parameter between groups favoring complementary therapies [13,15–18]. The long-term studies showed a significant and clinical improvement whereas the short-term studies are less convincing.
- ☆
Trial registration: This study was registered with Clinical.Trials.gov Protocol Registration System on with identification no. ID NCT01259245 (March 12, 2010).