Tai Chi Improves Mental Well-Being of Patients with Cardiovascular Disease

Ruth Taylor-Piliae, PhD, RN

While some previous studies have suggested activities such as yoga and Tai Chi could provide physical benefit to patients, new data from the University of Arizona indicates the latter could lead to improvements in mood and quality of life in patients with cardiovascular disease.

Using data from more than a dozen clinical trials, investigators found patients with cardiovascular disease taking part in Tai Chi had greater physical health and improved mental health compared to their counterparts who did not partake.

"If you've had a heart attack or stroke, or are affected by another heart condition, I would strongly recommend adding Tai Chi to your recovery and rehabilitation," said study author Ruth Taylor-Piliae, PhD, RN, associate professor of nursing at the University of Arizona, in a statement. “There are physical benefits like improved balance and it's good for mental health too."

To further explore the potential benefits of programs and activities such as Tai Chi in adults with cardiovascular disease, Taylor-Piliae and a colleague from the College of Nursing at University of Arizona performed a systematic review and meta-analysis through a literature search of 10 different databases. With its benefits on physical health well-established, the purpose of the current analysis was to assess if Tai Chi was associated with improvements in psychological well-being.

Using the AMED, CINAHL, Embase, OpenGrey, PsycARTICLES, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science databases, investigators performed a search for relevant studies published between July 11, 2009-July 10, 2019. To be eligible, published works needed to be designed as a randomized clinical trial (RCT) or quasi-experimental study with a comparison group, incorporate a Tai Chi exercise intervention, and examine 1 or more aspect of psychological well-being, such as quality of life (QOL), psychological distress, stress, anxiety, and/or depression, among individuals with cardiovascular disease.

From their search, a total of 15 clinical trials was identified for inclusion in the analysis. Of these 15, 13 were designed as RCTs and the other 2 were considered quasi-experimental studies with comparison groups.

Length of intervention between the 15 studies chosen for inclusion ranged from 6-52 weeks with a mean length of 17 weeks. Similarly, multiple controls were also used across the included studies, with usual care (n=8) being the most common followed by other exercises (n=6). Of note, 1 study had an education control.

In regard to outcomes, 14 studies assessed QOL, 7 assessed depression, 2 assessed psychological distress, 2 assessed anxiety, and 1 assessed stress. Investigators highlighted the broad array of cardiovascular diseases included in the trials, including 5 examining patients with chronic heart failure, 4 examining patients with hypertension, 4 examining stroke survivors, and 2 examining patients with coronary heart disease.

Investigators pointed out Comprehensive Meta-Analysis version 2.0 software from Biostat Inc. was used to calculate the effect sizes using random-effects models.

A cohort of 1853 participants was identified from the aforementioned studies. Results of the investigators analyses indicated Tai Chi was associated with significantly better general QOL (Hedges’ g 0.96; p=0.02, I 2 =94.99%), mental health QOL (Hedges’ g=0.20; p=0.01, I 2 =15.93) and physical health QOL (Hedges’ g=0.40; P=0.00, I2=0%) compared with controls. The analyses also indicated Tai Chi was associated with less depression (Hedges’ g=0.69; p=0.00, I2=86.64%) and psychological distress (Hedges’ g=0.58; P=.00, I2=0%) compared with controls.

In the aforementioned statement, Taylor-Piliae highlighted the universality of tai chi as an activity for patients with cardiovascular disease.

"Tai chi is well suited for people of any age or exercise ability and can be safely adapted for anybody. People with low tolerance to exercise or breathing problems can do it in a chair. Group classes for others with cardiovascular disease are a positive place for social support and camaraderie - there is no judgement; you just do what you can,” Taylor-Piliae said.

This study, “Tai Chi exercise for psychological well-being among adults with cardiovascular disease: A systematic review and meta-analysis,” was published in the European Journal of Cardiovascular Nursing.