Tai Chi Tops Exercise as Fibromyalgia Treatment

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Although aerobic exercise is the most commonly prescribed non-drug treatment for fibromyalgia, tai chi may be a more effective intervention, a randomized clinical trial published in the BMJ suggests.¹

The study
In the study, which included 226 adults with fibromyalgia, those who attended tai chi classes reported significantly more improvement in function, overall impact, and symptoms compared with those who participated in aerobic exercise. A longer duration of tai chi resulted in greater therapeutic benefits, according to investigators, who added that benefits were consistent in patients led by three different instructors, which suggests the generalizability of the intervention across different settings.

Based on those results, this mind-body approach “may be considered a therapeutic option in the multidisciplinary management of fibromyalgia,” wrote the investigators, led by Chenchen Wang, MD, of the Center for Complementary and Integrative Medicine and Division of Rheumatology, Tufts Medical Center, in Boston.

It is encouraging when a simple management strategy works for a disabling condition, said GP and occupational physician Andrew J. Ashworth of West Lothian, Scotland, in a comment on the results. “Evidence of effectiveness compared with alternatives is welcome,” he noted.

Background
Tai chi, which has been practiced for many centuries, originated as a martial art and is grounded in traditional Chinese medicine. “This complex, multicomponent mind-body intervention integrates physical, psychosocial, spiritual, and behavioral elements to promote health and fitness,” Dr Wang and colleagues said in their report.

This is not the first randomized trial of tai chi in fibromyalgia, but it is believed to be the largest; moreover, it compares tai chi to aerobic exercise, whereas some earlier investigations used wellness training, stretching and education as control interventions.

A previous randomized study by Dr Wang and colleagues, which compared wellness training and stretching with tai chi, showed that tai chi resulted in clinically important improvements in the fibromyalgia impact questionnaire (FIQ) total score and quality of life. In a subsequent randomized study by Jones and associates, 12 weeks of tai chi, practiced twice weekly, improved fibromyalgia symptoms including pain and physical function when compared with an education control group.

The present study is unique because it evaluated different styles of tai chi and different “dosages,” ie, once or twice weekly.

Study results
The current prospective, randomized, 52-week, single-blind comparative effectiveness trial included a total of 151 adults assigned to one of four tai chi groups, and 75 assigned to an aerobic exercise group.

Individuals assigned to tai chi participated in supervised tai chi interventions for 12 or 24 weeks, once or twice weekly, while individuals in the control group participated in 24 weeks of supervised aerobic exercise, twice weekly.

Investigators found that the five interventions-the four tai chi groups and the exercise group-all improved scores on the revised fibromyalgia impact questionnaire (FIQR) from baseline to 24 weeks. However, the improvement for all four tai chi groups combined was significantly better compared with the exercise group, with a 5.5-point difference between groups (-14.7 points for tai chi vs -9.2 points for exercise; P = .005).

That 5.5-point difference in FIQR scores was actually not clinically important, based on an estimated minimal clinically important difference of 8.1 points.

However, there was a clinically significant improvement looking just at the group of individuals participating in 24 weeks of tai chi, twice weekly-in other words, the group matched in intensity to the aerobic exercise intervention. For that comparison, there was a 16.2-point difference between groups (-25.4 points for tai chi vs -9.5 points for exercise; P < .001).

One observation in the trial that deserves further study, according to investigators, is that participants had reduced use of analgesics, antidepressants, muscle relaxants, and antiepileptic drugs over the course of the intervention. That was consistent across tai chi groups and the aerobic exercise group.

“We further expect that the mind-body therapy might in the future help to reduce the burden associated with long-term opioid use for patients with fibromyalgia,” Dr Wang and co-authors wrote.

References:

1. Wang C, Schmid CH, Fielding RA, et al. Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. BMJ. 2018;360:k851. doi: 10.1136/bmj.k851.