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Twice-weekly tai chi eased fibromyalgia.

Twice-weekly tai chi exercises led to a statistically significant decrease in fibromyalgia symptoms, compared with wellness education and stretching.

The finding is consistent with other studies that have shown the benefits of tai chi for fibromyalgia, as well as pain, depression, and overall quality of life (N. Engl. J. Med. 2010;363:743-54).

Dr. Chenchen Wang of the division of rheumatology at Tufts Medical Center, Boston, and colleagues looked at patients seen at Dr. Wang's facility between July 2007 and May 2009. All patients were at least 21 years old and met American College of Rheumatology (ACR) 1990 diagnostic criteria for fibromyalgia, including "history of widespread musculoskeletal pain on the right and left sides of the body as well as above and below the waist, with a minimum duration of 3 months, and tenderness on pressure at 11 or more of 18 specific sites."

Patients were excluded if they had any tai chi training or serious comorbidities such as rheumatoid arthritis or other conditions that might limit their mobility; if they were pregnant or planning on becoming pregnant; or if they scored less than 24 out of 30 points on the Mini Mental State Examination.

The primary end point was improvement on the Fibromyalgia Impact Questionnaire (FIQ), which scores symptoms from 1 to 100, with 100 being the worst.

Thirty patients completed a 12-week, twice-weekly, 60-minute tai chi program, plus a 24-week evaluation. Participants also were encouraged to practice at home for 20 minutes per day on their own, and "to maintain their tai chi practice, using an instructional DVD, up until the follow-up visit at 24 weeks."

Meanwhile, 29 control patients completed a twice-weekly, 60-minute wellness education and stretching program, plus the 24-week follow-up. The program included a didactic portion on pain management strategies and nutrition, plus a portion devoted to stretching. Patients also were encouraged to stretch at home each day for 20-minute periods.

Both groups were predominantly female (greater than 85%) and had mean ages of 50 years and 51 years for the tai chi group and the control group, respectively. The mean baseline FIQ score in the tai chi group was 62.9, compared with 68.0 in the control group; the rate of attendance was 77% and 70% for the active treatment and control group, respectively.

According to Dr. Wang, by 12 weeks, the tai chi group had a significantly greater decrease in the total FIQ score, to 35.1 (-27.8 points, 95% confidence interval -33.8 to -21.8) compared with controls, who fell to 58.6 (-9.4 points, 95% CI, -15.5 to -3.4), for a between-group difference of slightly more than 18 points.

The improvement in symptoms held up at 24 weeks, with a change from baseline among the tai chi group of -28.6 points from baseline (95% CI, -34.8 to -22.4), compared with -10.2 among controls (95% CI, -16.4 to -4.0).

Similar to findings at the 12-week mark, that amounted to a between-group difference of more than 18 points.

Dr. Wang looked at sleep improvement, as measured on the Pittsburgh Sleep Quality Index, graded on a scale from 0 to 21, with higher score indicating poorer sleep. At 12 weeks, the tai chi patients had reduced their score by 3.6 points from baseline, compared with 0.7 points for the control group; at 24 weeks, the tai chi group had dropped their score by 4.2 points, compared with 1.2 in controls.

The researchers also saw significant improvement among tai chi patients on the physician global assessment score, the patient global assessment score, the 6-minute walk test, and both the physical and mental components of the Medical Outcomes Study 36-Item Short Form Health Survey.

Only patients' body mass index and their scores on the Chronic Pain Self Efficacy Scale, which measures patients' confidence in their ability to perform a particular task, did not change significantly, compared with controls.

The authors pointed out their inability to conduct a double-blind study, since it "would have required the use of sham tai chi, for which no validated approach currently exists."

Dr. Wang reported having no financial conflicts of interest. Several authors received grants from the National Institutes of Health and the National Center for Complementary and Alternative Medicine, which cosponsored the study.


Promising, but More Data Needed

The findings from the research by Dr. Wang and associates showing that tai chi lessened the severity of fibromyalgia symptoms are provocative and in line with findings from small studies of tai chi in other patient populations.

However, still other studies have shown mixed results. For example, although an 8-week, randomized, controlled study of mindfulness meditation and tai chi--like movements, known as qigong, in 128 patients with fibromyalgia showed significant reductions in pain, disability, and depression, these improvements were no better than those seen in the control group, which received educational support (J. Rheumatol. 2003;30:2257-62).

Given this background, the positive results across all outcome measures reported by Dr. Wang and associates are striking.

Questions remain: How much of the benefit of tai chi is due to a placebo effect? What is an appropriate control for tai chi? And what do these findings mean for practice?

Replications of this study on a larger scale over longer periods of time are needed, with different practitioners and different styles at multiple sites. Additionally, research should focus on comparisons with similar therapies such as yoga, plus an assessment of cost-effectiveness.

The potential efficacy and lack of adverse effects now make it reasonable for physicians to support patients' interest in exploring these types of exercises, even if it is too early to take out a prescription pad and write "tai chi."

Dr. Yeh's remarks are paraphrased from her editorial accompanying the research report by Dr Wang and associates (N. Engl. J. Med. 2010; 363:783-4).

GLORIA Y. YEH, M.D., is in the division for research and education in complementary and integrative medical therapies at Harvard Medical School, Boston. She reported having no disclosures relative to the editorial.


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Author:Napoli, Denise
Publication:Internal Medicine News
Geographic Code:1USA
Date:Sep 1, 2010
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