Tai Chi

Abstract and key points
  • Tai chi is a non-combative martial art that combines breathing techniques with sequences of slow graceful movements
  • The is limited evidence that tai chi may increase joint mobility and quality of life (e.g. fatigue)
  • Tai chi has a good safety record
  • Evidence is currently lacking about the effectiveness of Tai chi for supportive cancer care

Tai chi is a non-combative martial art that combines breathing techniques with sequences of slow graceful movements. It is sometimes referred to as a ‘meditation in motion’.

There is some evidence from one systematic review of nine randomized clinical trials that Tai chi may increase joint mobility and handgrip dynamometer strength.

For quality of life the evidence is inconclusive. One systematic review of five RCTS reports concluded that there was no evidence to support tai chi for quality of life-related outcome measures. One systematic review of 13 randomized clinical trials reports evidence that a tai chi/qigong combination may improve health-related quality of life (FACTG) among various cancer populations. The findings of all reviews are however limited by the methodological shortcomings of the included trials.

Only preliminary evidence from individual controlled clinical trials of tai chi is available for systolic blood pressure reduction, improvement of immune function as well as a tai chi/qigong combination for balance performance, improved joint mobility and higher blood flow velocity.

There is therefore no strong evidence about tai chi’s specific effects in cancer patients.

Tai chi has a good safety record, but as it is a moderate form of aerobic exercise, it may be beneficial for people to check with their health practitioner if they have a known heart condition, severe osteoporosis or musculoskeletal difficulties.

Document history

Summary updated and revised in June 2016 by Helen Cooke.
Summary updated in November 2013 by Helen Cooke.
Summary first published in August 2012, authored by Helen Cooke.

Citation

Helen Cooke, CAM-Cancer Consortium. Tai Chi [online document]. June 16, 2016.

What is it?

Description

Tai chi (short for Tai chi Chuan) is a non-combative martial art that combines breathing techniques with sequences of slow graceful movements. It is sometimes categorised as a mind-body intervention1 and referred to as a ‘meditation in motion’2.

Application and dosage

Tai chi is usually taught in groups by an individual who is either trained or experienced in Tai chi. Sessions normally last around 60 minutes in length. The lengths of the teaching courses vary, but they typically last 10-12 weeks. The classes generally include warm-up exercises, a Tai chi practice and a cool-down. Some sessions include breathing and meditation exercises. It is suggested that people carry out Tai chi exercises at home as part of a daily practice.

History/provider(s)

Tai chi has its roots in ancient Chinese philosophy and martial arts2 and is one of the approaches used in traditional Chinese medicine. It had developed a unique style by the end of the Ming Dynasty (1368-1644 AD). Many different styles of Tai chi have evolved during its development. These include Chen, Wu, Sun, Li and Yang Style. Variations have been derived from these styles, including Wudang, the Hao, and the Cheng Man-ching. Whilst Chen is the oldest style, Yang is the most popular. A 24-posture Tai chi form was compiled in 1956 based on a more complicated Yang form style, which involves 105 postures1. Although the Yang style was used in many of the studies reviewed for this summary, not all list the style of Tai chi taught.

Claims of efficacy/ mechanism(s) of action

It has been proposed that partaking in Tai chi may result in energy expenditure equivalent to that of brisk walking, which may improve the aerobic capacity, flexibility, strength, mood and quality of life of cancer survivors3. This has yet to be verified by research. Proponents of traditional Chinese medicine believe there are meridians (pathways) that travel through the body carrying chi (life energy). Tai chi is purported to smooth the flow of chi, to aid relaxation and keep the mind calm and focused4.

Alleged indication

Tai chi is reported to have positive effects on health related quality of life, self-esteem, mood, anxiety, blood pressure, osteoporosis, natural killer cells, cardio-respiratory function, flexibility, balance and strength in the elderly, but studies are lacking across different cancer populations5.

Prevalence of use

A 2010 survey reported that 0.8% of male (n=891) and 2.4% of female (n=1371) cancer survivors in the US use Tai chi6. Precise prevalence figures are not available for Europe or other countries.

Legal issues

Although various organisations offer certification worldwide, there is no standardised training or recognised credentialing/licensing process in place for Tai chi instructors at present. Traditionally, students are taught and authorised by ‘master teachers/instructors’,

Cost(s) and expenditures

The cost of sessions varies between countries, but an approximate cost of €8-15/US $15-20 is generally charged.

Does it work?

Three systematic reviews including meta-analyses, four randomised controlled trials and three non-randomised controlled trials were reviewed for this summary. The controlled trials are described in Table 1. There is preliminary evidence that Tai Chi (and Tai Chi/Qigong) may be a helpful supportive care intervention in terms of handgrip dynamometer strength and increased joint mobility. The evidence for health-related quality of life is mixed.

It is, due to the challenges of applying blinding, problematic to test the efficacy of Tai chi. The studies included in this summary, therefore, relate to the effectiveness of Tai chi, rather than the efficacy.

Systematic reviews

Three systematic reviews including meta-analyses of Tai chi for cancer have been published: one assessing Tai Chi in relieving treatment-related side effects and quality of life in women with breast cancer7, one of improving quality of life in breast cancer patients17,and one of Qigong and Tai Chi (combined as one body of evidence) on the health-related outcomes of cancer patients8.

The first systematic review (2015) analysed the available randomized controlled trials (RCTs) on the effects of Tai Chi Chuan (TCC) in relieving treatment-related side effects and quality of life in women with breast cancer7. Nine trials (total sample size n=322) were examined. Compared with control therapies, the pooled results suggested that TCC showed significant effects in improving handgrip dynamometer strength, limb elbow flexion (elbow extension, abduction, and horizontal adduction). No significant differences were observed in pain, interleukin-6, insulin-like growth factor, BMI, physical well-being, social or emotional well-being, or general health-related quality of life. Again, these findings need to be interpreted with caution due to the small sample sizes of the included studies and their methodological limitations (including short follow-up periods).

The second systematic review assessed the effects of tai chi on quality of life as well as other physical outcomes17. Five RCTs involving 407 patients were included in the meta-analysis. No convincingly positive effects were reported for physical, emotional and functional well-being, body mass index, bone mineral density, and muscle strength.

A 2014 systematic review and meta-analysis evaluated the treatment effects of qigong/tai chi on the health-related outcomes of cancer patients8. Thirteen trials with a total sample size n=592 met the author’s inclusion criteria for the qualitative synthesis, 9 thereof with a total sample size n= 499 for the meta-analysis. The researchers combined qigong and tai chi as one body of evidence. The primary outcome for this review was changes in quality of life (QOL) and other physical and psychological effects in cancer patients. The secondary outcome for this review was adverse events of the qigong/tai chi intervention. Qigong or tai chi interventions were shown to have positive effects on cancer-specific quality of life measured by FACTG within 12-week’s follow-up as well as fatigue, immune function and cortisol levels. No serious adverse events were reported in the studies. These findings need to be interpreted with caution due to the the small sample sizes of included RCTs identified and high risk of bias in included trials.  

Clinical trials

Four RCTs and three non-randomised controlled trials have been published that are not included in any of the above reviews. These trials are described in Table 1.

One recent randomised controlled trial (feasibility study) found significant reductionsin systolic blood pressure and levels of cortisolin senior female cancer survivors9. Qualitative analyses indicated that the TCC group felt they received mental and physical benefits, whereas HEC group reported on social support benefits and information received10. The authors acknowledge that the outcomes limited to one-week post intervention. Other limitations include a small, heterogeneous sample (n=63) of senior cancer survivors.

Two RCTs reported that regular TCC appears to enhanceimmune function(peripheral blood mononuclear cell function) innon-small cell lung cancer patients11 and immune and inflammatory markers12 in breast cancer patients with insomnia. The short intervention time (16 weeks) may not have been long enough to see significant change in immune and inflammatory markers.

Three non-randomised controlled trials exploring the benefits of a tai chi/qigong combination intervention (TC qigong) reported improved balance performance13, improved joint mobility and reduced problems14 and higher blood flow velocity, lower arterial resistance, higher palmer skin temperature and better aerobic capacity then the control group receiving usual care15 in nasopharyngeal cancer survivors. The lack of randomisation and subject self-selection bias affects the reliability of the results.

Is it safe?

Adverse events

No adverse events were reported in the studies included in this summary.

Contraindications

As Tai chi is a moderate form of aerobic exercise it may be beneficial for people to check with their health practitioner if they have a known heart condition, severe osteoporosis or musculoskeletal difficulties14.

Interactions

No known interactions.

Warnings

Older people may benefit from a brief health check if they are suffering from any of the conditions mentioned in the contraindication section14.

References
  1. Mansky P, Sannes T, Wallerstedt D, Ge A, Ryan M, Johnson LL et al.Tai chi chuan: mind-body practice or exercise intervention? Studying the benefit for cancer survivors. Integr Cancer Ther 2006; 5:192-201.
  2. Peters D. The Complete Family Guide to New Medicine. Dorling Kindersley (2005).
  3. Janelsins MC, Davis PG, Wideman L, Katula JA, Sprod LK, Peppone LJ et al.Effects of Tai Chi Chuan on insulin and cytokine levels in a randomized controlled pilot study on breast cancer survivors. Clinical Breast Cancer 2011;11:161-170.
  4. Tai Chi Union for Great Britain website. [Accessed 30/10/15].
  5. Mustian KM, Katula JA, Gill DL, Roscoe JA, Lang D, Murphy K. Tai Chi Chuan, health-related quality of life and self-esteem: a randomized trial with breast cancer survivors. Supportive Care in Cancer 2004;12:871-6.
  6. Fouladbakhsh JM, Stommel M. Gender, symptom experience, and use of complementary and alternative medicine practices among cancer survivors in the U.S. cancer population. Oncology Nursing Forum 2010;37:E7-E15.
  7. Pan Y, Yang K, Shi X, Liang H, Zhang F, Lv Q. Tai chi chuan exercise for patients with breast cancer: a systematic review and meta-analysis. eCAM 2015;2015:535237.
  8. Zeng Y, Luo T, Xie H, Huang M, Cheng AS. Health benefits of qigong or tai chi for cancer patients: a systematic review and meta-analyses. Complement Thera Med 2014;22:173-86.  
  9. Campo RA, Light KC, O'Connor K, Nakamura Y, Lipschitz D, LaStayo PC, et al. Blood pressure, salivary cortisol, and inflammatory cytokine outcomes in senior female cancer survivors enrolled in a tai chi chih randomized controlled trial. J Cancer Survivorship 2015;9:115-25.
  10. Campo RA, O'Connor K, Light KC, Nakamura Y, Lipschitz DL, Lastayo PC, et al. Feasibility and Acceptability of a Tai Chi Chih Randomized controlled trial in senior female cancer survivors. IntegrCancer Ther 2013;12:464-74.
  11. Liu J, Chen P, Wang R, Yuan Y, Wang X, Li C. Effect of Tai Chi on mononuclear cell functions in patients with non-small cell lung cancer. BMC Complement Altern Med 2015;15:3.
  12. Irwin MR, Olmstead R, Breen EC, Witarama T, Carrillo C, Sadeghi N, et al. Tai chi, cellular inflammation, and transcriptome dynamics in breast cancer survivors with insomnia: a randomized controlled trial. J Natl Cancer Inst Monogr. 2014;2014:295-301.
  13. Fong SS, Chung LM, Tsang WW, Leung JC, Charm CY, Luk WS, et al. Balance Performance in Irradiated Survivors of Nasopharyngeal Cancer with and without Tai Chi Qigong Training. eCAM 2014;2014:719437.
  14. Fong SS, Ng SS, Lee HW, Pang MY, Luk WS, Chung JW, et al. The effects of a 6-month Tai Chi Qigong training program on temporomandibular, cervical, and shoulder joint mobility and sleep problems in nasopharyngeal cancer survivors. Integr Cancer Ther 2015;14:16-25.
  15. Fong SS, Ng SS, Luk WS, Chung JW, Leung JC, Masters RS. Effects of a 6-month Tai Chi Qigong program on arterial hemodynamics and functional aerobic capacity in survivors of nasopharyngeal cancer. J Cancer Survivorship 2014;8:618-26.
  16. Wang R, Liu J, Chen P, Yu D. Regular tai chi exercise decreases the percentage of type 2 cytokine-producing cells in postsurgical non-small cell lung cancer survivors. Cancer Nursing 2013;36:E27-34
  17. Yan JH, Pan L, Zhang XM, Sun CX, Cui GH. Lack of efficacy of Tai Chi in improving quality of life in breast cancer survivors: a systematic review and meta-analysis. Asian Pac J Cancer Prev 2014;15:3715-20.

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