Is Tai Chi beneficial for psychological well-being among healthy elderly?
Date of publication of the systematic review: May 2010
Design
Systematic review including 3 randomized controlled trials 1-3 which recruited participants who were healthy elderly.
Participants
Trial 1: 76 healthy elderly (mean age: 52 years, 50% male) who were not receiving any medication and were not engaged in any exercise program prior enrollment to the study. Any subject having a history of coronary artery disease, strokes, functionally limiting orthopedic problems, or any other major health problems were excluded.
Trial 2: 112 healthy elderly (age range: 59 to 86 years, mean age: 69.6 in Tai Chi group, 70.2 in health education group, 36% male).
Trial 3: 98 healthy elderly (mean age: 73 years, 24% male) with low daily routine activities defined as non-involvement in a structured exercise program one month prior to participation.
Intervention
Trial 1: A 12-week Tai Chi training program was practiced regularly with a frequency of 3 times per week. Each session included a 10-minutes warm-up, a 30-minutes Tai Chi exercise, and a 10-minute cool-down. The Tai Chi intervention was provided by a trained instructor.
Trial 2: 16 weeks of Tai Chi administered to groups of 7 to 10 persons. Each Tai Chi session lasted 40 minutes and was given three times per week for a total 120 minutes of weekly instruction.
Trial 3: A 60-min Tai Chi practice session twice a week for 24 consecutive weeks. The sessions consisted of a 15-min warm-up, 30 min of Tai Chi practice, followed by a 15-min cool-down period. During the practice, participants were led by an instructor. Participants were also encouraged to practice at home.
Comparator
Comparison 1: Tai Chi versus sedentary life style. Sedentary life style referred to maintaining their usual sedentary life style and eating habits.
Comparison 2: Tai Chi versus health education. A 120-minute health education session was delivered per week for 16 weeks.
Comparison 3: Tai Chi versus controls who maintained their normal routine actives without starting any new exercise programs.
Major Outcomes
Outcome 1: Trait anxiety test score from baseline to 12 weeks;
Outcome 2: State anxiety test score from baseline to 12 weeks;
Outcome 3: Depression test score as assessed by Beck depression scale from baseline to week 25;
Outcome 4: Physical functioning score as assessed by SF-36 from baseline to week 25;
Outcome 5: Mental health score as assessed by SF-36 from baseline to week 25;
Outcome 6: Depression score as assessed by Epidemiologic Studies Depression Scale from baseline to the end of treatment at 6 months;
Outcome 7: Psychological distress score as assessed by subscale of Subjective Exercise Experiences scale from baseline to the end of treatment at 6 months;
Outcome 8: Life satisfaction as assessed by the Satisfaction With Life scale from baseline to the end of treatment at 6 months.
Settings
The included trials were conducted in outpatient settings.
Comparison    Tai Chi versus sedentary life style
Main Results
Compared to sedentary life style, the practice of Tai Chi showed significant benefits on participants’ psychological well-being as demonstrated by the reduction of trait anxiety test score (mean difference (MD): -7.0, 95% CI: -9.9 to -4.1) and state anxiety test score (MD: -6.2, 95% CI: -9.0 to -3.4) from baseline to 12 weeks.
Comparison 1: Tai Chi versus sedentary life style among healthy elderly
Outcomes No. of studies (Total no. of participants) Mean score (SD)/ No. of participants Heterogeneity test (I2) MD (95% CI) Overall quality of evidence*
Intervention Comparator
1 1 (76) 32.8 (6.2)/ 37 39.8 (6.6)/ 39 Not applicable as there is only 1 study. -7.0 (-9.9 to -4.1) Moderate
2 1 (76) 30.6 (6.2)/ 37 36.8 (6.0)/ 39 Not applicable as there is only 1 study. -6.2 (-9.0 to -3.4) Moderate
Keys: SD = standard deviation; MD = mean difference; CI = confidence interval.
Comparison    Tai Chi versus health education
Main Results
Compared to health education, the practice of Tai Chi did not show significant benefits on the following outcomes: depression score assessed by Beck Depression Scale score (mean difference (MD): -0.35, 95% CI: -1.54 to 0.84), physical functioning score assessed by SF-36 (MD: 1.19, 95% CI: -2.82 to 5.20) and mental health score assessed by SF-36 (MD: 1.33, 95% CI: -2.59 to 5.25).
Comparison 2: Tai Chi versus health education among healthy elderly
Outcomes No. of studies (Total no. of participants) Mean change (SD) /No. of participants Heterogeneity test (I2) MD (95% CI) Overall quality of evidence*
Intervention Comparator
3 1 (112) -1.68 (2.84)/59 -1.33 (3.45)/53 Not applicable as there is only 1 study. -0.35 (-1.54 to 0.84) Low
4 1 (112) 3.36 (9.13)/59 2.17 (11.94)/53 Not applicable as there is only 1 study. 1.19 (-2.82 to 5.20) Low
5 1 (112) 3.22 (9.69)/59 1.89 (11.10)/53 Not applicable as there is only 1 study. 1.33 (-2.59 to 5.25) Low
Keys: SD = standard deviation; MD =mean difference; CI = confidence interval.
Comparison    Tai Chi versus maintenance of routine activities
Main Results
Compared to maintenance of routine activities, the practice of Tai Chi showed significant benefits on participants’ psychological well-being as demonstrated by the reduction of by Epidemiologic Studies Depression Scale score (mean difference (MD): -0.034, 95% CI: not reported) and psychological distress score assessed by a subscale of the Subjective Exercise Experiences scale (MD: -0.176, 95% CI: not reported) from baseline to the end of treatment at 6 months. Besides, Tai Chi also showed significant effects on improving participants’ life satisfaction score assessed by the Satisfaction With Life scale from baseline to the end of treatment at 6 months (MD: 0.115, 95% CI: not reported).
Comparison 3: Tai Chi versus control maintaining routine activities among healthy elderly
Outcomes No. of studies (Total no. of participants) Mean change (SD)/ No. of participants Heterogeneity test (I2) MD (95% CI) Overall quality of evidence*
Intervention Comparator
6 1 (98) Not reported/53 Not reported/45 Not applicable as there is only 1 study. - 0.034 (not reported) Low
7 1 (98) Not reported/53 Not reported/45 Not applicable as there is only 1 study. -0.176 (not reported) Low
8 1 (98) Not reported/53 Not reported/45 Not applicable as there is only 1 study. 0.115 (not reported) Low
Keys: SD = standard deviation; MD =Mean difference; CI = Confidence interval. All the mean differences were statistically significant at the 0.05 level.
Comparison    Tai Chi versus sedentary life style
Main Results
Compared to sedentary life style, the practice of Tai Chi showed significant benefits on participants’ psychological well-being as demonstrated by the reduction of trait anxiety test score (mean difference (MD): -7.0, 95% CI: -9.9 to -4.1) and state anxiety test score (MD: -6.2, 95% CI: -9.0 to -3.4) from baseline to 12 weeks.
Comparison 1: Tai Chi versus sedentary life style among healthy elderly
Outcomes 1 2
No. of studies (Total no. of participants) 1 (76) 1 (76)
Mean score (SD)/ No. of participants Intervention 32.8 (6.2)/ 37 30.6 (6.2)/ 37
Comparator 39.8 (6.6)/ 39 36.8 (6.0)/ 39
MD (95% CI) -7.0 (-9.9 to -4.1) -6.2 (-9.0 to -3.4)
Overall quality of evidence* Moderate Moderate
Keys: SD = standard deviation; MD = mean difference; CI = confidence interval.
Comparison    Tai Chi versus health education
Main Results
Compared to health education, the practice of Tai Chi did not show significant benefits on the following outcomes: depression score assessed by Beck Depression Scale score (mean difference (MD): -0.35, 95% CI: -1.54 to 0.84), physical functioning score assessed by SF-36 (MD: 1.19, 95% CI: -2.82 to 5.20) and mental health score assessed by SF-36 (MD: 1.33, 95% CI: -2.59 to 5.25).
Comparison 2: Tai Chi versus health education among healthy elderly
Outcomes 3 4 5
No. of studies (Total no. of participants) 1 (112) 1 (112) 1 (112)
Mean change (SD) /No. of participants Intervention -1.68 (2.84)/59 3.36 (9.13)/59 3.22 (9.69)/59
Comparator -1.33 (3.45)/53 2.17 (11.94)/53 1.89 (11.10)/53
MD (95% CI) -0.35 (-1.54 to 0.84) 1.19 (-2.82 to 5.20) 1.33 (-2.59 to 5.25)
Overall quality of evidence* Low Low Low
Keys: SD = standard deviation; MD =mean difference; CI = confidence interval.
Comparison    Tai Chi versus maintenance of routine activities
Main Results
Compared to maintenance of routine activities, the practice of Tai Chi showed significant benefits on participants’ psychological well-being as demonstrated by the reduction of by Epidemiologic Studies Depression Scale score (mean difference (MD): -0.034, 95% CI: not reported) and psychological distress score assessed by a subscale of the Subjective Exercise Experiences scale (MD: -0.176, 95% CI: not reported) from baseline to the end of treatment at 6 months. Besides, Tai Chi also showed significant effects on improving participants’ life satisfaction score assessed by the Satisfaction With Life scale from baseline to the end of treatment at 6 months (MD: 0.115, 95% CI: not reported).
Comparison 3: Tai Chi versus control maintaining routine activities among healthy elderly
Outcomes 6 7 8
No. of studies (Total no. of participants) 1 (98) 1 (98) 1 (98)
Mean change (SD)/ No. of participants Intervention Not reported/53 Not reported/53 Not reported/53
Comparator Not reported/45 Not reported/45 Not reported/45
MD (95% CI) - 0.034 (not reported) -0.176 (not reported) 0.115 (not reported)
Overall quality of evidence* Low Low Low
Keys: SD = standard deviation; MD =Mean difference; CI = Confidence interval. All the mean differences were statistically significant at the 0.05 level.
Conclusion
Benefits
Compared to sedentary life style and maintenance of routine activities, practice of Tai Chi could significantly benefit the psychological wellbeing of healthy elderly by reducing their trait and state anxiety test scores, depression score, psychological distress score, and also by improving their life satisfaction. Besides, as compared to health education, practice of Tai Chi also showed beneficial effects for the psychological wellbeing of healthy elderly by reducing the Beck Depression Scale score and increasing the physical functioning score and mental health score from baseline to week 25 as assessed by SF-36. However, these beneficial effects were statistically insignificant. For outcomes 1 and 2, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect. For outcomes from 3 to 8, the overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
Adverse effects originated from the practice of Tai Chi were not reported in all the included trials.
Link to Original Article
http://www.ncbi.nlm.nih.gov/pubmed/20492638
The synopsis is based on the following article:
Wang C, Bannuru R, Ramel J, Kupelnick B, Scott T, Schmid CH. Tai Chi on psychological well-being: systematic review and meta-analysis. BMC Complement Altern Med. 2010 May 21;10:23.
3 trials included in the systematic review:
1. Tsai JC, Wang WH, Chan P, Lin LJ, Wang CH, Tomlinson B, et al. The beneficial effects of Tai Chi Chuan on blood pressure and lipid profile and anxiety status in a randomized controlled trial. J Altern Complement Med 2003, 9:747-754.
2. Irwin MR, Olmstead R, Oxman MN. Augmenting immune responses to varicella zoster virus in older adults: a randomized, controlled trial of Tai Chi. J Am Geriatr Soc 2007, 55:511-517.
3. Li F, Duncan TE, Duncan SC, McAuley E, Chaumeton NR, Harmer P. Enhancing the psychological well-being of elderly individuals through Tai Chi exercise: A latent growth curve analysis. Struct Equ Model 2001, 8:53-83.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.