BELLARMINE UNIVERSITY, LOUISVILLE, KY

The Effects of Tai Chi vs. Cycling

on Patients with Congestive Heart Failure

Laura Stigler, Lauren Rouse,Megan Kaiser, Adam Fischer

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Background• Endurance training has many aerobic

benefits in individuals with CHF

• Tai Chi improves exercise tolerance and promotes hemodynamic stability– Kentucky Tai Chi and Qigong Center

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Clinical Significance

• Physical therapists must be able to effectively treat these patients

• Physical therapy is needed to prevent additional cardiopulmonary complications

• CHF is a chronic condition

BELLARMINE UNIVERSITY, LOUISVILLE, KY

PICO Question

•Patient : Patients with CHF

•Intervention : Tai Chi training

•Comparison : Cycling

•Outcome : VO2 Max

6MWT distanceQOL

http://www.easternhealingcenter.com/En/essence_tai_chi.htm

http://www.wpclipart.com/recreation/cycling/bicycle_parts/bike_wheel.png.html

BELLARMINE UNIVERSITY, LOUISVILLE, KY

TAI CHIARTICLE DESIGN SUBJECTS INTERVENTIONS

Yeh et al, 2009

RCT(Level 1b)

N=30 LVEF < 40%

Tai Chi + usual care

Usual carePan et al, 2013

Systematic review(Level 1a)

N=242 Age=68.6 yrs. CHF

Tai Chi group Control group:

pharmacological, cycling, walking, general exercise and education

Barrow et al, 2007

RCT(Level 1b)

N=65 Age: 46-90

yrs. CHF

Tai Chi group Control group:

exercise without rehab

Wei and Liu, 2003

RCT(Level 1b)

N=70 Age: 53-68

yrs. CHF

Tai Chi + usual care

Usual care

BELLARMINE UNIVERSITY, LOUISVILLE, KY

TAI CHIARTICLE OUTCOME MEASURES CONCLUSIONS

Yeh et al, 2009

Minnesota Living with Heart Failure Questionnaire (MLHFQ)

6MWT

MLHFQ sign. improved (p=0.001)

6MWT sign. improved (p=0.001)

Pan et al, 2013

MLHFQ 6MWT

6MWT distance increased 25 m (MDIC) but was not sign.

Barrow et al, 2007

MLHFQ Symptom Checklist

90-R

MLHFQ sign. improved (p=0.01)

Symptom Checklist 90-R sig. improved (p<0.01)

Wei and Liu, 2003

LVEF LVEF sign. improved (p=0.01)

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Yeh et al, 2009METHODS

• Usual Care group (n=15)– Pharmacologic therapy– Dietary and exercise counseling

• Tai Chi group (n=15)– 12 weeks of Tai Chi + usual care– 1 hr class 2x/week

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Yeh et al, 2009RESULTS

• QOL (Minnesota Living with HF Questionnaire) significantly improved (p=0.001)

• Exercise capacity (6MWT) significantly improved (p=0.001)

BELLARMINE UNIVERSITY, LOUISVILLE, KY

TAI CHI + CYCLING

ARTICLE

DESIGN

SUBJECTS

INTER-VENTIONS

OUTCOME

MEASURES

CONCLUSIONS

Caminiti et al, 2003

RCT (Level 1b)

N=60 Age=

73.8 yrs.

CHF

Exercise training group: cycling or walking

Combined training group: Tai Chi + cycling or walking

6MWT MacNe

wQLML QOL question-naire

QOL sign. improved (p=0.026)

6MWT distance sign. increased (p=0.001)

SBP sign. decreased

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Caminiti et al, 2003METHODS

• Exercise training: 30 min of cycling or walking at 60-70% VO2max

• Combined training:

– Tai Chi for 30 min 2x/week

– Cycling or walking for 30 min 2x/week

4 sessions/week for 12 weeks

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Caminiti et al, 2003RESULTS

• QOL (MacNewQLML) significantly improved (esp social and emotional) (p=0.026)

• 6MWT distance increased from 214+32 m to 291+46 m (p=0.001)

• SBP significantly decreased (p=0.025)

BELLARMINE UNIVERSITY, LOUISVILLE, KY

CYCLINGARTICLE DESIGN SUBJECTS INTERVENTIONS

Smart et al, 2004

RCT(Level 1b)

N=30 Age=63.8

yrs CHF

Weeks 1-16: cycling Weeks 8-16: cycling +

strengthening Weeks 16-52: HEP only

Giannuzzi et al, 2003

RCT(Level 1b)

N=90 LVEF < 35%

Exercise group: cycling Control group:

educational support

Belardinelli et al, 1999

RCT(Level 1b)

N=94 Mean age:

59 yrs CHF LVEF < 40%

1st phase: 3x/week (cycling), 60% VO2max

2nd phase: 12 months, 2x/ week (cycling), 60% VO2max

Control group: no exercise

BELLARMINE UNIVERSITY, LOUISVILLE, KY

CYCLINGARTICLE OUTCOME

MEASURESCONCLUSIONS

Smart et al, 2004

MLHFQ Peak VO2

QOL improved (p=0.1) Peak VO2 sign. improved

(p=0.001)Giannuzzi et al, 2003

6MWT QOL

assessment

6MWT distance increased by 20%

LVEF increased 16% SBP and RPP decreased O2 uptake increased at

ventilatory threshold and peak exercise

Belardinelli et al, 1999

MLHFQ VO2

Peak O2 uptake improved

18% (p=0.01) Ventilatory threshold

improved 30% MLHFQ sign. improved

(p=0.001)

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Giannuzzi et al, 2003METHODS

• Functional eval at baseline and 6 mo FU• Exercise group:

– 30 min cycle ergometer > 3x/wk at 60% of peak VO2

– > 30 min daily walk and calisthenics• Control group:

– Educational support

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Giannuzzi et al, 2003RESULTS

• Ejection fraction increased in exercise group by 16%

• SBP and rate-pressure product at rest decreased slightly in exercise group

• O2 uptake increased at ventilatory threshold and at peak exercise

• 6MWT distance increased by 20%

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Conclusion

• Research has not yet compared effects of cycling versus Tai Chi on patients with CHF

• Both resulted in improved QOL, 6MWT distance and VO2max

• Consider incorporating both interventions into POC for patients

BELLARMINE UNIVERSITY, LOUISVILLE, KY

References

• Barrow DE, Bedford A. Ives G, OToole L, Channer KS. An evaluation of the effects of Tai Chi Chuan and Chi Kung training in patients with symptomatic heart failure: a randomised controlled pilot study. Postgrad Med J. 2007;83(985):717-721.

• Belardinelli R, Georgiou D, Cianci G, Purcaro A. Randomized, controlled trial of long-term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome. Circulation. 1999;99:1173-1182.

• Caminiti G, Volterrani M, Marazzi G, Cerrito A, Massaro R, Arisi A, Franchini A, Sposato B, Rosano G. Tai Chi enhances the effects of endurance training in the rehabilitation of elderly patients with chronic heart failure. Rehab Research Prac. 2011;2011:1-6.

• Giannuzzi P, Temporelli PL, Corrà U, Tavazzi L. Antiremodeling effect of long-term exercise training in patients with stable chronic heart failure. Circulation. 2003;108:554-559.

BELLARMINE UNIVERSITY, LOUISVILLE, KY

References

• Pan L, Yan JH, Guo YZ, Yan JH. Effects of Tai Chi training on exercise capacity and quality of life in patients with chronic heart failure: a meta-analysis. Eur J Heart Fail. 2013;15(3): 316-323.

• Smart N. A, Murison, R. Rate of change in physical fitness and quality of life and depression following exercise training in patients with congestive heart failure. Congestive Heart Failure. 2013; 19:1.

• Wei L, Liu HY. The effect of simplified Tai Chi on cardiovascular function in patients with heart failure. Chin J Clin Rehahil. 2003;7:1460-1461.

• Yeh GY, Wood MJ, Lorell BH, et al. Effects of Tai Chi mind-body movement therapy on functional status and exercise capacity in patients with chronic heart failure: a randomized controlled trial. Am J Med. 2004;117(8):541-548.