Tai chi is associated with a lift in the mood and quality of life of older adults with cardiovascular disease, according to a new meta-analysis of more than a dozen existing studies on the topic.
“If you’ve had a heart attack or stroke, or are affected by another heart condition, I would strongly recommend adding tai chi to your recovery and rehabilitation,” says Ruth Taylor-Piliae, one of the study’s authors and a professor of nursing at the University of Arizona, in a released statement. “There are physical benefits like improved balance, and it’s good for mental health too.”
Almost half of American adults — 121 million people — have some form of cardiovascular disease, which are problems with the heart, blood vessels or both. Most (about 90 percent) have high blood pressure, while the rest have such conditions as coronary heart disease, chronic heart failure or a history of stroke. The risk of developing these conditions increases with age.
It’s common for people with cardiovascular disease to experience a decreased quality of life, as well as symptoms of psychological distress, such as stress, anxiety and depression. As background information in the meta-analysis points out, 20 percent of people with coronary heart disease, 27 percent of people with high blood pressure and 35 percent of stroke survivors report symptoms of depression.
Tai chi — a mind-body form of exercise that combines slow, gentle movements with relaxation and breathing — has been shown to boost the psychological well-being of people with various chronic diseases, including cardiovascular disease. It’s also been linked to a reduction in symptoms of anxiety and depression and in improving quality of life. But those studies have tended to be small, and information specifically about tai chi’s effects on people with cardiovascular disease has been limited.
Taylor-Piliae and her co-author, doctoral student Brooke Finlay, decided to do a meta-analysis — a type of study that pools data from multiple studies to get a result with a strong statistical power — to get a better sense of the association between tai chi and psychological wellbeing.
Combining the data
For the meta-analysis, the researchers looked at the data from 15 English- and German-language clinical trials conducted in Asia, North America and Europe during the past decade. The studies included a total of 1,853 participants with high blood pressure, coronary heart disease, heart failure or a history of stroke. Their ages averaged in the 60s.
The studies randomly assigned some of their participants to take a tai chi class regularly for periods that ranged between six and 52 weeks. The average number of classes across the studies was 36. The rest of the studies’ participants — the control groups — were assigned to receive either their usual care, some other type of exercise or an educational program about easing stress and staying healthy.
All participants were questioned at the beginning and at the end of the study about their quality of life. Their levels of psychological distress, stress, anxiety and depression were also assessed.
The meta-analysis found that, overall, older adults in the tai chi groups reported significantly better quality of life and less depression and psychological distress at the end of the studies than those in the control groups.
No statistically significant association was found between tai chi and reduced anxiety, perhaps because few studies measured anxiety, say Taylor-Piliae and Finlay.
Interestingly, tai chi appears to offer people with cardiovascular disease different benefits based on their diagnosis. For example, those in the studies with coronary heart disease who took up tai chi reported significantly better psychological quality of life than those in the control groups, while those with high blood pressure reported significantly better physical health quality of life. People in the tai chi groups with chronic heart failure did not, however, report significant improvement in quality of life, but they experienced less depression and psychological distress compared with the control groups.
Tai chi did not appear to have a significant effect on the quality of life of stroke survivors. “This is because there were very few studies on psychological well-being or quality of life variables in this group,” says Taylor-Piliae. “There is a lot of research on tai chi in stroke survivors but nearly all of them looked at physical function such as balance and gait.”
‘Synergy between postures and breathing’
The meta-analysis has limitations. Notably, the data it used came only from studies published in English or German. In addition, women were underrepresented in most of the studies involving people with coronary heart disease or chronic heart failure, a factor that limits the findings’ generalizability for those two conditions.
Still, the findings are in line with other research that has linked mind-body exercise programs, such as yoga, with improved outcomes — both physical and psychological — in heart patients.
“I think it’s the synergy between postures and breathing,” says Taylor-Piliae. “During tai chi you have good body posture, and research has shown that this enhances mood. We also know that holding your breath can cause stress and anxiety.”
“Tai chi is well suited for people of any age or exercise ability and can be safely adapted for anybody,” she adds. “People with low tolerance to exercise or breathing problems can do it in a chair. Group classes for others with cardiovascular disease are a positive place for social support and camaraderie — there is no judgment; you just do what you can.”
Of course, taking an in-person tai chi class right now, in the midst of the coronavirus pandemic, is not recommended, and Taylor-Piliae warns against beginners signing up for an online class. Doing the movements incorrectly may lead to knee pain, she points out.
“During the COVID lockdown, you could search for where there are some group-based tai chi classes so you’re ready to enroll when they restart,” she advises.
FMI: The study was published in the European Journal of Cardiovascular Nursing, which is published by the European Society of Cardiology. You’ll find an abstract of the study on the journal’s website, but the full study is behind a paywall.