title: Tai chi exercise in patients with chronic heart failure: a randomized clinical trial.
abstract: BACKGROUND
  Preliminary evidence suggests that meditative exercise may have benefits for patients with chronic systolic heart failure (HF); this has not been rigorously tested in a large clinical sample. We sought to investigate whether tai chi, as an adjunct to standard care, improves functional capacity and quality of life in patients with HF.
  
  
  METHODS
  A single-blind, multisite, parallel-group, randomized controlled trial evaluated 100 outpatients with systolic HF (New York Heart Association class I-III, left ventricular ejection fraction ≤40%) who were recruited between May 1, 2005, and September 30, 2008. A group-based 12-week tai chi exercise program (n = 50) or time-matched education (n = 50, control group) was conducted. Outcome measures included exercise capacity (6- minute walk test and peak oxygen uptake) and disease-specific quality of life (Minnesota Living With Heart Failure Questionnaire).
  
  
  RESULTS
  Mean (SD) age of patients was 67 (11) years; baseline values were left ventricular ejection fraction, 29% (8%) and peak oxygen uptake, 13.5 mL/kg/min; the median New York Heart Association class of HF was class II. At completion of the study, there were no significant differences in change in 6-minute walk distance and peak oxygen uptake (median change [first quartile, third quartile], 35 [-2, 51] vs 2 [-7, 54] meters, P = .95; and 1.1 [-1.1, 1.5] vs -0.5 [-1.2, 1.8] mL/kg/min, P = .81) when comparing tai chi and control groups; however, patients in the tai chi group had greater improvements in quality of life (Minnesota Living With Heart Failure Questionnaire, -19 [-23, -3] vs 1 [-16, 3], P = .02). Improvements with tai chi were also seen in exercise self-efficacy (Cardiac Exercise Self-efficacy Instrument, 0.1 [0.1, 0.6] vs -0.3 [-0.5, 0.2], P < .001) and mood (Profile of Mood States total mood disturbance, -6 [-17, 1] vs -1 [-13, 10], P = .01).
  
  
  CONCLUSIONS
  Tai chi exercise may improve quality of life, mood, and exercise self-efficacy in patients with HF. Trial Registration clinicaltrials.gov Identifier: NCT00110227.
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Brookline, MA 02446, USA. gyeh@bidmc.harvard.edu
authors.forename: Gloria Y
authors.initials: GY
authors.lastname: Yeh
authors.forename: Ellen P
authors.initials: EP
authors.lastname: McCarthy
authors.forename: Peter M
authors.initials: PM
authors.lastname: Wayne
authors.forename: Lynne W
authors.initials: LW
authors.lastname: Stevenson
authors.forename: Malissa J
authors.initials: MJ
authors.lastname: Wood
authors.forename: Daniel
authors.initials: D
authors.lastname: Forman
authors.forename: Roger B
authors.initials: RB
authors.lastname: Davis
authors.forename: Russell S
authors.initials: RS
authors.lastname: Phillips
mesh_terms: D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000503:physiopathology* / Q000628:therapy*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010101:Oxygen Consumption; D010349:Patient Compliance; D011788:Quality of Life; D020377:Self Efficacy; D012720:Severity of Illness Index; D016037:Single-Blind Method; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D026302:Tai Ji; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking
chemical_list: D015415:Biomarkers