title: Tai chi mind-body exercise in patients with COPD: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is a chronic, progressively debilitating condition that is prevalent in the US and worldwide. Patients suffer from progressive dyspnea and exercise intolerance. Physical exercise is beneficial, but conventional pulmonary rehabilitation programs are underutilized. There remains a need for novel interventions that improve symptoms, quality-of-life, and functional capacity. Tai chi is an increasingly popular mind-body exercise that includes physical exercise, breathing training, mindful awareness, and stress management--components that are essential to the self-management of COPD. There are, however, limited data on the effectiveness of tai chi as a therapeutic intervention in this population.
  
  
  METHODS
  The Primary Aims are to evaluate the efficacy, safety, and feasibility of a 12-week tai chi program for patients with COPD. We utilize a randomized controlled trial design, with participants assigned in a 2:1 ratio to either a group tai chi program (N = 63) or a time/attention-matched education control (N = 31). Our primary outcomes are COPD-specific quality-of-life and exercise capacity. Secondary outcomes include dyspnea, mood, functional status, self-efficacy, and lung function. Cardiopulmonary exercise testing is done in a subset of patients (N = 50). To explore optimal training duration, a subgroup of patients in tai chi are randomly assigned to complete an additional 12 weeks training (total 24 weeks) (Exploratory Aim 1). To explore the impact of a simplified seated intervention including only a subset of tai chi's training components, a third randomly assigned group (N = 31) receives a 12- week mind-body breathing program (N = 31) (Exploratory Aim 2).
  
  
  CONCLUSIONS
  Results of the BEAM study (Breathing, Education, Awareness, Movement) will provide preliminary evidence regarding the value of tai chi for improving quality of life and exercise capacity in patients with COPD, including information regarding optimal duration. They will also inform the feasibility and potential benefit of an alternative mind-body breathing intervention, and provide insight regarding how isolated mind-body exercise components contribute to the overall effects of tai chi. Should the results be positive, tai chi and related mind-body practices may offer a novel exercise option that is potentially accessible to a large proportion of patients with COPD.
  
  
  BACKGROUND
  This trial is registered in Clinical Trials.gov, ID number NCT01551953. Date of Registration March 1 2012.
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, 1309 Beacon Street, Brookline, MA 02446, USA. gyeh@hms.harvard.edu.
authors.forename: Gloria Y
authors.initials: GY
authors.lastname: Yeh
authors.forename: Peter M
authors.initials: PM
authors.lastname: Wayne
authors.forename: Daniel
authors.initials: D
authors.lastname: Litrownik
authors.forename: David H
authors.initials: DH
authors.lastname: Roberts
authors.forename: Roger B
authors.initials: RB
authors.lastname: Davis
authors.forename: Marilyn L
authors.initials: ML
authors.lastname: Moy
mesh_terms: D001945:Breathing Exercises; D002985:Clinical Protocols; D004644:Emotions; D006801:Humans; D026441:Mind-Body Therapies; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D026302:Tai Ji