title: Does Tai Chi relieve fatigue? A systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Fatigue is not only a familiar symptom in our daily lives, but also a common ailment that affects all of our bodily systems. Several randomized controlled trials (RCTs) have proven Tai Chi to be beneficial for patients suffering from fatigue, however conclusive evidence is still lacking. A systematic review and meta-analysis was performed on all RCTs reporting the effects of Tai Chi for fatigue.
  
  
  METHODS
  In the end of April 2016, seven electronic databases were searched for RCTs involving Tai Chi for fatigue. The search terms mainly included Tai Chi, Tai-ji, Taiji, fatigue, tiredness, weary, weak, and the search was conducted without language restrictions. Methodological quality was assessed using the Cochrane Risk of Bias tool. RevMan 5.3 software was used for meta-analysis. Publication bias was estimated with a funnel plot and Egger's test. We also assessed the quality of evidence with the GRADE system.
  
  
  RESULTS
  Ten trials (n = 689) were included, and there was a high risk of bias in the blinding. Two trials were determined to have had low methodological quality. Tai Chi was found to have improved fatigue more than conventional therapy (standardized mean difference (SMD): -0.45, 95% confidence interval (CI): -0.70, -0.20) overall, and have positive effects in cancer-related fatigue (SMD:-0.38, 95% CI: -0.65, -0.11). Tai Chi was also more effective on vitality (SMD: 0.63, 95% CI: 0.20, 1.07), sleep (SMD: -0.32, 95% CI: -0.61, -0.04) and depression (SMD: -0.58, 95% CI: -1.04, -0.11). However, no significant difference was found in multiple sclerosis-related fatigue (SMD: -0.77, 95% CI: -1.76, 0.22) and age-related fatigue (SMD: -0.77, 95% CI: -1.78, 0.24). No adverse events were reported among the included studies. The quality of evidence was moderate in the GRADE system.
  
  
  CONCLUSIONS
  The results suggest that Tai Chi could be an effective alternative and /or complementary approach to existing therapies for people with fatigue. However, the quality of the evidence was only moderate and may have the potential for bias. There is still absence of adverse events data to evaluate the safety of Tai Chi. Further multi-center RCTs with large sample sizes and high methodological quality, especially carefully blinded design, should be conducted in future research.
  
  
  BACKGROUND
  PROSPERO CRD42016033066.
authors.affiliation: The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Xiang
authors.affiliation: Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China.
authors.forename: Liming
authors.initials: L
authors.lastname: Lu
authors.affiliation: Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China.
authors.forename: Xiankun
authors.initials: X
authors.lastname: Chen
authors.affiliation: Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China.|National Center for Design Measurement and Evaluation in Clinical Research, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
authors.forename: Zehuai
authors.identifier: http://orcid.org/0000-0002-1797-2047
authors.initials: Z
authors.lastname: Wen
mesh_terms: D005221:Fatigue / Q000628:therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D026302:Tai Ji; D016896:Treatment Outcome