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PurposeTo examine the effects of a 12-week tai chi program on quality of life and exercise capacity in patients with heart failure. Methods Thirty patients with chronic stable heart failure and left ventricular ejection fraction ≤40% (mean [± SD] age, 64 ± 13 years; mean baseline ejection fraction, 23% ± 7%; median New York Heart Association class, 2 [range, 1 to 4]) were randomly assigned to receive usual care (n = 15), which included pharmacologic therapy and dietary and exercise counseling, or 12 weeks of tai chi training (n = 15) in addition to usual care. Tai chi training consisted of a 1-hour class held twice weekly. Primary outcomes included quality of life and exercise capacity. Secondary outcomes included serum B-type natriuretic peptide and plasma catecholamine levels. For 3 control patients with missing data items at 12 weeks, previous values were carried forward. Results At 12 weeks, patients in the tai chi group showed improved quality-of-life scores (mean between-group difference in change, –25 points, P = 0.001), increased distance walked in 6 minutes (135 meters, P = 0.001), and decreased serum B-type natriuretic peptide levels (–138 pg/mL, P = 0.03) compared with patients in the control group. A trend towards improvement was seen in peak oxygen uptake. No differences were detected in catecholamine levels. Conclusion Tai chi may be a beneficial adjunctive treatment that enhances quality of life and functional capacity in patients with chronic heart failure who are already receiving standard medical therapy.

ObjectiveTo assess the effects of a 12-week Tai Chi exercise program on sleep using the sleep spectrogram, a method based on a single channel electrocardiogram (ECG)-derived estimation of cardiopulmonary coupling, previously shown to identify stable and unstable sleep states. Methods We retrospectively analyzed 24-h continuous ECG data obtained in a clinical trial of Tai Chi exercise in patients with heart failure. Eighteen patients with chronic stable heart failure, left ventricular ejection fraction ⩽40% (mean [±standard deviation] age, 59±14 years, mean baseline ejection fraction 24%±8%, mean) were randomly assigned to receive usual care (N=10), which included pharmacological therapy and dietary and exercise counseling, or 12 weeks of Tai Chi training (N=8) in addition to usual care. Using the ECG-based sleep spectrogram, we compared intervention and control groups by evaluating baseline and 12-week high (stable) and low (unstable) frequency coupling (HFC & LFC, respectively) as a percentage of estimated total sleep time (ETST). Results At 12 weeks, those who participated in Tai Chi showed a significant increase in HFC (+0.05±0.10 vs. −0.06±0.09 % ETST, p=0.04) and significant reduction in LFC (−0.09±0.09 vs. +0.13±0.13 % ETST, p<0.01), compared to patients in the control group. Correlations were seen between improved sleep stability and better disease-specific quality of life. Conclusions Tai Chi exercise may enhance sleep stability in patients with chronic heart failure. This sleep effect may have a beneficial impact on blood pressure, arrhythmogenesis and quality of life.