7Tai Chi and yoga as complementary therapies in rheumatologic conditions
Introduction
Musculoskeletal diseases, especially inflammatory rheumatologic diseases, have during the last few decades undergone major developments in their medical management. In addition to medical treatment and necessary surgical treatment, non-pharmacological treatment is a corner stone when treating patients with rheumatic diseases. Further, recommendations for non-pharmacological treatment have a number of approaches, for example, self-management, education and provision of information about osteoarthritis (OA) and its treatment are widely issued as core recommendations for the treatment of OA hip and knee [1], and exercise is a corner stone used by health professionals to achieve improvement of physical function, reduction of pain and an improved quality of life.
Apart from regular non-pharmacological treatment, other interventions, including electrophysical therapies, also are often given and acupuncture is by many accepted as a complimentary therapy. Complementary therapy is treatment given in addition to regular treatment. Together with alternative therapy, which substitutes regular, conventional treatment, complementary and alternative medicine are often stated together and abbreviated as CAM. Both Tai Chi and yoga are considered as complementary medicine.
As for exercise, an important issue remains to patients with musculoskeletal and rheumatologic diseases how best exercise can be used for alleviation of complaints. The choice of modality should be based on scientific evidence and patient experience and need.
Recently, patient schools and educational programmes have been developed [2] and patient focus has led to asking patients about their views when the rheumatologic disease is to be treated. However, educational trials have not given the major reward one might have hoped for with small effect sizes, even in short-term evaluations [3]. To improve health, it may be wise to experiment with new ideas, other treatment modalities and self-management programmes [4].
Sometimes, it is difficult to motivate individuals to involve in demanding exercise, especially when benefits are not immediately seen, corresponding to our human inclination to avoid stressful and unnecessary activities. In chronic musculoskeletal conditions, people need to learn to cope and live throughout their lives with health conditions which are incurable. Therefore, it may be worthwhile to explore health effects of some traditions which have been practised through centuries and which recently have been embraced by practitioners also in Western societies.
Tai Chi and yoga are mind–body interventions. Such interventions represent techniques designed to enhance the mind's capacity to affect bodily function and symptoms, and have become increasingly popular. We have no exact numbers on how many patients with specific rheumatologic diseases apply Tai Chi or yoga in their daily lives. As a consequence of their popularity, Tai Chi and yoga deserve to be examined for their ability to contribute to the care of patients with rheumatologic diseases. Enthusiasm for a specific exercise may be a predictor for success, but also enthusiasm for a popular exercise needs to meet demands for evidence. This also applies to Tai Chi and yoga if we are to advocate their use in daily practice. Tai Chi is already officially supported by several national arthritis foundations.
This article attempts to encompass scientific evidence on the therapeutic benefits of Tai Chi and yoga for major rheumatologic disorders, with main focus on rheumatoid arthritis (RA) and OA which are typical rheumatic diseases and which have been best studied. Literature was retrieved mainly through PubMed, primarily with the search terms Tai Chi and yoga, combined with rheumatologic diagnoses, but also including supplementary information from published systematic reviews and meta-analyses.
Section snippets
Tai Chi
Tai Chi (also called Tai Chi Chuan, Taijiquan, T'ai Chi or Tai Chi Quan) has for many centuries been a martial art form which has been practised in Oriental cultures. For several hundred years, these movement forms have been applied for exercise and Tai Chi is every day being practised by millions of Chinese, predominantly by the elderly. Tai Chi has also been fought in competitions with rapid movements, whereas today and for therapeutic reasons it usually is applied with standardised slow
Yoga
Yoga is originally an ancient Indian science [44], but has also become a therapeutic tool in physical, psychological and psychosomatic disorders and there are numerous schools and types of yoga (such as Iyengar, Viniyoga and Shivananda) The different schools vary in how they prioritise physical and spiritual aspects in their practice. A yoga session may last over 1–2 h and contains different elements performed in a sequence: postures (asanas of Hatha yoga), breathing techniques (pranayama) and
Conclusions
This review shows that a number of trials have examined the effect of Tai Chi and yoga in rheumatologic conditions, especially RA and OA are the diseases mostly studied. A few investigators have also addressed osteoporosis, ankylosing spondylitis and fibromyalgia with Tai Chi or yoga as an intervention. In OA, predominantly knee OA has been studied for both Tai Chi and yoga. Knee OA is a frequent disease which affects mobility in the lower extremities and is therefore a target for exercise.
Implications for future research
If new evidence supports that Tai Chi and yoga reduce pain, improve physical function, enhance flexibility and psychosocial quality of life as well as improved balance, then Tai Chi and yoga will receive scientific endorsement for effectiveness and promote health as popular and attractive treatment modalities for patients with rheumatologic diseases in Western countries.
There is variation with very different ways that Tai Chi and yoga are practised within and between populations. Duration of
Summary
Tai Chi and yoga are popular complementary mind–body exercise modalities, widely practised in rheumatologic diseases such as RA and OA. From a theoretical perspective, Tai Chi and yoga are expected to benefit patients with OA, RA and other rheumatologic diagnoses. When reviewing existing scientific evidence for the effect of these complementary treatment modalities, studies have in general produced findings pointing at reduced pain, improved disability, increased flexibility and sometimes
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Cited by (25)
Investigation of the effectiveness of Tai Chi exercise program in patients with scleroderma: A randomized controlled study
2020, Complementary Therapies in Clinical PracticeCitation Excerpt :It has been used in the literature to increase muscle strength, improve balance and reduce the risk of falling, especially in older adult [13]. Additionally, there were studies showing the positive effects of Tai Chi on sleep, fatigue, endurance, balance, anxiety and depression in rheumatologic diseases such as fibromyalgia, rheumatoid arthritis and osteoarthritis [15]. To the best our knowledge, there is no study in the literature that has examined the effect of Tai Chi in patients with scleroderma.
Movement and manual therapy for adults with arthritis: 2012 National Health Interview Survey
2018, Complementary Therapies in MedicineOsteoarthritis
2018, Integrative Medicine: Fourth EditionHave complementary therapies demonstrated effectiveness in rheumatoid arthritis?
2016, Reumatologia ClinicaCitation Excerpt :Thus Tai Chi may benefit RA patients who have limited strength, mobility and comorbidities (cardiovascular risk, osteoporosis and depression).60 Several reviews about the effect of Tai Chi in RA patients have been published, including a Cochrane Review.59,60,62–64 Tai Chi was associated with improvement in terms of RA disease activity.
Characteristics of traditional Chinese medicine use in patients with rheumatoid arthritis in Taiwan: A nationwide population-based study
2015, Journal of EthnopharmacologyCitation Excerpt :Second, Qiqong exercise or tai chi was not covered by the NHI program. Although tai chi has been recommended in knee osteoarthritis by the American College of Rheumatology (Uhlig, 2012), it is deemed as one of the suggestions in the TCM consultations and thus not reimbursed by the insurance. Except this, most of the TCM therapeutic approaches by licensed TCM doctors were covered in the NHI system.
So much research, so little application: Barriers to dissemination and practical implementation of Tai Ji Quan
2014, Journal of Sport and Health ScienceCitation Excerpt :It is clear from the conclusions of the most recent reviews that the field of Tai Ji Quan research is very active but in disarray. For example, the 27 reviews involving Tai Ji Quan (either as the primary intervention for a particular condition or as one of several interventions investigated to determine their effect on a particular condition) published between January 2012 and October 2013 covered 15 different conditions, including fall prevention,15–18 rheumatology,18–23 Parkinson's disease,24–26 fibromyalgia,27,28 psychological conditions,29–32 cardiovascular conditions,33–36 peripheral neuropathy,37 and chronic pain.38 Despite the range of conditions being investigated, the consensus of the reviews' authors is that the research literature, including that involving RCT, leaves much to be desired.