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Tai Chi and yoga as complementary therapies in rheumatologic conditions

https://doi.org/10.1016/j.berh.2012.05.006Get rights and content

Tai Chi and yoga are complementary therapies which have, during the last few decades, emerged as popular treatments for rheumatologic and musculoskeletal diseases. This review covers the evidence of Tai Chi and yoga in the management of rheumatologic diseases, especially osteoarthritis of the knee, hip and hand, and rheumatoid arthritis.

There is evidence that Tai Chi and yoga are safe, and some evidence that they have benefit, leading to reduction of pain and improvement of physical function and quality of life in patients. Recommendations for Tai Chi in knee osteoarthritis have recently been issued by the American College of Rheumatology. To allow broader recommendations for the use of Tai Chi and yoga in rheumatic diseases, there is a need to collect more evidence researched with larger randomised controlled trials.

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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