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  • Researchers Say Tai Chi Shows Promise Over Aerobic Exercise for Fibromyalgia

    In brief:

    • Researchers measured outcomes of 226 adults with fibromyalgia divided into 2 groups: 1 group received twice-weekly 60-minute aerobic exercise classes for 24 weeks; the second group received tai chi classes and was further divided into 12- and 24-week program groups, with some participants receiving tai chi once a week and others receiving the class twice a week.
    • At 24 weeks, the twice-weekly, 24-week tai chi group reported the most significant improvement compared with the aerobic exercise group—an average 16.1 point difference on the Fibromyalgia Impact Questionnaire (FIQR).
    • All tai chi groups reported better scores than the aerobic group on secondary outcome measures including global assessment, efficacy, depression, coping, and anxiety.
    • All groups—tai chi and aerobic exercise—reported decreased use of drugs including analgesics, antidepressants, and muscle relaxers.
    • Researchers believe the mind-body approach of tai chi may contribute to its effectiveness and suggest it may be useful in reducing opioid use

    Tai chi may not just be another option in the management of pain for individuals with fibromyalgia— according to authors of a new study, it may actually be a more effective physical activity than aerobic exercise, arguably the most common nondrug treatment approach for the condition.

    In a randomized controlled trial, researchers analyzed the progress of 226 adults with fibromyalgia over a 52-week period. Participants were placed into 1 of 5 groups: an aerobic exercise group that met twice weekly for 24 weeks; a tai chi group that met once a week for 12 weeks; a tai chi group that met twice a week for 12 weeks, and once weekly and twice weekly tai chi groups that met for 24 weeks. The outcomes, measured at 12, 24, and 52 weeks, covered a wide range of areas, but researchers focused on improvements to the fibromyalgia impact questionnaire (FIQR) as the primary outcome. Results were published in BMJ.

    The aerobic exercise group participated in a "closely supervised" group program "consistent with current recommended guidelines of moderate intensity exercises for fibromyalgia," according to authors. That program included an active warm-up with stretching, "choreographed aerobic training" that progressed from low to moderate intensity, and a cool-down involving low intensity movements and stretching. The hour-long sessions were customized to each participant and were adjusted over time to reach training heart rate goals ranging from 67.9% to 79.5% of maximum heart rate. Individuals in the aerobic group also were encouraged to walk 30 minutes daily.

    All tai chi groups received the same Yang-style tai chi instruction, provided by experienced instructors who participated in a training session on protocol and concepts related to fibromyalgia. The only differences were in the frequency and timeline for the 60-minute sessions: once weekly versus twice weekly, and 12 weeks versus 24 weeks. As with the aerobic exercise group and encouragement to walk, tai chi participants were encouraged to engage in tai chi outside of the scheduled classes for at least 30 minutes a day. Both groups were instructed to continue exercise after they completed their programs.

    While researchers mainly were focused on FIQR scores, they also recorded outcomes for secondary measures including depression, global assessment, self-efficacy, sleep, overall health, social support, and physical activity. Physical assessments also were included by way of the chair stand, 6-minute walk test, and balance tests.

    Authors of the study describe participant characteristics—mean age of 52, 92% women, 61% white, with an average reported duration of body pain of 9 years—as balanced among all 5 groups. Likewise, participant baseline treatment expectations were similar.

    Here's what researchers found:

    • At 24 weeks, the combined tai chi groups (once and twice weekly) improved FIQR scores over the aerobic group by an average of 5.5 points on the 100-point scale—a "significantly" different improvement rate, yet one that authors describe as not clinically important. However, when researchers compared groups with similar intensity—the twice-weekly 24-week aerobic group matched against the twice-weekly 24-week tai chi group—the improvement difference rose to an average of 16.2 points on the FIQR scale, doubling the minimum clinically significant difference mark identified by researchers.
    • The 24-week tai chi group recorded greater improvement than the 12-week group in FIQR and depression scores, but those differences tended to fade at the 52-week mark.
    • All groups—tai chi and aerobic—reported lower use of analgesics, antidepressants, muscle relaxants and antiepileptic drugs.
    • All tai chi groups reported significantly better improvements than the aerobic group in several secondary outcomes including global assessment, anxiety, self-efficacy, and coping strategies.
    • Tai chi participants attended 62% of possible classes, compared with a 40% attendance rate among the aerobic group.

    "By improving psychological wellbeing, coping, and self-efficacy, tai chi mind-body exercise may help to bolster confidence of patients with fibromyalgia to engage in behaviors that help them manage their symptoms and to persist in those behaviors," authors write. "Tai chi might also help buffer the negative impact of fibromyalgia on the patients' physical and psychosocial wellbeing."

    Authors note several limitations that may have affected the results. First, they write, patients were aware of their treatment group, and expectations could have produced placebo or nocebo responses. Second, the class attendance rates for both groups were not great, and they differed substantially between the tai chi and aerobic groups. Third, they write, there was a substantial loss of patient reporting due to dropoff as the study progressed, "a common problem in clinical trials of participants with chronic pain." The researchers also acknowledge that tai chi may not be a viable option in many places (their study was conducted in the metro Boston area).

    Authors believe that among the listed limitations, the attendance rate differences also may be interpreted as an indicator of the potential for tai chi as an intervention. "Attendance can be considered part of the intervention, and so part of the benefit of tai chi is that patients are more likely to continue to practice it," authors write. And while both the aerobic and tai chi groups reported decreased use of drugs, authors write that the fact that the tai chi group tended to stick with the program longer suggests that "tai chi, which can address both the physical and the psychological symptoms in chronic pain, could be particularly effective in targeting opioid use and misuse."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.


    • I’ve lived with fibromyalgia for 15 years and I’ve been practicing QiGong (Yang-style) for 8 of theses years. I could barely walk into class the first time and standing for an hour was impossible. Today I teach Qi-gong in the western suburbs twice weekly and continue to work with my master once a week. This practice has helped me to manage living with pain. My life is better and hopeful in large part to this and the support I have around me.

      Posted by Carolyn on 3/29/2018 11:17 AM

    • Thank you for this. I'm getting ready for the Tai Chi Gala ( http://taichigala.com/ ) in PA in June and could use all the practice I can get! :)

      Posted by Thomas Tash on 4/20/2018 10:13 AM

    • Tai chi is such a great way to stay fit and healthy - or help with conditions like fibromyalgia, Parkinsons or (in my case) asthma. I started with an online tai chi class (whitecraneonline.com) as well as regular classes too.

      Posted by Andrew on 10/22/2019 10:51 AM

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