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Effects of the tai chi qigong programme on functional capacity, and lung function in chronic obstructive pulmonary disease patients: A ramdomised controlled trial

 

Effects of the tai chi qigong programme on functional capacity, and lung function in chronic obstructive pulmonary disease patients: A ramdomised controlled trial

Intervention of this study was combind centre-and home-base TCQ - a design that appeared to ensure safety, correctness, and facilitate long term training. The participants are included the more homogeneity of COPD participants (mild and moderate degree of COPD). TCQ practice could be applied at home in mild or moderate degree of COPD.

Effects of the tai chi qigong programme on functional capacity, and lung function in chronic obstructive pulmonary disease patients: A ramdomised controlled trial

Tai Chi for COPD Patients

Highlights

  • Intervention of this study was combind centre-and home-base TCQ - a design that appeared to ensure safety, correctness, and facilitate long term training.
  • The participants are included the more homogeneity of COPD participants (mild and moderate degree of COPD).
  • TCQ practice could be applied at home in mild or moderate degree of COPD.
  • The benefical effect of TCQ training was demonstrated on functional capacity, dyspnea score, and quality of life only after 6 weeks of training, while previous studies showed that TCQ effect improved these outcomes by at least week 12.

Abstract

Although the beneficial effect of exercise on the health of Chronic Obstructive Pulmonary Disease (COPD) patients has been widely demonstrated, that of Tai Chi Qigong (TCQ), as an alternative exercise, has been inconclusive. Therefore, this study aimed to evaluate the effects of combined center-and home-based TCQ on functional capacity and lung function in patients with mildly and moderately severe COPD. A total of 50 patients, with a mild and moderate degree of COPD, were recruited and randomly assigned to either the TCQ (n = 25) or control group (n = 25). The TCQ group completed 12-week center-and 12-week home-based training. The control group attended a meeting class once a week for 12 weeks. Outcome measures were assessed at baseline, and the 6th, 12th and 24th week. The primary outcomes were functional capacity (6-min walk test; 6MWT) and lung function. The secondary outcomes were dyspnea score and quality of life. The TCQ group demonstrated significant improvement in functional capacity at week 12 and 24 (p < 0.05) and dyspnea score and quality of life at week 6, 12 and 24 (p < 0.05) when compared to baseline. Functional capacity, forced expiratory volume in 1st second (FEV1), dyspnea score, and quality of life were significantly better in the TCQ group from week 6 to week 24 when compared to the control group (p < 0.05). Combined center-and home-based TCQ training for patients with mildly and moderately severe COPD is effective in improving functional capacity, dyspnea score, and quality of life.

Abbreviations

COPD
Chronic Obstructive Pulmonary Disease
GOLD
The Global Initiative for Chronic Obstructive Lung Disease
SGRQ
St. George Respiratory Questionnaire
TCQ
Tai Chi Qigong
mMRC
modified Medical Research Council Dyspnea Scale
FEV1
forced expiratory volume in 1 s
FVC
forced vital capacity
6MWT
6-min walk test
ERV
expiratory reserve volume

 

1. Introduction

Chronic obstructive pulmonary disease (COPD) is one of the most important public health problems worldwide. The World Health Organization estimated that COPD will become the 3rd leading cause of death worldwide by 20301 and rank as the 5th Disability-Adjusted Life Years (DALYs) in the same year.2 COPD is characterized by persistent respiratory symptoms and airflow limitation. The most common respiratory symptoms include dyspnea, cough and/or sputum production.3 Dyspnea is related with daily life activity. COPD patients often suffer from dyspnea and exacerbation, which leads to inactivity, deconditioning, and poor functional capacity and quality of life.4, 5 Several interventions have been investigated with the aim of improving lung function, decreasing dyspnea symptoms and improving quality of life in these patients.6, 7, 8, 9, 10, 11 These interventions include pulmonary rehabilitation, exercise, yoga, acupuncture, and Tai chi qigong (TCQ).

TCQ is a mind-body exercise that involves whole body movements, breathing techniques, postural control, and internal awareness.12 Several studies have demonstrated the advantages of TCQ in elderly persons with chronic diseases,13 especially those with disorders of the cardio-cerebro-vascular, respiratory and musculoskeletal systems.14

Previous studies have investigated the effects of TCQ in COPD patients on several outcomes including functional capacity, lung function, quality of life, and findings have been inconclusive.12, 15, 16, 17, 18, 19, 20, 21 Although, several studies reported significant improvement in functional capacity, lung function and quality of life after TCQ training,15, 16 a systematic review and meta-analysis concluded that TCQ significantly improved functional capacity but not lung function and quality of life in patients with COPD.21 The authors noted that the evidenced effect of TCQ on health related quality of life was not conclusive and futher methodologically sound studies were needed before definitive conclusions could be drawn. Factors including heterogeneity of the participants and duration of training might account for less conclusive findings in previous studies, which often included patients with all degrees of COPD severity. Therefore, implementing the same TCQ programme may not fully benefit such patients, since the intensity was not optimised enough to help improving their conditions. Few studies have examined the long term effect of TCQ training on lung function and quality of life of individuals with COPD.15, 16 Further, TCQ has often been implemented as a center-based programme in these previous studies and then followed up after the training ended. While center-based training could ensure safety and correctness, factors such as lack of transportation and time conflict could be a major constraint for long term training. Thus, combined center-and home based TCQ might be an alternative programme to overcome the shortcoming of center-based training.15, 16

Therefore, this study aimed to evaluate the effects of a combined 12-week center-and 12-week home-based TCQ programme on functional capacity, lung function, dyspnea, and quality of life in patients with mild and moderate degree of COPD.

2. Materials and methods

2.1. Design

This study was a randomised controlled trial with concealed allocation, blinding of assessors and intention-to-treat analysis. COPD patients, who were registered at the COPD Clinic, were assigned randomly to either the TCQ (intervention) or non TCQ (control). Randomisation was stratified by the current Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage of COPD in two strata (mild and moderate degree). Each strata was allocated to blocks of four and randomised by drawing lots.

A blinded assessor conducted the assessments at baseline, and the 6th, 12th and 24th week.

2.2. Participants

Fifty participants were recruited from the COPD Clinic of Chiang Dao Hospital, Chiang Mai, Thailand between November 2015 and November 2016 (Fig. 1). The inclusion criteria included clinically diagnosed patients with a mild or moderate degree of COPD, aged 40 years or older and able to walk independently. The exclusion criteria comprised acute exacerbation within 4 weeks before starting the study and having significant, cognitive impairment, tuberculosis, asthma, and musculoskeletal, psychological, cardiovascular and benign conditions that preclude exercise. Sample size calculation was based on previous findings of the therapeutic effects of Qigong on functional capacity by using the 6-min walk test (6MWT),22 with a power of 80% and an alpha of 5%. Fifty subjects were recruited and randomly assigned to either of the two groups; TCQ (n = 25), or control group (n = 25).

2.3. Ethics approval

The study protocol was approved by the Research Ethics Committee, Faculty of Medicine, Chiang Mai University (Ref No: 497/2015). The participants gave their written informed consent before data collection began.

2.4. Intervention

The TCQ group received the TCQ programme, which was an 8-form modified TCQ from Dr. Pual Lam of the Tai Chi for Health Institute23 under supervision of one of its certified TCQ instructors. Participants attended TCQ classes 3 times a week in the center-based programme led by a TCQ instructor. They also were assigned to practice at home 2 times a week, and a TCQ poster was given to each participant in order to simplify self-practice at home. After 12 week of center-based TCQ training, all of the participants continued to practice at home, 3 times per week for a futher 12 weeks (i.e. total training duration = 24 weeks), with their training recorded in a logbook. Weekly phone calls and monthly home visits were implemented in order to facilitate adherence. The control group received usual care and did not received any interventions. They attended a meeting once a week for 12 consecutive week in order to share their health experience.

2.5. Outcome measurements

Outcome measurements were taken at baseline, and the 6th, 12th (end of center-based training) and 24th week (end of home-based training). The primary outcomes were functional capacity and lung function. The secondary outcomes were dyspnea score and quality of life.

2.5.1. Primary outcomes

Functional capacity was assessed by using the 6-min walk test (6MWT),24 which measures the distance that an individual is able to walk as far as possible in 6 min.

Lung functions, including forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC), were measured by spirometry.

2.5.2. Secondary outcome

Dyspnea score was measured by using a Thai version of the modified Medical Research Council Dyspnea Scale (mMRC). In a scale of 0–4, 0 indicates “only gets breathless with strenuous exercise” and 4 indicates “too breathless”.24

Quality of life was assessed using a Thai version of the St. George's Respiratory Questionnaire (SGRQ), which is used for a specific measurement of quality of life in COPD patients and a 50-item questionnaire designed to measure the impact of COPD. Score ranged from 0 to 100, with higher scores indicating more limitations.25, 26

2.6. Statistics

Data were analysed using SPSS version 22.0. Independent t-tests and chi-square tests, were conducted to compare the demographic characteristics and all baseline outcomes measured between the TCQ and control group. The pair t-test was used to compare the mean differences within each group. The independent t-test was used to assess the mean difference (i.e. 24th week-baseline) between the two groups. A p-value of <0.05 (2-sided) was set as the level of statistical significance. The 95% confidence intervals around the mean differences were calculated. The principle of intention-to-treat was applied to all analyses.

3. Results

A total of 175 individuals with COPD were screened and assessed, of which 50 were eligible to participate and complete the study at week 24 (TCQ group = 25, Control group = 25). None of the participants dropped out of the study. The flow of participants throughout the trial is shown in Fig. 1. Demographic data and baseline characteristics of the participants are presented in Table 1. No statistically significant difference was found in any of the demographic variables (Table 1).

 

Conclusion

In conclusion, this study demonstrated that combined center and home-based TCQ training improves functional capacity, dyspnea score, the quality of life of individuals with mild to moderate COPD. Furthermore, TCQ is safe and feasible for mild to moderate COPD patients to practice at home.

 

The full article including all charts etc can be found at https://www.sciencedirect.com/science/article/pii/S222541101830748X