Tai Chi May Help Reduce Pain of Knee Osteoarthritis in Older Patients
By Laurie Barclay, MD
Medscape Medical News
November 2, 2009 — Tai Chi exercise may help reduce the pain of knee osteoarthritis (OA) in older patients, according to the results of a prospective, single-blind, randomized controlled trial reported in the November issue of Arthritis Care Research. This physical discipline is a traditional style of Chinese martial arts using slow, rhythmic movements to promote mental relaxation and improve balance, strength, and flexibility.
"Tai Chi is a mind-body approach that appears to be an applicable treatment for older adults with knee OA," lead author Chenchen Wang, MD, MSc, from Tufts University School of Medicine in Boston, Massachusetts, said in a news release. "Our observations emphasize a need to further evaluate the biologic mechanisms and approaches of Tai Chi to extend its benefits to a broader population."
The study sample consisted of 40 patients from the greater Boston area who had confirmed, symptomatic knee OA but who were in good health otherwise. Mean age was 65 years, and mean body mass index was 30.0 kg/m2. Patients were randomly assigned to a Tai Chi group or to an attention control group, and both groups had sessions twice weekly for 12 weeks. Analysis was by intent-to-treat, and assessments were performed at 12, 24, and 48 weeks.
The Tai Chi intervention consisted of 60-minute Yang-style sessions, each of which included 10 minutes of self-massage and a review of Tai Chi principles, 30 minutes of Tai Chi movement, 10 minutes of breathing technique, and 10 minutes of relaxation.
The attention control group also had 60-minute sessions, each consisting of 40 minutes of education about OA, dietary and nutrition recommendations, appropriate therapies for OA, or physical and mental health education. This was followed by 20 minutes of stretching exercises for the upper body, trunk, and lower body, with each stretch held for 10 to 15 seconds.
After completion of the 12-week intervention, knee pain was significantly less in the Tai Chi group vs the control group, with a –118.80-mm difference in improvement from baseline on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale (95% confidence interval, –183.66 to –53.94; P = .0005).
Secondary outcomes of physical function, self-efficacy, depression, and health status for knee OA were also significantly better in the Tai Chi group vs the control group. No severe adverse events were observed.
Limitations of this study include more severe knee OA in the attention control group, possible unidentified confounding, relatively small sample size, incomplete blinding, and limited generalizability because instruction was given by a single Tai Chi master.
"Tai Chi reduces pain and improves physical function, self-efficacy, depression, and health-related quality of life," the study authors write.
They also note that physical components of Tai Chi meet current exercise recommendations for OA, including range-of-motion and flexibility exercises, muscle conditioning, and aerobic training. Furthermore, they suggest that the mental discipline of Tai Chi may minimize negative effects of chronic pain by improving psychological well-being, life satisfaction, and perceptions of health.
The National Center for Complementary ad Alternative Medicine of the National Institutes of Health supported this study, but the conclusions are solely those of the study investigators. The study authors have disclosed no relevant financial relationships.
