Tai chi better for fibromyalgia than aerobic exercise

The slow movements of Tai Chi may offer more therapeutic value for patients with fibromyalgia than aerobic exercise, new research suggests.

Currently, moderate aerobic exercise is a recommended as standard care for fibromyalgia, but studies have suggested the ancient Chinese martial art of Tai Chi may be more effective, according to researchers from the Tufts University School of Medicine in Boston.

To test this hypothesis, they conducted a 52-week prospective single-blind comparative effectiveness study involving 226 adults with fibromyalgia, who were randomised into five groups.

One group was allocated to take part in a one-hour aerobic exercise class twice a week for 24 weeks, which progressively intensified to reach 40 minutes of aerobic training plus warm up and cool down.

The other four groups took part in ‘Yang style’ tai chi classes – which involved gentle low impact sequence of movements – delivered at different ‘doses’: once a week or twice a week for 12 weeks or 24 weeks.

During the study period, participants took their regular medication and were asked to keep up a daily routine, with those in the aerobic group assigned to 30 minutes walking and the tai chi groups asked to do a tai chi practice.

They were assessed for primary outcomes using the fibromyalgia impact questionnaire (FIQR) – which considers pain, physical function, fatigue, morning tiredness, depression, anxiety, job difficulty and overall wellbeing, and secondary outcomes including sleep and functional limitation, at 12, 24 and 52 weeks.

Published in the BMJ, the results showed at 24 weeks, all five groups had FIQR scores improved on baseline.

But those who undertook tai chi twice a week for 24 weeks showed a larger clinically important effect for the primary outcome, and significant effects for the secondary outcome, compared to those who undertook aerobic exercise.

At 52 weeks, the combined tai chi groups continued to show more improvement in most primary and secondary outcomes than the exercise group.

Additionally, attendance rates were higher in the tai chi groups than the aerobic exercise group (62% vs 40%).

When it came to comparisons within the tai chi groups, those who practised for 24 weeks achieved significant improvements in depression and mental health compared to those who stopped after 12, “indicating that psychological benefits might be associated with longer mind-body practice”, the authors write.

There were no significant differences between the groups that practiced tai chi weekly or twice weekly.

The authors suggest that with its slow, meditative movements and minimal side effects, tai chi may be “better embraced by patients with fibromyalgia in the long term” compared to aerobic exercise which is commonly prescribed.

Study lead author Professor Chenchen Wang, director of the Center for Complementary and Integrative Medicine in the Division of Rheumatology said it may be time to rethink what type of exercise is most effective for patients with fibromyalgia and consider what types  of exercise patients will embrace in the long term.

“Despite the well established benefits of aerobic exercise as a core standard treatment for fibromyalgia, patients in our trial had difficulty adhering to the aerobic exercise programmeThis may not be surprisingmany patients with fibromyalgia find performing and adhering to exercise programmes hard. Complaints such as “thfloor is too hard,” “I cannot stand this,” “I’m too tired,” or “I’m in too much pain” were common,” she wrote.

“What we found suggests that patients may be more likely to enjoy, manage, and continue to practise tai chi, perhaps because it involves gentle, low impact movements with minimal side effects.

“Therefore this mind-body approach may be considered a therapeutic option in the multidisciplinary management of fibromyalgia.”

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