Tai chi for treating rheumatoid arthritis
Editorial Group: Cochrane Musculoskeletal Group
Published Online: 19 JUL 2004
Assessed as up-to-date: 25 APR 2004
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Han A, Judd M, Welch V, Wu T, Tugwell P, Wells GA. Tai chi for treating rheumatoid arthritis. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD004849. DOI: 10.1002/14651858.CD004849.
- Publication Status: Edited (no change to conclusions)
- Published Online: 19 JUL 2004
Rheumatoid arthritis (RA) is a chronic, systemic inflammatory autoimmune disease that results in the destruction of the musculoskeletal system. The major goals of treatment are to relieve pain, reduce inflammation, slow down or stop joint damage, prevent disability, and preserve or improve the person's sense of well-being and ability to function. Tai Chi, interchangeably known as Tai Chi Chuan, is an ancient Chinese health-promoting martial art form that has been recognized in China as an effective arthritis therapy for centuries.
To assess the effectiveness and safety of Tai Chi as a treatment for people with RA.
We searched the Cochrane Controlled Trials Register (CCTR), MEDLINE, Pedro and CINAHL databases up to September 2002, using the Cochrane Collaboration search strategy for randomised controlled trials. We also searched the Chinese Biomedical Database up to December 2003 and the Beijing Chinese Academy of Traditional Medicine up to December 2003.
Randomized controlled trials and controlled clinical trials examining the benefits and harms of exercise programs with Tai Chi instruction or incorporating principles of Tai Chi philosophy were selected. We included control groups who received no therapy, sham therapy or another type of therapy.
Data collection and analysis
Two reviewers determined the studies to be included in this review, rated the methodological quality and extracted data using standardized forms.
Four trials including 206 participants, were included in this review. Tai Chi-based exercise programs had no clinically important or statistically significant effect on most outcomes of disease activity, which included activities of daily living, tender and swollen joints and patient global overall rating. For range of motion, Tai Chi participants had statistically significant and clinically important improvements in ankle plantar flexion. No detrimental effects were found. One study found that compared to people who participated in traditional ROM exercise/rest programs those in a Tai Chi dance program reported a significantly higher level of participation in and enjoyment of exercise both immediately and four months after completion of the Tai Chi program.
The results suggest Tai Chi does not exacerbate symptoms of rheumatoid arthritis. In addition, Tai Chi has statistically significant benefits on lower extremity range of motion, in particular ankle range of motion, for people with RA. The included studies did not assess the effects on patient-reported pain.
Plain language summary
Tai chi for rheumatoid arthritis
Does Tai Chi help people with rheumatoid arthritis?
To answer this question, scientists analysed 4 studies. The studies tested 202 people who had rheumatoid arthritis. Some people attended classes, were taught or practiced Tai Chi for 8 to 10 weeks. The other people did not receive classes with Tai Chi. The studies were not high quality but this Cochrane Review provides the best evidence about Tai Chi that we have today.
What is Tai Chi and how could it help people with rheumatoid arthritis?
Rheumatoid arthritis is a disease in which the body's immune system attacks its own healthy tissues. The attack happens mostly in the joints of the feet and hands and causes redness, pain, swelling and heat around the joint. Tai Chi, also called 'Tai Chi Chuan' combines deep breathing and relaxation with slow and gentle movements. In older people, Tai Chi has been shown to decrease stress, increase muscle strength in the lower body, and improve balance, posture and the ability to move. It is not known whether Tai Chi could provide the same benefits for people with rheumatoid arthritis.
Does Tai Chi work?
Two studies tested and showed that people's ability to do daily chores, the tenderness in their joints, the number of swollen joints they had and the strength of their grip was about the same whether they did Tai Chi or not.
One study tested and showed that the range of motion of the ankle, hip and knee improved more when doing Tai Chi than not doing Tai Chi. After 10 weeks of Tai Chi and then 4 months later, people doing Tai Chi enjoyed the programme and felt that they had improved more than people who did not do Tai Chi.
The studies, however, did not test for improvements in pain or quality of life.
Were there any side effects?
In two of the studies, about one third of the people doing Tai Chi complained of a sore knee, shoulder or lower back during the first 3 weeks but the pain did decrease and they continued to do Tai Chi (except in one person). More people left the studies when they did not do Tai Chi.
What is the bottom line?
There is "silver" level evidence that Tai Chi improves the range of motion of the ankle, hip and knee in people with rheumatoid arthritis. It did not improve people's ability to do chores, joint tenderness, grip strength or their number of swollen joints nor did it increase their symptoms of rheumatoid arthritis. But, people felt that they improved when doing Tai Chi and enjoyed it.
It is still not known if it improves pain in rheumatoid arthritis or that person's quality of life. It is also not clear how much, how intense and for how long Tai Chi should be done to see benefits.
Based on Han A, Robinson V, Judd M, Taixiang W, Wells G, Tugwell P. Tai Chi for Treating Rheumatoid Arthritis. In The Cochrane Library, Issue 3, 2004 (in press).
搜尋包括Cochrane Controlled Trials Register (CCTR) EDLINE, Pedro and CINAHL databases up to September 2002。同時搜尋Chinese Biomedical Database up to December 2003 and the Beijing Chinese Academy of Traditional Medicine up to December 2003。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
是否太極可幫助類風濕關節炎患者？要回答這個問題，科學家分析了4個研究。該研究測試了202位風濕性關節炎患者。有些人參加課程，被教導或練習太極拳 8至10週。其他人則沒有上太極課。這些研究不是高品質但是Cochrane review提供了今日我們所擁有關於太極最好的證據。什麼是太極及它如何能幫助類風濕關節炎患者？類風濕關節炎是人體的免疫系統攻擊其自身的健康組織的一種疾病。攻擊大多發生在手腳關節，造成紅腫，疼痛，腫脹和關節周圍熱。太極，也叫做‘太極拳’結合深呼吸和透過緩慢溫柔的運動來放鬆。在老年人身上，太極拳已被證明可減少壓力，增加肌肉強度在下半身，並且改善平衡，姿態和行走能力。目前還不知道是否太極能夠提供類風濕關節炎患者相同的好處。是否太極有用嗎？2項研究測試變且顯示患者做日常家務的能力，關節壓痛，關節腫脹的數目，握力在病患是否有無作太極都大致相同。一項研究測試表明，比起不打太極拳，打太極拳病人的踝關節，髖關節和膝關節運動範圍提高。 在做了10週後的太極，然後 4個月後，患者再打太極拳時會很喜歡這個項目，並認為他們得到了改善勝過沒有做太極的人。但是這些研究並沒有測試疼痛或生活品質的改善。有沒有什麼副作用？在2個研究中，約三分之一的人在剛開始3周打太極拳完會抱怨膝蓋，肩膀或下背疼痛，但疼痛會減少，他們繼續做太極拳(除1人沒有)。在沒有做太極組，更多的人離開試驗。什麼是底線？有“銀”級的證據表明太極拳可促進類風濕關節炎的患者踝關節，髖關節和膝關節運動範圍。它無法改善患者做家務能力，關節壓痛，握力或關節腫脹數目，但也沒有增加他們類風濕關節炎的症狀。但是，患者感到他們在打太極拳是有改善和享受它的。目前尚不知道是否能改善類風濕關節炎的疼痛，或該人的生活品質。也還不清楚太極要作多少、多強，多久才能見效益。根據Han A, Robinson V, Judd M, Taixiang W, Wells G, Tugwell P. Tai Chi for Treating Rheumatoid Arthritis. In The Cochrane Library, Issue 3, 2004(in press)