Intervention Review

Tai chi for treating rheumatoid arthritis

  1. Alice Han1,*,
  2. Maria Judd2,
  3. Vivian Welch3,
  4. Taixiang Wu4,
  5. Peter Tugwell5,
  6. George A Wells6

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 19 JUL 2004

Assessed as up-to-date: 25 APR 2004

DOI: 10.1002/14651858.CD004849


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.

Author Information

  1. 1

    Toronto, Ontario, Canada

  2. 2

    Canadian Health Services Research Foundation/Fondation canadienne de la recherche sur les services de santé, Research Use/Agente principale de programme, Utilisation de la Recherche, Ottawa, Ontario, Canada

  3. 3

    University of Ottawa, Centre for Global Health, Institute of Population Health, Ottawa, Ontario, Canada

  4. 4

    West China Hospital, Sichuan University, Chinese Cochrane Centre, Chinese Clinical Trial Registry, Chinese EBM Centre, INCLEN Resource and Training Centre, Chengdu, Sichuan, China

  5. 5

    Ottawa Hospital, Centre for Global Health, Institute of Population Health, Department of Medicine, Ottawa, Ontario, Canada

  6. 6

    University of Ottawa Heart Institute, Cardiovascular Research Reference Centre, Ottawa, Ontario, Canada

*Alice Han, 5-83 Pape Avenue, Toronto, Ontario, M4M 2V5, Canada. alice.han@mail.mcgill.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 JUL 2004

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

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.

Objectives

To assess the effectiveness and safety of Tai Chi as a treatment for people with RA.

Search methods

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.

Selection criteria

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.

Main results

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.

Authors' conclusions

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

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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).

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以太極運動治療類風濕性關節炎

類風濕性關節炎是一種慢性發炎自體免疫疾病造成骨骼肌肉系統疾病。治療主要目標為疼痛緩解、減少發炎、延緩或停止關節破壞、預防失能、增進病患自我良好感覺及活動功能。太極拳是中國數百年來當治療類風濕性關節炎之方法。

目標

評估太極拳治療類風濕性關節炎之效果及安全性。

搜尋策略

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。

選擇標準

隨機對照試驗研究評估太極指導運動或運用太極哲學治療類風濕性關節炎之效果及害處。太極治療與安慰劑或假治療或另一種治療方式比較。

資料收集與分析

兩位作者獨立以標準格式進行資料摘錄,並對每篇試驗研究的品質進行評估。

主要結論

4個研究包含206例病患於分析中。太極治療在大部分疾病活動性並無顯著差異,包括日常生活、關節疼痛及腫脹、病人整體自我評估。在踝關節掌屈活動度,太極治療有顯著增加及臨床改善,無不良作用。一篇研究指出不論是運動完馬上或完成4個月後,太極舞比傳統關節活動度運動在參與度及享受運動快樂方面較佳。

作者結論

研究顯示太極治療不會惡化類風濕性關節炎之症狀。此外太極治療改善下肢關節活動度,特別是踝關節。這些研究未評估患者自評疼痛。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

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)