Tai Chi

To evaluate the feasibility of tai chi to improve well-being for women with breast cancer treatment-associated arthralgia

Women met twice weekly for eight weeks for group tai chi under supervision. The program was a gentle, low-impact form of tai chi focusing on body awareness, deep breathing, and weight bearing. Women were provided written information for home practice. Participants were asked to complete journal entries after each tai chi session and home exercise, encouraged to maintain usual activities, and asked to refrain from other exercise during the study. Study measures were obtained at baseline and at the end of 8 weeks.

• N = 12  
• MEAN AGE = 59 years (range = 49-76 years)
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: All had completed initial breast cancer treatment and were post-menopausal, currently free of disease, and on aromatase inhibitors.  
• OTHER KEY SAMPLE CHARACTERISTICS: 91.6% were white, one-third were employed full-time, and 58% had some college education.

• SITE: Single site
• SETTING TYPE: Outpatient   
• LOCATION: New Jersey

PHASE OF CARE: Late effects and survivorship

Single-group observational, mixed-method, feasibility

• Functional Assessment of Cancer Therapy–Breast (FACT-B)
• Brief Pain Inventory
• Hospital Anxiety and Depression Scale (HADS)
• Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-fatigue)
• Qualitative analysis of journal entries

There was a reduction in anxiety from 8.0 to 5.7 (p = .003) and in depression from 5.17 to 2.42 (p = .02). A positive, but non significant, reduction in fatigue and pain occurred. Themes from analysis of qualitative results were improved relaxation and reduced stress, an increase in undisturbed sleep, and perceived value from the group and instructor support. There were no adverse events.

Tai chi participation appears to be feasible for breast cancer survivors and may have positive effects on anxiety and other symptoms.

• Small sample (< 30)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Risk of bias (no appropriate attentional control condition) 
• Risk of bias (sample characteristics)
• Other limitations/explanation: Adherence to sessions is not reported. Sample was limited to women on aromatase inhibitors experiencing pain from arthralgia.

Tai chi sessions are feasible for cancer survivors and may be of benefit. This combination of relaxation and exercise disciplines may be helpful and acceptable to some patients. Study findings here suggest that the supportive nature of instructor-led group sessions contributed to the positive results.

To assess the effectiveness of Tai Chi in managing cancer-related fatigue

Patients were randomized to the Tai Chi or low-impact exercise groups. Tai Chi was taught by instructors in the community and via DVD. Patients were enrolled during hospitalization for chemotherapy. Sessions were conducted for 12 days during each course of chemotherapy every other day across four courses of treatment. Study assessments were conducted prior to the first and third courses of chemotherapy and at the end of the fourth course.

• N = 91
• MEAN AGE = Not reported. Forty-four percent were aged over 60 years.
• MALES: 74.7%, FEMALES: 25.3%
• KEY DISEASE CHARACTERISTICS: All had lung cancer; the majority had stage III or IV disease.
• OTHER KEY SAMPLE CHARACTERISTICS: The majority had sixth grade or less of education.

• SITE: Single site  
• SETTING TYPE: Home  
• LOCATION: China

• PHASE OF CARE: Active antitumor treatment

• Randomized, active, controlled trial

• Multidimensional Fatigue Inventory-Short Form (MFI-SF)

Fatigue scores increased in all patients. At six weeks, general and physical fatigue subscale scores were lower in the Tai Chi group (p < 0.05). Vigor scale scores were higher in the Tai Chi group (p < 0.05). These scores were also better in the Tai Chi group at 12 weeks (p < 0.05). No other differences existed between groups. 

Tai Chi was beneficial for patients with lung cancer to reduce treatment-related fatigue while undergoing chemotherapy.

• Small sample (< 100)
• Risk of bias (no blinding)
• Questionable protocol fidelity
• Subject withdrawals ≥ 10%  
• Whether exercise and Tai Chi sessions were done with instructors or self-managed in the home is unclear. Similarly, whether sessions were done in individual or group settings is unclear.
• Compliance with sessions was not evaluated.

The findings suggest that Tai Chi can be an effective intervention to combat fatigue during cancer treatment with chemotherapy. Exercise has been shown to be an effective intervention, and patients who did Tai Chi experienced less fatigue than those doing low-impact exercise. This study had multiple limitations, so the strength of this finding is limited. Additional research is warranted to provide strong support for this intervention.