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).

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.

Read the full abstract...
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 strategy: 

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.

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