Could Tai Chi Encourage More Patients to Take Up Cardiac Rehab?

Preliminary research suggests that tai chi, with its slow, gentle approach, might offer a safe and attractive option for patients who do not take up conventional cardiac rehabilitation.

A report on the study, which has been published in the Journal of the American Heart Association, explains that the majority of heart attack patients who are offered cardiac rehab refuse it, in many cases because they are put off by physical exercise.

Some patients are put off cardiac rehab because they believe that it might be painful, unpleasant, or perhaps not even achievable in their current physical condition.

In the United States, heart disease accounts for 1 in 4 deaths and claims 600,000 lives per year. It is the leading cause of death for men and women.

Of the 735,000 people in the U.S. who experience a heart attack every year, 2 out of 7 have already had a heart attack.

Need to improve cardiac rehab usage

At present in the U.S., despite evidence of its benefits, more than 60 percent of patients decline conventional cardiac rehabilitation following a heart attack.

Given this situation, the study authors urge that there is a need to improve the take-up rate of cardiac rehabilitation, to get patients more physically active and reduce their heart risk.

“We thought,” explains lead author Elena Salmoirago-Blotcher, an assistant professor of medicine at the Warren Alpert School of Medicine at Brown University in Providence, RI, “that tai chi might be a good option for these people because you can start very slowly and simply and, as their confidence increases, the pace and movements can be modified to increase intensity.”

As well as helping to achieve low- to moderate-intensity physical activity, tai chi’s emphasis on breathing and relaxation might also relieve stress and reduce psychological distress, she adds.

Therefore, the team carried out a randomized, controlled trial to find out how safe and acceptable tai chi might be – as well as what impact it might have on weight, physical activity, fitness, and quality of life – for heart patients who had refused conventional rehabilitation therapy.

Trial tested LITE and PLUS tai chi programs

The trial compared two regimes: a PLUS and a LITE tai chi program, both adapted from a routine used for patients with lung disease and heart failure.

The PLUS program consisted of 52 classes of tai chi over 24 weeks. The LITE program was a shorter version, with 24 classes over 12 weeks. All participants were also given an instructional DVD so that they could practice tai chi at home during and after the program.

The participants were 29 coronary heart disease patients (21 men and 8 women) – aged 67.9 years, on average – who were physically inactive and had declined cardiac rehabilitation but expressed an interest in a tai chi program. Nine patients were enrolled in the LITE program and 21 on the PLUS.

None of the participants had physical conditions that would preclude they’re being able to do tai chi (for example, recent joint replacement or other orthopedic condition).

Most of the group had had a previous heart attack or undergone a procedure to open a blocked artery, and all continued to have high cardiovascular risk factors.

These factors included having high cholesterol (75.9 percent of the group), having diabetes (48.3 percent), being obese (45 percent) or overweight (35 percent), and continuing to smoke (27.6 percent).

‘Safe bridge to more strenuous exercise’

The results of the trial showed that tai chi was safe: apart from some mild muscular pain at the start of the program, there were no adverse side effects from the tai chi itself.

The participants liked the program that they completed, and all of them said that they would recommend it to a friend.

The researchers say that the attendance level – participants went to 66 percent of scheduled classes – showed that the tai chi program was “feasible.”

Although neither program raised aerobic fitness, as measured after 3 months, the participants on the PLUS program did have higher levels of moderate to vigorous activity after 3 and 6 months.

“On its own,” says Prof. Salmoirago-Blotcher, “tai chi wouldn’t obviously replace other components of traditional cardiac rehabilitation, such as education on risk factors, diet, and adherence to needed medications.”

In an accompanying article on possible ways to improve the take-up of cardiac rehabilitation, a panel of experts writes that it “remains powerful, yet underutilized, tool” in the management of patients following a heart attack or blocked artery procedure.

They suggest that the tai chi study offers an option “that addresses barriers at the individual level (e.g., negative sentiment toward exercise).”

If proven effective in larger studies, it might be possible to offer it as an exercise option within a rehab center as a bridge to more strenuous exercise, or in a community setting with the educational components of rehab delivered outside of a medical setting.”

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About Malanga

People in many parts of the world may not be familiar with malanga. However, this root vegetable has been farmed longer than many other plants.

According to the University of Florida’s Institute of Food and Agricultural Sciences, malanga goes by many other names, including “…yautia, cocoyam, eddo, coco, tannia, sato-imo, and Japanese potatoes.” The scientific name for malanga is Xantyosoma sagittifolium, but it is more commonly known as the elephant ear plant.

In this article, we take a look at malanga, examining its nutritional content, possible health benefits, and how to include this root vegetable in a diet.

What is malanga?

Malanga root vegetable chopped up on wooden background.
Malanga is a type of root vegetable grown in the Caribbean. The part of the plant that is eaten is the tuber, similar to a potato.

Malanga originated in South America, but it is now grown in the Caribbean, Central America, and certain parts of Africa and Asia.

It is sometimes confused with other tropical root vegetables, such as taro. The two plants have subtle differences in their structures. The malanga plant has sizeable leaves and may grow to be more than 5 feet tall.

The part of the malanga plant that is eaten is known as a tuber. The tubers grow underground and are similar in size to a potato. People should remove the brown, hairy skin of the tubers before eating them.

The flesh of the malanga root is light-colored and can be prepared using a variety of cooking methods, such as baking, frying, and stewing. Malanga can also be ground to make flour for baking.

Nutritional information

According to the American Diabetes Association, 1/3 cup cooked malanga provides the following:

  • 70 kilocalories
  • 0.1 g of fat
  • 16 g of carbohydrate
  • 1 g of protein

The same amount provides 3 g of fiber, which is 10 percent of the daily recommended amount of fiber for adults.

Regarding vitamins and minerals, 1/3 cup cooked malanga provides the following proportions of daily recommended amounts:

  • potassium: 9 percent
  • phosphorus: 5 percent
  • magnesium: 5 percent

It also contains smaller amounts of vitamin C, calcium, iron, and folate.

Possible health benefits

There have not been many studies specifically looking at the health benefits of malanga. One study in rats did report that malanga may be a source of antioxidants.

However, malanga contains many components that have been associated with health benefits.

Cholesterol

Malanga contains insoluble fibre, which may help to manage and reduce blood pressure and cholesterol levels.

While it is usually the root of the malanga plant that is eaten, one study looked at the benefits of consuming fiber from malanga leaves.

The leaves contain a type of fiber called insoluble fiber. This type of fiber has been associated with an improved digestive function, lower risk of colon cancer, and healthier weight.

In contrast, soluble fiber is mainly associated with blood pressure and cholesterol improvements.

All of the rats in the study were fed a high-fat diet, but some of the rats also received varying types of dietary fiber. At the end of the study, the rats that ate the malanga leaf had significantly lower total cholesterol levels than the other rats, despite the malanga containing mainly insoluble fiber.

The malanga root itself is also a good source of fiber. As mentioned above, 1/3 cup of cooked malanga contains 10 percent of an adult’s daily recommended amount of fiber.

review of studies found that eating more fiber is associated with significantly lower total and LDL (or “bad”) cholesterol levels. Since high cholesterol is a risk factor for heart disease, eating more fiber may help protect against heart disease.

Weight

Besides its effects on blood cholesterol levels, dietary fiber may also play a role in weight management. This is important because obesity is a risk factor for many chronic diseases.

In the same study mentioned above, rats in the malanga leaf group gained less weight than the other groups.

review of studies found that a diet higher in fiber may help prevent weight gain. Adding malanga to a diet is one way to increase fiber intake.

Blood pressure

A 1/3 cup serving of cooked malanga provides 320 milligrams (mg) of potassium. Some studies have reported that there is an association between dietary potassium intake and blood pressure.

In one study, higher potassium intake was associated with a significantly lower risk of high blood pressure. This is important because high blood pressure increases the risk of heart disease and stroke. Potassium relaxes blood vessels, which lessens the work required by the heart to pump blood through the body.

How to incorporate malanga into a diet

Stew with meat and root vegetables.
Malanga can be used to replace potato and may be included in a variety of dishes, including stews.

There are many ways to include malanga into a diet. Malanga is available in many Latin American grocery stores, as well as some supermarket chains.

The vegetable needs to be washed, peeled and cooked before being eaten. People should not eat malanga raw.

Malanga has a similar texture as potatoes and can replace potatoes in many recipes. Malanga flour can also be used to replace wheat flour in baked goods.

Malanga is described as having a woody or earthy taste with a hint of nuts.

Boiled malanga can be mashed with milk and olive oil to make a tasty side dish. It is a natural thickener and can be added to soups and stews.

Recipe ideas

See below for recipes that use malanga:

Possible risks

Malanga is likely safe for most people, except for those who are allergic to it or have certain medical conditions.

In general, malanga is considered a well-tolerated food that is unlikely to cause an allergic reaction.

A 1/3 cup serving of cooked malanga has 320 mg of potassium. According to the National Kidney Foundation, foods that contain more than 200 mg of potassium per serving are considered high potassium.

Some people with kidney disease or those who take certain medications may need to limit high-potassium foods. Having too much potassium in the blood can cause dangerous side effects, such as abnormal heart rhythm and weakness.

Anyone who is concerned should check with their doctor to see if they need to limit potassium in their diet.

Overall, malanga provides many useful nutrients. Some of these nutrients may offer health benefits when included as part of a healthful diet.

Malanga is well-known in many parts of the world but not commonly eaten in others. As interest in regional cuisines grows, malanga may become even more widely available.

Although not a familiar taste for some, it is a versatile root vegetable that can be used in many recipes.