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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