Effect of tai chi therapy on functional status and exercise capacity in patients with chronic heart failure: results of a randomized controlled trial

Background: Exercise training is an accepted component of therapy in patients with chronic heart failure, however, little is known about the potential effects of mind-body movement therapies such as Tai Chi in this population. This study investigated whether Tai Chi may be a beneficial adjunct to standard treatment in patients with chronic heart failure.
Methods: We randomized thirty patients with chronic stable heart failure, systolic dysfunction, and left ventricular ejection fraction £40% to receive either twelve weeks of supervised Tai Chi training (n=15) in addition to their usual care or usual care alone (n=15). Patients were recruited from heart failure specialty clinics. Usual care included pharmacologic therapy and diet counseling as described in current American College of Cardiology/American Heart Association Consensus Guidelines The Tai Chi intervention consisted of a 1-hour class twice weekly and a video for home practice Primary outcomes measured at baseline and at 12 weeks included quality of life using the Minnesota Living with Heart Failure Questionnaire (MLHF, range 0-105, 0=best) and exercise capacity using the six-minute walk test and peak oxygen uptake. Secondary outcomes included serum B-type natiuretic peptide (BNP), plasma catecholamines, and heart rate variability.
Results- The mean age (±SD) of study patients was 63.7± 13.4 years, mean baseline left ventricular ejection fraction (±SD) was 23± 7.9%, median New York Heart Association Class was 2, and 63% were male. The most common causes of heart failure were idiopathic dilated cardiomyopathy (56%) and ischemic cardiomyopathy (26%). Most patients were taking an ACE inhibitor (90%), beta-blocker (90%), and diuretic (93%). There were no significant differences between intervention and control patients at baseline. At 12 weeks, patients who participated in Tai Chi improved (lower) scores on the MLHF (change ± SEM -17± 3 vs. +8± 4 points, p<01), increased six-minute walk distance (change of+277± 39 vs. -206± 82, p<01) and improved (lower) BNP levels (-48±27 vs. +21±86 pg/ml, p=.03). Trends towards improvement were seen in peak oxygen uptake and heart rate variability. No differences between groups were detected in the catecholamine analysis.
Conclusion: Tai Chi may be a beneficial adjunct that enhances quality of life and functional capacity in patients with chronic heart failure who are already receiving optimal medical therapy.