Impact of Tai Chi on CRP, TNF-alpha and IL-6 in inflammation: a systematic review and meta-analysis

Background:
Previous studies have reported that C reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), and interleukin-6 (IL-6) in Coronavirus disease 2019 (COVID-19) patients are significantly increased, and their progressive increases are clinical warning indicators of severe and critical severity. The purpose of this meta-analysis is to evaluate the efficacy of Tai Chi on CRP, TNF-alpha and IL-6, and provide a basis for complementary treatment of COVID-19.

Methods:
Five English databases (PubMed, Web of Science, Physiotherapy Evidence Database, Cochrane Library and Embase) and four Chinese electronic databases (CNKI, Wanfang, China Science and Technology Journal Database and SinoMed) were searched from inception to April 1st, 2020. Combination MeSH and free text terms were used to make up search strategy. Interventions in RCTs were Tai Chi with or without comparison (usual care, health education, drug therapy, psychosocial therapy). Revman version 5.3 was used to analyze the extracted data. Continuous outcomes were described by SMD, and the I2 test was used to assess heterogeneity. Revised Physiotherapy Evidence Database scale was used to assess methodological quality.

Results:
Nine RCTs involving 571 participants met the inclusion criteria, and the sample size ranged from 19 to 100 per study. Tai Chi can significantly reduce TNF-alpha (Tai Chi intervention: SMD =-0.92, 95% CI: -1.32 to -0.53; Tai Chi plus drug treatment intervention: SMD =-0.63, 95% CI: -1.15 to -0.11), moreover, it could reduce the amount of IL-6 (Tai Chi intervention: SMD =-0.62, 95% CI: -1.00 to -0.23; Tai Chi plus drug treatment intervention: SMD =-2.17, 95% CI: -3.69 to -0.64) and CRP (Tai Chi plus drug treatment intervention: SMD =-1.98, 95% CI: -2.47 to -1.50) while with a high exercise amount. A low exercise amount of Tai Chi showed poor efficacy on CRP (Tai Chi intervention: SMD =-0.18, 95% CI: -0.61 to 0.25; Tai Chi plus drug treatment intervention: SMD =-0.15, 95% CI: -0.47 to 0.16) and IL-6 (Tai Chi intervention: SMD =0.15, 95% CI: -0.24 to 0.55).

Discussion:
The strength of evidence might be limited due to relatively low methodological quality, heterogeneity and indirectness. The overall results elucidate that Tai Chi could significantly reduce TNF-alpha while it did not show the same effects in IL-6 and CRP. After subgroup analysis, Tai Chi with a high exercise amount can reduce IL-6 and CRP. Tai Chi with a high exercise amount could be suggested as a complementary intervention for people with COVID-19.

Trial registration:
PROSPERO CRD42020177655.

Keywords: Tai Chi; inflammation; meta-analysis.

PMID: 34353036 DOI: 10.21037/apm-21-640