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Tai chi, originally a Chinese martial arts, practises physical and mental integration with large, slow, and gracious movements. Tai chi has been shown to improve balance and prevent falls,1 increase flexibility,2 improve physical function,3,4 and has recently been applied in osteoarthritis.5,6 Little is known about possible beneficial effects of tai chi in rheumatoid arthritis (RA). We therefore performed an 8 week pilot study to explore the efficacy of a tai chi instruction programme on disease related measures in patients with RA.
PATIENTS AND METHODS
Fifteen women with RA aged 40–70 years (mean (SD) age 57.0 (8.6) years, mean (SD) disease duration 12.3 (5.7) years) with at least moderate disability (modified Health Assessment Questionnaire (MHAQ) ⩾1.5) 1 year before the study were randomly selected from the Oslo RA register and included.
Before, after 4 weeks of intervention, and within 1 week after completion of the 8 week intervention, patients were examined by blinded assessors. Self reported health status included the HAQ, Short Form-36 (SF-36), physical scales from the Arthritis Impact Measurement Scales (AIMS-2), pain, global assessment of disease activity, fatigue (100 mm visual analogue scale), and self efficacy.
At the final examination patients stated preferences for tai chi compared with previous conventional exercise, considering the usefulness of the method and the enjoyment experienced (100 mm Likert scales (50 = equality, 100 favours tai chi)). Physical performance tests measured muscle function in the shoulders and arms (high scores = good function),7 the index of muscle function in the lower extremities (low scores = good function),8 grip strength (Grippit handgrip force in the dominant hand), and the 6 minute walking test. The disease activity score (DAS28) was calculated from 28 joint counts, erythrocyte sedimentation rate, and patient global assessment.
The teaching programme included a standardised 8 week instruction programme with tai chi exercise (adapted Sun style for patients with arthritis9) twice weekly for 45 minutes, given by two instructors certified in teaching Sun style. The programme aimed at improving muscle strength, joint flexibility, and balance.
RESULTS AND DISCUSSION
All 15 patients completed the 8 week intervention and all assessments. No injuries were received during the exercise sessions. Self reported health status measures did not improve or deteriorate during the study (table 1). Similarly, no changes were seen in the performance measures (muscle strength, flexibility, balance, and cardiovascular fitness), joint counts, laboratory measures for inflammation, and disease activity. Patients, with the exception of two, clearly preferred tai chi to their previous physiotherapeutic intervention, finding it more useful and more enjoyable.
Tai chi instruction and exercise over 8 weeks in this study was safe und feasible, but it did not improve measures of physical function, self reported health status, or disease activity. However, most study subjects clearly favoured tai chi compared with other physical exercise. A major study limitation was the small number of subjects, and another, the short follow up. Usually an intervention period of 10–12 weeks with tai chi has been advocated,5,6,10 so that patients can adapt to the concept of tai chi and gradually increase exercise intensity. Furthermore, several of the physical performance measures showed a ceiling effect, with good scores at baseline, and measures with higher responsiveness should be selected. Tai chi has in other studies improved arthritic symptoms in osteoarthritis,5,6 but not in RA.10
These findings from a pilot study do not justify a controlled trial, but support further explorative investigations of tai chi in RA.