Abstract
BackgroundPsychological risk factors have been recognised as potential, modifiable risk factors in the development and progression of cardiovascular disease (CVD). Tai Chi, a mind-body exercise, has the potential to improve psychological well-being and quality of life. We aim to assess the effects and safety of Tai Chi on psychological well-being and quality of life in people with CVD and/or cardiovascular risk factors.MethodsWe searched for randomised controlled trials evaluating Tai Chi for psychological well-being and quality of life in people with CVD and cardiovascular risk factors, from major English and Chinese databases until 30 July 2021. Two authors independently conducted study selection and data extraction. Methodological quality was evaluated using the Cochrane Risk of Bias tool. Review Manager software was used for meta-analysis.ResultsWe included 37 studies (38 reports) involving 3525 participants in this review. The methodological quality of the included studies was generally poor. Positive effects of Tai Chi on stress, self-efficacy, and mood were found in several individual studies. Meta-analyses demonstrated favourable effects of Tai Chi plus usual care in reducing anxiety (SMD − 2.13, 95% confidence interval (CI): − 2.55, − 1.70, 3 studies, I2 = 60%) and depression (SMD -0.86, 95% CI: − 1.35, − 0.37, 6 studies, I2 = 88%), and improving mental health (MD 7.86, 95% CI: 5.20, 10.52, 11 studies, I2 = 71%) and bodily pain (MD 6.76, 95% CI: 4.13, 9.39, 11 studies, I2 = 75%) domains of the 36-Item Short Form Survey (scale from 0 to 100), compared with usual care alone. Tai Chi did not increase adverse events (RR 0.50, 95% CI: 0.21, 1.20, 5 RCTs, I2 = 0%), compared with control group. However, less than 30% of included studies reported safety information.ConclusionsTai Chi seems to be beneficial in the management of anxiety, depression, and quality of life, and safe to practice in people with CVD and/or cardiovascular risk factors. Monitoring and reporting of safety information are highly recommended for future research. More well-designed studies are warranted to determine the effects and safety of Tai Chi on psychological well-being and quality of life in this population.Systematic review registrationInternational Prospective Register for Systematic Reviews (PROSPERO), CRD42016042905. Registered on 26 August 2016.
Highlights
Psychological risk factors have been recognised as potential, modifiable risk factors in the development and progression of cardiovascular disease (CVD)
Stress, anxiety, and depression have been increasingly recognised as the potential, modifiable non-physical cardiovascular risk factors that are associated with the development of CVD [11, 12], they are frequently undertreated among people with CVD [13] or cardiovascular risk factors [14]
There is still no consensus on the minimal important difference (MID) and minimal clinically important difference (MCID) of SF-36 in patients with cardiovascular risk factors or CVDs, prior systematic reviews of MID and MCID in health-related quality of life demonstrated that MID for SF-36 in patients with pulmonary fibrosis ranged from 2 to 4 points and in patients with prostate cancer ranged from 6 for mental health to 14 for role physical [74]
Summary
Psychological risk factors have been recognised as potential, modifiable risk factors in the development and progression of cardiovascular disease (CVD). Tai Chi, a mind-body exercise, has the potential to improve psychological well-being and quality of life. We aim to assess the effects and safety of Tai Chi on psychological well-being and quality of life in people with CVD and/or cardiovascular risk factors. Exercise-based cardiac rehabilitation (CR) is effective in supporting longterm lifestyle changes, reducing the risk of cardiovascular mortality, improving health-related quality of life (QoL), and reducing hospital readmissions [5, 6]. Given the number of people with CVD is increasing worldwide [1], a novel, effective and alternative exercise option to increase the uptake of CR and improve psychological outcomes and QoL in these populations is needed [15, 16]
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