Tai Chi Chih Research Articles

Grey matter volume predicts improvement in geriatric depression in response to Tai Chi compared to Health Education.

Geriatric depression (GD) is associated with cognitive impairment and brain atrophy. Tai-Chi-Chih (TCC) is a promising adjunct treatment to antidepressants. We previously found beneficial effects of TCC on resting state connectivity in GD. We now tested the effect of TCC on gray matter volume (GMV) change and the association between baseline GMV and clinical outcome. Forty-nine participants with GD (>=60 y) underwent antidepressant treatment (38 women). Participants completed 3 months of TCC (N = 26) or health and wellness education control (HEW; N = 23). Depression and anxiety symptoms and MRI scans were acquired at baseline and 3-month follow-up. General linear models (GLMs) tested group-by-time interactions on clinical scores. Freesurfer 6.0 was used to process T1-weighted images and to perform voxel-wise whole-brain GLMs of group on symmetrized percent GMV change, and on the baseline GMV and symptom change association, controlling for baseline symptom severity. Age and sex served as covariates in all models. There were no group differences in baseline demographics or clinical scores, symptom change from baseline to follow-up, or treatment-related GMV change. However, whole-brain analysis revealed that lower baseline GMV in several clusters in the TCC, but not the HEW group, was associated with larger improvements in anxiety. This was similar for right precuneus GMV and depressive symptoms. While we observed no effect on GMV due to the interventions, baseline regional GMV predicted symptom improvements with TCC but not HEW. Longer trials are needed to investigate the long-term effects of TCC on clinical symptoms and neuroplasticity.

Inflammatory Markers of Geriatric Depression Response to Tai Chi or Health Education Adjunct Interventions

Underlying inflammation is associated with an increased risk of depression in older adults. In this study, we examined the role of inflammatory biomarkers in antidepressant response in depressed older adults undergoing adjunct Tai Chi Chih (TCC) or Health education interventions. Older adults aged 60 years and above with a diagnosis of major depression were randomized to 12 weeks of TCC versus Health and Wellness Education (HEW) as an adjunct therapy to their stable antidepressant treatment regimen. A panel of 19 cytokine/chemokines was measured at baseline and 12 weeks. Five factors were derived using factor analysis. General linear models were estimated to examine the change in factor scores and the association of these changes on depression remission rates, controlling for age, sex, and body mass index. Of the 170 randomized participants (TCC: n=85 and HEW: n=85), 55 TCC and 58 HEW completed the 3-month assessment. The groups did not differ at baseline in any measure. At follow-up, neither the changes in cytokine/chemokines scores nor the depression remission rate differed significantly between TCC and HEW. However, remitters and non-remitters differed significantly in changes in a factor composed of growth-regulated oncogene protein-alpha (GRO-alpha), epidermal growth factor (EGF), and soluble CD40 ligand (sCD40L). GRO-alpha and EGF levels (in both groups) were significantly increased in remitters compared to non-remitters. Changes in certain cytokines/chemokines may accompany improvement in depressive symptoms in older adults. Future studies will need to explore the role of these molecules in remission of late-life depression.

Impact of Tai Chi as an adjunct treatment on brain connectivity in geriatric depression

BackgroundAs an adjunct to antidepressant treatment, Tai Chi Chih (TCC) is superior to health education and wellness (HEW) training in improving the general health of patients with geriatric depression (GD). This study investigated the brain connectivity changes associated with TCC and HEW in combination with antidepressant treatment in patients with GD. MethodsForty patients with GD under stable antidepressant treatment underwent TCC training (n = 21) or HEW training (n = 19) for 12 weeks, and completed baseline and 3-month follow-up resting state magnetic resonance imaging scans. Within-group and between-group differences in parcel-to-parcel connectivity changes with intervention were evaluated by general linear modeling. Relationships between significant connectivity changes and symptom/resilience improvement were evaluated by partial least squares correlation analysis. ResultsSignificantly greater increases in connectivity with TCC than with HEW (FDR-corrected p < .05) were observed for 167 pairwise connections, most frequently involving the default mode network (DMN). In both groups, increased connectivity involving largely DMN regions was significantly and positively correlated with improvement in symptoms/resilience. LimitationsThe sample size was relatively small, mainly due to neuroimaging contraindications (e.g., implants). Additionally, the standard antidepressant treatment varied greatly among patients, adding heterogeneity. ConclusionsNon-pharmacological adjuncts, such as TCC, may enhance DMN connectivity changes associated with improved depressive symptoms and psychological resilience in the treatment of GD.

A Randomized Controlled Trial of Tai Chi Chih or Health Education for Geriatric Depression

ObjectivesGeriatric depression is difficult to treat and frequently accompanied by treatment resistance, suicidal ideations and polypharmacy. New adjunctive mind-body treatment strategies can improve clinical outcomes in geriatric depression and reduce risk for side-effects of pharmacological treatments. MethodsWe conducted a 3-month randomized controlled trial to assess the efficacy and tolerability of combining Tai Chi Chih (TCC) or Health Education and Wellness training (HEW) with the stable standard antidepressant treatment on mood and cognitive functioning in depressed older adults (NCT02460666). Primary outcome was change in depression as assessed by the Hamilton Rating Scale for Depression (HAM-D) post-treatment. Remission was defined as HAM-D ≤ 6; naturalistic follow-up continued for 6 months. We also assessed psychological resilience, health-related quality of life and cognition. ResultsOf the 178 randomized participants, 125 completed the 3-month assessment and 117 completed the 6-month assessment. Dropout and tolerability did not differ between groups. Remission rate within TCC was 35.5% and 33.3%, compared to 27.0% and 45.8% in HEW, at 3 and 6 months respectively (χ2(1) = 1.0, p = 0.3; χ2(1) = 1.9, p =0.2). Both groups improved significantly on the HAM-D at 3 and 6 months. TCC demonstrated a greater improvement in general health compared to HEW. ConclusionsBoth TCC and HEW combined with a standard antidepressant treatment improved symptoms of depression in older adults. While TCC was superior to HEW in improving general health, we did not find group differences in improvement in mood and cognition.

Efeito do exercício físico nas funções cognitivas em idosos depressivos: revisão sistemática

Introdução: O exercício físico é considerado uma estratégia eficaz para reduzir os sintomas da depressão e melhorar as funções cognitivas. Objetivo: Sumarizar o efeito do exercício físico nas funções cognitivas em idosos depressivos. Métodos: Efetuou-se revisão sistemática conduzida em sete bases de dados, utilizando 32 descritores na língua inglesa, organizados em quatro grupos comando. Resultados: Dois ensaios clínicos foram incluídos, um aplicando treinamento combinado, e outro utilizando Tai Chi Chih. O período de intervenção variou de 4 a 14 semanas. A sessão dos exercícios físicos durou de uma até duas horas. Verificou-se um efeito significativo no teste LPS-3 para o grupo que realizou exercício combinado (t (5) = -2,668; p = 0,044). Os idosos que praticaram Tai Chi Chih apresentaram melhor desempenho no teste de recordação tardia e diminuíram os erros no teste de trilha A (pré: 0,44 ± 0,72; pós: 0,19 ± 0,47). Conclusão: Verificou-se uma melhora nas funções cognitivas, especificamente nos domínios de atenção e função executiva.

T'ai Chi Chih—An Evidence-Based Mindfulness Practice: Literature Review

T'ai chi chih (TCC) is a moving meditation associated with improvements in physiological and psychological conditions, such as immunity to shingles virus, reduction in inflammatory markers, decrease in sympathetic nervous system activity, and reductions in geriatric depression and chronic diseases in cancer survivors. Consisting of 19 repetitive movements and one pose, TCC is easy to learn and particularly accessible to the aging population. It is taught by accredited instructors who have completed an intensive training that is standardized worldwide. This review includes published randomized controlled trials focused on TCC to date. Results are summarized, and methodology is described. Of particular interest are researchers' notes stating why TCC was selected as the control intervention and how the study participants responded. As an accredited teacher of TCC, the author comments on the usefulness of the practice as an evidence-based mindfulness practice. Furthermore, ongoing studies suggest using TCC for quality of life and lifestyle issues; social, emotional and psychological conditions; and research on specific populations that may benefit from TCC.

Clinical Rounds

In Brief Tai Chi Chih is effective for insomnia in breast cancer survivors...tattooing: tell patients to think before they ink...is your facility safe from ransomware?...and more

TTAi Chi Chih, an Evidence Based Mindfulness Practice: Literature Review

T’ai Chi Chih (TCC) is a moving meditation positively associated with physiological and psychological conditions, such as immunity to shingles virus, reduction in inflammatory markers, decrease in sympathetic nervous system, geriatric depression and chronic diseases in cancer survivors. Consisting of 19 repetitive movements and one pose, TCC is easy to learn and particularly accessible to the aging population. It is taught by accredited instructors who have completed an intensive training that is standardized worldwide. This review includes all published randomized controlled trials (RCT) studies focused on TCC to date. Results are summarized and methodology is described. Of particular interest is researchers’ notes stating why TCC was selected as the control intervention and how the study participants responded. As an accredited teacher of TCC, the author comments on the usefulness of the practice as an evidence based mindfulness practice. Furthermore, ongoing studies are suggested using TCC for quality of life and lifestyle issues, social, emotional and psychological conditions, and research on specific populations that may benefit from TCC.

Improved sleep quality in older adults with insomnia reduces biomarkers of disease risk: Pilot results from a randomized controlled comparative efficacy trial

Sleep disturbances have been linked to increased morbidity and mortality, yet it is unknown whether improving sleep quality in older adult patients with insomnia alters biomarkers of diabetes and cardiovascular disease risk. Determine the comparative efficacy of cognitive behavioral therapy (CBT), tai chi chih (TCC), and a sleep seminar control (SS) to reduce multisystem biomarkers of disease risk in older adults with insomnia. Randomized controlled comparative efficacy trial. Los Angeles community. A population-based sample of 109 older adults with chronic and primary insomnia. Random assignment to CBT, TCC, or SS for 2-h group sessions weekly over 4 months with a 16-month evaluation (1 year after follow-up). Multisystem biological risk comprised of 8 biomarkers: high-density lipoprotein, low-density lipoprotein, triglycerides, hemoglobinA1c, glucose, insulin, C-reactive protein, and fibrinogen. Using clinical laboratory cutoffs defined as abnormal, a multisystem risk score was computed representing a sum of the deviation around the cutoffs across the 8 biomarkers. In addition, high risk grouping was classified if subjects exhibited 4 or more biomarkers in the abnormal laboratory range. An interaction of time-by-treatment-by-high risk group was found (F(4, 197.2)=3.14, p=.02) in which both TCC (p=.04) and CBT (p=.001) showed significantly lower risk scores as compared to SS at 16-months. CBT reduced risk of being in the high risk group at 4-months (odds ratio [OR]=.21 [95% CI, .03-1.47], p<.10) and at 16-months (OR=.06 [95% CI, .005-.669]; p<.01). TCC reduced the risk at 16-months (OR=.10 [95% CI, .008-1.29]; p<.05) but not at 4 months. Of participants who were classified in the high risk category at baseline, improvements in sleep quality, as defined by a clinical severity threshold, reduced the likelihood of being in the high risk group at 16-months, OR=.08 (95% CI, .008-.78); p=.01. Participants classified as having high multisystem biological risk at entry and assigned to CBT or TCC show improvements in risk scores after one year follow-up. Given that these clinical biomarkers are associated with cardiovascular, metabolic, and inflammatory disease risk, improving sleep quality has the potential to reduce the risk of chronic disease in older adults with insomnia. Clinical Trial Registration # and name—ClinicalTrials.gov: NCT00280020, Behavioral Treatment of Insomnia in Aging

Cognitive Behavioral Therapy and Tai Chi Reverse Cellular and Genomic Markers of Inflammation in Late-Life Insomnia: A Randomized Controlled Trial

BackgroundSleep disturbance is associated with activation of systemic and cellular inflammation, as well as proinflammatory transcriptional profiles in circulating leukocytes. Whether treatments that target insomnia-related complaints might reverse these markers of inflammation in older adults with insomnia is not known. MethodsIn this randomized trial, 123 older adults with insomnia were randomly assigned to cognitive-behavioral therapy for insomnia (CBT-I), tai chi chih (TCC), or sleep seminar education active control condition for 2-hour sessions weekly over 4 months with follow-up at 7 and 16 months. We measured C-reactive protein (CRP) at baseline and months 4 and 16; toll-like receptor-4 activated monocyte production of proinflammatory cytokines at baseline and months 2, 4, 7, and 16; and genome-wide transcriptional profiling at baseline and month 4. ResultsAs compared with sleep seminar education active control condition, CBT-I reduced levels of CRP (months 4 and 16, ps < .05), monocyte production of proinflammatory cytokines (month 2 only, p < .05), and proinflammatory gene expression (month 4, p < .01). TCC marginally reduced CRP (month 4, p = .06) and significantly reduced monocyte production of proinflammatory cytokines (months 2, 4, 7, and 16; all ps < .05) and proinflammatory gene expression (month 4, p < .001). In CBT-I and TCC, TELiS promoter-based bioinformatics analyses indicated reduced activity of nuclear factor-κB and AP-1. ConclusionsAmong older adults with insomnia, CBT-I reduced systemic inflammation, TCC reduced cellular inflammatory responses, and both treatments reduced expression of genes encoding proinflammatory mediators. The findings provide an evidence-based molecular framework to understand the potential salutary effects of insomnia treatment on inflammation, with implications for inflammatory disease risk.

Blood pressure, salivary cortisol, and inflammatory cytokine outcomes in senior female cancer survivors enrolled in a tai chi chih randomized controlled trial

Blood pressure, salivary cortisol, and inflammatory cytokine outcomes in senior female cancer survivors enrolled in a tai chi chih randomized controlled trial

Blood pressure, salivary cortisol, and inflammatory cytokine outcomes in senior female cancer survivors enrolled in a tai chi chih randomized controlled trial.

Older cancer survivors are a vulnerable population due to an increased risk for chronic diseases (e.g., cardiovascular disease) compounded with treatment late-effects and declines in physical functioning. Therefore, interventions that reduce chronic disease risk factors (i.e., blood pressure, chronic inflammation, and cortisol) are important in this population. Tai chi chih (TCC) is a mind-body exercise associated with reductions in chronic disease risk factors, but has not been examined with older cancer survivors. In a feasibility randomized controlled trial of TCC, we examined secondary outcomes of blood pressure, salivary cortisol, and inflammatory cytokines (interleukin (IL)-6, IL-12, tumor necrosis factor-α, IL-10, IL-4) due to their implications in chronic diseases. Sixty-three senior female cancer survivors (M age = 67 years, SD = 7.15) with physical functioning limitations (SF-12 physical functioning ≤80 or role-physical ≤72) were randomized to 12-weeks (60-min, three times a week) of TCC or Health Education control (HEC) classes. Resting blood pressure, 1-day salivary cortisol samples, and fasting plasma samples for cytokine multiplex assays were collected at baseline and 1-week post-intervention. Controlling for baseline values, the TCC group had significantly lower systolic blood pressure (SBP, p = 0.002) and cortisol area-under-curve (AUC, p = 0.02) at post-intervention than the HEC group. There was no intervention effect on inflammatory cytokines (p's > 0.05). This TCC feasibility trial was associated with significant reductions in SBP and cortisol AUC in senior female cancer survivors. Larger, definitive trials are needed to confirm these findings. Senior survivors' have an increased risk for chronic diseases; however, TCC interventions may help reduce associated risk factors.

The Effect of an 8-Week Tai Chi Exercise Program on Physical Functional Performance in Middle-Aged Women

The purpose of this study was to determine the effectiveness of an 8-week Tai Chi Chih exercise program on physical functional performance (PFP) among women aged 45 to 65 years. A quasi-experimental design with a nonequivalent comparison group was used. Forty-one healthy inactive women were assigned to either an intervention group (n = 19) or a comparison group (n = 19). A 60-min Tai Chi Chih exercise class was conducted twice a week for 8 weeks. PFP was measured at baseline and postintervention using the Continuous Scale Physical Functional Performance-10 (CS-PFP 10). Between-group differences were analyzed using one-way analysis of covariance (ANCOVA). After participating in the 8-week program, intervention group participants showed greater improvement in the CS-PFP measures (p < .05, η(2) > .06). However, the comparison group had little changes. The findings from this study suggest that participation in an 8-week Tai Chi Chih exercise program can improve PFP in healthy, community-dwelling middle-aged women.

Exercise for late-life depression? It depends

Exercise for late-life depression? It depends

Feasibility and Acceptability of a Tai Chi Chih Randomized Controlled Trial in Senior Female Cancer Survivors

The purpose of this randomized controlled trial (RCT) was to examine the feasibility and acceptability of a Tai Chi Chih (TCC) intervention in senior female cancer survivors with physical functioning limitations, and its effects on health-related quality of life (QOL). This was a two-armed, parallel group, RCT with 12-weeks of Tai Chi Chih or Health Education Control. Sixty-three senior (M age = 67 years, SD = 7.15) female cancer survivors (83% breast cancer, stages I-III) with physical functioning limitations (SF-12 Health Survey role-physical & physical functioning subscales) were randomized to 12-weeks of TCC or Health Education control (HEC). Primary outcomes were feasibility and acceptability. Secondary outcomes included health-related QOL (SF-36 Health Survey), and participants' qualitative feedback on the intervention. Retention (TCC = 91%; HEC = 81%) and class attendance (TCC = 79%; HEC = 83%) rates, and satisfaction levels for both study arms were high, but did not significantly differ from one another. At one-week post-intervention, none of the SF-36 scores differed between the TCC and HEC groups. Within-group analyses revealed significant improvements in the mental component summary score in TCC (p = 0.01), but not in HEC. Qualitative analyses indicated that the TCC group felt they received mental and physical benefits, whereas HEC group reported on social support benefits and information received. The TCC intervention was found to be a feasible and acceptable modality for senior female cancer survivors. Future, larger definitive trials are needed to clarify TCC dosage effects on QOL in this vulnerable population.

Tai chi chih improves inflammatory markers, cognition and quality of life scores in elderly depressed patients

Tai chi chih improves inflammatory markers, cognition and quality of life scores in elderly depressed patients

Regulation of gene expression by yoga, meditation and related practices: A review of recent studies

Integrative medicine (IM) approaches have gained significant interest in recent years to provide a solution for the health care challenges we face today. Yogic cognitive-behavioral practices are among the most widely used IM approaches and include diverse practices such as yoga asanas, meditation, breathing exercises, Qi Gong, Tai Chi Chih, and various others. Studies to date suggest that these yogic/meditative practices have significant positive effects on the mind–body system and thereby can increase wellness and support the healing process from disease. Previous work has provided evidence for both psychological and physiological effects of these practices; however, the mechanisms of these effects, especially at the molecular level, have largely been missing. Three recent studies started to provide some of this information through gene expression profiling in circulating immune cells, which support the hypothesis that yogic/meditative practices have a measurable effect at the molecular level. These studies are reviewed herein and some future perspectives are considered.

New Data Assign Inflammation Crucial Role in Mental Decline

New Data Assign Inflammation Crucial Role in Mental Decline

Mitigating Cellular Inflammation in Older Adults: A Randomized Controlled Trial of Tai Chi Chih

To evaluate the effects of a behavioral intervention, Tai Chi Chih (TCC) on circulating markers of inflammation in older adults. A prospective, randomized, controlled trial with allocation to two arms, TCC and health education (HE), 16 weeks of intervention administration, and 9 weeks follow-up. A total of 83 healthy older adults, aged 59 to 86 years. The primary endpoint was circulating levels of interleukin 6 (IL-6). Secondary outcomes were circulating levels of C-reactive protein, soluble IL-1 receptor antagonist, soluble IL-6 receptor, soluble intercellular adhesion molecule, and IL-18. Severity of depressive symptoms, sleep quality, and physical activity was also assessed over the treatment trial. Among those older adults with high levels of IL-6 at entry, a trend for a treatment group by time interaction was found (F[1,70] = 3.48, p = 0.07), in which TCC produced a drop of IL-6 levels comparable to those found in TCC and HE subgroups who had low levels of IL-6 at entry (t72's = 0.80, 1.63, p's >0.10), whereas IL-6 in HE remained higher than the TCC and HE subgroups with low entry IL-6 (t72 = 2.47, p = 0.02; t72 = 1.71, p = 0.09). Decreases in depressive symptoms in the two treatment groups correlated with decreases of IL-6 (r = 0.28, p <0.05). None of the other cellular markers of inflammation changed in TCC versus HE. TCC can be considered a useful behavioral intervention to reduce circulating levels of IL-6 in older adults who show elevated levels of this inflammatory marker and are at risk for inflammation-related morbidity.

Complementary Use of Tai Chi Chih Augments Escitalopram Treatment of Geriatric Depression: A Randomized Controlled Trial

Nearly two-thirds of elderly patients treated for depression fail to achieve symptomatic remission and functional recovery with first-line pharmacotherapy. In this study, we ask whether a mind-body exercise, Tai Chi Chih (TCC), added to escitalopram will augment the treatment of geriatric depression designed to achieve symptomatic remission and improvements in health functioning and cognitive performance. : One hundred twelve older adults with major depression age 60 years and older were recruited and treated with escitalopram for approximately 4 weeks. Seventy-three partial responders to escitalopram continued to receive escitalopram daily and were randomly assigned to 10 weeks of adjunct use of either 1) TCC for 2 hours per week or 2) health education (HE) for 2 hours per week. All participants underwent evaluations of depression, anxiety, resilience, health-related quality of life, cognition, and inflammation at baseline and during 14-week follow-up. Subjects in the escitalopram and TCC condition were more likely to show greater reduction of depressive symptoms and to achieve a depression remission as compared with those receiving escitalopram and HE. Subjects in the escitalopram and TCC condition also showed significantly greater improvements in 36-Item Short Form Health Survey physical functioning and cognitive tests and a decline in the inflammatory marker, C-reactive protein, compared with the control group. : Complementary use of a mind-body exercise, such as TCC, may provide additional improvements of clinical outcomes in the pharmacologic treatment of geriatric depression.