Background Preliminary evidence suggests that meditative exercise may have benefits for patients with chronic systolic heart failure (HF); this has not been rigorously tested in a large clinical sample. We sought to investigate whether tai chi, as an adjunct to standard care, improves functional capacity and quality of life in patients with HF. Methods A single-blind, multisite, parallel-group, randomized controlled trial evaluated 100 outpatients with systolic HF (New York Heart Association class I-III, left ventricular ejection fraction ≤40%) who were recruited between May 1, 2005, and September 30, 2008. A group-based 12-week tai chi exercise program (n=50) or time-matched education (n=50, control group) was conducted. Outcome measures included exercise capacity (6-minute walk test and peak oxygen uptake) and disease-specific quality of life (Minnesota Living With Heart Failure Questionnaire). Results Mean (SD) age of patients was 67(11) years; baseline values were left ventricular ejection fraction, 29% (8%) and peak oxygen uptake, 13.5 mL/kg/min; the median New York Heart Association class of HF was class II. At completion of the study, there were no significant differences in change in 6-minute walk distance and peak oxygen uptake (median change [first quartile, third quartile], 35 [−2, 51] vs 2 [−7, 54] meters, P=.95; and 1.1 [−1.1, 1.5] vs −0.5 [−1.2, 1.8] mL/kg/min, P=.81) when comparing tai chi and control groups; however, patients in the tai chi group had greater improvements in quality of life (Minnesota Living With Heart Failure Questionnaire, −19 [−23, −3] vs 1 [−16, 3], P=.02). Improvements with tai chi were also seen in exercise self-efficacy (Cardiac Exercise Self-efficacy Instrument, 0.1 [0.1, 0.6] vs −0.3 [−0.5, 0.2], P<.001) and mood (Profile of Mood States total mood disturbance, −6 [−17, 1] vs −1 [−13, 10], P=.01). Conclusion Tai chi exercise may improve quality of life, mood, and exercise self-efficacy in patients with HF. Trial Registration clinicaltrials.gov Identifier: NCT00110227

OBJECTIVES Summarize and critically evaluate research on the effects of Tai Chi on cognitive function in older adults. DESIGN Systematic review with meta-analysis. SETTING Community and residential care. PARTICIPANTS Individuals aged 60 and over (with the exception of one study) with and without cognitive impairment. MEASUREMENTS Cognitive ability using a variety of neuropsychological testing. RESULTS Twenty eligible studies with a total of 2,553 participants were identified that met inclusion criteria for the systematic review: 11 of the 20 eligible studies were randomized controlled trials (RCTs), 1 was a prospective non-randomized controlled study, 4 were prospective non-controlled observational studies, and 4 were cross-sectional studies. Overall quality of RCTs was modest, with 3 of 11 trials categorized as high risk of bias. Meta-analyses of outcomes related to executive function in RCTs of cognitively healthy adults indicated a large effect size when Tai Chi was compared to non-intervention controls (Hedge’s g=0.90; p=0.043) and moderate effect size when compared to exercise controls (Hedge’s g=0.51; p=0.003). Meta-analyses of outcomes related to global cognitive function in RCTs of cognitively impaired adults, ranging from mild cognitive impairment to dementia, showed smaller but statistically significant effects when Tai Chi was compared to both non-intervention controls (Hedge’s g=0.35; p=0.004) and other active interventions (Hedge’s g=0.30; p=0.002). Findings from non-randomized studies add further evidence that Tai Chi may positively impact these and other domains of cognitive function. CONCLUSION Tai Chi shows potential to enhance cognitive function in older adults, particularly in the realm of executive functioning and in those individuals without significant impairment. Larger and methodologically sound trials with longer follow-up periods are needed before more definitive conclusions can be drawn.

Medical pain management is in crisis; from the pervasiveness of pain to inadequate pain treatment, from the escalation of prescription opioids to an epidemic in addiction, diversion and overdose deaths. The rising costs of pain care and managing adverse effects of that care have prompted action from state and federal agencies including the DOD, VHA, NIH, FDA and CDC. There is pressure for pain medicine to shift away from reliance on opioids, ineffective procedures and surgeries toward comprehensive pain management that includes evidence-based nonpharmacologic options. This White Paper details the historical context and magnitude of the current pain problem including individual, social and economic impacts as well as the challenges of pain management for patients and a healthcare workforce engaging prevalent strategies not entirely based in current evidence. Detailed here is the evidence-base for nonpharmacologic therapies effective in postsurgical pain with opioid sparing, acute non-surgical pain, cancer pain and chronic pain. Therapies reviewed include acupuncture therapy, massage therapy, osteopathic and chiropractic manipulation, meditative movement therapies Tai chi and yoga, mind body behavioral interventions, dietary components and self-care/self-efficacy strategies. Transforming the system of pain care to a responsive comprehensive model necessitates that options for treatment and collaborative care must be evidence-based and include effective nonpharmacologic strategies that have the advantage of reduced risks of adverse events and addiction liability. The evidence demands a call to action to increase awareness of effective nonpharmacologic treatments for pain, to train healthcare practitioners and administrators in the evidence base of effective nonpharmacologic practice, to advocate for policy initiatives that remedy system and reimbursement barriers to evidence-informed comprehensive pain care, and to promote ongoing research and dissemination of the role of effective nonpharmacologic treatments in pain, focused on the short- and long-term therapeutic and economic impact of comprehensive care practices.