Efficacy and Safety of Tai Chi for Parkinson's Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background and ObjectiveIn Parkinson's disease (PD), wearing off and side effects of long-term medication and complications pose challenges for neurologists. Although Tai Chi is beneficial for many illnesses, its efficacy for PD remains uncertain. The purpose of this review was to evaluate the efficacy and safety of Tai Chi for PD.MethodsRandomized controlled trials (RCTs) of Tai Chi for PD were electronically searched by the end of December 2013 and identified by two independent reviewers. The tool from the Cochrane Handbook 5.1 was used to assess the risk of bias. A standard meta-analysis was performed using RevMan 5.2 software.ResultsTen trials with PD of mild-to-moderate severity were included in the review, and nine trials (n = 409) were included in the meta-analysis. The risk of bias was generally high in the blinding of participants and personnel. Improvements in the Unified Parkinson's Disease Rating Scale Part III (mean difference (MD) −4.34, 95% confidence interval (CI) −6.67–−2.01), Berg Balance Scale (MD: 4.25, 95% CI: 2.83–5.66), functional reach test (MD: 3.89, 95% CI: 1.73–6.04), Timed Up and Go test (MD: −0.75, 95% CI: −1.30–−0.21), stride length (standardized MD: 0.56, 95% CI: 0.03–1.09), health-related quality of life (standardized MD: −1.10, 95% CI: −1.81–−0.39) and reduction of falls were greater after interventions with Tai Chi plus medication. Satisfaction and safety were high. Intervention with Tai Chi alone was more effective for only a few balance and mobility outcomes.ConclusionsTai Chi performed with medication resulted in promising gains in mobility and balance, and it was safe and popular among PD patients at an early stage of the disease. This provides a new evidence for PD management. More RCTs with larger sample size that carefully address blinding and prudently select outcomes are needed. PROSPERO registration number CRD42013004989.

The impact of Tai Chi and Qigong mind-body exercises on motor and non-motor function and quality of life in Parkinson's disease: A systematic review and meta-analysis

“…First, a number of prior reviews have been limited to qualitative synthesis and have not also included quantitative meta-analytical methods [63, 64]. For studies that did include meta-analysis, one in 2014 focused only on Tai Chi (excluding Qigong) and included 9 trials in quantitative synthesis (vs. 15 in the present study) [7]. Another 2014 meta-analysis focused only on motor outcomes and included 8 trials [13].…”

“…This concern is reinforced by limitations in methodological quality and by the heterogeneity of both TCQ interventions and controls. Third, we did not distinguish outcomes that were assessed on and off-medication, as has been done in prior reviews [7, 14]. Fourth, there were too few studies to compare the effects of TCQ on subgroups of PD patients, such as early vs. later disease progression or tremor dominant vs. postural instability and gait difficulty.…”

“…Tai Chi and Qigong (TCQ) are two increasingly popular mind-body interventions that have the potential to address a range of motor and non-motor symptoms associated with PD [7]. TCQ share a common history which includes elements of traditional Chinese medicine, martial arts conditioning, and Asian lifestyle philosophy.…”

Does Tai Chi relieve fatigue? A systematic review and meta-analysis of randomized controlled trials

“…The control group included those using other forms of physical activity either with or without conventional treatment, conventional treatment only, placebo, or no treatment at all. The control group did not use Tai Chi [38]. There were no limitations to intervention and follow up times.…”

Physical therapy and occupational therapy in Parkinson's disease

“…Potentially, effective programs are an Intensive Rehabilitation Program (4 weeks, 5 times a week, combined types of exercise) [78,79], and the Lee Silverman Voice Treatment -BIG program (high amplitude movements, sensory recalibration and self-cueing) [80]. Other types of exercise for which evidence is increasing are Tai Chi [81][82][83], hydrotherapy [84], boxing [85] and dancing [86][87][88]. There is very little evidence for exercise to improve hand function.…”