Fighting Fit

A systematic review and meta-analysis of Tai Chi or Qigong has been published in the Journal of Parkinsonism and Related disorders.

It is fair to say that there have been no game-changing therapeutic breakthroughs in Parkinson’s since the licensing of levodopa in 1967. Although both Tai Chi and Qigong predate this discovery by thousands of years, this paper is a timely reminder that benefit doesn’t always come in pill form.

“Both [Tai Chi and Qigong] integrate balance, flexibility, and neuromuscular coordination training with a number of cognitive components, including heightened body awareness, focused mental attention, imagery, multi-tasking, and planned and goal-oriented training”

Meta-analyses can shine sunlight on an otherwise murky world of studies, trials and observations. By carefully taking all the published literature on a given topic, critically analysing the way the studies have been reported and conducted - looking in particular for risks of bias - and then putting all the small data sets together, the results are more than the sum of its parts.

This study confirms previously reported findings of better movement and balance, but was the first to undertake meta-analysis of the effects of these exercises by people with PD on depression and cognitive function.

The results are heartening. They found 15 studies from around the world (Italy, Germany, USA, Korea and China). Participants in their studies had on average mild-to-moderate PD, although there were participants with severe Parkinson’s. The average age is in keeping with what we see in the UK (mean 67.5 years). This reassures me that the findings reported are applicable to the majority of people with Parkinson’s in the UK.

Movement, balance and frequency of falls were generally robustly improved in those doing the exercises compared to those who had no treatment. The findings were not quite as marked in those who were given other forms of exercise (e.g. dance, aerobic or resistance training).

They also found that there was less depression vs controls (although this finding was quite weak when compared to people doing other forms of exercise) and a very robust finding of better quality of life, even when compared to other exercises. The effect on cognition wasn’t statistically significant but did suggest some improvement. The magnitude of the effect of Tai Chi/Qigong on quality of life is similar to that of Deep Brain Stimulation!

I am delighted with the results of this study, but I’m not surprised. This comes hot on the heels of the Lancet Commission on Dementia where physical and social exercise were key ways to protect the brain.

Effects of Tai Chi/Qigong on non-motor function. Data values indicate weight, effect size and confidence interval of LL (lower limit) to UL (upper limit).  
Plots to the left of zero indicate negative effect sizes for all outcomes in favor of Tai Chi (i.e. fewer symptoms). 

The last paragraph is interesting, and I reflected that had this been a study examining the effects of a drug, and the senior author was the CEO of a pharma company, my attitude would have been much more scathing!

"Conflict of interest

Financial disclosure

Peter Wayne is the founder and sole owner of the Tree of Life Tai Chi Center. Peter Wayne's interests were reviewed and managed by the Brigham and Women's Hospital and Partner's HealthCare in accordance with their conflict of interest policies."

http://www.prd-journal.com/article/S1353-8020(17)30185-2/fulltext

Song R, Grabowska W, Park M, Osypiuk K, Vergara-Diaz GP, Bonato P, et al. 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. Parkinsonism Relat Disord. 2017 Aug;41:3–13. 

PURPOSE:To systematically evaluate and quantify the effects of Tai Chi/Qigong (TCQ) on motor (UPDRS III, balance, falls, Timed-Up-and-Go, and 6-Minute Walk) and non-motor (depression and cognition) function, and quality of life (QOL) in patients with Parkinson's disease (PD).

METHODS:A systematic search in 7 electronic databases targeted clinical studies evaluating TCQ for individuals with PD published through August 2016. Meta-analysis was used to estimate effect sizes (Hedges's g) and publication bias for randomized controlled trials (RCTs). Methodological bias in RCTs was assessed by two raters.

RESULTS:Our search identified 21 studies, 15 of which were RCTs with a total of 735 subjects. For RCTs, comparison groups included no treatment (n = 7, 47%) and active interventions (n = 8, 53%). Duration of TCQ ranged from 2 to 6 months. Methodological bias was low in 6 studies, moderate in 7, and high in 2. Fixed-effect models showed that TCQ was associated with significant improvement on most motor outcomes (UPDRS III [ES = -0.444, p < 0.001], balance [ES = 0.544, p < 0.001], Timed-Up-and-Go [ES = -0.341, p = 0.005], 6 MW [ES = -0.293, p = 0.06], falls [ES = -0.403, p = 0.004], as well as depression [ES = -0.457, p = 0.008] and QOL [ES = -0.393, p < 0.001], but not cognition [ES = -0.225, p = 0.477]). I(2) indicated limited heterogeneity. Funnel plots suggested some degree of publication bias.

CONCLUSION:Evidence to date supports a potential benefit of TCQ for improving motor function, depression and QOL for individuals with PD, and validates the need for additional large-scale trials.