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Tai Chi and Diabetes

June 15, 2009 Written by JP       [Font too small?]

No matter what area of medicine you study, you’re bound to find some degree of controversy or debate. Do you think exercise is good for cardiovascular health or improving mood? Much of the evidence supports that position, but some studies dispute that as well. How about eating fresh fruits and vegetables? That’s got to be healthy, right? A preponderance of the evidence points to that conclusion but, again, there are always findings to the contrary in scientific literature. It’s important to know that there are always opposing points of view. So a study with negative findings should not cause one to lose faith in a perfectly viable remedy.

T’ai Chi is an example of a promising therapy that has a somewhat checkered modern history. As you’ll read below, several studies published in the past few years indicate that this mind-body technique may be a beneficial adjunct for managing diabetes. But in the interest of fairness and full disclosure, I’ll also present some evidence that T’ai Chi may not always be effective. After reviewing the positive and negative studies, I’ll share my own view about the relevance of the following data.

The Positive Studies

  • A study published this month in The Journal of Alternative and Complementary Medicine determined that 6 months of consistent T’ai Chi practice could improve the overall health of type 2 diabetics. 62 patients participated in a twice-weekly course of 19 T’ai Chi movements. Blood tests and questionnaires relating to “diabetes self-care activities” and quality of life were provided prior to the commencement of the exercise and after the completion of the study. Those who engaged in the exercises at least 80% of the time showed significant declines in fasting glucose and A1c (a measure of long-term blood glucose levels). That same group demonstrated improvements in diabetic self-care, mental health, social function and vitality. A vital observation was that nearly 50% of the volunteers did not maintain the recommended practice schedule (as measured by a minimum of 80% adherence). (1)
  • In 2008, The American Journal of Chinese Medicine reported on a trial involving 20 middle-aged females with type 2 diabetes. Half of this group engaged in Tai Ji Quan (a form of T’ai Chi). This experiment took place over the course of 14 weeks and involved one hour daily exercises practiced 5 days a week. Noteworthy improvements in glycaemic (blood sugar) control and a reduction in triglyceride levels were noted. The authors concluded that, “TJQ exercise could be used as an intervention tool to improve glycaemic control and serum TG level in the elderly people.” (2) These results are supported by other recent trials that document drops in A1C and blood sugar levels and increases in “insulin receptor numbers”. (3,4)
  • The benefits of T’ai Chi may extend beyond that of simple blood sugar control. In 2007, a study in the journal Diabetes Technology and Therapeutics revealed that a T’ai Chi intervention program helped elderly patients with type 2 diabetes to reduce the number of falls they typically sustained by increasing foot sensation. Advanced cases of diabetes often lead to a lack of feeling in the feet, commonly referred to as diabetic peripheral neuropathy. Measures of sensory perception (of the feet) and overall balance were improved in all the T’ai Chi participants. A beneficial decline in their A1C level was also noted. (5)

The Negative Studies

  • Two recent trials specifically looked at the effects of a modified form of T’ai Chi that was geared toward diabetics. “T’ai Chi for Diabetes” involves 12 “soft, smooth and subtle movements with the knees bent in a slight semi-squat position”. In one study, this form of T’ai Chi was compared to a group that engaged in no additional activity (a “wait list” group). No statistically significant changes were found in measures of A1C (long term blood sugar), walking endurance and total cholesterol levels. The T’ai Chi group did, however, exhibit benefits with regard to physical and social function. (6) Another study tested T’ai Chi against a “sham exercise” routine consisting of calisthenics and gentle stretching. Balance was found to improve in both groups. But there was an expectation that T’ai Chi would improve other measures of health and physical function and it did not do so in this study. (7) A similar 4 month trial found that both T’ai Chi and a “sham exercise” improved mobility in a group of elderly type 2 diabetics. (8)

Based on the evidence, if I had diabetes, I would still consider T’ai Chi as a complementary therapy, but would keep a few things in mind: 1) It’s important to be consistent with the practice; 2) I wouldn’t put all my eggs in one basket. This would only be one part of a much broader approach to managing blood sugar and my overall health. 3) I would engage in T’ai Chi believing that it would make me healthier in both body and mind. This last recommendation is tremendously important. I think that the benefits of T’ai Chi are likely based on the very real mental and physiological changes that it provokes. But I also know that the placebo effect is a very powerful tool, which can help improve the outcome of any treatment. (9) It’s a waste not to utilize it more frequently.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!

JP

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13 Comments & Updates to “Tai Chi and Diabetes”

  1. anne h Says:

    I read once that statistics are like a bikini. They reveal alot, while they keep vital parts covered up!

  2. JP Says:

    Maybe so. :) Or perhaps they’re kind of like a photo shoot. Unless you’re actually there, you can’t really know what’s being focused on and/or excluded. Then there’s the issue of things being “touched up” in post-production.

    Be well!

    JP

  3. tfshao Says:

    There is a set of exercises based on Wu Taiji Quan for treating diabetes (8 Methods for Treating Diabetes). It is quite strenuous and takes about 30minutes. It claims success but no specific data was provided. I think anyone who can stick to this set of exercise either is already physically fit or he will get the benefit. There are many studies proving exercises is good for diabetes. So, Taiji or not probably makes no difference. Yet, Taiji certainly has other intriguing aspects.

  4. JP Says:

    Thanks for your comments. I’m sure that being physically active is helpful but I suspect at least part of the benefits of Tai Chi stem from its stress reducing effect as well. Reducing stress hormone levels can help lower blood sugar for instance.

    Be well!

    JP

  5. Ken Shim, RMT Says:

    Sometimes we need to stop compartmentalizing life so much. Tai chi is great for anything. It might not be a miracle cure, but few things are, if taken in isolation. We must remember to follow the basics: eat well, exercise often, love others and love ourselves… everything else is secondary. Most things that get us off our butts and start burning off calories will help us achieve better balance in our bodies whether this balance is to reduce chance of stroke, osteoporosis or diabetes. We humans are creatures of action after all. The best thing about tai chi is that it is slow moving, grounding, safe, using a complete range of exercises and motions and forces us to focus our attention inward to our bodies and breath.

  6. JP Says:

    I agree with all of your comments, Ken. Well said! :)

    Be well!

    JP

  7. Brandy Says:

    I am writing a speech for college with T’ai Chi being a beneficial alternative exercise for people with diabetes one academic study I have shows the improvements in oxidative stress chemicals in the body. Ultimately the study group using T’ai Chi had better cardiovascular health due to the reduction of the oxidative stress chemicals even better results than the conventional exercise group.

  8. JP Says:

    Brandy,

    Wonderful. I’ll bet it’s going to be a compelling presentation.

    I’m aware of the study you’re referring to. In fact, I’ve included it in an upcoming column that’s set to post next week.

    I wish you all the best with your upcoming speech and future studies.

    Be well!

    JP

  9. JP Says:

    Update 06/06/15:

    http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322015000300157&lng=en&nrm=iso&tlng=en

    Clinics (Sao Paulo). 2015 Mar;70(3):157-61.

    Analysis of static and dynamic balance in healthy elderly practitioners of Tai Chi Chuan versus ballroom dancing.

    OBJECTIVE: To determine whether Tai Chi Chuan or ballroom dancing promotes better performance with respect to postural balance, gait, and postural transfer among elderly people.

    METHODS: We evaluated 76 elderly individuals who were divided into two groups: the Tai Chi Chuan Group and the Dance Group. The subjects were tested using the NeuroCom Balance Master¯ force platform system with the following protocols: static balance tests (the Modified Clinical Tests of Sensory Interaction on Balance and Unilateral Stance) and dynamic balance tests (the Walk Across Test and Sit-to-stand Transfer Test).

    RESULTS: In the Modified Clinical Test of Sensory Interaction on Balance, the Tai Chi Chuan Group presented a lower sway velocity on a firm surface with open and closed eyes, as well as on a foam surface with closed eyes. In the Modified Clinical Test of Sensory Interaction on Unilateral Stance, the Tai Chi Chuan Group presented a lower sway velocity with open eyes, whereas the Dance Group presented a lower sway velocity with closed eyes. In the Walk Across Test, the Tai Chi Chuan Group presented faster walking speeds than those of the Dance Group. In the Sit-to-stand Transfer Test, the Tai Chi Chuan Group presented shorter transfer times from the sitting to the standing position, with less sway in the final standing position.

    CONCLUSION: The elderly individuals who practiced Tai Chi Chuan had better bilateral balance with eyes open on both types of surfaces compared with the Dance Group. The Dance Group had better unilateral postural balance with eyes closed. The Tai Chi Chuan Group had faster walking speeds, shorter transfer times, and better postural balance in the final standing position during the Sit-to-stand Test.

    Be well!

    JP

  10. JP Says:

    Updated 12/26/15:

    http://www.ncbi.nlm.nih.gov/pubmed/26702640

    Arthritis Res Ther. 2015 Dec 24;17(1):380.

    The beneficial effects of Tai Chi exercise on endothelial function and arterial stiffness in elderly women with rheumatoid arthritis.

    BACKGROUND: Rheumatoid arthritis (RA) has been known to be associated with increased risk of cardiovascular disease (CVD). The aim of this study was to investigate the effects of Tai Chi exercise on CVD risk in elderly women with RA.

    METHOD: In total, 56 female patients with RA were assigned to either a Tai Chi exercise group (29 patients) receiving a 3-month exercise intervention once a week or a control group (27 patients) receiving general information about the benefits of exercise. All participants were assessed at baseline and at 3 months for RA disease activity (Disease Activity Score 28 and Routine Assessment of Patient Index Data 3), functional disability (Health Assessment Questionnaire), CVD risk factors (blood pressure, lipids profile, body composition, and smoking), and three atherosclerotic measurements: carotid intima-media thickness, flow-mediated dilatation (FMD), and brachial-ankle pulse wave velocity (baPWV).

    RESULTS: FMD, representative of endothelial function, significantly increased in the Tai Chi exercise group (initial 5.85 ± 2.05 versus 3 months 7.75 ± 2.53 %) compared with the control group (initial 6.31 ± 2.12 versus 3 months 5.78 ± 2.13 %) (P = 1.76 × 10-3). Moreover, baPWV, representative of arterial stiffness, significantly decreased in the Tai Chi exercise group (initial 1693.7 ± 348.3 versus 3 months 1600.1 ± 291.0 cm/s) compared with the control group (initial 1740.3 ± 185.3 versus 3 months 1792.8 ± 326.1 cm/s) (P = 1.57 × 10-2). In addition, total cholesterol decreased significantly in the Tai Chi exercise group compared with the control group (-7.8 ± 15.5 versus 2.9 ± 12.2 mg/dl, P = 2.72 × 10-2); other changes in RA-related characteristics were not significantly different between the two groups. Tai Chi exercise remained significantly associated with improved endothelial function (FMD; P = 4.32 × 10-3) and arterial stiffness (baPWV; P = 2.22 × 10-2) after adjustment for improvement in total cholesterol level.

    CONCLUSION: Tai Chi exercise improved endothelial dysfunction and arterial stiffness in elderly women with RA, suggesting that it can be a useful behavioral strategy for CVD prevention in patients with RA.

    Be well!

    JP

  11. JP Says:

    Updated 06/28/17:

    https://www.ncbi.nlm.nih.gov/pubmed/28654312

    J Altern Complement Med. 2017 Jun 27.

    Effects of a T’ai Chi-Based Health Promotion Program on Metabolic Syndrome Markers, Health Behaviors, and Quality of Life in Middle-Aged Male Office Workers: A Randomized Trial.

    OBJECTIVES: To determine the effects of a t’ai chi-applied worksite health promotion program on metabolic syndrome markers, health behaviors, and quality of life in middle-aged male office workers at a high risk of metabolic syndrome.

    DESIGN: A prospective randomized controlled study.

    SETTING: Health center of a government office building in Korea.

    SUBJECTS: Forty-three male office workers with two or more metabolic syndrome markers.

    INTERVENTIONS: The office workers were randomly assigned either to an experimental group that received t’ai chi combined with health education twice weekly for 12 weeks, or to a control group that received health education only.

    OUTCOME MEASURES: Blood sampling for metabolic syndrome markers and structured questionnaires for health behaviors and quality of life.

    RESULTS: The experimental group showed significant reductions in systolic (t = -3.103, p = 0.003) and diastolic (t = -2.159, p = 0.037) blood pressures and the triglyceride level (t = -2.451, p = 0.019) compared with the control group. Those in the experimental group also performed health behaviors more frequently (t = 4.047, p < 0.001) and reported a significantly better quality of life (t = 3.193, p = 0.003) than those in the control group.

    CONCLUSION: The study findings show that t’ai chi was an effective adjunctive intervention in a worksite health promotion program for middle-aged office workers at a high risk of metabolic syndrome. Future studies should examine the long-term effects of t’ai chi-applied worksite health promotion programs in individuals with confirmed metabolic syndrome.

    Be well!

    JP

  12. JP Says:

    Updated 08/21/18:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6079589/

    J Diabetes Res. 2018 Jul 5;2018:7350567.

    The Effects of Tai Chi on Type 2 Diabetes Mellitus: A Meta-Analysis.

    Objective: To investigate the effects of Tai chi in type 2 diabetes mellitus (type-2 DM) patients using systematic review and meta-analysis.

    Methods: Seven electronic resource databases were searched, and randomized controlled trials on the role of Tai chi in type-2 DM patients were retrieved. The meta-analysis was performed with RevMan 5.3, and research quality evaluation was conducted with the modified Jadad scale.

    Results: Fourteen studies, with 798 individuals related to the intervention of Tai chi on diabetes, were included. The results showed that, compared with nonexercise, Tai chi had the effect of lowering fasting blood glucose [MD = -1.39, 95% CI (-1.95, -0.84), P < 0.0001] and the subgroup effect size decreased with the increase of total exercise amount, there is no significant difference between Tai chi and other aerobic exercises [MD = -0.50, 95% CI (-1.02, 0.02), P = 0.06]; compared with nonexercise, Tai chi could reduce HbA1c [MD = -0.21, 95% CI (-0.61, 0.19), P = 0.31], and the group effect size decreased with the increase of total exercise amount. The reducing HbA1c effect of Tai chi was better than that of other aerobic exercises, but the difference was at the margin of statistical significance [MD = -0.19, 95% CI (-0.37, 0.00), P = 0.05]; compared with nonexercise, Tai chi had the effect of reducing 2 h postprandial blood glucose [MD = -2.07, 95% CI (-2.89, -1.26), P = 0.0002], there is no significant difference between Tai chi and other aerobic exercises in reducing 2 h postprandial blood glucose [MD = -0.44, 95% CI (-1.42, 0.54), P = 0.38].

    Conclusion: Tai chi can effectively affect the management of blood glucose and HbA1c in type-2 DM patients. Long-term adherence to Tai chi has a better role in reducing blood glucose and HbA1c levels in type 2 DM patients.

    Be well!

    JP

  13. JP Says:

    Updated 09/11/18:

    https://www.sciencedirect.com/science/article/pii/S0020748918302013?via%3Dihub

    Int J Nurs Stud. 2018 Aug 24;88:44-52.

    Tai Chi exercise is more effective than brisk walking in reducing cardiovascular disease risk factors among adults with hypertension: A randomised controlled trial.

    BACKGROUND: Physical inactivity is a major modifiable lifestyle risk factor associated with cardiovascular disease. Tai Chi is a safe and popular form of physical activity among older adults, yet direct comparisons are lacking between Tai Chi and brisk walking in their ability to reduce cardiovascular disease risk factors and improve psychosocial well-being.

    METHODS: 246 adults (mean age = 64.4 ± 9.8 years, age range = 30-91 years, 45.5% men) with hypertension and at least two but not more than three modifiable cardiovascular disease risk factors (diabetes, dyslipidaemia, overweight, physical inactivity and smoking) were randomly assigned to either Tai Chi (n = 82), brisk walking (n = 82) or control (n = 82) groups. The Tai Chi and brisk walking groups engaged in moderate-intensity physical activity 150 min/week for 3 months; daily home-based practice was encouraged for another 6 months. The primary outcome was blood pressure. Secondary outcomes were fasting blood sugar, glycated haemoglobin, total cholesterol, triglycerides, high- and low-density lipoprotein, body mass index, waist circumference, aerobic endurance, perceived stress, quality of life and exercise self-efficacy. Data were collected at baseline, post-intervention at 3 months and follow-up assessments at 6 and 9 months. Generalised estimating equation models were used to compare the changes in outcomes over time between groups.

    RESULTS: At baseline, the participants had an average blood pressure = 141/81 and average body mass index = 26; 58% were diabetics, 61% presented with dyslipidemia and 11% were smokers. No significant difference was noted between groups. Tai Chi significantly lowered blood pressure (systolic -13.33 mmHg; diastolic -6.45 mmHg), fasting blood sugar (-0.72 mmol/L), glycated haemoglobin (-0.39%) and perceived stress (-3.22 score) and improved perceived mental health (+4.05 score) and exercise self-efficacy (+12.79 score) at 9 months, compared to the control group. In the Tai Chi group, significantly greater reductions in blood pressure (systolic -12.46 mmHg; diastolic -3.20 mmHg), fasting blood sugar (-1.27 mmol/L), glycated haemoglobin (-0.56%), lower perceived stress (-2.32 score), and improved perceived mental health (+3.54 score) and exercise self-efficacy (+12.83 score) were observed, compared to the brisk walking group. No significant changes in the other cardiovascular disease risk indicators were observed over time between groups.

    CONCLUSION: Nurses play a key role in promoting exercise to reduce cardiovascular disease risk and foster a healthy lifestyle among adults. Tai Chi is better than brisk walking in reducing several cardiovascular disease risk factors and improving psychosocial well-being, and can be recommended as a viable exercise for building a healthy life free of cardiovascular disease.

    Be well!

    JP

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