Mind-body (including meditation and yoga)
Secondary Topic: Patient-Centered Outcomes Research
Tertiary Topic: State of the science/evidence base for integrative modalities
Comparative Effectiveness of Tai Chi versus Aerobic Exercise for Fibromyalgia: A Randomized Controlled Trial
Chenchen Wang, MD, MSc, Tufts Medical Center, Boston, MA, United States; Christopher H Schmid, PhD, Brown University, Providence, RI, United States; Roger A Fielding, PhD, Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, MA, United States; William F Harvey, MD, MSc, Tufts Medical Center, Boston, MA, United States; Lori L Price, MAS, MLA, Tufts University, Boston, MA, United States; Jeffrey B Driban, PhD, ATC, CSCS, Tufts Medical Center, Boston, MA, United States; Kieran F Reid, PhD, MPH, Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, MA, United States; Robert A Kalish, MD, Tufts Medical Center, Boston, MA, United States; Ramel Rones, N/A, Center for Mind-body Therapies, Boston, MA, United States; Timothy E McAlindon, MD, MPH, Tufts Medical Center, Boston, MA, United States
Late Breaker: No
Fibromyalgia is a complex disorder with psychological and pain components. Tai Chi, an integrated mind-body approach, has potential in treating fibromyalgia. It is unknown whether Tai Chi is more effective than aerobic exercise, a common treatment for fibromyalgia, and if its effectiveness depends on dosage and duration.
52-week, single-blind, randomized trial of Tai Chi (TC) vs. aerobic exercise for fibromyalgia (ACR 1990, 2010 diagnostic criteria). Participants were randomized into 4 TC groups (once or twice per week, 12 or 24 weeks) or aerobic exercise (twice per week, 24 weeks). Primary endpoint was change in Revised Fibromyalgia Impact Questionnaire (FIQR) score at 24 weeks. Secondary endpoints included change in patient global assessment, Hospital Anxiety and Depression scale (HADS), sleep quality (PSQI), self-efficacy, and 6-minute walk. Comparative efficacy of the five treatments was determined by longitudinal fixed-effects models using the intent-to-treat principle at 0, 12, 24 and 52 weeks. We report treatment contrasts at 24 weeks comparing: 1) aerobic exercise vs. four TC groups; 2) 12-week TC vs. 24-week TC; and 3) once-per-week TC vs. twice-per-week TC.
We included 226 subjects (mean age = 52±12, duration of pain = 9±8 years, BMI 30.0±6.7 kg/m2, 92% women, 61% white). The average of 4 TC groups, compared to aerobic exercise, showed significant improvements in FIQR (p=0.03), patient global (p=0.005), anxiety (p=0.006), and self-efficacy (p=0.0004). All other secondary outcomes favored TC over aerobic exercise at 12, 24 and 52 weeks. 24-week TC groups achieved significant improvements in FIQR, depression, and mental-component scores compared to 12-week groups (Table 1). TC with the same dosage and duration as aerobic exercise demonstrated an even larger effect for FIQR (16.2 points, 95%CI: 8.7, 23.6; p<0.0001). TC effects were consistent across instructors.
Tai Chi results in similar or greater symptom improvement than aerobic exercise, and longer duration demonstrated greater improvement.