The researchers also saw significant improvement among the tai chi patients on the physician global assessment score, the patient global assessment score, the 6-minute walk test, and both of the physical and mental components of the Medical Outcomes Study 36-Item Short Form Health Survey.
Only tai chi patients' body mass index and their scores on the Chronic Pain Self Efficacy Scale, which measures patients' confidence in their ability to perform a particular task, did not change significantly in the course of the study, compared with controls.
Dr. Wang and her associates pointed out some limitations, including their inability to conduct a double-blind study, since it “would have required the use of sham tai chi, for which no validated approach currently exists,” though they recommended that one be developed in the future.
Moreover, the investigators stated that the patients' preexisting knowledge and attitudes about tai chi may have resulted in a placebo effect.
To minimize this, they “informed participants only that the study was designed to test the effects of two different types of exercise training programs,” thereby deemphasizing the role of tai chi in order to “lessen participants' expectations.”
The participants also were encouraged to practice at home for 20 minutes per day on their own.
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MY TAKE
Despite Its Promise, Tai Chi Needs More Study
The findings from the research by Dr. Wang and associates showing that tai chi lessened the severity of fibromyalgia symptoms are provocative and in line with findings from small studies of tai chi in other patient populations.
However, there are other studies that have shown mixed results.
For example, although an 8-week, randomized, controlled study of mindfulness meditation and tai chi–like movements, known as qigong, in 128 patients with fibromyalgia showed significant reductions in pain, disability, and depression, these improvements were no better than those that were seen in the control group, which received educational support (J. Rheumatol. 2003;30:2257-62).
Considering this background, the positive results across all of the outcome measures that were reported by Dr. Wang and her associates are striking.
Nevertheless, questions remain: How much of the benefit of tai chi is due to a placebo effect? What is an appropriate control for tai chi? And what do these findings mean for clinical practice?
Going forward, replications of this study on a larger scale over longer periods of time are needed, with different practitioners and different styles at multiple sites, as well as determination of the optimal “dose” of tai chi.
Additionally, research should focus on comparisons with similar therapies such as yoga, plus an assessment of cost-effectiveness.
Even so, the potential efficacy and lack of adverse effects now make it reasonable for physicians to support patients' interest in exploring these types of exercises, even if it is too early to take out a prescription pad and write “tai chi.”
Dr. Yeh's remarks are paraphrased from her editorial, which accompanied the research report by Dr. Wang and associates (N. Engl. J. Med. 2010;363:783-4).
GLORIA Y. YEH, M.D., is in the division for research and education in complementary and integrative medical therapies at Harvard Medical School, Boston, as well as the division of general medicine and primary care at Beth Israel Deaconess Medical Center, Boston. She cowrote the editorial with Ted J. Kaptchuk, also of Harvard and the division of general medicine and primary care at Beth Israel, and Dr. Robert H. Shmerling, who is with the division of rheumatology at Beth Israel. The investigators were not involved with this study and stated they had no disclosures relative to their editorial.
