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Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k851 (Published 21 March 2018) Cite this as: BMJ 2018;360:k851 Visual abstract, showing the study population, design and primary outcomes.

Opinion

Time to rethink exercise for fibromyalgia care

Opinion

The unintended consequences of tai chi for fibromyalgia

  1. Chenchen Wang, director and professor of medicine1,
  2. Christopher H Schmid, professor of biostatistics and co-director2,
  3. Roger A Fielding, director and professor of medicine3,
  4. William F Harvey, assistant professor of medicine1,
  5. Kieran F Reid, scientist III3,
  6. Lori Lyn Price, statistician4,
  7. Jeffrey B Driban, assistant professor of medicine1,
  8. Robert Kalish, associate professor of medicine5,
  9. Ramel Rones, tai chi instructor6,
  10. Timothy McAlindon, division chief and professor of medicine1
  1. 1Center for Complementary and Integrative Medicine and Division of Rheumatology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA
  2. 2Department of Biostatistics and Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
  3. 3Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Tufts University School of Medicine, Boston, USA
  4. 4The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
  5. 5Division of Rheumatology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
  6. 6Center for Mind-Body Therapies, Boston, MA, USA
  1. Correspondence to: C Wang cwang2{at}tuftsmedicalcenter.org
  • Accepted 13 February 2018

Abstract

Objectives To determine the effectiveness of tai chi interventions compared with aerobic exercise, a current core standard treatment in patients with fibromyalgia, and to test whether the effectiveness of tai chi depends on its dosage or duration.

Design Prospective, randomized, 52 week, single blind comparative effectiveness trial.

Setting Urban tertiary care academic hospital in the United States between March 2012 and September 2016.

Participants 226 adults with fibromyalgia (as defined by the American College of Rheumatology 1990 and 2010 criteria) were included in the intention to treat analyses: 151 were assigned to one of four tai chi groups and 75 to an aerobic exercise group.

Interventions Participants were randomly assigned to either supervised aerobic exercise (24 weeks, twice weekly) or one of four classic Yang style supervised tai chi interventions (12 or 24 weeks, once or twice weekly). Participants were followed for 52 weeks. Adherence was rigorously encouraged in person and by telephone.

Main outcome measures The primary outcome was change in the revised fibromyalgia impact questionnaire (FIQR) scores at 24 weeks compared with baseline. Secondary outcomes included changes of scores in patient’s global assessment, anxiety, depression, self efficacy, coping strategies, physical functional performance, functional limitation, sleep, and health related quality of life.

Results FIQR scores improved in all five treatment groups, but the combined tai chi groups improved statistically significantly more than the aerobic exercise group in FIQR scores at 24 weeks (difference between groups=5.5 points, 95% confidence interval 0.6 to 10.4, P=0.03) and several secondary outcomes (patient’s global assessment=0.9 points, 0.3 to 1.4, P=0.005; anxiety=1.2 points, 0.3 to 2.1, P=0.006; self efficacy=1.0 points, 0.5 to 1.6, P=0.0004; and coping strategies, 2.6 points, 0.8 to 4.3, P=0.005). Tai chi treatment compared with aerobic exercise administered with the same intensity and duration (24 weeks, twice weekly) had greater benefit (between group difference in FIQR scores=16.2 points, 8.7 to 23.6, P<0.001). The groups who received tai chi for 24 weeks showed greater improvements than those who received it for 12 weeks (difference in FIQR scores=9.6 points, 2.6 to 16.6, P=0.007). There was no significant increase in benefit for groups who received tai chi twice weekly compared with once weekly. Participants attended the tai chi training sessions more often than participants attended aerobic exercise. The effects of tai chi were consistent across all instructors. No serious adverse events related to the interventions were reported.

Conclusion Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise, the current most commonly prescribed non-drug treatment, for a variety of outcomes for patients with fibromyalgia. Longer duration of tai chi showed greater improvement. This mind-body approach may be considered a therapeutic option in the multidisciplinary management of fibromyalgia.

Trial registration ClinicalTrials.gov NCT01420640.

Footnotes

  • Contributors: CW had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. CW, CHS, and WFH act as guarantors of this study. CW, CHS, RAF, and TMcA designed the study. CW, CHS, RAF, WFH, KFR, LLP, JBD, and RK acquired the data. All authors analyzed and interpreted the data and prepared the manuscript. CHS and LLP carried out the statistical analysis. CW obtained funding. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding: This study was supported by the National Center for Complementary and Integrative Health of the National Institutes of Health (NIH, R01AT006367 and K24AT007323), the National Center for Research Resources, NIH (UL1 RR025752) and the National Center for Advancing Translational Sciences, NIH (UL1TR000073 and UL1TR001064). RAF and KRF are supported in part by supported by the US Department of Agriculture, under agreement No 58-1950-4-003 and the Boston Claude D Pepper Older Americans Independence Center (1P30AG031679). The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Complementary and Integrative Health of the National Institutes of Health. The organizations mentioned here did not have any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: all authors had financial support from National Center for Complementary and Integrative Health at the National Institutes of Health in the US for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study was and approved by the Tufts Health Sciences Campus institutional review board and the National Institutes of Health, and informed consent was given by all patients.

  • Data sharing: The investigators will share data (with associated coding library) used in developing the results presented in this manuscript on request to the corresponding author at cwang2@tuftsmedicalcenter.org. Anonymized record level data will be made available on proposal for analysis by those who have received ethical clearance from their host institution.

  • Transparency: The lead author (CW) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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