Historically, patients with chronic systolic heart failure (HF) were considered too frail to exercise and, through the late 1980s, avoidance of physical activity was a standard recommendation. Current concepts regarding the role of exercise in the management of HF have shifted, with some studies suggesting that increased activity can have profound benefits on functional capacity, cardiovascular measures, and affective state, ie, in moderating the morbidity associated with deconditioning, exercise intolerance, and depression linked with sedentary behaviors.
Typically, these patients are older with multiple morbidities; they often are fundamentally limited by deconditioning and have low cardiac output, arrhythmias, anxiety, and depression. Easily implemented, practical interventions that are enjoyable, promote exercise self-efficacy, and increase quality of life are needed.
Tai chi may represent an additional exercise option for patients with HF because it integrates multiple relevant processes, including mild to moderate aerobic activity, upper and lower extremity training, and core strengthening. In addition, it includes a meditative component that may enhance stress management, promoting important psychosocial benefits for those living with HF.
In this context, our objective was to perform a large clinical trial to determine whether a 12-week tai chi exercise program improves exercise capacity and quality of life in patients with chronic systolic HF as an adjunct to standard medical care in comparison with group-based heart health education.
Adherence to the study protocol was good. The mean proportions of classes attended were 75.0% and 66.7% in the tai chi and education groups, respectively. The mean number of hours of home tai chi practice during the 12 weeks was 9.9 hours. At 6 months’ follow-up telephone contact, 34 patients in the tai chi group (68.0%) reported continued practice (including daily, weekly, and monthly).
Their findings support those of prior studies of tai chi that also reported improvements in quality of life, mood (decrease in anxiety and enhancement in vigor), and exercise self-efficacy in other patient populations, including those with cardiovascular disease and cardiovascular risk factors.
Because chronic systolic HF is a progressive and debilitating condition, the importance of beneficially affecting patient-perceived quality of life is increasingly appreciated. They observed large, clinically significant changes in quality of life in this study, similar to or even greater than what has been seen with cardiac resynchronization therapy. In addition, given the relationship between depression and HF, improvement in mood in this population is also highly relevant.