Tai Chi and Qigong Practices for Chronic Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Several randomized controlled trials (RCTs) have assessed the role of Tai Chi and Qigong Practices (TQPs) in managing chronic heart failure (CHF). They have included broad variations in comparators, sample sizes, and results. This study evaluates existing RCTs for evidence of TQPs rehabilitation effects for CHF.

Methods: Both English and Chinese databases were searched from their inception to October 23, 2019. RCTs were included if they compared the addition of TQPs into routine managements (RMs) to RMs alone or compared TQPs to general exercise, with RMs as a consistent cointervention in both groups. Data were screened and extracted independently using predesigned forms. RCT quality was assessed with the Cochrane tool. The primary outcomes were peak oxygen consumption (VO_2peak), 6-minute walking distance (6MWD), and Minnesota Living with Heart Failure Questionnaire (MLHFQ). Mean differences (MDs) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed with an I ² statistic.

Results: A total of 33 RCTs with 2,465 patients were included in the systematic review. Compared to the RMs alone, TQPs plus RMs improved VO_2peak (MD: 1.24 mL/kg/min, 95% CI, 0.91 to 1.57; I ² = 0%), 6MWD (MD: 59.63 meters, 95% CI, 43.35 to 75.90 I ² = 88%), and MLHFQ (MD: -8.63 scores; 95% CI, -10.60 to -6.67; I ² = 94%). Compared to general exercise, superior improvements were found in the TQP group; they were significant in MLHFQ (MD: -9.18 scores; 95% CI, -17.95 to -0.41; I ² = 86%), but not in VO_2peak or 6MWD. Evidence was also found of TQPs' safety and high adherence.

Conclusions: Considering that there are low costs, multiple physical benefits, and no equipment required, TQPs are a promising rehabilitation therapy, as an adjunct to routine pharmacotherapies or as an alternative to conventional exercises, especially in home-based settings.

Figure 1

Summary of findings. a: 30% of the information from 1 high-risk RCT; removing this RCT significantly altered the effect estimates; 25% of the studies had a high risk of the randomization process. b: 20% of the information from 1 high-risk RCT; removing this RCT moderately altered the size of effect estimates; 17% of the studies had a high risk of the randomization process. c: considerable heterogeneity based on I². d: imprecision, as OIS criteria were not met, primarily due to the small sample size (<400). 6MWD: 6-minute walking distance, BNP: B-type natriuretic peptide, CI: confidence interval, FU: follow-up, LVEF: left ventricular ejection fraction, MLHFQ: Minnesota Living with Heart Failure Questionnaire, NYHA: New York Heart Association, Peak VO2: peak oxygen consumption, RCT: randomized controlled trial, RM: routine management (according to current guidelines).

Figure 2

Meta-analysis results for MLHFQ (total score) including overall pooled effects and subgroup effects. The pooled effect from all included studies and each subgroup is shown in red diamond and blue square, respectively. Both are along with their 95% confidence intervals. Meta-analysis results showing individual study data are presented in Supplementary Materials: eFigures 2 and 3 for part A and part B, respectively. MLHFQ: Minnesota Living with Heart Failure Questionnaire, No.: number, CI: confidence interval, TQP: Tai Chi and Qigong Practice, NA: not available, TC&QG: Tai Chi and Qigong, RM: random-effects model, MCID: minimum clinically important difference, EF: ejection fraction, HFrEF: heart failure with reduced ejection fraction, HFpEF: heart failure with perceived ejection fraction.

Figure 3

Meta-analysis results for 6MWD (meters) including overall pooled effects and subgroup effects. The pooled effect from all included studies and each subgroup is shown in red diamond and blue square, respectively. Both are along with their 95% confidence intervals. Meta-analysis results showing that individual study data are presented in Supplementary Materials: eFigures 4 and 5 for part A and part B, respectively. 6MWD: 6-minute walking distance, No.: number, CI: confidence interval, TQP: Tai Chi and Qigong Practice, NA: not available, TC&QG: Tai Chi and Qigong, RM: random-effects model, MCID: minimum clinically important difference.

Figure 4

Meta-analysis results for peak VO2 (mL/kg/min) including overall pooled effects and subgroup effects. The pooled effect from all included studies and each subgroup is shown in red diamond and blue square, respectively. Both are along with their 95% confidence intervals. Meta-analysis results showing that individual study data are presented in Supplementary Materials: eFigures 6 and 7 for part A and part B, respectively. VO2: oxygen consumption, No.: number, CI: confidence interval, TQP: Tai Chi and Qigong Practice, NA: not available, RM: random-effects model, FM: fixed-effects model, MCID: minimum clinically important difference.

Figure 5

Meta-analysis results for LVEF (%) including overall pooled effects and subgroup effects. The pooled effect from all included studies and each subgroup is shown in red diamond and blue square, respectively. Both are along with their 95% confidence intervals. Meta-analysis results showing that individual study data are presented in Supplementary Materials: eFigures 8 and 9 for part A and part B, respectively. LVEF: left ventricular ejection fraction, No.: number, CI: confidence interval, TQP: Tai Chi and Qigong Practice, NA: not available, TC&QG: Tai Chi and Qigong, RM: random-effects model, FM: fixed-effects model, MCID: minimum clinically important difference.

Figure 6

Meta-analysis results for BNP (pg/mL) including overall pooled effects and subgroup effects. The pooled effect from all included studies and each subgroup is shown in red diamond and blue square, respectively. Both are along with their 95% confidence intervals. Meta-analysis results showing that individual study data are presented in Supplementary Materials: eFigures 10 and 11 for part A and part B, respectively. BNP: B-type natriuretic peptide, No.: number, CI: confidence interval, TQP: Tai Chi and Qigong Practice, NA: not available, RM: random-effects model, MCID: minimum clinically important difference.