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Fibromyalgia: tai chi at least as beneficial as aerobic exercise

By Jane Lewis
Tai chi is as at least as effective as aerobic exercise for managing fibromyalgia, if not more so, a US study published in the BMJ has found.

The researchers found that tai chi – an intervention that integrates physical, psychosocial, emotional, spiritual and behavioural elements – may be especially well suited to treating fibromyalgia.

Commenting on the findings, Professor Geoff Littlejohn, Emeritus Director of Monash Health Rheumatology, Melbourne, said tai chi targeted fibromyalgia at several levels. ‘The physical component modifies sensory input from the musculoskeletal system, while the meditative and relaxation components modify central processes which modulate the sensory sensitivity at a central level.’

He said the well-conducted study showed tai chi achieved similar or greater improvement in symptoms than regular exercise. ‘Tai chi is cheap, easy to access and enjoyable and, like other mind-body strategies such as yoga, should be recommended as one component of the multi-component strategies often required for management of fibromyalgia.’

The prospective, randomised, single-blind comparative effectiveness trial included 226 adults (average age, 52 years) who had had fibromyalgia for an average of nine years and who had not participated in tai chi or similar interventions in the past six months. Participants were randomly assigned to five treatment groups: supervised aerobic exercise (24 weeks, twice weekly) or one of four supervised tai chi interventions (12 or 24 weeks, once or twice weekly).

At 24 weeks, all groups showed improvement in the primary outcome: fibromyalgia impact questionnaire scores. However, compared with the aerobic exercise group, the combined tai chi groups showed significantly more improvement (group difference, 5.5 points). Compared with aerobic exercise of equal intensity and duration (twice weekly for 24 weeks), tai chi showed a significantly larger effect for the primary outcome (group difference, 16.2 points), as well as many secondary outcomes, including patient’s global assessment, anxiety and coping strategies.

A longer duration of tai chi had more benefit (24 weeks vs 12 weeks; difference, 9.6 points), and the effects of tai chi were consistent across all instructors.

Professor Littlejohn said that as understanding of fibromyalgia progressed, there was more emphasis on management strategies that targeted central pain modulatory processes.

‘Tai chi fits nicely with this,’ he told Medicine Today.
BMJ 2018; 360: k851.