Effect of Taiji Versus Aerobic Exercise for Fibromyalgia

A recently published research investigation compares Taiji exercise with aerobic exercise for the treatment of fibromyalgia. Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. This research concluded that participants of either exercise routine show improvements after practicing twice a week for 24 weeks, and participants of the Taiji exercise routine show more improvements than participants of the aerobic exercise routine.

What Is Fibromyalgia? Fibromyalgia [1] is a condition that causes pain all over the body. The most common symptoms of fibromyalgia are

  • Pain and stiffness all over the body.
  • Fatigue and tiredness.
  • Depression and anxiety.
  • Sleep problems.
  • Problems with thinking, memory, and concentration.
  • Headaches, including migraines.

It affects about 4 million adults in the U.S., or about 2% of the U.S. population, with women twice more likely than men.

Fibromyalgia should be treated by a doctor or team of healthcare professionals who specialize in the treatment of fibromyalgia and other types of arthritis, called rheumatologists.

Fibromyalgia is usually treated with medication (pain relievers and anti-depression medicines), aerobic exercises, and often with addition of stress management techniques (such as meditation, yoga, massage, and better sleeping habits), and behavior therapy to treat any underlying depression.

Why The Need for This Study? Since use of pain relievers and anti-depression medicines could have serious side effects, such as addiction and adverse mood changes, some people prefer to rely on treatment with only aerobic exercise. This leads to the importance of this research, whether doing Taiji exercise can be an alternative to aerobic exercise.

Description of Recent Research Investigation: A recent research investigation was published in the March 21, 2018 issue of the medical journal BMJ [2]. This involves a randomized, 52 week, single blind comparative effectiveness trial involving 226 adults with fibromyalgia (as defined by the American College of Rheumatology 1990 and 2010 criteria). The trial was performed at the Tufts Medical Center in Boston, Massachusetts. The 226 participants were randomly assigned, with 115 being assigned to one of four Taiji groups (12 or 24 weeks, once or twice weekly) and 75 to an aerobic exercise group (twice weekly for 24 weeks). The average pain duration of the participants was 9 years. Roughly about 2/3 of the participants were also taking pain relievers to treat their fibromyalgia. The trial did not change or recommend changes in medical therapy. The mean age of the participants was 52, and 92% were females, and 61% were of the white race. Participants were evaluated at the end of 12 weeks, 24 weeks, and 52 weeks.

The aerobic exercise consisted of several components of an active warm-up including low intensity movements and dynamic stretching, choreographed aerobic training, progressing gradually from low to moderate intensity, and cool down exercises. The Taiji exercise consisted of warm-up and stretching exercises, meditative movements, breathing techniques, various relaxation methods, and doing Taiji forms [3]. There were three Taiji instructors.

The participants were assessed via the Revised Fibromyalgia Impact Questionnaire (FIQR) [4], as well as other assessment tools, such as the patient’s global assessment and the hospital anxiety and depression scale [5]. The FIQR is a series of questions about the degree of difficulty of doing various daily tasks.

Results of Research Investigation: The FIQR scores improved for all five groups: (1) Taiji group meeting twice per week for 24 weeks, (2) Taiji group meeting once per week for 24 weeks, (3) Taiji group meeting twice per week for only 12 weeks, (4) Taiji group meeting once per week for only 12 weeks, and (5) aerobic exercise group meeting twice per week for 24 weeks.

There were 4 major results:

  1. The improvements for the Taiji group that met twice weekly for 24 weeks (Group 1) and the Taiji group that met once per week for 24 weeks (Group 2) were statistically significantly more than the aerobic group (Group 5). An improvement by 8.1 points in the FIQR score (0-100) is statistically significant. This research study shows that Groups 1/2 showed an improvement of 16.2 points as compared to Group 5.
  2. The Taiji groups who met for 24 weeks (Groups 1 and 2) show greater improvement than the Taiji groups who met for only 12 weeks (Groups 3 and 4).
  3. There was no significant difference between the improvements between the Taiji group meeting twice per week for 24 weeks (Group 1) and once per week for 24 weeks (Group 2), or between the Taiji group meeting twice per week for 12 weeks (Group 3) and once per week for 12 weeks (Group 4).
  4. The results for the Taiji participants did not depend on the Taiji instructor.

Result 3 that concludes that meeting twice per week did not show more improvement than meeting once per week may seem puzzling. However, we need to keep in mind that the participants were told by the instructors to practice daily. So this means that most likely the participants in various Taiji groups during the trial were already practicing several times per week independent of whether they had formal practices twice per week or only once per week.

The reason that there was a significant difference between Groups 1/2 and Groups 3/4 is because the participants in Groups 3/4 are less likely to continue practicing Taiji when their official lessons were finished after 12 weeks.

Result 4 means that the positive results of the Taiji groups were due to Taiji, and not to the specific Taiji instructor.

Implication and Significance: Traditionally medication and aerobic exercise are often combined as the main treatment method for people inflicted with fibromyalgia. However, since medicines such as pain relievers and anti-depression medicines may have potential serious side effects such as addiction and adverse mood changes, often aerobic exercise may be the major treatment for many fibromyalgia patients. Since some people may not be able or may not want to do some of the aerobic exercise, having Taiji exercise as an alternative treatment option, especially when it may even be a better treatment option than aerobic exercise, is a significant medical finding.

The trial also showed that the Taiji participants as a whole attended 62% of possible classes, whlle the aerobic exercise participants as a whole attended only 40% of possible classes. This suggests that a Taiji program may be able to retain more of the fibromyalgia patients than a aerobic exercise program.

[1] Fibromyalgia, Center for Disease Control and Prevention: https://www.cdc.gov/arthritis/basics/fibromyalgia.htm.[2] C. Wang, et. al., “Effects of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial,” March 21, 2018, BMJ journal: https://doi.org/101136/bmj.k851. BMJ used to stand for British Medical Journal, but now only the acronym is used. The pdf file for this article can be downloaded at: https://www.researchgate.net/publication/323938961_Effect_of_tai_chi_versus_aerobic_exercise_for_fibromyalgia_Comparative_effectiveness_randomized_controlled_trial

[3] The paper did not identify the specific Taiji forms that were performed. My guess is that they were simple Yang-style forms.

[4] The Revised Fibromyalgia Impact Questionnaire (FIQR) can be found at: https://fiqrinfo.ipage.com/FIQR%20FORM.pdf.

[5] See reference 2 for a description of other assessment tools and other findings at 52 weeks.

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2 Responses to “Effect of Taiji Versus Aerobic Exercise for Fibromyalgia”

  1. RUBY TSAO says:

    Thanks for the report. Taiji may cause less pain and less injury as low impact exercise. Slow motion requiring sustained position is long term training for muscle strength. In Taiji “Horse Stance”, body weight is on the knees, equivalent of weight-lifting without the weight. Taiji is especially suitable for seniors to prevent knee pain and falls by building up strength and balance. Going through a series of 18 styles or more requires “discipline”, an important ingredient in long term success of any exercise program. Taiji is good exercise with or without fibromyalgia.

  2. Corinne Tan says:

    This report confirms what I always thought. I am convinced from my own experience that Taiji keeps the aches and pains at bay. I try to do the set several times a week. When I am traveling and can’t do Taiji, by body lets me know that I must or I will feel increasingly worse on subsequent days.

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