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Tai Chi Qigong for Health >> Tai Chi Qigong for Arthritis

Tai Chi, Qigong, Yoga Therapies and Osteoarthritis of the Knee
Terry Kit Selfe (University of Western Virginia School of Medicine, University of Virginia Health System)
Kim E. Innes (University of Western Virginia School of Medicine, University of Virginia Health System)

December 27, 2010 - Osteoarthritis (OA) is the most common form of arthritis, with an estimated 27 million U.S. adults having the condition, which most commonly affects the hip, knee, and hand joints . 80% of those aged 65 years or older show radiographic signs of OA [2]. Globally, OA is the eighth leading cause of disability with the joint most frequently associated with disability being the knee. The prevalence of knee OA increases with age; therefore, the impact of this disease will become even more substantial with the aging of the population.
Currently there is no cure for OA. The main emphasis of treatment involves managing the pain and dysfunction related to the disorder. The American College of Rheumatology (ACR) guidelines for the medical management of knee OA recommend non-pharmacologic therapies as a first line course of treatment. More recent practice guidelines from the Osteoarthritis Research Society International (OARSI) place initial emphasis on self-help strategies and therapies that are patient-driven, as opposed to passive treatments provided by health-care professionals.
Mind-body therapies may offer particular promise for alleviating the symptoms associated with knee OA. There is growing evidence to suggest that the practice of patient-driven mind-body therapies such as meditative practices can decrease pain, reduce other distressful symptoms, and enhance both physical and physiological function in a broad range of populations. Consistent with current OARSI recommendations, mind-body therapies stress the importance of active patient engagement in the management of his/her own health and well-being; the gentle nature of these disciplines make them especially suitable to older adults with OA.
However, systematic reviews regarding the effects of mind-body therapies on OA of the knee are lacking. The objective of our study is to review the clinical studies evaluating the use of patient-driven, mind-body therapies for the treatment of symptoms of osteoarthritis of the knee.
Findings of these eight studies suggest that mind-body therapies may improve specific outcomes related to osteoarthritis of the knee, notably pain and physical function. There were four tai chi studies (two Yang-style and two Sun-style); three of the four reported statistically significant reductions in pain, and all four yielded statistically significant improvements in physical function. The evidence regarding qigong comes from two RCTs, one of Tai Chi qigong and the other of Baduanjin qigong, both of which found statistically significant pain reduction in the qigong group vs. control. The Baduanjin qigong study also reported improved physical function, while the Tai Chi qigong did not. The weakest evidence was provided by the two Iyengar yoga studies. While both reported improvements in pain and physical function, they only represented 10 yoga group participants between them; larger controlled trials are needed before any generalized conclusions can be drawn.
The mechanisms underlying the reported beneficial effects of mind-body therapies on OA symptoms remain unknown. However, recent controlled studies have shown tai chi, qigong, and yoga to increase strength or endurance, enhance cardiopulmonary fitness, and improve balance in a range of populations, including older adults. In addition, a now growing number of controlled investigations suggest that the practice of yoga, tai chi, and qigong may reduce psychological distress and enhance emotional well-being, improve sleep, decrease perceived stress and reactivity to stressors, improve coping skills, and reduce sympathetic activation. These changes, in turn, may contribute to the decreased pain and enhanced physical function reported following the practice of these active mind-body therapies.
In conclusion, collectively these studies suggest that specific mind-body therapies may help reduce pain and improve physical function in persons with osteoarthritis of the knee. However, there are few rigorous controlled trials and the potential benefits of several mind-body interventions have not yet been systematically investigated. Additional high-quality studies are needed to clarify the effects of specific mind-body therapies on standardized measures of pain, physical function, and related indices in persons with OA of the knee, and to investigate possible underlying mechanisms.
This article is published in Current Rheumatology Reviews, 2009 Nov 1;5(4):204-211.




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