Effects of Tai Chi on Lung Function,Exercise Capacity and Psychosocial Outcomes in Patients With Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

Objectives: To explore whether tai chi can improve lung function, exercise capacity, and health-related outcomes in patients with chronic obstructive pulmonary disease (COPD). Methods: The PubMed, Embase, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure (CNKI), Wanfang, and China Science and Technology Journal Database (VIP) databases were searched from inception to January 5, 2023. The methodological quality of the included studies was evaluated according to the Cochrane Handbook for Systematic Reviews of Interventions criteria. Results: A total of 1430 participants from 20 randomized controlled trials were included in this review. The results indicated significant effects of tai chi on FEV1, 6WMD, anxiety, and quality of life (p < 0.01), but not on FEV1%, FEVI/FVC, depression, and social support. Conclusions: Tai chi might be a potential alternative therapy to improve FEV1, 6WMD, anxiety, and quality of life for patients with COPD.

Keywords

Tai chi COPD FEV1 6WMD anxiety depression

Introduction

Chronic diseases are the biggest emerging threat to global health (Lozano et al., 2016). Chronic obstructive pulmonary disease (COPD) ranks the third leading cause of death currently worldwide and is a multi-factorial progressive chronic lung disease, defining features include persistent airflow obstruction and chronic airflow limitation because of airway and/or alveolar abnormalities (López-Campos et al., 2016). Most patients with COPD may experience lower exercise tolerance, enhanced dyspnea, as well as reduced quality of life (Decramer et al., 2012; Gu et al., 2021). Increased COPD symptoms provoke anxiety and depression, which inevitably lead to further breathlessness and exacerbation of panic. This causes a vicious circle whereby any activities that involve physical exertion are avoided, thereby leading to accelerated disease progression and increased mortality (Bourbeau & Nault, 2007; Martí et al., 2020; Ngai et al., 2016). In addition, COPD, as an incurable condition, carries a huge and growing economic and social burden (Barbosa et al., 2020). Therefore, it is imperative to explore effective therapy to help patients manage their symptoms to improve exercise capacity, lung function as well as other health-related functions.

The current treatment options for COPD include pharmacological, non-pharmacological (e.g., smoking cessation, exercise, oxygen therapy and pulmonary rehabilitation), and surgical treatment (e.g., lung transplantation; Mulhall & Criner, 2016; Vogelmeier et al., 2020). While pharmaceuticals have been studied extensively and utilized, their disease-modifying effects are limited or even uncertain (Mulhall & Criner, 2016; Ngai et al., 2016). Invasive surgical treatments have known postoperative complications (Decramer et al., 2012). Tai chi is a type of fitness exercise combining psychological treatment and physical exercise with no special equipment and attracts the attention and interest of the world (Polkey et al., 2018). Tai chi is characterized by slow, controlled graceful movements of different body parts, which integrates mental concentration and deep breathing (Chan et al., 2011; Wang et al., 2022). The potential benefits of tai chi have been well established by promoting circulation of ‘‘Qi’’ (vital energy) in the meridians, regulating functions of the internal organs, and improving psychological condition without risks of surgery and adverse drug reactions (Chan et al., 2011; Wang et al., 2022; Zhang et al., 2019).

The health benefits of tai chi have been observed in many chronic conditions, such as osteoarthritis, chronic pain, and Parkinson’s disease (Cai et al., 2022; Deuel & Seeberger, 2020; Hu, X. et al., 2020b; Urits et al., 2021; Zhang et al., 2021). However, whether tai chi is beneficial in improving lung function and health-related outcomes in COPD patients is presently inconclusive. A Cochrane systematic review explored the effects of tai chi for symptom improvement in COPD and found better effects on pulmonary function, but not on dyspnea level and quality of life (QoL; Ngai et al., 2016). A randomized controlled trial (RCT) including 120 patients conducted by Polkey et al. (2018) revealed a significant difference for QoL and 6-min walk distance (6MWD), but not for FEV1. A recently published RCT also evaluated the benefits of tai chi for COPD, and significant effects on mood, social support, and functional capacity were observed (Kraemer et al., 2021). Currently, no consensus has been reached about the benefits of tai chi (Zhang et al., 2019). With a plethora of original studies recently published, it is possible to explore a comprehensive picture of the potential benefits of tai chi for patients with COPD in terms of lung function and health-related outcomes (Kraemer et al., 2021; Zhu et al., 2018). Hence, this systematic review aims to evaluate the effects of tai chi on lung function, exercise capacity, and psychosocial outcomes in patients with COPD.

Methods and Search Strategy

This systematic search followed an international prospectively registered protocol (PROSPERO CRD42023389695). PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Chinese National Knowledge Infrastructure (CNKI), Wanfang, and China Science and Technology Journal (VIP) databases were searched to identify RCTs related to this topic from inception to January 5, 2023. Reference lists of related system reviews and meta-analyses were also manually searched to expand our search scope and identify more eligible RCTs. RCTs published in English and Chinese were included. The specific search strategy is shown in the supplementary material.

Inclusion Criteria

Types of Trials We only included RCTs written in English and Chinese. Dissertations, conference papers, and abstracts were excluded.

Types of Participants The inclusion criteria for the articles included clinically diagnosed adults (≥18 years) with COPD.

Types of Interventions The participants only received tai chi without other interventions. The control group could receive usual care, no intervention, or other non-tai chi interventions.

Types of Outcomes The primary outcomes in this systematic review were lung function (FEV1, FEV1%, FEV1/FVC) and exercise capacity measured by 6MWD. The secondary outcomes in this systematic review were psychosocial outcomes including anxiety, depression, QoL, and social support.

Study Selection and Data Extraction

Two reviewers independently read titles and abstracts identified by the search and then screened the full manuscripts of potentially relevant RCTs. The same two reviewers also independently extracted the data of eligible studies and recorded these on a Microsoft Excel spreadsheet, including author, year, participant characteristics, study location, details of intervention and control, time point as well as outcomes. Any disagreements were resolved through discussion with the third researcher.

Quality Appraisal

Two reviewers independently evaluated the quality of the eligible RCTs with the risk of bias tool from the Cochrane Collaboration (version 5.1.0), focusing on sequence generation, allocation concealment, blinding, attrition bias, completeness of outcome data, and other sources of bias (Higgins et al., 2019). The risk of bias for each item was adjudicated as ‘yes’ (low bias), ‘no’ (high bias), or ‘unclear’ (lack of relevant information or uncertainty of bias). Any discrepancies were also settled by a discussion with a third researcher.

Data Synthesis and Analysis

RevMan 5.30 was used for data synthesis and analysis. The standard mean difference (SMD) or mean difference (MD) with a 95% confidence interval (CI) was used to calculate the pooled effect size. Effect sizes were classified as small (SMD < 0.40), moderate (SMD = 0.40), or large (SMD > 0.70; Higgins et al., 2019). Statistical heterogeneity was assessed using the Cochran Q test and the Higgins I² statistical test. A fixed-effect model was used when no significant heterogeneity was observed (p > .05 and I² < 50%); otherwise, a random-effect model was applied. Sensitivity analysis was performed by removing each included RCT at a time to compare the effect sizes and CIs of the remaining RCTs. Potential publication bias was assessed with Egger’s test.

Results

Study Selection and Characteristics

A total of 582 records were identified. After removing duplicates, 366 articles were excluded after the title and abstract screen. After reviewing the full text, 20 finally fulfilled the inclusion criteria and were included for further analysis. The flow chart of study selection and screen is presented in Figure 1.

Figure 1.

Flow chart for the selection process.

Eleven included RCTs were written in the English language and nine in Chinese. The details of the characteristics were shown in Table 1. The results of the risk of bias among the 20 articles were presented in Figure 2.

Table 1.

Study Characteristics.

Study	Country	Mean Age	Sample Size	Intervenor	Intervention	Frequency and Duration	Time Point	Outcomes
Hu/2020	China	TG: 62.09 ± 3.80	TG:42	Professional coach	TG: Tai chi	35 min/time, 2 times/day, 3 months	3 months	Lung function: FEV1, FEV1/FVC, FEV1%
		CG: 62.20 ± 3.51	CG:42		CG: Usual care			Quality of life: SGRQ
								Anxiety: SCL-90
								Depression: SCL-90
Du/2013	China	TG:65.24 ± 8.37	TG:36	Professional coach	TG: Tai chi	TG:30 min/time, 2 times/day, 12 weeks	12 weeks	Lung function: FEV1%
		CG:64.48 ± 6.54	CG:38		CG: Usual care	CG: 30 min/time, 12 weeks		Exercise capacity:6MWT
		CG:64.48 ± 6.54	CG:38		CG: Usual care	CG: 30 min/time, 12 weeks		Quality of life: SGRQ
Zhang/2014	China	TG:68.02 ± 6.91	TG:18	NA	TG: Tai chi	60 min/time, 2 times/day, 12 months	12 months	Lung function: EV1, FEV1/FVC, FEV1%
		CG:66.71 ± 5.84	CG:18		CG: Usual care			Exercise capacity: 6MWT
		CG:66.71 ± 5.84	CG:18		CG: Usual care			Quality of life: CAT
Yao/2004	China	TG:66.1 ± 4.0	TG:40	Professional coach	TG: Tai chi	30 min/time, once/day, 3 months	3 months	Lung function: FEV1/FVC, FEV1%
Yao/2004	China	CG:66.2 ± 4.2	CG:40	Professional coach	CG: Usual care	30 min/time, once/day, 3 months	3 months	Lung function: FEV1/FVC, FEV1%
Pan/2018	China	NA	TG:20	Professional coach	TG: Tai chi	30 min/time, 3 times/week, 8 weeks	8 weeks	Lung function: EV1, FEV1%
			CG:21		CG: Usual care			Exercise capacity: 6MWT
								Anxiety: HADS
								Depression: HADS
								Quality of life: SGRQ
Zhang/2019	China	TG:49.24 ± 2.19	TG:29	NA	TG: Tai chi	60 min/time, 2 times/day, 24 months	24 months	Lung function: FEV1, FEV1%
Zhang/2019	China	CG:50.13 ± 2.08	CG:29	NA	CG: Usual care	60 min/time, 2 times/day, 24 months	24 months	Lung function: FEV1, FEV1%
Wang/2014	China	TG:68.82 ± 7.74	TG:12	Physical education teacher	TG: Tai chi	60 min/time, 7 times/week, 8 weeks	8 weeks	Lung function: FEV1%
		CG:73 ± 5.27	CG:12		CG: Usual care			Exercise capacity: 6MWT
		CG:73 ± 5.27	CG:12		CG: Usual care			Quality of life: SGRQ
Ren/2017	China	TG:59.2 ± 4.5	TG:30	Tai chi master	TG: Tai chi	60 min/time, 2 times/week, 12 weeks	12 weeks	Lung function: FEV1; FEV1/FVC
		CG:58.9 ± 4.2	CG:30		CG: Usual care			Exercise capacity: 6MWT
								Anxiety: SAS
								Depression: SDS
								Quality of life: CAT
Li/2011	China	TG:64.56 ± 4.73	TG:40	NA	TG: Tai chi	30 min/time, 4–5 times/week, 3 months	3 months	Anxiety: SAS
Li/2011	China	CG:62.68 ± 5.76	CG:40	NA	CG: Usual care	30 min/time, 4–5 times/week, 3 months	3 months	Depression: SDS
Aileen/2013	Hongkong China	TG:71.7 ± 8.2	TG:70	NA	TG: Tai chi	60 min/time, 2 times/week, 3 months	3 months	Lung function: FEV1
Aileen/2013	Hongkong China	CG:73.6 ± 7.4	CG:67	NA	CG: Usual medical treatment	60 min/time, 2 times/week, 3 months	3 months	Exercise capacity: 6MWT
Aileen/2010	Hongkong China	TG:71.7 ± 8.2	TG:70	NA	TG: Tai chi	60 min/time, 2 times/week, 3 months	3 months	Quality of life: SGRQ
Aileen/2010	Hongkong China	CG:73.6 ± 7.4	CG:67	NA	CG: Usual medical treatment	60 min/time, 2 times/week, 3 months	3 months	Social support: MSPSS
Gloria/2020	USA	TG:68.6 ± 9.2	TG:61	Certified and experienced instructors	TG: Tai chi	30 min/time, 3 times/week, 12 weeks	12 weeks	Depression: CES-D
Gloria/2020	USA	CG:68.1 ± 6.7	CG:31	Certified and experienced instructors	CG: Usual care	30 min/time, 3 times/week, 12 weeks	12 weeks	Depression: CES-D
Kantatong/2019	Thailand	TG:69.68 ± 7.67	TG:25	Tai chi instructor	TG: Tai chi	2 times/week, 12 weeks + 3 times/week, 12 weeks	24 weeks	Lung function: FEV1
		CG:67.5 ± 7.7	CG:25		CG: Usual care			Exercise capacity: 6MWT
		CG:67.5 ± 7.7	CG:25		CG: Usual care			Quality of life: SGRQ
Kristen/2021	USA	TG:68.6 ± 9.2	TG:61	Tai chi instructor	TG: Tai chi	TG:30 min/time, 3times/week, 12 months/CG:30 min/time, 6 times/week, 12 months	12 weeks	Exercise capacity: 6MWT
Kristen/2021	USA	CG:66.2 ± 4.2	CG:31	Tai chi instructor	CG: Mind-body breathing		12 weeks	Depression: CES-D
Leung/2013	Australia	37.0 ± 8.0	TG:22	NA	TG: Tai chi	60 min/time, once/day, 12 weeks	12 weeks	Anxiety: HADS
			CG:20		CG: Usual care			Depression: HADS
			CG:20		CG: Usual care			Quality of life: CRQ
Marilyn/2021	USA	TG:69.6 ± 7.5	TG:36	Tai chi instructor	TG: Tai chi	60 min/time, 2 times/week, 12 weeks + 60 min/time, once/day, 12 weeks	24 weeks	Exercise capacity: 6MWT
		CG:70.5 ± 9.2	CG:37		CG: Usual care			Depression: CES-D
								Quality of life: CRQ
								Social support: MSPSS
Niu/2013	China	TG: 59.7 ± 2.76	TG:20	NA	TG: Tai chi	50 min/time, once/day, 12 months	6 months	Lung function: FEV1, FEV1%
Niu/2013	China	CG: 61.3 ± 2.89	CG:20	NA	CG: Usual care	50 min/time, once/day, 12 months	6 months	Exercise capacity: 6MWD
Polkey/2018	China	NA	TG:60	NA	TG: Tai chi	TG: 60 min/time, 5 times/week, 12 weeks	12 weeks	Lung function: FEV1
			CG:60		CG: Pulmonary rehabilitation	CG: 60 min/time, 2 times/week, 12 weeks		Exercise capacity: 6MWD
			CG:60		CG: Pulmonary rehabilitation	CG: 60 min/time, 2 times/week, 12 weeks		Quality of life: SGRQ
Wang/2019	China	TG:67.83 ± 5.32	TG:26	Qualified instructor	TG: Tai chi	40–50 min/time, 3 times/week, 3 months	3 months	Lung function: FEV1, FEV1%, FEV1/FVC
		CG:67.86 ± 5.98	CG:24		CG: Usual care			Exercise capacity: 6MWD
		CG:67.86 ± 5.98	CG:24		CG: Usual care			Quality of life: CAT
Zhu/2018	China	TG:67.87 ± 5.22	TG:30	Tai chi instructor	TG: Tai chi	60 min/time, 3 times/day, 12 months	3 months	Lung function: FEV1%
		CG:68.1 ± 6.57	CG:30		CG: Usual care			Exercise capacity: 6MWD
		CG:68.1 ± 6.57	CG:30		CG: Usual care			Quality of life: CAT

Note. TG: treatment group; CG: control group; FEV1: forced expiratory volume in 1 second; FEV1%: FEV1 percentage predicted normal values; FEV1/FVC: forced expiratory volume in 1 second/forced vital capacity; SCL-90: Self-reporting Inventory; GRSQ: George Respiratory Questionnaire; 6MWT: 6-minute Walking Distance Test; CAT: COPD Assessment Test; HADS: Hospital Anxiety and Depression Scale; SAS: Self-rating Anxiety Scale; SDS: Self-rating Depression Scale; MSPSS: Multidimensional Scale of Perceived Social Support; CES-D: Center for Epidemiologic Studies; CRQ: Chronic Respiratory Disease Questionnaire.

Figure 2.

Risk of bias assessment.

Results of Meta-Analysis

The final values were used in our final efficacy analysis. The results of our analysis of each outcome were described below.

Lung Function

Ten trials including 665 patients evaluated the effects of tai chi on lung function using FEV1 (Chan, A. W. K. et al., 2013; Hu et al., 2020a; Kantatong et al., 2019; Niu et al., 2014; Pan et al., 2018; Polkey et al., 2018; Ren et al., 2017; Wang et al., 2018; Zhang et al., 2014; Zhang & Liu, 2019). The results indicated a significant difference between the tai chi and the control groups (MD = 0.12, 95% CI = 0.01 to 0.23, p = .03; I² = 85%, p < .01) with a random-effects model (Figure 3). However, the different trends were observed about the FEV1 predicted value from 10 RCTs (Du et al., 2013; Hu et al., 2020b; Niu et al., 2014; Pan et al., 2018; Wang et al., 2014; Wang et al., 2019; Yao, 2004; Zhang et al., 2014; Zhang & Liu, 2019; Zhu et al., 2018) (MD = 2.85, 95% CI = −1.04 to 6.75, p = .15; I² = 89%, p < .01) (Figure 4), and FEV1/FVC reported in five articles (Hu et al., 2020b; Ren et al., 2017; Wang et al., 2019; Yao, 2004; Zhang et al., 2014) (MD = 2.27, 95% CI = −4.25 to 8.79, p = .49; I² = 85%, p < .01) (Figure 5).

Figure 3.

The effect of tai chi intervention on FEV1.

Figure 4.

The effect of tai chi intervention on FEV1%.

Figure 5.

The effect of tai chi intervention on FEV1/FVC.

Exercise Capacity

Thirteen studies (Chan et al., 2013; Du et al., 2013; Kantatong et al., 2019; Kraemer et al., 2021; Moy et al., 2021; Niu et al., 2014; Pan et al., 2018; Polkey et al., 2018; Ren et al., 2017; Wang et al., 2014; Wang et al., 2019; Zhang et al., 2014; Zhu et al., 2018), involving 825 participants, assessed the benefits for exercise capacity measured by 6MWD. Because of inter-study heterogeneity (I² = 88%, p < .01), a random-effect model was performed. The data pooling revealed that tai chi can significantly increase the distance covered on the 6MWD compared to the control (MD = 34.6, 95% CI = 17.45 to 51.75, p < .01; I² = 88%, p < .01) (Figure 6).

Figure 6.

The effect of Tai chi intervention on 6MWD.

Anxiety

Five trials (Hu et al., 2020b; Leung et al., 2013; Li, 2011; Pan et al., 2018; Ren et al., 2017), including 303 participants, evaluated the effects on anxiety, measured by the Self-reporting Inventory (SCL-90), the Hospital Anxiety and Depression Scale (HADS), and the Self-rating Anxiety Scale (SAS). With a random-effects model, a significant difference in anxiety was observed (SMD = −0.69, 95% CI = −1.15 to −0.22, p < .01; I² = 73%, p < .01) (Supplementary material 2).

Depression

Eight trials (Hu et al., 2020b; Kraemer et al., 2021; Leung et al., 2013; Li, 2011; Moy et al., 2021; Pan et al., 2018; Ren et al., 2017; Yeh et al., 2020) with data from 530 participants assessed the effects on depression measured by SCL, HADS, SAS and the Center for Epidemiologic Studies (CES-D). With a random-effects model, pooled results in depression after tai chi intervention revealed no significant difference between groups (SMD = −0.57, 95% CI = −1.21 to 0.06, p = .08; I² = 92%, p < .01) (Supplementary material 2).

QoL

For QoL, three questionnaires were used to evaluate program effectiveness, including George Respiratory Questionnaire (SGRQ), Chronic Respiratory Disease Questionnaire (CRQ), and COPD Assessment Test (CAT). The collated differences from 13 RCTs (Chan, A. W. K. et al., 2013; Du et al., 2013; Hu et al., 2020b; Kantatong et al., 2019; Leung et al., 2013; Moy et al., 2021; Pan et al., 2018; Polkey et al., 2018; Ren et al., 2017; Wang et al., 2014; Wang et al., 2019; Zhang et al., 2014; Zhu et al., 2018) with 831 patients revealed significant difference between groups (SMD = −0.78, 95% CI = −1.20 to −0.37, p < .01; I² = 87%, p < .01), based on a random-effects model (Supplementary material 2).

Social Support

MSPSS (Multidimensional Scale of Perceived Social Support) was used to evaluate the level of social support in the included two articles (Chan et al., 2013; Moy et al., 2021). Significant effects were found from 206 data between groups (MD = −0.02, 95% CI = −0.51 to 0.48, p = .94; I² = 0%, p = .56), based on a fixed-effects model (Supplementary material 2).

Publication Bias and Sensitivity Analyses

Egger’s test was performed to determine publication bias from all the literature. The p value from the Egger is 0.77, which showed no publication bias exists in included trials. Sensitivity analysis was carried out by excluding individual trials one by one. Except for FEV1, no substantial modification for other outcomes in this review. Hence, the effects on FEV1 should be interpreted with caution. (Figure 7).

Figure 7.

Egger’s test of publication bias.

Discussion

This systematic review and meta−analysis aimed to analyze the RCTs on tai chi about its influence on lung function, exercise capacity, and psychosocial outcomes in patients with COPD. This systematic review involved 20 RCTs. In these, 1430 participants were randomly allocated to a tai chi group or a control group for minimum training of 8 weeks to maximum training of 24 months. By analyzing eligible studies, our pooled effect sizes showed that tai chi is a potential therapy for FEV1, 6WMD, anxiety, and QoL in patients with COPD. Healthcare staff could combine tai chi with usual medical care to optimize the management of COPD.

FEV1, FEV1%, and FEV1/FVC were used to reflect the lung function. The pooled results found that tai chi was beneficial for improving EFV1 in adults with COPD. This is in accordance with the conclusions of the previous Cochrane meta-analysis results conducted by Ngai et al., (2016). Nagi’s review including 4 studies with 570 patients also showed a significant improvement in FEV1 (p = 0.01) in patients with COPD after receiving tai chi. A possible explanation is that tai chi is a low-intensity, noncompetitive, and nonimpact exercise incorporating deep breathing into a body movement (Zhang et al., 2019). Repetitive deep breathing training draws the breath down into the lower tension (the main energy center of the body), increasing lung capacity and benefiting cardiorespiratory function (Chan, A. W. et al., 2013; Wang et al., 2019). However, no effects were observed on FEV1% and FEV1/FVC. As we only evaluated the effects on the post-intervention point, the improvement of lung function due to the pathophysiological process of COPD might not be demonstrable in short duration (Wu et al., 2018). Additionally, the limited number of RCTs included and differences in the characteristics of interventions could also affect the effects of intervention. Hence, it was still unclear whether improvements gained in lung function after tai chi intervention due to the variation of duration and doses of intervention. More RCTs are needed to reinforce the evidence of effects on lung function (Wu et al., 2018).

The 6MWT is a simple and valid evaluation parameter for assessing exercise capacity that measures the maximum distance covered in 6 min and is widely used in patients with COPD (Guyatt et al., 1985; Holland & Nici, 2013). In this meta-analysis, a statistically significant increase in 6MWD was observed in participants receiving tai chi compared with the control. This result was consistent with previously published reviews showing improvements in exercise capacity in patients with COPD (Wu et al., 2014). Tai chi should be in a semi-squatting position, and this may promote muscle endurance and further prolong exercise tolerance as reflected by longer distance capacity in 6MWT (Ngai et al., 2016).

Psychosocial outcomes are also a significant domain of disease management for patients with COPD (Yeh & Horwitz, 2017). This review showed significant effects of tai chi on anxiety and QoL. This is in line with research suggesting that tai chi may confer psychosocial benefits for patients with respiratory diseases (Philip et al., 2019; Wu et al., 2018). Previous evidence showed that patients with COPD found tai chi to be enjoyable, promoted exercise self-efficacy, removed psychosocial barriers to exercise (e.g., anxiety), and enhanced motion regulation processes (Yeh et al., 2010). Hence, an individual’s QoL is improved by removing negative emotions such as anxiety. A previous study also clarified that tai chi emphasizes the overall adjustment in patients with physical, mental, and psychological status, thereby contributing to further improvement in QoL for patients (Huston & Mcfarlane, 2016). However, there was also no significant improvement found in our review regarding depression and social support compared with the control group. Several factors such as insufficient required sample size, a small number of eligible RCTs, different styles and numbers of forms of tai chi adopted may partly explain the lack of significant findings.

Strengths and Limitations

Our study followed the guidelines for performing rigorous systematic reviews. Moreover, all included studies were RCTs, which reinforces the evidence of our results. We also proposed a rigorous screening and search strategy to identify the most comprehensive literature. Consequently, the results of our review are widespread belief. However, some limitations should also be mentioned in our review. First, grey literature and Google Scholar were not searched due to limited access to the website, leading to publication bias in our review. Second, tai chi intervention duration, frequency, and intensity were different between the intervention and control groups, affecting the reliability of the results. Third, we included articles published only in English and Chinese, leading to inclusion criteria bias. Fourth, since we only considered the immediate effects after tai chi intervention, the sustainability of intervention effects was not explored in our review. Therefore, pooled results in our review should be interpreted with caution given these limitations.

Conclusion

This meta-analysis further strengthened the support for the positive effects of tai chi on lung function, exercise capacity, and psychosocial outcomes in patients with COPD. Although existing included studies were limited, this review demonstrated the potential effects of tai chi on FEV1, 6WMD, anxiety, and QoL in patients with COPD, but not on FEV1%, FEVI/FVC, depression, and social support. More scientific and reasonable RCTs are warranted to confirm such positive effects of tai chi in COPD patients.

Supplemental Material

Supplemental Material - Effects of Tai Chi on Lung Function, Exercise Capacity and Psychosocial Outcomes in Patients With Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-analysis of Randomized Controlled Trials

Supplemental Material for Effects of Tai Chi on Lung Function, Exercise Capacity and Psychosocial Outcomes in Patients With Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-analysis of Randomized Controlled Trials by Ying Yang, Li Yang, Xuejin Yang, and Yuqi Tian in Biological Research For Nursing.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Data Availability

The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) network (PROSPERO CRD42023389695).

ORCID iD

Ying Yang

Supplemental Material

Supplemental material for this article is available online.

References

Barbosa

M. T.

Sousa

C. S.

Morais-Almeida

Simões

M. J.

Mendes

(2020). Telemedicine in COPD: An overview by topics. Copd, 17(5), 601–617. https://doi.org/10.1080/15412555.2020.1815182

Bourbeau

Nault

(2007). Self-management strategies in chronic obstructive pulmonary disease. Clinics in Chest Medicine, 28(3), 617–628. https://doi.org/10.1016/j.ccm.2007.06.002

Cai

S. B.

Chen

J. K.

Bai

X. H.

Jing

C. X.

Zhang

J. Q.

(2022). Tai chi for anxiety and depression symptoms in cancer, stroke, heart failure, and chronic obstructive pulmonary disease: A systematic review and meta-analysis. Complementary Therapies in Clinical Practice, 46, 101510. https://doi.org/10.1016/j.ctcp.2021.101510

Chan

A. W.

Lee

Suen

L. K.

Tam

W. W.

(2011). Tai chi Qigong improves lung functions and activity tolerance in COPD clients: A single blind, randomized controlled trial. Complementary Therapies in Medicine, 19(1), 3–11. https://doi.org/10.1016/j.ctim.2010.12.007

Chan

A. W. K.

Lee

D. T. F.

Suen

L. K. P.

Tam

W. W. S.

Chair

S. Y.

Griffiths

P. J.

(2013). The sustaining effects of tai chi qigong on physiological health for COPD patients: A randomized controlled trial: Complementary Therapies in Medicine. 21(6), 585–594. https://doi.org/10.1016/j.ctim.2013.09.008

Decramer

Janssens

Miravitlles

(2012). Chronic obstructive pulmonary disease. Lancet, 379(9823), 1341–1351. https://doi.org/10.1016/s0140-6736(11)60968-9

Deuel

L. M.

Seeberger

L. C.

(2020). Complementary therapies in Parkinson disease: A review of acupuncture, Tai Chi, Qi Gong, Yoga, and Cannabis. Neurotherapeutics: The Journal of the American Society for Experimental NeuroTherapeutics, 17(4), 1434–1455. https://doi.org/10.1007/s13311-020-00900-y

S. T.

Xing

Wang

C. X.

Ding

L. M.

Yang

F. B.

Liu

Z. L.

Zhu

(2013). Chinese journal of sports medicine. Chinese Journal of Sports Medicine, 32(005), 403–407.

Yang

Zhang

(2021). Mediating role of psychological capital in the relationship between social support and treatment burden among older patients with chronic obstructive pulmonary disease. Geriatric Nursing (New York, N.Y.), 42(5), 1172–1177. https://doi.org/10.1016/j.gerinurse.2021.07.006

10.

Guyatt

G. H.

Sullivan

M. J.

Thompson

P. J.

Fallen

E. L.

Pugsley

S. O.

Taylor

D. W.

Berman

L. B.

(1985). The 6-minute walk: A new measure of exercise capacity in patients with chronic heart failure. Canadian Medical Association Journal, 132(8), 919–923.

11.

Higgins

Thomas

Chandler

Cumpston

Welch

V. A.

(2019). Cochrane Handbook for systematic Reviews of interventions (prevajalec, trans.). Cochrane Handbook for systematic reviews of interventions.

12.

Holland

A. E.

Nici

(2013). The return of the minimum clinically important difference for 6-minute-walk distance in chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 187(4), 335–336. https://doi.org/10.1164/rccm.201212-2191ED

13.

J. P.

Han

P. X.

Sang

X. L.

J. C.

X. M.

(2020a). Clinical effect of Taijiquan rehabilitation training on middle-aged and elderly patients with stable chronic obstructive pulmonary disease. Chinese Journal of Gerontology, 40(24), 3.

14.

Lai

Wang

(2020b). Effects of Taichi exercise on knee and ankle proprioception among individuals with knee osteoarthritis. Research in Sports Medicine (Print), 28(2), 268–278. https://doi.org/10.1080/15438627.2019.1663520

15.

Huston

McFarlane

(2016). Health benefits of tai chi: What is the evidence? Canadian family physician Medecin de famille canadien, 62(11), 881–890.

16.

Kantatong

Panpanich

Deesomchok

Sungkarat

Siviroj

(2019). Effects of the tai chi qigong programme on functional capacity, and lung function in chronic obstructive pulmonary disease patients: A ramdomised controlled trial. Journal of Traditional and Complementary Medicine, 10(4), 354–359.

17.

Kraemer

K. M.

Litrownik

Moy

M. L.

Wayne

P. M.

Beach

Klings

E. S.

Reyes Nieva

Pinheiro

Davis

R. B.

Yeh

G. Y.

Yeh

G. Y.

(2021). Exploring tai chi exercise and mind-body breathing in patients with COPD in a randomized controlled feasibility trial. Copd, 18(3), 288–298. https://doi.org/10.1080/15412555.2021.1928037

18.

Leung

R. W.

McKeough

Z. J.

Peters

M. J.

Alison

J. A.

(2013). Short-form Sun-style t'ai chi as an exercise training modality in people with COPD. The European Respiratory Journal, 41(5), 1051–1057. https://doi.org/10.1183/09031936.00036912

19.

Z. D.

(2011). Clinical effect of Taijiquan in relieving depression and anxiety in chronic obstructive pulmonary disease. Chinese Journal of Aesthetic Medicine, 20(s6), 129–130.

20.

López-Campos

J. L.

Tan

Soriano

J. B.

(2016). Global burden of COPD. Respirology, 21(1), 14–23. https://doi.org/10.1111/resp.12660

21.

Lozano

Naghavi

Foreman

Lim

Shibuya

Aboyans

Abraham

Adair

Aggarwal

Ahn

S. Y.

Alvarado

Anderson

H. R.

Anderson

L. M.

Andrews

K. G.

Atkinson

Baddour

L. M.

Barker-Collo

Bartels

D. H.

Bell

M. L.

Ahn

S. Y. J. L.

(2012). Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the global burden of disease study 2010. Lancet (London, England), 380(9859), 2095–2128. https://doi.org/10.1016/S0140-6736(12)61728-0

22.

Martí

J. D.

McWilliams

Gimeno-Santos

(2020). Physical therapy and rehabilitation in chronic obstructive pulmonary disease patients admitted to the intensive care unit. Seminars in Respiratory and Critical Care Medicine, 41(6), 886–898. https://doi.org/10.1055/s-0040-1709139

23.

Moy

M. L.

Wayne

P. M.

Litrownik

Beach

Klings

E. S.

Davis

R. B.

Pinheiro

Yeh

G. Y.

(2021). Long-term exercise after pulmonary rehabilitation (LEAP): A pilot randomised controlled trial of tai chi in COPD. ERJ Open Research, 7(3). 00025. https://doi.org/10.1183/23120541.00025-2021

24.

Mulhall

Criner

G. J. R.

(2016). Non-pharmacological treatments for COPD, Respirology (Carlton, Vic.). 21(5), 791–809. https://doi.org/10.1111/resp.12782

25.

Ngai

S. P.

Jones

A. Y.

Tam

W. W.

(2016). Tai Chi for chronic obstructive pulmonary disease (COPD). The Cochrane Database of Systematic Reviews, 2016(6), Cd009953. https://doi.org/10.1002/14651858.CD009953.pub2

26.

Niu

Luo

B. L.

(2014). The effect of tai chi on chronic obstructive pulmonary disease: A pilot randomised study of lung function, exercise capacity and diaphragm strength. Heart, Lung & Circulation, 23(4), 347–352. https://doi.org/10.1016/j.hlc.2013.10.057

27.

Pan

Wang

Z. X.

Min

Xiao

Huang

Y. L.

Mao

Wang

(2018). The effect of 24 simplified Taichi on pulmonary rehabilitation in patients with stable chronic obstructive pulmonary disease. Chinese Journal of Rehabilitation Medicine, 33(6), 6.

28.

Philip

K. E.

Akylbekov

Stambaeva

Sooronbaev

Jones

(2019). Music, dance, and harmonicas for people with COPD. Respiratory Care, 64(3), 359. https://doi.org/10.4187/respcare.06701

29.

Polkey

M. I.

Qiu

Z. H.

Zhou

Zhu

M. D.

Y. X.

Chen

Y. Y.

S. P.

Y. S.

Jiang

B. T.

Mehta

Zhong

N. S.

Luo

Y. M.

(2018). Tai chi and pulmonary rehabilitation compared for treatment-naive patients with COPD: A randomized controlled trial. Chest, 153(5), 1116–1124. https://doi.org/10.1016/j.chest.2018.01.053

30.

Ren

Z. F.

Zhang

Hou

G. H.

Yang

Kang

X. H.

Wang

R. Y.

(2017). Effects of Tai Chi Zen on exercise ability and quality of life in chronic obstructive pulmonary disease. Chinese Journal of Traditional Chinese Medicine, 32(8), 4.

31.

Urits

Schwartz

R. H.

Orhurhu

Maganty

N. V.

Reilly

B. T.

Patel

P. M.

Wie

Kaye

A. D.

Mancuso

K. F.

Kaye

A. J.

Viswanath

(2021). A comprehensive review of alternative therapies for the management of chronic pain patients: Acupuncture, tai chi, osteopathic manipulative medicine, and chiropractic care. Advances in Therapy, 38(1), 76–89. https://doi.org/10.1007/s12325-020-01554-0

32.

Vogelmeier

C. F.

Román-Rodríguez

Singh

Han

M. K.

Rodríguez-Roisin

Ferguson

G. T.

(2020). Goals of COPD treatment: Focus on symptoms and exacerbations. Respiratory medicine, 166, 105938. https://doi.org/10.1016/j.rmed.2020.105938.

33.

Wang

Lee

Benson

Fricchione

Wang

Yeung

A. S. J.

(2014). The effects of tai chi on depression, anxiety, and psychological well-being: A systematic review and meta-analysis: International Journal of Behavioral Medicine. 21(4), 605, 617. https://doi.org/10.1007/s12529-013-9351-9

34.

Wang

Chen

Liu

(2019). The effects of tai chi on lung function, exercise capacity and health related quality of life for patients with chronic obstructive pulmonary disease: A pilot study. Heart, Lung & Circulation, 28(8), 1206–1212. https://doi.org/10.1016/j.hlc.2018.05.204

35.

Wang

L. H.

K. L.

Chen

X. D.

Liu

Q. J.

(2018). The effects of tai chi on lung function, exercise capacity and health related quality of life for patients with chronic obstructive pulmonary disease: A pilot study. Heart Lung Circulation, 28(8), 1206–1212.

36.

Wang

Zhang

Jin

(2022). Effects of tai chi and qigong on cognition in neurological disorders: A systematic review and meta-analysis. Geriatric Nursing (New York, N.Y.), 46, 166–177. https://doi.org/10.1016/j.gerinurse.2022.05.014

37.

L. L.

Lin

Z. K.

Weng

H. D.

Q. F.

Liu

K. X.

(2018). Effectiveness of meditative movement on COPD: A systematic review and meta-analysis. International Journal of Chronic Obstructive Pulmonary Disease, 13, 1239–1250. https://doi.org/10.2147/copd.S159042

38.

Liu

Wang

Yan

(2014). Effects of tai chi on exercise capacity and health-related quality of life in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. International Journal of Chronic Obstructive Pulmonary Disease, 9, 1253–1263.

39.

Yao

Y. P.

(2004). Effect of tai chi chuan on chronic obstructive pulmonary disease. Chinese Journal of Rehabilitation Theory and Practice, 10(7), 2.

40.

Yeh

G. Y.

Horwitz

(2017). Integrative medicine for respiratory conditions: Asthma and chronic obstructive pulmonary disease. The Medical Clinics of North America, 101(5), 925–941. https://doi.org/10.1016/j.mcna.2017.04.008

41.

Yeh

G. Y.

Litrownik

Wayne

P. M.

Beach

Klings

E. S.

Reyes Nieva

Pinheiro

Davis

R. B.

Moy

M. L.

(2020). BEAM study (breathing, education, awareness, movement): A randomised controlled feasibility trial of tai chi exercise in patients with COPD. BMJ Open Respiratory Research, 7(1), e000697. https://doi.org/10.1136/bmjresp-2020-000697

42.

Yeh

G. Y.

Roberts

D. H.

Wayne

P. M.

Davis

R. B.

Quilty

M. T.

Phillips

R. S.

(2010). Tai chi exercise for patients with chronic obstructive pulmonary disease: A pilot study. Respiratory Care, 55(11), 1475–1482.

43.

Zhang

Wei

Cao

Song

Jin

(2019). Effects of traditional Chinese exercise on cognitive and psychological outcomes in older adults with mild cognitive impairment: A systematic review and meta-analysis. Medicine (Baltimore), 98(7), e14581. https://doi.org/10.1097/md.0000000000014581

44.

Zhang

X. C.

Cai

Y. L.

Zhang

Chen

X. H.

Jia

X. H.

Zhang

X. Y.

Wang

L. J.

(2014). Effect of 24-style tai chi combined with respiratory function training and western medicine on stable COPD. Journal of Traditional Chinese Medicine, 55(22), 1937–1941.

45.

Zhang

Han

Yin

Huang

Lian

Yang

(2021). The effects of long-term tai-chi practice on blood pressure under normal conditions. The American Journal of the Medical Sciences, 361(5), 598–606. https://doi.org/10.1016/j.amjms.2020.11.008

46.

Zhang

Liu

D. H.

(2019). Effects of twenty-four style Tai Chi combined with respiratory rehabilitation training on lung function and quality of life in patients with chronic obstructive pulmonary disease. Journal of Practical Traditional Chinese Medicine, 35(3), 2.

47.

Zhu

Shi

Yan

Wang

Huang

(2018). A modified 6-form Tai Chi for patients with COPD. Complementary Therapies in Medicine, 39, 36–42. https://doi.org/10.1016/j.ctim.2018.05.007

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