Tai Chi exercise for psychological well-being among adults with cardiovascular disease: A systematic review and meta-analysis

Background: Regular exercise is beneficial for adults with cardiovascular disease to improve psychological well-being. Tai Chi is a mind-body exercise thought to promote psychological well-being. Aim: Examine the efficacy of Tai Chi in improving psychological well-being among persons with cardiovascular disease. Methods: An electronic literature search of 10 databases (AMED, CINAHL, Embase, OpenGrey, PsycARTICLES, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science) was conducted. Clinical trials that examined one or more aspect of psychological well-being, incorporated a Tai Chi intervention among cardiovascular disease participants, and were published in English or German languages were included. Comprehensive Meta-Analysis version 2.0 software (Biostat, Inc.) was used to calculate the effect sizes (i.e. Hedges'g) and the 95% confidence intervals using random effects models. Results: A total of 15 studies met the inclusion criteria, enrolling 1853 participants (mean age = 66 years old, 44% women). Outcomes included: quality of life (QOL), stress, anxiety, depression, and psychological distress. When Tai Chi was compared with controls, significantly better general QOL (Hedges'g0.96;p=0.02,I-2=94.99%), mental health QOL (Hedges'g=0.20;p=0.01,I-2=15.93) and physical health QOL (Hedges'g=0.40;p=0.00,I-2=0%); with less depression (Hedges'g=0.69;p=0.00,I-2=86.64%) and psychological distress (Hedges'g=0.58;p=0.00,I-2=0%) were found. Conclusions: Few Tai Chi studies have been conducted during the past decade examining psychological well-being among older adults with cardiovascular disease. Further research is needed with more rigorous study designs, adequate Tai Chi exercise doses, and carefully chosen outcome measures that assess the mechanisms as well as the effects of Tai Chi.