Effects Of Tai Chi On Cardiopulmonary Function And Quality Of Life In Patients With Stable Angina Pectoris

With the increasing incidence and mortality of cardiovascular disease(CVD)in China,more attention is paid on the first aid and treatment in acute phase,while prevention of CVD and management of rehabilitation are less emphasized.Despite the use of coronary intervention and standard medication therapy,some patients still suffer from immobilization,angina pector reoccurrence,depression of different extent,disability to return to work.Rehabilitation of CVD plays a pivotal role in CVD prevention and improvement of prognosis.Cardiac rehabilitation is a comprehensive management focused on medication,exercise training,psychology,nutrition,risk factor controlling,aiming to improve life quality,prevent incidence of CVD and enable patients returning to normal social life.Investigations in domestic and abroad proved the benefit of cardiac rehabilitation in prevention and improvement of prognosis of CVD.Exercise training plays the core part of cardiac rehabilitation.Most exercise training modality derives from abroad.There are various forms of sports rehabilitation in traditional Chinese medicine(TCM),characterized by movement adjustment,body and mind mingling,gentle movements,harmony between body and spirit,etc.To make full use of TCM rehabilitation,pick up the suitable TCM exercise training therapy and to observe its efficacy on physical,psychology and social restoration,have profound significance for formation of integrated western and traditional medical cardiac rehabilitation model.Tai chi is the traditional Chinese exercise-training model as well as the common exercise among the people.Clinical researches about Tai chi in abroad mostly focus on exercise system disease,nervous system disease,tumor,hypertension,coronary heart disease(CHD),and diabetes mellitus field,but it has not been used in cardiac rehabilitation routinely.While in China,researches about Tai Chi mainly focus on the theory analyze.Despite some researches reporting the clinical efficacy of Tai Chi,but data involving precise assessment of cardiopulmonary function is rare.Improvement of Tai Chi combined with standard western medicine exercise rehabilitation on cardiopulmonary function and quality of life in patients with CHD is still controversial.Evidence-based evidence is still needed.The current study conducted systematic evaluation of published randomized controlled trials about the effects of Tai Chi on the cardiorespiratory function of patients with stable coronary heart disease based on literature review.In addition,we conducted a randomized,controlled trials to observe the improvement of Tai Chi on patients' cardiopulmonary function,exercise ability and quality of life.Research 1Systematic evaluation of the effects of Tai Chi on cardiopulmonary function of CHD patients based on randomized controlled trialsBased on published randomized controlled trials to evaluate the effects of Tai Chi on cardiopulmonary function in CHD patients,and thus to provide evidence for application of Tai Chi in CHD rehabilitation.Methods:(1)search strategy:literature search in Cochrane library(2006-2018),Pubmed database(1981-2018),OVID database(1980-2018),EMBASE database(1992-2018),Chinese journal database(1960-2018),Chinese biomedical journals database(1977-2018),Chinese scientific journal database(1988-2018),Chinese medical literature database(2002-2018),Wanfang library of China Academic Conference(1995-2018),Wanfang library of China Academic thesis(1996-2018),domestic CVD conference literature as well as related reference articles.According to previous including and excluding criteria,compare the efficacy of Tai Chi on cardiopulmonary function in CHD patients,and establish systematic evaluation based on the quality standard of Cochrane systematic evaluation brochure 5.3.Statistic 12.0software was applied for data analysis.(2)Search words:Chinese key word:randomized controlled trial,stable coronary heart disease,Tai Chi,cardiopulmonary.English key words:"coronary heart isease","Tai Chi/Ji/Qi","randomized controlled study","Cardiorespiratory/cardiopulmonary function".Results:395 articles were screen out,and 5 were included after exclusion.290 participants were included in the 5 trials,with 170 in experiment arm and 120 in control arm.Data were published between 1999 and 2015,patients ranging from post coronary artery bypass and coronary artery intervention,stable recovery phase of chronic stable angina and myocardial infarction,4 trials assessed the effects of Tai Chi on maximum oxygen consumption(VO2 max),and the results showed that Tai Chi could increase VO2 max compared with compare arm,indicating that Tai Chi could improve cardiopulmonary function in CHD patients.Conclusion:Tai Chi could improve cardiopulmonary function in CHD patients;increase VO2,while more high quality researches are needed to support it.Research 2Effects of Tai Chi on cardiopulmonary function and quality of life in patients with stable angina pectorisAim:To observe the efficacy of Tai Chi on cardiopulmonary function and quality of life in CHD patients via comparing between standardized exercise training and Tai Chi combined with standardized exercise training.Methods:68 CHD patients were randomized into experiment arm and 68 were into control arm.Control arm were subjected to standardized western medical exercise training,while Tai Chi was added in experiment arm.Exercise training lasted for 12 weeks,cardiopulmonary function,exercise tolerance,grip strength of the upper limb,body flexibility,balance,mental state,blood lipid level,tobacco dependence,TCM syndrome,quality of life were compared between the two arms.Results:136 stable CHD patients were enrolled in the current study between January 2016 to October 2017 from cardiac rehabilitation center of Beijing First Hospital of Integrated Chinese and Western Medicine.126 were included finally(10 missed),among which 61 were divided into experiment arm,and 65 were control arm.Participants were comparable in terms of demographic data,baseline status of combined disease,drug use,laboratory test results,TCM syndrome score,cardiopulmonary exercise test.Major efficacy indicator after exercise rehabilitation:PVO2 of experiment arm and control arm were 1535±303.33vs 1418±352.20 ml/min(P<0.05).Minor efficacy indicator after exercise rehabilitation:?maximum O2 pulse(VO2/HR),maximum minute ventilation volume(VE)in experiment arm were higher than that of control arm(P<0.05),the rest were not significant(P>0.05).?CHD risk factor comparison:triglyceride(TG)in experiment arm was lower than control arm(P<0.05),GAD-7 score in experiment was superior than control(P<0.05).Total Cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),body mass index(BMI),Nicotine dependence scale,PHQ-9 score did not show significant difference between two arms(P>0.05).?Body forward distance and single foot standing time in experiment arm were superior than control arm(P<0.05),maximum exercise were higher than control arm but without significant difference(P>0.05).?the degree of treatment satisfaction scale in Seattle angina question naire in experiment arm were superior than control arm(P<0.05),while no significant difference showed in terms of degree of physical activity limitation,the frequency of angina pectoris,and the cognitive dimension of the disease(P>0.05).?in terms of TCM syndrome score,Qi deficiency and blood stasis score of experiment arm were superior than that of control arm,phlegm turbidity score showed no significant difference(P>0.05).Conclusion:1.Tai Chi improves cardiopulmonary function in CHD patients,improves PVO2,Maximum O2 pulse and minute ventilation volume;2.Tai Chi improves CHD risk factors in CHD patients,decreasing TG,and alleviate anxiety;3.Tai Chi improves partial flexibility and balance in CHD patients including improvement of body forward flexion and improvement of the standing time of single foot;4.Tai Chi improves partial score of quality of life in CHD patients[the degree of treatment satisfaction[TS]score];5.Tai Chi improves Qi deficiency and blood stasis;6.Standardized exercise training improve exercise endurance,cardiopulmonary exercise function,body flexibility balance,the symptoms of anxiety and depression,blood lipid and body mass level,tobacco dependence,Qi deficiency,phlegm turbidity and blood stasis syndrome,and the life quality level in patients with stable angina even without combination of Tai Chi.The combination of Tai Chi will gain further benefit in some of the indicators.