Tai Chi for osteopenic women: design and rationale of a pragmatic randomized controlled trial
Post-menopausal osteopenic women are at increased risk for skeletal fractures. Current osteopenia treatment guidelines include exercise, however, optimal exercise regimens for attenuating bone mineral density (BMD) loss, or for addressing other fracture-related risk factors (e.g.
poor balance, decreased muscle strength) are not well-defined. Tai Chi is an increasingly popular weight bearing mind-body exercise that has been reported to positively impact BMD dynamics and improve postural control, however, current evidence is inconclusive.
This study will determine the effectiveness of Tai Chi in reducing rates of bone turnover in post-menopausal osteopenic women, compared with standard care, and will preliminarily explore biomechanical processes that might inform how Tai Chi impacts BMD and associated fracture risks.
Methods: A total of 86 post-menopausal women, aged 45-70y, T-score of the hip and/or spine -1.0 and -2.5, have been recruited from primary care clinics of a large healthcare system based in Boston. They have been randomized to a group-based 9-month Tai Chi program plus standard care or to standard care only.
A unique aspect of this trial is its pragmatic design, which allows participants randomized to Tai Chi to choose from a pre-screened list of community-based Tai Chi programs. Interviewers masked to participants'treatment group assess outcomes at baseline and 3 and 9 months after randomization.
Primary outcomes are serum markers of bone resorption (C-terminal cross linking telopeptide of type I collagen, bone formation (osteocalcin), and BMD of the lumbar spine and proximal femur (dual-energy X-ray absorptiometry). Secondary outcomes include health-related quality-of-life, exercise behavior, and psychological well-being.
In addition, kinetic and kinematic characterization of gait, standing, and rising from a chair are assessed in subset of participants (n=16) to explore the feasibility of modeling skeletal mechanical loads and postural control as mediators of fracture risk.
Conclusion: Results of this study will provide preliminary evidence regarding the value of Tai Chi as an intervention for decreasing fracture risk in osteopenic women. They will also inform the feasibility, value and potential limitations related to the use of pragmatic designs for the study of Tai Chi and related mind-body exercise.
If the results are positive, this will help focus future, more in-depth, research on the most promising potential mechanisms of action identified by this study.Trial registration: This trial is registered in Clinical Trials.gov, with the ID number ofNCT01039012.
Author: Peter WayneJulie BuringRoger DavisEllen ConnorsPaolo BonatoBenjamin PatrittiMary FischerGloria YehCalvin CohenDanette CarrollDouglas Kiel
Credits/Source: BMC Musculoskeletal Disorders 2010, 11:40
Published on: 2010-03-01
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
make sure to read our disclaimer prior to contacting 7thSpace Interactive. To contact our editors, visit our online helpdesk. If you wish submit your own press release, click here.
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http://www.taichimaster.com/bruces-picks/ the-year-of-the-tiger-tiger-bones-standing-qigong- practices/
I've also discussed the subject of Tai Chi research with a well known master Bruce Frantzis extensively.
It's not very well known, but there is already a tremendous amount of empirical data validating Tai Chi in China. Over there to cope with a much larger demand on the medical system than what it could support, the government developed a simplified Tai Chi form specifically geared towards health and mandated that anyone not needing emergency care practice tai chi for at least 3 months to see if the problem went away (as this was generally known to happen if the person actually did the exercises consistently-hence the requirement), and then if it still remained they were given access to normal medical care.
The Chinese found Tai Chi was an acceptable substitute for most medical problems (especially those involving physical degeneration) and subsequently engaged in many other large scale tests (with thousands to millions of participants) to optimize their health program.
Given the extreme degree of evidence showing even poorly done Tai Chi can help address medical ailments, I've been curious as to why is has not already been extensively validated in Clinical Trials.
Bruce told me that it was a combination of two factors
1) Often times a poorly designed Tai Chi method is taught.
2) For Tai Chi to work effectively, the patients must practice on a daily basis (which many people end up being unwilling to do)-missing sessions dramatically reduces the efficacy.
3) The standard double blind model for testing is extremely limited in dealing with concerns 1 and 2, and no cares have been taken to make sure they are done.
Bruce told me one condition that best exemplifies this situation arthritis. Beyond healing it, Tai Chi reduces the pain very quickly, and if stopped the pain often returns. Since pain is a strong motivating factor, people who use Tai Chi for arthritis can generally be expected to practice enough to actually solve their condition, and this fact is supported with western medical evidence.
That all said, I'm happy I'm seeing more and more of these research studies come out and my hope is that we're starting to hit the tipping point of a Tai Chi health care revolution. It worked so well in China, and honestly it's almost free! I think this sums up the dynamic we're in, and I'm happy this study is helping to be part of it. Take a look!
http://www.taichimaster.com/tai-chi/the-t ai-chi-tipping-point/