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Tai Chi for heart attack survivors: qualitative insights.

ABSTRACT: OBJECTIVES:Cardiac rehabilitation (CR) programmes are standard of care for patients following a coronary event. While such exercise-based secondary prevention programme do offer benefits, they are used by less than 30% of eligible patients and attrition within these programmes is high. This project is a nested qualitative assessment of a pilot programme considering Tai Chi (TC) as an alternative to CR. We hypothesised that TC may overcome several key barriers to CR. METHODS:A semistructured focus group agenda was used to assess three key domains of feasibility: (1) patients' experiences, (2) reasons/barriers for not having attended CR and (3) any improvements in physical activity and other secondary outcomes (quality of life, weight, sleep). A thematic analysis was used to better understand the key concepts. RESULTS:This high-risk group of patients reported that they enjoyed TC exercise, and felt confident and safe doing it. TC practice was reported to support other types of physical activity allowing for a generalisation of positive effects. DISCUSSION:This analysis is consistent with published reports of TC practice improving mood and psychological well-being. Qualitative methods allowed us to find emergent experiential reports of behaviour change factors found in established behaviour change theories.

SUBMITTER: Conboy L

PROVIDER: S-EPMC7265974 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Tai Chi for heart attack survivors: qualitative insights.

Conboy Lisa L Krol Julie J Tomas Jose J Yeh Gloria Y GY Wayne Peter P Salmoirago-Blotcher Elana E

BMJ supportive & palliative care 20190404 4

<h4>Objectives</h4>Cardiac rehabilitation (CR) programmes are standard of care for patients following a coronary event. While such exercise-based secondary prevention programme do offer benefits, they are used by less than 30% of eligible patients and attrition within these programmes is high. This project is a nested qualitative assessment of a pilot programme considering Tai Chi (TC) as an alternative to CR. We hypothesised that TC may overcome several key barriers to CR.<h4>Methods</h4>A semi ...[more]

PMID: 30948446

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Project description:ObjectiveTo qualitatively explore perceived physical and psychosocial effects and overall patient experience associated with a 12-week tai chi (TC) intervention and an education group in a clinical trial of patients with chronic heart failure (HF).Subjects and methodsWe randomized 100 patients with chronic systolic HF (NYHA Class 1-3, ejection fraction?40%) to a 12-week group TC program or an education control. At 12-weeks, semi-structured interviews were conducted on a random subset (n = 32; n = 17 in TC, n = 15 in control), audiorecorded and transcribed verbatim. Two independent reviewers extracted information using grounded-theory methods for emergent themes. We explored similarities and differences in themes/sub-themes between the groups, and examined qualitative association with changes from baseline to post-intervention in previously reported quantitative measures (e.g., Minnesota Living with HF, Cardiac Exercise Self Efficacy and Profile of Mood States).ResultsThe mean age (±SD) of participants was 68±9 years, baseline ejection fraction 29±7%, and median New York Heart Association class 2 HF. We idenitifed themes related to the patient's experience of illness, perceptions of self, and relationship to others. Specific psychosocial and physical benefits were described. Common themes emerged from both groups including: social support and self-efficacy related to activity/exercise and diet. The tai chi group, however, also exhibited a more global empowerment and perceived control. Additional themes in TC included mindfulness/self-awareness, decreased stress reactivity, and renewed social role. These themes mirrored improvements in previously reported quantitative measures (quality-of-life, self-efficacy, and mood) in TC compared to control. Patients in TC also reported physical benefits (e.g., decreased pain, improved energy, endurance, flexibility).ConclusionPositive themes emerged from both groups, although there were qualitative differences in concepts of self-efficacy and perceived control between groups. Those in tai chi reported not only self efficacy and social support, but overall empowerment with additional gains such as internal locus of control, self-awareness and stress management. Future studies of mind-body exercise might further examine perceived control, self-efficacy, and locus-of-control as potential mediators of effect.

Project description:Preliminary evidence suggests that meditative exercise may have benefits for patients with chronic systolic heart failure (HF); this has not been rigorously tested in a large clinical sample. We sought to investigate whether tai chi, as an adjunct to standard care, improves functional capacity and quality of life in patients with HF.A single-blind, multisite, parallel-group, randomized controlled trial evaluated 100 outpatients with systolic HF (New York Heart Association class I-III, left ventricular ejection fraction ?40%) who were recruited between May 1, 2005, and September 30, 2008. A group-based 12-week tai chi exercise program (n = 50) or time-matched education (n = 50, control group) was conducted. Outcome measures included exercise capacity (6- minute walk test and peak oxygen uptake) and disease-specific quality of life (Minnesota Living With Heart Failure Questionnaire).Mean (SD) age of patients was 67 (11) years; baseline values were left ventricular ejection fraction, 29% (8%) and peak oxygen uptake, 13.5 mL/kg/min; the median New York Heart Association class of HF was class II. At completion of the study, there were no significant differences in change in 6-minute walk distance and peak oxygen uptake (median change [first quartile, third quartile], 35 [-2, 51] vs 2 [-7, 54] meters, P = .95; and 1.1 [-1.1, 1.5] vs -0.5 [-1.2, 1.8] mL/kg/min, P = .81) when comparing tai chi and control groups; however, patients in the tai chi group had greater improvements in quality of life (Minnesota Living With Heart Failure Questionnaire, -19 [-23, -3] vs 1 [-16, 3], P = .02). Improvements with tai chi were also seen in exercise self-efficacy (Cardiac Exercise Self-efficacy Instrument, 0.1 [0.1, 0.6] vs -0.3 [-0.5, 0.2], P < .001) and mood (Profile of Mood States total mood disturbance, -6 [-17, 1] vs -1 [-13, 10], P = .01).Tai chi exercise may improve quality of life, mood, and exercise self-efficacy in patients with HF. Trial Registration clinicaltrials.gov Identifier: NCT00110227.

Project description:PurposeChronic obstructive pulmonary disease (COPD) is associated with multiple psychosocial and behavioral factors. Prior research suggests that mind-body interventions may support the development and maintenance of healthy behaviors and improve health-related quality-of-life in such patients. We sought to qualitatively explore cognitive, psychosocial, and behavioral changes in patients with COPD who participated in two different mind-body interventions compared to an education control.MethodsWe analyzed semi-structured qualitative exit interviews from a prospective, randomized pilot trial (N = 123) investigating 12-weeks of Tai Chi (TC) vs. mind-body breathing (MBB) vs. education (EDU) control in patients with moderate-severe COPD. TC involved traditional movements, that integrate meditative breathing, while MBB focused mainly on meditative breathing techniques alone. Interviews were audio-recorded and transcribed verbatim. Qualitative analysis of randomly selected transcripts was performed by two independent reviewers using an iterative process to identify emergent themes informed by grounded theory methods until thematic saturation was reached.ResultsA total of 66 transcripts were reviewed (N = 22 TC, N = 22 MBB, N = 22 EDU). Participants were mean age = 68.1 years, GOLD Stage = 2.3, baseline FEV11 percent predicted mean (SD): 58% (13.4), 42.4% female. We identified six frequently mentioned themes: 1) overall awareness and understanding, 2) self-care knowledge, skills and behaviors, 3) behavior-related neurocognitive concepts, 4) physical function, 5) psychological well-being, and 6) social support/social function. Compared to EDU, more participants in TC and MBB noted improvements in awareness of self and the mind-body connection (e.g., body and breath awareness), knowledge of breathing techniques and integration of self-care skills with daily activities, self-efficacy for symptom management (particularly managing anxiety and dyspnea), acceptance of disease, physical function improvements (e.g., endurance, dyspnea, fatigue), and psychological well-being (particularly relaxation, emotion regulation and decreased reactivity). Compared to MBB, those in TC shared more intention to continue with self-care behaviors, physical activity self-efficacy, and improved flexibility. All three groups, including EDU, noted increased social support and knowledge of disease. Those in EDU, however, had fewer mentions of processes related to behavior change, and less concrete changes in neurocognitive, psychological, and physical function domains.ConclusionsMind-body interventions including meditative breathing may impact behavior-related neurocognitive and emotional factors that improve self-care management and support positive behavioral changes in patients with COPD.Trial registrationThis trial is registered in Clinical Trials.gov, ID number NCT01551953.

Project description:Background:The newly compiled Bafa Wubu of Tai Chi (Eight Methods and Five Footworks) is a fitness routine that has been developed in accordance with the appeal of the General Administration of Sport of China and promoted both in China and abroad. This paper aims to compare the differences in energy consumption and related parameters between the two types of Tai Chi. Methods:A total of 60 healthy participants were recruited; 37 males (aged 37.4?±?10.4?years) and 23 females (aged 31.9?±?12.8?years). The maximal exercise capacity of participants was measured at baseline. Then, they received Tai Chi training for 12-week and their energy metabolism was measured dynamically. Results:A set of the Bafa Wubu of Tai Chi requires approximately 3?min, while a set of 24 form simplified Tai Chi approximately 5?min and 40?s. The average oxygen uptake/kg (VO2/kg, 10.8?±?2.52?ml/kg/min vs. 12.9?±?2.59?ml/kg/min, P?=?0.000), the highest VO2/kg (19.3?±?6.03?ml/kg/min vs. 24.1?±?7.50?ml/kg/min, p?=?0.000, the average metabolic equivalent (METs,2.3?±?0.16 METs vs. 3.2?±?0.14 METs, p?=?0.000), the highest oxygen pulse (VO2/HR, 11.1?±?0.99?ml vs. 13.9?±?0.93?ml, p?=?0.000) and rate of perceived exertion (RPE, 10.7?±?0.70 vs. 1.3?±?0.62, p?=?0.000) gained immediately after Bafa Wubu of Tai Chi exercise were significantly lower than those in 24 form simplified Tai Chi; heart rate recovery (HRR,1.5?±?0.41 vs. 1.3?±?0.45, p?=?0.008) at 1?min after the practice was significantly higher than after the 24 form simplified Tai Chi. Meanwhile, the average heart rate (HR, 104.1?±?11.41?bpm vs. 105.7?±?9.68?bpm, p?=?0.696) and the highest respiratory quotient (RQ, 1.0?±?0.06 vs. 0.9?±?0.09, p?=?0.643) were not significantly different. The intensity of Tai Chi was described as the highest oxygen uptake of the participants when they performed the Tai Chi divided by their individual maximal oxygen uptake. Tai Chi intensity during Bafa Wubu of Tai Chi (50%?±?11.7% vs. 64%?±?12.5%) was significantly lower than during 24 form simplified Tai Chi. Conclusion:The newly compiled Bafa Wubu of Tai Chi is characterized by lower energy consumption than 24 form simplified Tai Chi. Trial registration:Ethics Committee of Sports Science Experiment, Beijing Sport University- 2018010H. Registered 19 June 2018.

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Tai Chi for heart attack survivors: qualitative insights.

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Tai Chi for heart attack survivors: qualitative insights.

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