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Am Fam Physician. 2012;85(9):online

Background: Increased physical activity can improve functional capacity and mood in patients with chronic heart failure. However, exercise can be problematic for these patients because of the presence of comorbidities and general deconditioning.

Tai chi, a low-impact mind-body activity, may represent an achievable exercise option for patients with chronic heart failure. In addition to promoting core strengthening, tai chi provides physical activity (estimated at 1.6 to 4.6 metabolic equivalents) while achieving 50 to 74 percent of maximal heart rate. A preliminary study of patients with chronic heart failure reported that tai chi could improve quality of life, serum brain natriuretic peptide levels, and a six-minute walk distance when compared with usual care. Yeh and colleagues conducted a randomized trial to determine if tai chi improved exercise capacity and quality of life in persons with chronic heart failure.

The Study: A total of 100 patients with stable, chronic heart failure were assigned to a tai chi exercise program or a heart health education program for 12 weeks. To be included in the study, patients had to have a left ventricular ejection fraction of 40 percent or less, have New York Heart Association class I, II, or III heart failure, and have had no changes in medication in the previous three months. Patients were excluded if they had recent unstable angina, myocardial infarction, or major cardiac surgery within the past three months. Those who regularly practiced tai chi also were excluded.

The intervention group received two one-hour training sessions each week in Yang-style short-form tai chi, and were encouraged to practice at home at least three times per week. Patients were allowed to progress at their own comfort and pace. The control group received twice-weekly educational sessions covering the Heart Failure Society of America education modules (available at All patients were monitored using peak oxygen uptake levels, six-minute walk tests, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the Profile of Mood States instrument, and the Cardiac Exercise Self-efficacy Instrument (CESI).

Results: Peak oxygen uptake levels and six-minute walk times were similar in the tai chi and education groups throughout the study. However, compared with the education group, the tai chi group demonstrated significant improvement in quality-of-life markers, including overall MLHFQ and CESI scores, and the mood disturbance, depression, and vigor subscales on the Profile of Mood States. Three months after the intervention ended, a trend remained toward improved MLHFQ scores in the tai chi group versus the education group, but this was no longer significant. No adverse effects were noted in either group.

Conclusion: In patients with chronic heart failure, tai chi improved exercise self-efficacy, quality of life, and mood, although no changes were noted in peak oxygen intake levels or six-minute walk tests.

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