Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial

• Published in: BMJ (Online) 2018-03, Vol.360, p.k851-k851
• Main Authors: Wang, Chenchen, Schmid, Christopher H, Fielding, Roger A, Harvey, William F, Reid, Kieran F, Price, Lori Lyn, Driban, Jeffrey B, Kalish, Robert, Rones, Ramel, McAlindon, Timothy
• Format: Article
• Language: English
• Subjects: Aerobics; Anxiety; Arthritis; Cancer therapies; Clinical trials; Comparative Effectiveness Research; Evidence-based medicine; Exercise; Female; Fibromyalgia; Fibromyalgia - therapy; Humans; Male; Martial arts; Mental depression; Middle Aged; Motivation; Narcotics; Pain; Pain Measurement; Patients; Physical fitness; Prospective Studies; Quality of life; Questionnaires; Single-Blind Method; Sleep; Tai Ji; Treatment Outcome; United States
• ISSN: 0959-8138; 1756-1833
• DOI: 10.1136/bmj.k851

AbstractObjectivesTo determine the effectiveness of tai chi interventions compared with aerobic exercise, a current core standard treatment in patients with fibromyalgia, and to test whether the effectiveness of tai chi depends on its dosage or duration.DesignProspective, randomized, 52 week, single blind comparative effectiveness trial.SettingUrban tertiary care academic hospital in the United States between March 2012 and September 2016.Participants226 adults with fibromyalgia (as defined by the American College of Rheumatology 1990 and 2010 criteria) were included in the intention to treat analyses: 151 were assigned to one of four tai chi groups and 75 to an aerobic exercise group.InterventionsParticipants were randomly assigned to either supervised aerobic exercise (24 weeks, twice weekly) or one of four classic Yang style supervised tai chi interventions (12 or 24 weeks, once or twice weekly). Participants were followed for 52 weeks. Adherence was rigorously encouraged in person and by telephone.Main outcome measuresThe primary outcome was change in the revised fibromyalgia impact questionnaire (FIQR) scores at 24 weeks compared with baseline. Secondary outcomes included changes of scores in patient’s global assessment, anxiety, depression, self efficacy, coping strategies, physical functional performance, functional limitation, sleep, and health related quality of life.ResultsFIQR scores improved in all five treatment groups, but the combined tai chi groups improved statistically significantly more than the aerobic exercise group in FIQR scores at 24 weeks (difference between groups=5.5 points, 95% confidence interval 0.6 to 10.4, P=0.03) and several secondary outcomes (patient’s global assessment=0.9 points, 0.3 to 1.4, P=0.005; anxiety=1.2 points, 0.3 to 2.1, P=0.006; self efficacy=1.0 points, 0.5 to 1.6, P=0.0004; and coping strategies, 2.6 points, 0.8 to 4.3, P=0.005). Tai chi treatment compared with aerobic exercise administered with the same intensity and duration (24 weeks, twice weekly) had greater benefit (between group difference in FIQR scores=16.2 points, 8.7 to 23.6, P