Review
Effectiveness of tai chi for Parkinson's disease: A critical review

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Abstract

The objective of this review is to assess the effectiveness of tai chi as a treatment option for Parkinson's disease (PD). We have searched the literature using 21 databases from their inceptions to January 2008, without language restrictions. We included all types of clinical studies regardless of their design. Their methodological quality was assessed using the modified Jadad score. Of the seven studies included, one randomised clinical trial (RCT) found tai chi to be superior to conventional exercise in terms of the Unified PD Rating Scale (UPDRS) and prevention of falls. Another RCT found no effects of tai chi on locomotor ability compared with qigong. The third RCT failed to show effects of tai chi on the UPDRS and the PD Questionnaires compared with wait list control. The remaining studies were either non-randomised (n = 1) or uncontrolled clinical trials (n = 3). Collectively these data show that RCTs of the tai chi for PD are feasible but scarce. Most investigations suffer from methodological flaws such as inadequate study design, poor reporting of results, small sample size, and publication without appropriate peer review process. In conclusion, the evidence is insufficient to suggest tai chi is an effective intervention for PD. Further research is required to investigate whether there are specific benefits of tai chi for people with PD, such as its potential effect on balance and on the frequency of falls.

Introduction

The prevalence of Parkinson's disease (PD) is 0.5–1.0% among people aged 65–69 years, and rises to 1–3% among those aged 80 years and over [1]. Treatment involves not only appropriate drug therapy but also counseling, allied health intervention and, commonly, management of cognitive and psychiatric comorbidity. The chronic and debilitating symptoms of PD mean that patients often turn to complementary medicine for their alleviation [2], [3], [4].

Exercise and physiotherapy is often recommended for managing PD and there is some evidence of their effectiveness [5], [6], [7], [8], [9], [10]. Regular movement has a measurable effect on the signs and symptoms of the disease as well as on its progression [11], [12], [13], [14], [15]. It has been claimed that physical activity can help protect dopamine-producing cell from early death [11]. Exercise limits motor impairments and helps to maintain brain dopamine levels. The cessation of exercising makes symptoms reappear and leads to a decrease of dopamine levels [12], [13], [15]. Tai chi is a form of complementary medicine with similarities to aerobic exercise. It combines deep breathing and relaxation with slow and gentle movements [16]. It has been reported that tai chi has beneficial effects in reducing high blood pressure, and improving balance, muscle strength and fall prevention [17], [18], [19], [20], [21], [22]. Considering these effects, possible mechanisms of tai chi include balancing the neurotransmitter in the motor cortex-basal ganglia–motor cortex feedback loop and ameliorating PD symptoms by bypassing the faulty this circuit [23]. Others have postulated that tai chi might induce plastic changes in the central nervous system responsible for balance control [24].

Tai chi is supported by the National Parkinson Foundation of the United States and other related societies in Canada [25], [26], [27]. It is claimed that tai chi improves balance control, flexibility, and muscular strength, and reduces the risk of falls in the elderly [19], [20]. It therefore seems pertinent to evaluate the effectiveness of tai chi on PD. The objective of this systematic review was to summarize and critically assess the evidence for the effectiveness of tai chi in treating PD.

Section snippets

Data sources

Twenty-one electronic databases were searched from their inceptions up to January 2008 (Table 1). The search phrase used was “(tai chi OR taiji OR shadow boxing) AND Parkinson disease”. We also manually searched our own departmental files and relevant journals (FACT [Focus on Alternative and Complementary Therapies], up to December 2007). Further, the references in all located articles and the proceedings of the First International Conference of Tai Chi for Health (held in December 2006, Seoul,

Results

Eleven articles were located, of which four were excluded for the reasons given in Table 2[30], [31], [32], [33]. The remaining seven studies comprised three randomised clinical trials (RCTs) [34], [35], [36], one non-randomised controlled clinical trial (CCT) [37], and three were uncontrolled clinical trials (UCTs) [38], [39], [40]. Key data of the included studies are summarized in Table 3.

Discussion

Perhaps the most important finding of this systematic review is that there have been very few rigorous trials of the effects of tai chi on PD. This is surprising given that tai chi is an officially recommended method for treating the symptoms of PD. Most of the studies reviewed here were burdened with serious methodological flaws.

Of the seven studies analyzed in this review, five studies (three RCTs [34], [35], [36], one CCT [37], and one UCT [38]) were published only as abstracts, and hence

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