The impact of Tai Chi and Qigong mind-body exercises on motor and non-motor function and quality of life in Parkinson's disease: A systematic review and meta-analysis

Abstract

Purpose: To systematically evaluate and quantify the effects of Tai Chi/Qigong (TCQ) on motor (UPDRS III, balance, falls, Timed-Up-and-Go, and 6-Minute Walk) and non-motor (depression and cognition) function, and quality of life (QOL) in patients with Parkinson's disease (PD).

Methods: A systematic search in 7 electronic databases targeted clinical studies evaluating TCQ for individuals with PD published through August 2016. Meta-analysis was used to estimate effect sizes (Hedges's g) and publication bias for randomized controlled trials (RCTs). Methodological bias in RCTs was assessed by two raters.

Results: Our search identified 21 studies, 15 of which were RCTs with a total of 735 subjects. For RCTs, comparison groups included no treatment (n = 7, 47%) and active interventions (n = 8, 53%). Duration of TCQ ranged from 2 to 6 months. Methodological bias was low in 6 studies, moderate in 7, and high in 2. Fixed-effect models showed that TCQ was associated with significant improvement on most motor outcomes (UPDRS III [ES = -0.444, p < 0.001], balance [ES = 0.544, p < 0.001], Timed-Up-and-Go [ES = -0.341, p = 0.005], 6 MW [ES = -0.293, p = 0.06], falls [ES = -0.403, p = 0.004], as well as depression [ES = -0.457, p = 0.008] and QOL [ES = -0.393, p < 0.001], but not cognition [ES = -0.225, p = 0.477]). I2 indicated limited heterogeneity. Funnel plots suggested some degree of publication bias.

Conclusion: Evidence to date supports a potential benefit of TCQ for improving motor function, depression and QOL for individuals with PD, and validates the need for additional large-scale trials.

Keywords: Meta analysis; Motor activity; Parkinson disease; Quality of life; Tai Chi.

Copyright © 2017 Elsevier Ltd. All rights reserved.

Figures

Figure 1

Summary of the flow of our literature search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines

Figure 2

Effects of Tai Chi/Qigong on motor functions Note 1.data value indicated weight, effect size (Hedges’s g) and confidence interval of LL(lower limit) to UL(upper limit). 2. Plots to the left of zero indicate negative effect sizes all outcomes in favor of Tai Chi (i.e. less symptoms), except for balance where plots to the right of zero represent a positive effect.

Figure 3

Effects of Tai Chi/Qigong on non-motor functions and quality of life Note 1.data value indicated weight, effect size (Hedges’s g) and confidence interval of LL(lower limit) to UL(upper limit). 2. Plots to the left of zero indicate negative effect sizes all outcomes in favor of Tai Chi (i.e. less symptoms), except for quality of life where plots to the right of zero represent a positive effect.