Does Tai Chi relieve fatigue? A systematic review and meta-analysis of randomized controlled trials

Yu Xiang, Liming Lu, Xiankun Chen, Zehuai Wen, Yu Xiang, Liming Lu, Xiankun Chen, Zehuai Wen

Abstract

Background: Fatigue is not only a familiar symptom in our daily lives, but also a common ailment that affects all of our bodily systems. Several randomized controlled trials (RCTs) have proven Tai Chi to be beneficial for patients suffering from fatigue, however conclusive evidence is still lacking. A systematic review and meta-analysis was performed on all RCTs reporting the effects of Tai Chi for fatigue.

Methods: In the end of April 2016, seven electronic databases were searched for RCTs involving Tai Chi for fatigue. The search terms mainly included Tai Chi, Tai-ji, Taiji, fatigue, tiredness, weary, weak, and the search was conducted without language restrictions. Methodological quality was assessed using the Cochrane Risk of Bias tool. RevMan 5.3 software was used for meta-analysis. Publication bias was estimated with a funnel plot and Egger's test. We also assessed the quality of evidence with the GRADE system.

Results: Ten trials (n = 689) were included, and there was a high risk of bias in the blinding. Two trials were determined to have had low methodological quality. Tai Chi was found to have improved fatigue more than conventional therapy (standardized mean difference (SMD): -0.45, 95% confidence interval (CI): -0.70, -0.20) overall, and have positive effects in cancer-related fatigue (SMD:-0.38, 95% CI: -0.65, -0.11). Tai Chi was also more effective on vitality (SMD: 0.63, 95% CI: 0.20, 1.07), sleep (SMD: -0.32, 95% CI: -0.61, -0.04) and depression (SMD: -0.58, 95% CI: -1.04, -0.11). However, no significant difference was found in multiple sclerosis-related fatigue (SMD: -0.77, 95% CI: -1.76, 0.22) and age-related fatigue (SMD: -0.77, 95% CI: -1.78, 0.24). No adverse events were reported among the included studies. The quality of evidence was moderate in the GRADE system.

Conclusions: The results suggest that Tai Chi could be an effective alternative and /or complementary approach to existing therapies for people with fatigue. However, the quality of the evidence was only moderate and may have the potential for bias. There is still absence of adverse events data to evaluate the safety of Tai Chi. Further multi-center RCTs with large sample sizes and high methodological quality, especially carefully blinded design, should be conducted in future research.

Registration number: PROSPERO CRD42016033066.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flow diagram of study selection…
Fig 1. Flow diagram of study selection and identification.
Fig 2. Risk of bias graph: the…
Fig 2. Risk of bias graph: the reviewers’ judgments about each risk of bias item presented as percentages across all included studies.
Fig 3. Meta-analysis of Tai Chi for…
Fig 3. Meta-analysis of Tai Chi for fatigue.
A random effect model was performed to test for high statistical heterogeneity. Subgroup analysis was based on three different conditions including cancer, multiple sclerosis and age-related fatigue. Only descriptive analysis was performed for Tai Chi for rheumatoid arthritis, primary insomnia and COPD related fatigue.
Fig 4. Meta-analysis of Tai Chi for…
Fig 4. Meta-analysis of Tai Chi for fatigue.
Subgroup analysis was based on two different control groups including conventional treatment, low-impact exercise and health education. A random model was performed to test for high statistical heterogeneity. Only descriptive analysis was performed for Tai Chi compared with fast walking, and the way of life remained unchanged.
Fig 5. Forest plot of the subgroup…
Fig 5. Forest plot of the subgroup analysis of Tai Chi for fatigue based on intervention length.
Fig 6. Forest plot of the subgroup…
Fig 6. Forest plot of the subgroup analysis of Tai Chi for fatigue based on different frequency.
Fig 7. Forest plot of the subgroup…
Fig 7. Forest plot of the subgroup analysis of Tai Chi for fatigue based on different duration.
Fig 8. Forest plot of the sensitivity…
Fig 8. Forest plot of the sensitivity analysis of Tai Chi for fatigue.
Sensitivity analysis was performed based on excluding studies of low quality, those with small sample sizes, and those in which fatigue was due to age, not a particular condition. A random effect model was performed to manage the high heterogeneity.
Fig 9. Funnel plot of publication bias…
Fig 9. Funnel plot of publication bias of all included trials comparing Tai Chi exercise with control interventions.

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