Benefits of Tai Chi Quan on neurodegenerative diseases: A systematic review
Introduction
Neurodegenerative diseases are chronic disease states characterized by slow and progressive dysfunction and the loss of neurons and axons in the central nervous system (Heemels, 2016). According to primary clinical features, neurodegenerative disorders can be classified as Alzheimer's disease (AD) or dementia, Parkinson's disease (PD), multiple sclerosis (MS), amyotrophic lateral sclerosis, spinocerebellar ataxia, spinocerebellar atrophy, and motor neuron disease (Dugger and Dickson, 2017). The prevalence of neurodegenerative diseases is increasing as a result of lifespan extension (Kondo, 1996, Farooqui and Farooqui, 2009). These diseases tend to worsen over time and result in a variety of functional impairments, such as cognitive impairment (CI), motor dysfunction, and loss of self-care (Karlawish, 2014, Doherty et al., 2011). The 2019 Global Burden of Disease Study revealed that people with neurodegenerative diseases are leading contributors to the need for rehabilitation (Cieza et al., 2021). The data from the Global Burden Disease Results Tool showed that the trend in the percentage of people over the age of 55 with years lived with disabilities due to PD and AD globally over the past decade is still increasing (Global burden of disease study 2019, available from: https://vizhub.healthdata.org/gbd-compare/). The global costs for dementia will be US $2.54 trillion in 2030 (Jia et al., 2018). Many patients with PD reported that they paid more than US $500 out of pocket for drugs and assistive devices or rehabilitation therapy annually (Wong et al., 2014). Although these diseases have no cure, physical activity is a crucial allied support in the treatment of neurodegenerative disorders (Keus et al., 2009). Moderate physical activity contributes in delaying brain aging and improves cognition and memory (Di Liegro et al., 2019, Erickson et al., 2019). Physical activity can produce analgesic and antidepression effects and bring a sense of well-being (Koltyn et al., 2014). One of the most popular alternative and complementary methods in the management of neurodegenerative diseases is mind–body exercises, such as Tai Chi Quan (TCQ), yoga, and Qigong.
TCQ is a Chinese traditional exercise that comprises mental concentration, physical balance, muscle relaxation, and breathing (Hong et al., 2000). TCQ is a kind of light- to moderate-intensity exercise depending on duration, style, experience, and posture (Peng, 2012). Many studies have indicated the positive effects of TCQ in various conditions, such as musculoskeletal disorders, (Hall et al., 2009) falls, (Lomas-Vega et al., 2017), brain health, (Liu et al., 2018a) and other chronic diseases (Lan et al., 2002). A bibliometric analysis of TCQ for health promotion from 1980 to 2020 showed that one of the promising fields to focus on is the application of TCQ in neurodegenerative diseases (You et al., 2021). Previous studies supported the efficacy of TCQ in improving clinical features and dysfunction in patients with CI, PD, or MS (Lim et al., 2019, Song et al., 2017, Taylor and Taylor-Piliae, 2017).
In 2021, Yu et al. (2021) released the latest systematic review and meta-analysis of the impact of TCQ in patients with PD, and the pooled results showed that TCQ can bring up gains in motor function and balance. At the same year, Gu et al. (2021) published a systematic review and meta-analysis of the effect of TCQ in elderlies with CI and concluded that TCQ is a relatively safe activity to bring better changes in cognitive function. In 2017, Taylor and Taylor-Piliae (2017). However, these articles only summarized some aspects of TCQ’s effectiveness on neurodegenerative diseases. A clear and comprehensive interpretation of the benefits and potential mechanisms of TCQ in neurodegenerative diseases is crucial to project beneficial complementary and adjunctive therapeutic strategies. Therefore, we conducted an integrative review to summarize studies related to the efficacy of TCQ as a supportive therapy for patients with neurodegenerative diseases and discussed the underlying mechanisms of the efficacy of TCQ.
Section snippets
Data sources and searches
A preliminary search revealed that studies on the efficacy of TCQ on neurodegenerative diseases were concentrated on patients with PD, CI, and MS. The complete search strategy was carried out in the PubMed database and the Web of Science Core Collection database on August 20, 2021. The key words of search strategy were “Tai Chi”, “Taiji”, “Parkinson's”, "dementia”, “Alzheimer's disease”, “cognitive impairment”, and “multiple sclerosis”.
Study selection
The included criteria were 1) the types of studies were
Results
In the preliminary search, we obtained 138 records about PD, 85 records about CI, and 20 records for MS. After deduplication, 193 titles and abstracts were screened. 96 full- texts were reviewed. We obtained 28 studies about PD, 21 studies about CI, and 9 studies about MS (Fig. 1). 11 systematic reviews without meta-analyses were used to trace potential clinical trials. Finally, a total of 16 systematic reviews and meta-analyses and 31 clinical trials were evaluated and summarized in Table 1,
Benefits of Tai Chi Quan on neurodegenerative diseases
Sports rehabilitation can offer many benefits to patients with neurodegenerative diseases. TCQ combines many elements, such as cognition, breath, strength, and stability, and it can be practiced by groups or individuals. TCQ is widely recommended for the management of chronic conditions (Huston and McFarlane, 2016). Currently, studies on the efficacy of TCQ in the intervention of neurodegenerative diseases mainly focus on patients with PD, CI, or MS. The updated Canadian guideline recommends
Conclusions
Studies on the effectiveness of TCQ in neurodegenerative diseases, especially PD, CI, and MS, are increasing. Long-term and regular TCQ exercise can effectively improve the motor function, balance, global cognitive function, and prevent falls in patients with neurodegenerative diseases. In view of the different types of TCQ, the time of interventions, and the different outcomes of specific disease, the positive effects of TCQ on the quality of life and mood of patients with neurodegenerative
Funding
The study was supported by the Science and Technology Commission of Shanghai Municipality [grant numbers 19080503100, 21S31902400], the Fok Ying-Tong Education Foundation of China [grant number 161092], the Talent Development Fund of Shanghai Municipal [grant number 2021081], the Shanghai Clinical Research Center for Rehabilitation Medicine [grant number 21MC1930200)], and the Shanghai Key Lab of Human Performance (Shanghai University of Sport) [grant number 11DZ2261100], as well as by the
CRediT authorship contribution statement
Xue-Qiang Wang: Conceptualization, Methodology, Writing – review & editing, Funding acquisition. Rui Wang: Conceptualization, Methodology, Writing – original draft, Writing – review & editing, Visualization. Hao Zhou: Formal analysis, Writing – review & editing, Visualization. Yu-Chen Wang: Formal analysis, Writing – review & editing, Visualization. Xiao-Long Chang: Writing – review & editing, Visualization.
Competing interests
The authors declare that they have no competing interests.
References (130)
- et al.
The effect of tai chi exercise on gait initiation and gait performance in persons with parkinson's disease
Park. Relat. Disord.
(2013) - et al.
Effect of tai chi chuan on balance in women with multiple sclerosis
Complement Ther. Clin. Pr.
(2015) - et al.
Mind-body therapies and control of inflammatory biology: a descriptive review
Brain Behav. Immun.
(2016) - et al.
Neuroinflammation in alzheimer's disease: Current evidence and future directions
Alzheimers Dement
(2016) - et al.
Rodrigues e Silva A, et al. Costs of illness and care in parkinson's disease: an evaluation in six countries
Eur. Neuropsychopharmacol.
(2011) - et al.
Physical activity and disability outcomes in multiple sclerosis: a systematic review (2011-2016)
Mult. Scler. Relat. Disord.
(2018) - et al.
Mental and physical activities delay cognitive decline in older persons with dementia
Am. J. Geriatr. Psychiatry
(2014) - et al.
Complementary therapies in parkinson disease: a review of acupuncture, tai chi, qi gong, yoga, and cannabis
Neurotherapeutics
(2020) - et al.
Postural deformities in parkinson's disease
Lancet Neurol.
(2011) - et al.
Emotional processing in anterior cingulate and medial prefrontal cortex
Trends Cogn. Sci.
(2011)