BENEFIT OF TAI CHI AS AN ADJUNCT TO STANDARD CARE FOR PATIENTS WITH CHRONIC STA

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Heart Failure (HF) is a major public health problem in the United States, affecting approximately 5 million adults. Despite recent advances in pharmacological therapy and technological devices, HF is the most common reason for hospitalization among Medicare patients and is reaching epidemic proportions as the population ages. New and inexpensive interventions that can improve functional capacity, quality of life, as well as affect disease progression, are needed. Tai Chi is a popular mind-body exercise form that is a potential therapeutic adjunct for heart disease. Tai Chi incorporates both gentle physical activity and meditation. It may be particularly suited to frail and de-conditioned patients with HF, but has never been rigorously studied in this population. We conducted a feasibility study of Tai Chi in patients with HF (n=30) and found that those randomized to a Tai Chi program significantly improved their exercise capacity (six-minute walk distance), quality-of-life (Minnesota Living with Heart Failure score), and neurohormonal status (serum B-type natriuretic peptide levels) compared to patients who did not participate in Tai Chi. As part of a funded NCCAM study, we are now conducting a randomized controlled trial (n=150) over three years that compares a 12-week Tai Chi program with usual conventional care (both groups receiving HF educational materials). Patients with chronic stable HF (systolic dysfunction, left ventricular ejection fraction ?40%, New York Heart Association Class I-IV) will be recruited from outpatient primary care and cardiology clinics. Our primary aim will be to examine Tai Chi's effects on functional capacity and quality-of-life. Secondary aims are designed to further elucidate the mechanism of Tai Chi's effects, including examination of cognitive-behavioral or psychosocial influences (e.g., mood, psychosocial functioning, self-efficacy, beliefs and expectations of mind-body medicine) and HF-specific physiologic/metabolic processes in response to meditative exercise (e.g., neurohormonal status, heart rate variability and markers of autonomic tone, myocardial structure and function). The results of our proposed research will help define the role of Tai Chi in current HF management, further our understanding of the mechanism of action, and provide preliminary analyses of the costs and benefit of treatment.