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Tai Chi Improves Markers of Pre-Diabetes

Posted: Wednesday, April 09, 2008

For patients at risk of metabolic syndrome and type 2 diabetes, the Chinese exercises Tai Chi and Qigong may improve clinical parameters associated with the conditions, two small studies suggested. 

After 12 weeks of regular Tai Chi and Qigong exercises, 11 patients with hyperglycemia had significant improvement in body mass index, waist circumference, and blood pressure, Xin Liu, Ph.D., of the University of Queensland reported.
Additionally, glycosylated hemoglobin, fasting insulin, and insulin resistance all decreased. Study participants also found the exercise program acceptable, as indicated by attendance at more than 90% of the sessions and almost 80% adherence to home practice.  "These findings provide grounds for cautious optimism about a role for Tai Chi and Qigong exercise in managing metabolic syndrome and improving glycemic control," the authors concluded.
A second study, reported by K. D. Yang, M.D., of Chang Gung University in Taiwan, and colleagues, provided additional evidence of the potential benefits of the Chinese exercises. Those researchers found that a group of patients with type 2 diabetes had significant improvement in parameters of immune function, which were accompanied by a significant decrease in A1c. Physical activity has proven useful in managing patients with type 2 diabetes and prediabetes.
However, many patients are unwilling or unable to participate in conventional forms of exercise, such as strength training and gym-based activities, Dr. Liu and colleagues noted. Tai Chi and Qigong have attracted a worldwide following as a form of exercise with medical benefit, the authors continued. In particular, Tai Chi leads to energy expenditure comparable to other moderate-intensity activities, such as walking at a brisk pace. 
"These Chinese exercises may be easier to learn than gym-based exercises and do not require any complicated or expensive equipment," Dr. Liu said. To test the hypothesis that Tai Chi and Qigong can improve metabolic parameters of metabolic syndrome, the Australian investigators recruited 11 patients who had baseline blood glucose levels of 5.8 mmol/L to 8.7 mmol/L.  Seven participants met diagnostic criteria for metabolic syndrome, and eight had a family history of diabetes. Nine participants met Australian recommendations for physical activity (ˇÝ150 min/week). Participants attended three 90-minute Tai Chi/Qigong training sessions weekly for 12 weeks and were encouraged to practice the exercises at home.
The primary outcome was the change in clinical parameters associated with metabolic syndrome. At the end of the three-month evaluation, patients had improvement in: BMI (-1.05, P<0.001) Waist circumference (-2.80 cm, P<0.05) Systolic blood pressure (-11.64 mm Hg, P<0.01) Diastolic blood pressure (-9.73 mm Hg, P<0.001) bA1c (-0.32%, P<0.01) Fasting insulin (-9.93 pmol/L, P=0.051) insulin resistance (-0.53, P<0.05) Participants attended 92% of the supervised training sessions, and patient diaries showed 78% adherence to the exercises at home.
Because type 2 diabetes is associated with chronic inflammation implicated in vascular complications, the Taiwanese investigators theorized that interventions that favorably affect immune function might be beneficial in managing the disease. So they examined the effects of a 12-week course of Tai Chi on immune function in 30 patients with type 2 diabetes and 30 age-matched controls. Participants received instruction in 37 standardized Tai Chi movements, which they practiced at three 60-minute training sessions weekly and were encouraged to continue at home.

After 12 weeks, the control group had no significant changes in any diabetes-related parameters. In contrast, the patients with type 2 diabetes had a significant decline in A1c (P=0.047) and pro-inflammatory interleukin-4 (P=0.003); increased levels of anti-inflammatory interleukin-12 (P=0.035); and increased expression of the Th1 transcription factor T-bet (P=0.042).

A combination of [Tai Chi] exercise with medication may result in an even better improvement in both metabolism and immunity of patients with type 2 diabetes mellitus," the authors concluded. Practice Pearl:

Explain to patients that ancient exercises may help improve metabolic markers of pre-diabetes and may be more acceptable to patients compared with other forms of physical activity. British Journal of Sports Medicine; Liu X, et al. "Preliminary study of the effects of Tai Chi and Qigong medical exercise on indicators of metabolic syndrome and glycemic control in adults with raised blood glucose levels"

Source: Diabetes In Control: Br J Sports Med 2008; DOI: 10.116/bjsm.2007.045476. Yeh SH, et al. "Regular Tai Chi Chuan exercise improves T cell helper function of patients with type 2 diabetes mellitus with an increase n T-bet transcription factor and IL-12 production" Br J Sports Med 2008; DOI: 10.1136/bjsm.2007.043562.

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