Background

Physical activity và exercise appear lớn improve psychological health. However, the quantitative effects of Tai Chi on psychological well-being have rarely been examined. We systematically reviewed the effects of Tai Chi on ức chế, anxiety, depression và mood disturbance in eastern and western populations.

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Methods

Eight English và 3 Chinese databases were searched through March 2009. Randomized controlled trials, non-randomized controlled studies and observational studies reporting at least 1 psychological health outcome were examined. Data were extracted and verified by 2 reviewers. The randomized trials in each subcategory of health outcomes were meta-analyzed using a random-effects model. The quality of each study was assessed.

Results

Forty studies totaling 3817 subjects were identified. Approximately 29 psychological measurements were assessed. Twenty-one of 33 randomized and nonrandomized trials reported that 1 hour to lớn 1 year of regular Tai Chi significantly increased psychological well-being including reduction of stress (effect form size , 0.66; 95% confidence interval , 0.23 khổng lồ 1.09), anxiety (ES, 0.66; 95% CI, 0.29 to lớn 1.03), and depression (ES, 0.56; 95% CI, 0.31 to lớn 0.80), và enhanced mood (ES, 0.45; 95% CI, 0.trăng tròn to 0.69) in community-dwelling healthy participants và in patients with chronic conditions. Seven observational studies with relatively large sample sizes reinforced the beneficial association between Tai Chi practice & psychological health.

Conclusions

Tai Chi appears khổng lồ be associated with improvements in psychological well-being including reduced căng thẳng, anxiety, depression & mood disturbance, và increased self-esteem. Definitive conclusions were limited due to variation in designs, comparisons, heterogeneous outcomes and inadequate controls. High-chất lượng, well-controlled, longer randomized trials are needed to lớn better inform clinical decisions.


Peer Review reports


Background


Mental illness affects 450 million people worldwide with 25% of the population affected in their lifetimes<1>. It is a leading cause of disability for people aged 15-44<2>. A growing các mục of psychological states including bao tay, anxiety, depression và mood disturbance have been linked to lớn many chronic disorders such as coronary heart disease, cancer, diabetes và mental disorders as well as to accidents <3, 4>. Mental illness poses significant economic burdens khổng lồ those involved, reduces productivity và increases health care costs<5>. Thus, there is an urgent need for inexpensive sầu và effective strategies to lớn promote psychological well-being & improve sầu general heath status, especially for people with chronic conditions.

Over the past decade, evidence from epidemiological studies & clinical trials has demonstrated a positive sầu association between physical fitness and psychological health. Numerous studies have shown that physical activity & exercise as well as mind-body toàn thân practice reduce morbidity và mortality for coronary heart disease, hypertension, obesity, diabetes và osteoporosis, and improve the psychological status of the general population <6–10>.

Tai Chi, a form of Chinese low impact mind-body exercise, has been practiced for centuries for health & fitness in the East và is currently gaining popularity in the West. Our previous investigations have shown that Tai Chi has potential benefits in treating a variety of chronic conditions <11–13>. Significant improvement has been reported in balance, strength, flexibility, cardiovascular và respiratory function, as well as pain reduction and improved unique of life <11>. Several recent Reviews have suggested that Tai Chi appears to lớn improve sầu mood & enhance overall psychological well-being <11, 14, 15>. However, convincing quantitative evidence lớn estimate treatment effects has been lacking. No meta-analysis addressing any psychological outcomes with Tai Chi has ever been published. To better inform patients & physicians, we systematically reviewed the quantitative & qualitative relationship between Tai Chi và psychological health outcomes (bít tất tay, anxiety, depression, mood và self-esteem) by critically appraising & synthesizing the evidence from all published studies of healthy & chronically ill populations in the East and West.


Data sources và searches

We conducted a comprehensive computerized search of the medical literature using 8 English databases: MEDLINE (from 1950), PsycINFO (from 1806), CAB (from 1910), Health Star (from 1966), Cochrane Database of Systematic review (from 1991), CINAHL (from 1982), Global Health (from 1910) & Alt HealthWatch (from 1969). We also searched 3 major Chinese databases recommended by domain name experts in evidence-based medicine in Trung Quốc. These included: China Hospital Knowledge Database (from 1994), Trung Quốc National Knowledge Infrastructure (from 1915) & WanFang Data (from 1980) through March 2009. We also searched reference lists of selected articles and Reviews. The search terms for our reviews included "Tai Chi", "Tai Chi Chuan", "Tai Chi Chih", "ta"i đưa ra," "tai ji," "Tai Ji Quan", and "taijiquan".

Study selection

Published articles that reported original data of randomized controlled trials (RCT), non-randomized comparison studies (NRS) & observational studies (OBS)<11> were eligible if they clearly defined a Tai Chi intervention <16>. We considered English and Chinese publications with at least 10 human subjects và evaluation of at least 1 of the following psychological health outcomes: (1) Psychological stress--an imbalance between perceived capabilities and situational demands with manifestations in emotional states, as well as physiological, psychological & behavioral responses; (2) Anxiety--an emotional state, characterized by a cognitive sầu component (e.g. worry, self-doubt & apprehension) & a somatic component (e.g. heightened awareness of physiological responses such as heart rate, sweaty palms & tension); (3) Depression--a depressive state diagnosed with standard instruments and/or clinical interviews; (4) Mood--a pervasive sầu & sustained emotion that colors the perception of the world; (5) Self-esteem--a awareness of good processed by an individual & a representation of how positive sầu one feels about oneself in general <17–19>. We excluded articles such as đánh giá, case reports, and conference proceedings that did not provide primary data.

Data extraction and chất lượng assessment

We assessed the characteristics of the original research và extracted data based on study design; demographics; type và duration of Tai Chi exercise và controls; the psychological measures of bít tất tay, depression, anxiety, mood và self-esteem; results and/or the authors" main conclusions. When data were not provided in publications, we contacted the authors for information. Two reviewers extracted data & assessed trial quality of each study independently. Interrater reliability was satisfactory (r ≥ 90). The methodological chất lượng for the RCTs was evaluated based on the Jadad instrument <20>, which takes into lớn trương mục whether a study described randomization, blinding, & withdrawals/dropouts.

Assessment of effect sizes và statistical analysis

When data were reported, we computed effect sizes (ES) in each study separately for găng, anxiety, depression & mood. ES was determined by calculating the standardized mean difference between groups. Overall outcome was assessed by pooling the ES of each study.

We calculated Hedges" g score for each study as a measure of ES. To correct for small sample size bias we computed the bias-corrected Hedges" g score for each measure. The magnitude of the ES (clinical effects) indicates: 0-0.19 = negligible effect, 0.20-0.49 = small effect, 0.50-0.79 = moderate effect, 0.80(+) = large effect. RCTs used the difference between the treatment & control group means. NRS used within-group difference between pretreatment và post-treatment means. In studies that involved more than one active intervention, we restricted our analyses khổng lồ the Tai Chi and control groups. In view of significant heterogeneity, random-effect models were used for pooling. Heterogeneity was estimated with the I2 statistic for both RCTs & NRS. All analyses were conducted using Meta-Analyst 3.13 statistical software (Tufts Medical Center, Boston, MA) <21>.


We reviewed 2579 English & Chinese articles và retrieved 61 full-text articles for detailed evaluation (Figure 1). Twenty-one studies were eliminated for not reporting original or relevant psychological outcome data. Ultimately, forty studies were identified for data abstraction và critical appraisal. Our tìm kiếm did not identify any unpublished literature.



Table 1 lists the study thiết kế và number of studies và participants for each psychological domain. Table 2 describes the 40 studies including 17 RCTs, sixteen NRS and 7 OBS published between 1980 & 2009. They were conducted in 6 countries (USA, Trung Quốc, France, Germany, UK và Australia). There were 3072 healthy individuals (25 studies) and 745 patients with chronic conditions (14 studies); no data were available in 1 study <22>. Mean age ranged from 11 khổng lồ 92 years, and 62% of participants were female. Various controls were compared among mỏi the 17 RCTs, with 6 studies having multiple types of controls. Fourteen of the 16 NRS were self-comparisons while 2 used routine activity as controls. Three of the 7 OBS used routine activity, two used aerobic activity, one was a self-comparison và 1 used the general population as comparisons.


Nine RCTs reported on randomization; eight of these described an appropriate method, one an inappropriate one. Ten RCTs reported on blinding; in all 10, outcome assessors were blinded. Twelve sầu studies described withdrawals và dropouts. Dropout rates were high with 4 studies reporting dropouts ≥ 25%, and 3 others that reported attrition of 32%, 35%, & 47%. Eleven NRS và 6 OBS reported dropouts, with high rates listed for 3 NRS, reporting 57%, 43% & 33% (Table 2).

In all, we included 21 trials (12 RCTs and 9 NRS) of 33 that provided data on psychological quantitative measures in the meta-analysis. The 7 OBS were not included in the meta-analysis. Figure 2 displays the overall effects of Tai Chi on bao tay, anxiety, depression & mood. Table 3 qualitatively assesses the 19 studies that were excluded from the meta-analysis, showing study characteristics, methodology quality, and psychological outcomes. We describe below results for each outcome separately for studies that provided data for meta-analysis và those excluded from meta-analysis.



Effects of Tai Chi on stress, anxiety, depression & mood*. RCT = randomized controlled trial; NRS = nonrandomized comparison study (all the meta-analyzed NRS are self-comparison studies). N = number of participants. a McCain, 2008, included only Tai Chi versus wait danh sách control (n = 119); Fransen 2007, included only Tai Chi versus control group (n = 97); Chen và Sun 1997, included only participants in Tai Chi group as pretreatment, posttreatment (n = 18); Sattin 2005, included only clinically depressed participants in Tai Chi & control arms (n = 43). b Dechamps, 2009, used an active control compared to Tai Chi. *The magnitude of the effect kích cỡ (clinical effects) indicates: 0-0.19 = negligible effect, 0.20-0.49 = small effect, 0.50-0.79 = moderate effect, 0.80+ = large effect.


Five RCTs, five NRS và 1 OBS, conducted in 4 countries (USA, nước Australia, Germany and China) reported the effects of Tai Chi on căng thẳng in 870 participants with ages ranging from 16 to 85 years (Table 2). Most studies employed subjective sầu áp lực measures, including the Depression, Anxiety, Stress Scale <23>, Exercise Experiences Scale <24>, Self-Perceived Stress score <25>, Perceived Mental Stress score, Functional Assessment of HIV Infection <26>, Impact of Event Scale <27>, Perceived Stress Scale <28>, & the Chinese Psychological Stress Scores. Two objective sầu measures collected were body temperature<29> & salivary cortisol levels <30, 31>.

Meta-analysis results

Four RCTs & 4 NRS with 444 participants assessed the effects of Tai Chi on áp lực in individuals with HIV <32, 33>, elderly with symptomatic hip or knee osteoarthritis <34>, healthy participants <29, 35–37>, & elderly with cardiovascular disease risk factors <38>. Tai Chi was performed between 10 và 24 weeks (60 to 120 minutes, 1 to 4 times per week). We found statistically significant improvements in bao tay management & psychological digăng (ES, 0.66; 95% CI, 0.23 lớn 1.09) (Figure 2a), with an I2 = 82%. This result remained significant upon dropping the study with the largest effect <29>.

Studies not in meta-analysis

Three studies on áp lực were not included in the meta-analysis because 1 RCT and 1 NRS treated participants with Tai Chi practice for only one hour <39, 40>, and the third was an OBS<41> (Table 3). The RCT with 96 healthy adults showed significantly decreased levels of căng thẳng in all groups after one hour of intervention (Tai Chi, meditation, brisk walking và neutral reading) <39>. The NRS also reported a single one-hour Tai Chi intervention that significantly reduced áp lực in healthy adults <40>. The OBS using a Chinese psychological stress questionnaire with 76 healthy Chinese elderly reported that 5 years of regular Tai Chi experience (>30 minutes & >3 times per week) significantly improved ức chế compared with less physical activity (41>.

Summary

Overall, Tai Chi was positively associated with improved in căng thẳng levels in healthy adults, patients with HIV-related dibức xúc và elderly Chinese with cardiovascular disease risk factors <29, 32, 33, 35–41>. However, the overall study quality was modest with inadequate or no controls in the majority of studies.


Five RCTs, 9 NRS và 5 OBS investigated the anxiety-reducing effect of Tai Chi in 1869 people from 4 countries (USA, UK, Australia và China) (Table 2). Seven studies used the Protệp tin of Mood States Anxiety subscale<42> & 6 employed the State-Trait Anxiety Inventory <43>. The remainder used: the Depression, Anxiety, Stress Scale <23>, Connors" Teacher Rating Scale-Revised <44>, Taylor Manifest Anxiety Scale <45>, State Anxiety Inventory<46> và Zung Self-Rating Anxiety Scale <47>. Two disease-specific anxiety measures were used: the Symptom Checklist-90<48> and the Fibromyalgia Impact Questionnaire <49>.

Meta-analysis results

Two RCTs and 6 NRS with 359 participants including patients with symptomatic osteoarthritis <34>, healthy adults <37, 50–52>, elderly with cardiovascular disease risk factors <38>, individuals with fibromyalgia <53>, & adolescents with ADHD <54> found that Tai Chi practiced 2 to 4 times a week (30 to lớn 60 minutes/time) for 5 khổng lồ 24 weeks was associated with a significant reduction in anxiety (ES, 0.66; 95% CI, 0.29 to lớn 1.03) (Figure 2b) with I2 = 76%.

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Studies not in meta-analysis

Three RCTs, 2 NRS & 5 OBS were not included in the meta-analysis due khổng lồ laông xã of sufficient quantitative data (Table 3). The duration of Tai Chi interventions ranged from 1 hour to lớn 14 years (20 minutes lớn 1 hour, 1 khổng lồ 3 times a week). Results from 2 RCTs with 134 subjects reported that Tai Chi practice for a single 1 hour session <39>, or twice a week for 60 minutes/time over 8 weeks was associated with a significant reduction in anxiety scores both amuốn HIV patients<55> and healthy adults <39, 40, 56>. Of note, the third RCT by Brown et al, who randomized 135 healthy adults to lớn a Tai Chi-type activity, moderate or low intensity walking, walking with relaxation, or control reported results by gender <56>. The authors observed a significant decline in anxiety for women, but an insignificant decline in anxiety for men. Wall et al conducted an NRS with 11 6th & 8th graders who performed Yang style Tai Chi và Mindfulness-Based Stress Reduction training (1 hour once a week, for 5 weeks) và found that the participants were "calmer, more peaceful and enjoyed improved sleep relaxation" <57>. The other NRS by Mills et al reported a nonsignificant decrease in tension-anxiety in 8 adults with Multiple Sclerosis <58>. Five large OBS of 1091 healthy adult participants, who practiced Tai Chi between 6 months & 14 years, showed significantly reduced anxiety measures compared to the general population <59>, sedentary controls and people engaged in routine or moderate aerobic activity <60–63>.

Summary

Overall, Tai Chi was positively associated with reduced anxiety using one or more anxiety measures, but overall study unique was modest.


Ten RCTs, 6 NRS and 4 OBS examined the effects of Tai Chi on depression in 2008 subjects. Tai Chi intervention ranged from a single 1-hour session lớn 14 years. Six studies used the Center for Epidemiology Studies Depression Scale <64>. Seven used the Profile of Mood States Depression subscale <42>, & the rest tests were the Beông xã Depression Inventory <65>, Fibromyalgia Impact Questionnaire <49>, Zung Self-Rating Depression Scale<66> & Self-Rating Scale-90.

Meta-analysis results

Nine RCTs & 4 NRS in 634 people examined the effects of Tai Chi on depression versus education, routine activity, waiting list và other forms of exercise as well as self-comparison among healthy adults <35, 37, 51, 67–69>, individuals with rheumatoid arthritis <12>, osteoarthritis <13, 34>, fibromyalgia <53, 70>, depression disorders <71>, sedentary obese women <72>, & elderly Chinese with cardiovascular disease risk factors <38>. Of note, only two studies involved participants with clinically diagnosed depression <68, 69, 71>.

Overall, our analysis suggests that 6 lớn 48 weeks (40 minutes lớn 2 hours, 1 lớn 4 times a week) of Tai Chi practice resulted in significant depression-reduction effects compared khổng lồ various controls (ES, 0.56; 95% CI, 0.31 to 0.80) (Figure 2c) with I2 = 62%. This result remained significant upon dropping the study with the large effect <71>.

Studies not in meta-analysis

One RCT, 2 NRS và 4 OBS lacked sufficient quantitative sầu detail for analysis (Table 3). Brown et al found a significant decrease in depression for women <56>. The studies by Mills & Jin also reported significant decreases in depression after 8 weeks <58> và an hour of Tai Chi practice, respectively <40>. Four OBS in 842 healthy Chinese subjects showed that regular Tai Chi practice up to 14 years demonstrated statistically significant reductions in depressive symptoms compared with routine activity <59, 60, 62, 63>.

Summary

Overall, evidence from most studies showed that Tai Chi tended to reduce depression. This result was associated with improvement in symptoms và physical function in patients with rheumatoid arthritis và multiple sclerosis, as well as improvement in the immune response of healthy elderly participants. However, the vast majority of the studies suffer from less rigorous designs and were conducted on "healthy" populations with only two studies reporting results on participants diagnosed with clinical depression <68, 71>.


Evidence on the effects of Tai Chi on mood was examined from 4 RCTs, eight NRS và 3 OBS in 1613 subjects. Duration of Tai Chi practice ranged from 1 hour to 14 years (1 lớn 7 times a week). The majority of studies reported the total score of the Profile of Mood States scale <42>; other measures were the Functional Assessment of HIV Infection <26>, Positive and Negative Affect Schedule <73>, Life Satisfaction in the Elderly Scale <74>, Symptom Checklist-90 <48>, Conners" Teacher Rating Scale-Revised <44>, and Multiple Affect Adjective sầu Checklist-Revised <75>.

Meta-analysis results

Two RCTs & 4 NRS assessed the effects of Tai Chi on mood in healthy elderly <35, 76>, individuals with HIV <32>, elderly Chinese with cardiovascular disease risk factors <38>, & adolescents with attention-deficit hyperactivity disorder<54>. Tai Chi was performed between 5 and 24 weeks (30 lớn 90 minutes, 1 khổng lồ 4 times per week). Tai Chi significantly improved mood compared lớn various controls with overall ES of (0.45; 95% CI, 0.20 to lớn 0.69), and the I2 = 25% (Figure 2d).

Studies not in meta-analysis

Two RCTs, four NRS & 3 OBS lacked sufficient quantitative detail for analysis. Brown et al reported that 16 weeks of Tai Chi showed significantly elevated mood for women <56>. Significant improvement in mood was also reported in a RCT following short-term Tai Chi training <39>. Results from 3 NRS reported non-significant improvements in mood following 7 weeks to lớn 1 year of Tai Chi <22, 77, 78> and one NRS reported a significant decrease in mood disturbance after an hour of Tai Chi practice <40>. Similarly, 3 OBS of 799 subjects reported that 0.5 khổng lồ 14 years of Tai Chi practice significantly improved mood disturbance in healthy participants <62, 63>.

Summary

Overall, evidence suggested short và long-term Tai Chi practice had favorable effects on mood aý muốn healthy adults <35, 37, 39, 40, 56, 62, 63, 76>, elderly with cardiovascular risk factors <38>, obese women <32>, và adolescents with attention deficit hyperactivity disorder <54>. However, the overall study chất lượng was poor with inadequate or no controls in the majority of studies.


Meta-analysis results

Only 3 RCTs và 1 NRS evaluated the effects of Tai Chi on self-esteem in 425 subjects & there are no sufficient quantitative data for meta-analysis.

Studies not in meta-analysis

In these 4 trials, Tai Chi practice lasted from 12 khổng lồ 26 weeks (45 khổng lồ 60 minutes, 2 to lớn 3 times per week). Among mỏi the measurements employed were: Rosenberg"s 10-tòa tháp Global Self-Esteem Scale <79>, the Chinese version of the State Self-Esteem Scale <80>, Sonstroem Physical Examination Scale <81> và the Body Cathexis Score <82>. Results from 3 RCTs involving 286 subjects reported that 12 to 16 weeks of Tai Chi was associated with increases in self-esteem scores compared with control groups <56, 83, 84>. Two RCTs, however, reported nonsignificant results <56, 84>. A significant improvement in self-esteem was reported in a recent 26 week NRS that compared Tai Chi lớn routine activity aao ước 139 Chinese healthy elderly <85>.

Summary

Overall, Tai Chi was positively associated with improvement in self-esteem although no meta-analysis result was provided.


Tai Chi, a size of low impact mind-body toàn thân exercise, has spread worldwide over the past two decades. This systematic Đánh Giá & meta-analysis summarizes and updates results of the effects of Tai Chi exercise on health outcomes<11> in terms of psychological effects in various populations.

Evidence accrued from clinical trials và observational studies indicates that Tai Chi-- both short & long-term--appears lớn have mental health benefits in promoting psychological well-being, self-esteem and life satisfaction amuốn healthy subjects and patients with chronic conditions. Specifically, twenty-three of the 33 RCTs & NRS from our quantitative sầu meta-analysis và qualitative evidence synthesis reported that 1 hour lớn 1 year of regular Tai Chi activity significantly reduced bao tay, anxiety và depression, and enhanced mood in healthy adults và patients with chronic conditions. The 7 OBS with relatively large sample sizes reinforce the beneficial effects of Tai Chi on psychological health, although bias may be inherent in these observational data.

Our đánh giá is congruent with other recent epidemiological reports, experimental trials và literature nhận xét supporting the fact that physical activity and exercise are associated with better psychological health <8, 14, 15, 86>. Biddle et al recently reviewed evidence on physical activity và exercise in relation to lớn different aspects of mental health. They found that exercise is associated with the strongest anxiety-reduction effects and emphasized the causal link between physical activities & reduction in clinically-defined depression <18>. In particular, evidence from meta-analyses & narrative sầu Review demonstrates that physical activity & exercise as well as mind-body practice have sầu consistently been associated with positive sầu mood và affect <10, 14, 15, 87–89>.

There is insufficient evidence to find any dose-response effect of Tai Chi for psychological outcomes. The studies included in this đánh giá exhibit a wide variety of Tai Chi styles, frequency, duration và follow up. The Yang style was used in 17 studies. The majority of studies featured Tai Chi 2 khổng lồ 3 times per week (frequency), for at least đôi mươi minutes and for an average of 40 to 60 minutes per session (duration). The length of exercise programs ranged from 5 weeks khổng lồ 1 year, or a single hour for two studies. In the OBS, Tai Chi duration ranged from 6 months to 14 years, và all studies found positive sầu psychological benefits. Few studies reported the intensity & relationship between adherence khổng lồ Tai Chi và positive psychological effects. Further studies are needed khổng lồ optimize effective sầu evidence-based dose-response effects và should strictly dem& descriptions of intensity, frequency, duration & adherence of the Tai Chi exercise.

Tai Chi appears to be an effective therapeutic modality lớn improve psychological well-being aý muốn various populations. However, it is still difficult to draw firm conclusions. First, we did not include any unpublished studies. The overall methodological unique of previous studies is unsatisfactory, consisting mostly of small sized or nonrandomized comparisons. Given the few high chất lượng RCTs available for investigation, our review is limited by wide variations in methodological rigor of clinical trials và observational studies. Second, the heterogeneous amalgamation of instruments used to lớn collect clinical psychological health data restricts our ability lớn evaluate differences in these outcomes. Third, it remains unclear whether Tai Chi mind-body toàn thân exercise provides equal or superior psychological benefits compared to lớn moderate-intensity aerobic exercises. Fourth, most studies failed to provide objective sầu measures of bao tay and anxiety such as salivary cortisol cấp độ, blood pressure or heart rate, và some studies only reported a subphối of psychological outcomes. Due to the limited physiological variables in our analyses, we were unable to lớn analyze the effect of Tai Chi on physiological effects. Fifth, the studies included in the meta-analyses demonstrated a relatively high degree of heterogeneity. Various patient populations were used, & most studies involved healthy people. There were also many variations between the included studies with regard to lớn methodological unique (eg, problems of randomization, allocation concealment, or reporting results), which prohibited us from analyzing the quantitative evidence. However, it is difficult lớn compare results across studies because they were assessed at different time points. Additionally, all the studies published in mainland Trung Quốc, Hong Kong và Taiwan reported unanimously positive results. Differences in methodological rigor between eastern & western studies may be potential sources of heterogeneity, & publication bias may vary across countries and cultures.

Few published studies have specifically investigated the underlying mechanism of action of Tai Chi"s effects on psychological health. Many intermediate, but unidentified, variables may lie along the pathway from Tai Chi to improved psychological well-being. Measures of psychological variables và a multitude of other outcome measures are empirically inter-related, and treatment of each outcome can reciprocally and exponentially improve sầu the other. Improvement of psychological status is also associated with improvement in other clinical outcomes such as arthritic pain as well as health status <90>. The possible mechanisms for enhanced psychological health resulting from Tai Chi mind-toàn thân exercise may therefore act through its beneficial influence on biological, physiological, cardiovascular, neurological, & immunological effects as well as overall well-being <11, 67, 89, 91>.


In conclusion, the results of these studies suggest that Tai Chi may be associated with improvements in psychological well-being including reduced găng tay, anxiety, depression và mood disturbance, và increased self-esteem. High-quality, rigorous, prospective, well-controlled randomized trials with appropriate comparison groups and validated outcome measures are needed khổng lồ further understand the effects of Tai Chi as an intervention for specific psychological conditions in different populations. Knowledge about the physiological and psychological effects of Tai Chi exercise may lead khổng lồ new complementary and alternative medical approaches to promote health, treat chronic medical conditions, better inform clinical decisions and further explicate the mechanisms of successful mind-body toàn thân medicine.

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The authors gratefully acknowledge Marcie Griffith and Aghogho Okparavero for their help with review of this study. Dr. Wang is supported in part by the American College of Rheumatology Research & Education Health Professional Investigator Award, the Boston Older Americans Independence Center Research Career Development Award & R21AT003621 from the National Center for Complementary và Alternative Medicine (NCCAM). The contents of this manuscript are solely the responsibility of the authors & vì not necessarily represent the official views of the National Center for Complementary and Alternative Medicine or the National Institutes of Health. The sponsors had no role in the design & conduct of the study; collection, management, analysis, và interpretation of the data; và preparation, nhận xét or approval of the manuscript.


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