Brief ReportTai Chi practice and change in exercise habits in survivors of acute coronary syndromes: Is mindfulness a possible mechanism?
Introduction
Physical activity (PA) is a key target for the secondary prevention of coronary heart disease (CHD), yet only a minority of patients with CHD meets current PA recommendations.1 Referral to cardiac rehabilitation programs has been used to promote PA in these patients, but unfortunately less than 30% of eligible patients enroll in rehabilitation programs and attrition is high.2 This has prompted initiatives to promote the study of alternative options to improve exercise habits in this population.2 One such option is tai chi, a Chinese martial art integrating slow, gentle body movements with the cultivation of. awareness of the breath and body movements. Despite its gentle approach, energy expenditures during tai chi can reach levels consistent with moderate-intensity aerobic activity and practice has been associated with improvements in functional capacity.3
Two studies, including our own,4,5 have shown that tai chi can improve physical activity. Specifically, our study showed for the first time that a 6-month tai chi program can improve objectively assessed (accelerometry) moderate to vigorous PA (MVPA) in physically inactive CHD patients.5 However, the mechanisms by which mind-body exercise may improve exercise behaviors in patients with CHD are unknown. For the present analysis we were interested in studying the possible mechanisms underlying the effect of tai chi training on MVPA. We used Latent Class Modeling, a novel data-driven approach, to identify patterns of MVPA developed in response to tai chi training and to examine factors that may affect these patterns.
Section snippets
Methods
This exploratory analysis was conducted using data from the Gentle Cardiac Rehab Study (NCT02165254), a pilot clinical trial designed to examine the feasibility and possible effects of tai chi on PA among patients with CHD.5 A detailed description of the parent study has been provided elsewhere.6 Briefly, participants were recruited via flyers placed in public venues, on-line resources, and advertisements on local media outlets. Inclusion criteria were a history of CHD, being able to understand
Results
Participants (n = 29) were on average 67.9 years old (SD = 10.3). The majority was male (63%), white (93%), and reported at least some college education (75%). Almost 50% of the study participants were diabetic, 70% had high cholesterol levels or hypertension, more than 50% were obese, and about 30% were still active smokers.
Discussion
We used a novel data-driven analytical approach to explore whether changes in resilience, exercise self-efficacy, perceived social support, and mindfulness skills may play a role in modifying PA patterns in a group of physically inactive patients with CHD who received tai chi training. We found that improvements in mindfulness skills were significantly associated with high and sustained MVPA patterns. While these findings are only hypothesis-generating given the small sample size, our
Authors contributions
ESB obtained funding, conceived the study, and drafted the manuscript; DT assisted with manuscript drafting and revised the manuscript; SD conceived the study, conducted all statistical analyses, and revised the manuscript.
Financial disclosures
This project was funded by a grant (R34 AT007569) from the National Center for Complementary and Integrative Health (NCCIH) to Dr. Salmoirago-Blotcher.
Human subjects
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Rhode Island Hospital Institutional Review Board (docket 599729) approved the study protocol.
Declaration of Competing Interest
Elena Salmoirago-Blotcher reports research grants from the NIH, the American Heart Association, Brown University, and the Norman Prince Neuroscience Institute. Shira Dunsiger and Dyuti Trivedi have no conflicts to report.
Acknowledgements
None.
References (16)
- et al.
Tai Chi Chuan improves functional capacity after myocardial infarction: a randomized clinical trial
Am Heart J
(2015) - et al.
Design and methods of the gentle cardiac rehabilitation study – a behavioral study of tai chi exercise for patients not attending cardiac rehabilitation
Contemp Clin Trials
(2015) - et al.
Integrating mindfulness training in school health education to promote healthy behaviors in adolescents: feasibility and preliminary effects on exercise and dietary habits
Prev Med Rep
(2018) - et al.
Tai Chi and Qigong for the treatment and prevention of mental disorders
Psychiatr Clin North Am
(2013) - et al.
Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association
Med Sci Sports Exerc
(2007) - et al.
Referral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: a presidential advisory from the American Heart Association
Circulation
(2011) - et al.
Effect of T'ai chi chuan training on cardiovascular risk factors in dyslipidemic patients
J Altern Complement Med
(2008) - et al.
Tai Chi is a promising exercise option for patients with coronary heart disease declining cardiac rehabilitation
J Am Heart Assoc
(2017)
Cited by (2)
Energy Practices and Mindfulness Meditation
2022, MindfulnessEffects of 8-Week Tai Chi Chuan Practice on Mindfulness Level
2021, Mindfulness