Elsevier

EXPLORE

Volume 17, Issue 5, September–October 2021, Pages 475-478
EXPLORE

Brief Report
Tai Chi practice and change in exercise habits in survivors of acute coronary syndromes: Is mindfulness a possible mechanism?

https://doi.org/10.1016/j.explore.2020.09.001Get rights and content

Highlights

  • Tai Chi (TC) training may improve physical activity (PA) but mechanisms are unknown.

  • We used a data-driven approach to identify patterns and predictors of PA after TC.

  • Mindfulness scores at the end of training predicted higher PA at follow-up.

  • Improvements in mindfulness skills could be a key mechanism by which TC promotes PA.

  • These preliminary findings need to be confirmed in larger studies.

Abstract

Background

Mechanisms by which mind-body practice may improve exercise behaviors in patients with coronary heart disease (CHD) are unknown.

Purpose

To identify predictors of exercise behaviors developed in response to a tai chi intervention.

Methods

We conducted an exploratory analysis using data from a pilot study of tai chi for physically inactive patients with CHD. We used Latent Class Analysis to identify patterns of moderate to vigorous physical activity (MVPA) (accelerometry-assessed, average min/week) over the 9-month study period. Logistic regression was used to evaluate associations between MVPA patterns and changes in exercise self-efficacy (Self-efficacy for exercise scale), social support (Multidimensional Scale of Perceived Social Support), resilience (Brief Resilience Survey), and mindfulness (Five Facets of Mindfulness) at 6 months.

Results

Data supported a 3-class model over time: 31% of participants were in class 1 (high and sustained MVPA, > 200 min/week), 21% were in class 2 (low and decreasing MVPA, < 100 > 50 min/week), and 48% in class 3 (low and stable MVPA, < 50 min/week). Higher mindfulness scores at 6 months were associated with a high and sustained MVPA pattern (b = 1.89, SE = 0.15, p = .01). Social support was inversely associated with low and decreasing MVPA (b = -0.72, SE = 0.34, p = .04). No associations were noted with the other factors.

Conclusions

Improvements in mindfulness were associated with a distinct high and sustained MVPA pattern. Although only hypothesis-generating, these findings suggest that improvements in mindfulness skills could be a mechanism for the possible effect of Tai Chi in the promotion of MVPA.

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.

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