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Background: Tai Chi (TC) is a traditional Chinese martial art with demonstrated beneficial effects on physical and mental health. In this study, the authors performed a systematic review to assess the efficiency of TC in different populations' cognitive function improvement. Design: The present systematic review utilized the Chinese National Knowledge Infrastructure (1915-), Wanfang (1998-), VIP (1989-), Chinese Biomedicine databases (1978-), PubMed (1950-), Web of Science (1900-), Cochrane Library (1948-), Embase (1974-), EBSCOhost (1922-), and OVID (1996-) databases to search and identify relevant articles published in English and Chinese from the beginning of coverage through October 17, 2020. Randomized controlled trials (RCTs) published from the beginning of coverage through October 17, 2020 in English and Chinese were retrieved from many indexing databases. Selected studies were graded according to the Cochrane Handbook for Systematic Reviews of Intervention 5.1.0. The outcome measures of cognitive function due to traditional TC intervention were obtained. Meta-analysis was conducted by using RevMan 5.4 software. We follow the PRISMA 2020 guidelines. Results: Thirty-three RCTs, with a total of 1808 participants, were included. The study showed that TC could progress global cognition when assessed in middle-aged as well as elderly patients suffering from cognitive and executive function impairment. The findings are as follows: Montreal Cognitive Assessment Scale: mean difference (MD) = 3.23, 95% CI = 1.88-4.58, p  < 0.00001, Mini-Mental State Exam: MD = 3.69, 95% CI = 0.31-7.08, p  = 0.03, Trail Making Test-Part B: MD = -13.69, 95% CI = -21.64 to -5.74, p  = 0.0007. The memory function of older adults assessed by the Wechsler Memory Scale was as follows: MD = 23.32, 95% CI = 17.93-28.71, p  < 0.00001. The executive function of college students evaluated by E-prime software through the Flanker test was as follows: MD = -16.32, 95% CI = -22.71 to -9.94, p  < 0.00001. Conclusion: The TC might have a positive effect on the improvement of cognitive function in middle-aged and elderly people with cognitive impairment as well as older adults and college students.

Introduction: An important gap between randomized efficacy research and real-world implementation of complementary therapies is the role of patient preferences in influencing engagement and outcome. Several studies have highlighted the benefits of patient preference on health outcomes, but few have investigated the factors associated with preference for interventions, which may be critical to assure the success of program implementation. The current study sought to explore the factors associated with patient preference in an ongoing randomized preference-based trial of Mindfulness-Based Cancer Recovery (MBCR) versus Tai Chi/ qigong (TCQ) (the Mindfulness and Tai Chi/ qigong in Cancer Health [MATCH] study). Materials and Methods: A multi-method study design was used. A subsample of participants were purposely selected from the ongoing MATCH study to have representation from both intervention arms and from both men and women across different age groups. Open-ended, semi-structured qualitative interviews were conducted to explore the factors influencing initial patient preference. Interviews were transcribed verbatim and analyzed by using inductive thematic analysis. The treatment acceptability and preference measure was administered to determine patients' ratings of acceptability and credibility of both preferred and nonpreferred interventions. Results: A total of 13 participants were interviewed prior to program attendance, with 8 (62%) preferring TCQ and 5 (38%) choosing MBCR. Major themes related to patients' preference for intervention included: (1) expectations about the preferred intervention; (2) knowledge of the intervention; (3) past experiences with the intervention; and (4) self-efficacy. Participants' mean treatment acceptability scores were higher for their preferred program than their nonpreferred program. Conclusion: Understanding the factors that influence cancer survivors' preference for mind-body interventions can augment health care providers' knowledge of the barriers and facilitators for successful implementation of interventions in clinical settings, as well as help patients make informed treatment decisions and improve satisfaction and outcomes. Clinical trial registration no.: NCT03641222.

Background: Although there is extensive evidence from randomized controlled trials (RCTs) that Tai Chi maintains health, prevents injury, and mitigates the effects of a number of chronic diseases, it appears that physicians do not commonly recommend it. The objective of this study was to understand academic physicians' views on Tai Chi and why there is an apparent gap between the evidence on Tai Chi and its application in practice. Design: A qualitative study was conducted using purposive and snowball sampling and semistructured interviews with 15 academic physicians in 6 countries: Australia, Canada, France, New Zealand, the Netherlands, and the United States. The interviews were recorded and transcribed and then coded and analyzed with NVivo 12 software. Results: All participants were aware of Tai Chi. More than half had never attended a continuing education event where Tai Chi was mentioned or read a scientific article on it. Most had seen or heard of science-based evidence on it, and a few were well versed in the literature in their area of expertise. Almost three-quarters of physicians interviewed thought Tai Chi could be a therapeutic option; however, when asked how often they recommended Tai Chi, about a third indicated never, about a half said only occasionally, and a few identified it regularly. Three factors-lack of access, lack of both physician and patient awareness, and an anticipated lack of patient receptivity to it-seemed to account for most of the hesitation to recommend it. Some thought Tai Chi may be seen as foreign. All made useful suggestions on how to increase the uptake of Tai Chi, including learning from other physicians and integrating more of the evidence into knowledge products, as well as learning more about Tai Chi in undergraduate and continuing medical education. Conclusions: This exploratory study found that although all the academic physicians interviewed had heard about Tai Chi, most were unaware of the extent of evidence from RCTs supporting its therapeutic effects. To apply this evidence in their practice, they wanted to learn more about it from other physicians, have better integration of the evidence into medical knowledge products, and know that there was access, and patient receptivity, to Tai Chi classes in the communities where they practiced.

Objective: To determine the perceived benefits of t'ai chi in older adults with chronic low-back pain (cLBP). Design: A qualitative analysis from a randomized controlled feasibility trial. Subjects: Eighteen participants (65+ years old) with cLBP of at least moderate intensity. Intervention: A 36-week intervention beginning with twice weekly classes for 12 weeks, weekly classes for 6 weeks, biweekly classes for 6 weeks, and monthly classes for 12 weeks. Participants were asked to practice at home on nonclass days and videos were provided to assist in that process. Outcome Measures: Participants in the focus groups were asked to provide feedback on their experiences with the study as well as the benefits of their t'ai chi practice. We used demographic and class attendance data to describe the sample. Results: Regarding the benefits of t'ai chi practice, five major themes were identified: functional benefits, pain reduction/pain relief, psychospiritual benefits, the importance of social support in learning t'ai chi , and the integration of t'ai chi into daily activities. The most common functional benefits were improvements in balance, flexibility, leg strength, and posture. Some reported pain reduction or pain relief, but others did not. Increased relaxation, mindfulness, and a sense of connectedness were subthemes that emerged from psychospiritual benefits. Social support benefits included motivation to attend class and group support while learning a new skill. Finally, improved body awareness allowed participants to integrate t'ai chi skills into their daily activities. Conclusions: This qualitative analysis demonstrates the multifaceted benefits of t'ai chi for older adults living with cLBP.

Objectives: T'ai chi (TC) has been found effective for improving chronic low back pain (cLBP). However, such studies did not include adults over 65 years of age. This study was designed to evaluate the feasibility and acceptability of TC in this population compared with Health Education (HE) and with Usual Care (UC). Design: Feasibility randomized controlled trial. Settings/Location: Participants were recruited from Kaiser Permanente Washington and classes took place in a Kaiser facility. Patients: Adults 65 years of age and older with cLBP. Interventions: Twenty-eight participants were randomized to 12 weeks of TC followed by a 24-week tapered TC program, 12 were assigned to a 12-week HE intervention and 17 were assigned to UC only. Outcome Measures: Feasibility and acceptability were determined by recruitment, retention and 12-, 26-, and 52-week follow-up rates, instructor adherence to protocol, class attendance, TC home practice, class satisfaction, and adverse events. Results: Fifty-seven participants were enrolled in two cohorts of 28 and 29 during two 4-month recruitment periods. Questionnaire follow-up completion rates ranged between 88% and 93%. Two major class protocol deviations were noted in TC and none in HE. Sixty-two percent of TC participants versus 50% of HE participants attended at least 70% of the classes during the 12-week initial intervention period. Weekly rates of TC home practice were high among class attendees (median of 4.2 days) at 12 weeks, with fewer people practicing at 26 and 52 weeks. By 52 weeks, 70% of TC participants reported practicing the week before, with a median of 3 days per week and 15 min/session. TC participants rated the helpfulness of their classes significantly higher than did HE participants, but the groups were similarly likely to recommend the classes. Conclusion: The TC intervention is feasible in this population, while the HE group requires modifications in delivery.

Objectives: Falls are common in Parkinson's disease (PD). Exercise interventions can prevent falls. This review aims to (1) explore the existing evidence regarding the cost-effectiveness of exercise-based fall prevention programs for people with PD and (2) discuss the implications of the review findings for future research and clinical practice. Design: Databases AMED Allied and Complementary Medicine, CINAHL, CRD, EBSCO, EMBASE, MEDLINE, PubMed, Scopus, and Web of Science were searched from their inception until June 2019. Randomized and nonrandomized trials that included an economic evaluation of fall prevention programs for people with PD were considered. Quality of the economic evaluation was assessed using the Consensus on Health Economic Criteria list (CHEC-list), and the methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) and Cochrane risk of bias tool. Results: Nine hundred and sixty-five studies were screened to include three studies involving 556 participants. Quality of economic evaluation assessed using CHEC-list was high. The methodological quality was high for two studies and low for one study. Tested interventions included Tai Ji Quan, physiotherapist-led, supervised, weekly and monthly balance, and strengthening exercises. The duration of the interventions ranged from 10 weeks to 6 months, while the intervention frequency ranged from two sessions per week to one session per month. Treatment sessions lasted for 60 min in all three studies. One high economic and methodological quality study comparing Tai Ji Quan with resistance and stretching exercises reported least cost resource use among Tai Ji Quan group (USD 80,441) and greater incremental number of falls prevented. All three tested interventions had an 80% probability of being cost-effective with the corresponding country-specific threshold incremental cost-effectiveness ratio values. Conclusions: The findings provide some evidence for exercise-based intervention as a cost-effective treatment option for preventing falls in PD; however, due to the limited number of available studies, heterogeneity of the interventions, and diversity of assessment settings, a firm conclusion cannot be established. Additional studies evaluating the cost-effectiveness of fall prevention programs involving larger samples and using different treatment parameters in various settings are warranted.

Objectives: The aim of this pilot study was to assess the effects of a t'ai chi program on health-related quality of life (HR-QOL) in centrally obese adults with depression. Methods: Two hundred thirteen participants were randomly allocated to either a t'ai chi intervention group ( n  = 106) or a usual medical care control group ( n  = 107). The t'ai chi group involved 3 × 1.5 h supervised and group-based training sessions per week for 24 weeks. Indicators of HR-QOL were assessed by questionnaire at baseline, 12 weeks, and 24 weeks. Results: There were significant improvements in favor of the t'ai chi group for the SF-36 subscales of physical functioning ( p  < 0.01), role physical ( p  < 0.01), and role emotional ( p  < 0.01) at 12 and 24 weeks. Scores for bodily pain were improved in the control group at 12 weeks ( p  < 0.01) and 24 weeks ( p  < 0.05), but not in the t'ai chi group. There was also a significant improvement in favor of the control group in general health ( p  < 0.05) at 12 weeks, but not at 24 weeks. A further analysis showed clinically significant changes in favor of the t'ai chi group in physical functioning ( p  < 0.05 or p  = 0.05), role physical ( p  < 0.05), and role emotional ( p  < 0.05), and in favor of the control group in bodily pain ( p  < 0.05) at 12 and 24 weeks. Conclusions: The findings show that t'ai chi exercise improved indicators of HR-QOL including physical functioning, role physical, and role emotional in centrally obese adults with depression.

Background: Chinese medicine, when applied as a whole system of care, traditionally incorporates self-care techniques and patient understanding as key aspects of patient recovery and health maintenance. Objectives: This review aims to explore the literature to date on Traditional Chinese Medicine (TCM) self-care in settings outside of Asia, beyond the sole application of t'ai chi or qigong , to consider simple self-care techniques as health care interventions that may be generalized to a wider population. Design: AMED, CINAHL, EMBASE, PubMed, and MEDLINE databases were searched for articles from inception to July 2018. Studies were included, which were undertaken in settings outside of Asia and/or Asian communities, and were excluded if they solely examined t'ai chi or qigong . Results: Findings of the included studies ( n  = 37) were categorized into four key areas in relation to the TCM self-care component evaluated: self-acupressure, self-acupuncture, self-moxibustion, and the adoption of prescribed lifestyle, diet, and exercise advice based on a TCM diagnosis. The studies included randomized clinical trials, case studies, hospital audits, and qualitative evaluations. The studies assessed TCM self-care in relation to a wide range of health conditions, with the majority of studies concluding positive findings. Conclusion: This review draws attention to the potential role of TCM self-care techniques, in settings outside of Asia, beyond the sole practices of t'ai chi and qigong , as an adjunct to health maintenance and recovery. Only tentative conclusions can be drawn from the existing research, however, due to variability across studies in reporting transparency and the overall low number of studies retrieved. Further research is warranted.

Background: Mind-body exercise interventions are typically multimodal, complex, and pluralistic, and few have been developed with the goal of therapeutically targeting a specific medical population. It is thus important that clinical trials evaluating mind-body interventions provide some justification for the use of the specific protocol being evaluated., Objectives: This article reports the results of a systematic review of the quality of reporting of protocol rationale and content validity for using a specific t'ai chi protocol in a randomized controlled trial (RCT)., Methods: Electronic literature searches were conducted using PubMed/MEDLINE, EBSCOhost, and the Cochrane Library from inception through June 2015. Search terms were Tai Chi, Taiji, Tai Chi Chuan; searches were limited to English-language RCTs. Inclusion and exclusion of trials were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors assessed the level of reporting with respect to t'ai chi protocol validation using a 5-point grading system based on whether (1) a specific protocol was mentioned, (2) rationale for the specific protocol was stated and supported, and (3) formal evaluation for content validity was conducted., Results: There was significant heterogeneity in the quality of reporting related to protocol rationale and content validity. A total of 171 publications were identified. Studies met between 0 and 4 validity criteria (of possible 5, more indicating better quality), with a mean of 2.52 (±SD 1.2) and median of 3. Twenty (12%) trials did not mention a specific t'ai chi protocol, 10 (6%) trials met 0 of 5 criteria, and 47 (31%) studies met 4 of 5 criteria. Formal validity assessments were employed in only one trial., Conclusions: The poor quality of protocol rationale and content validity reporting limits our ability to accurately evaluate the evidence of t'ai chi as a therapeutic intervention. The development of formal guidelines for developing and reporting intervention validity for multimodal mind-body exercises like t'ai chi may improve the quality and interpretability of research.

Objectives: This study aims to investigate the effects of t'ai chi and qigong (TCQ) training on severity of obstructive sleep apnea (OSA)., Design: A prospective, 12-week, single-center, double-blinded, randomized controlled trial., Setting: Sleep Disorders Center of Medical Faculty in Istanbul, Turkey., Subjects: Fifty adult patients with mild and moderate OSA., Interventions: Patients were randomly allocated into either an intervention group or a control group. The intervention group (n = 25) received TCQ training under physiotherapist supervision for 1 h, three times per week, for 12 weeks and a home exercise program was provided for another 2 days. The control group (n = 25) received only a home exercise program for 12 weeks, 5 days per week., Outcome Measures: All patients were assessed before and after the exercise program. Objective parameters of sleep were measured by polysomnography, while subjective parameters of sleep were assessed using the Epworth Sleepiness Scale (ESS) and the 3-factor Pittsburgh Sleep Quality Index (PSQI). Pulmonary functions were assessed with a pulmonary function test; health-related quality of life was evaluated through the Short Form-36., Results: In the intervention group, there was a statistically significant decrease in the apnea-hypopnea index (AHI) (p = 0.001) and percentage and duration of stage N2 sleep (p = 0.041 and p = 0.037, respectively), while there was a statistically significant increase in percentage and duration of stage N3 sleep when compared with the controls (p = 0.048 and p = 0.043, respectively). There was a statistically significant decrease in the ESS, PSQI sleep efficiency, and total scores (p = 0.001, p = 0.003, and p = 0.003, respectively)., Conclusions: Our study results suggest that TCQ training may reduce AHI and daytime sleepiness, while improving subjective sleep quality, in patients with mild and moderate OSA.

Objective: This study aims to investigate the effect of t'ai chi exercise on hypertension in young and middle-aged in-service staff., Methods: A total of 208 subjects with grade 1 hypertension were enrolled into this study. These subjects were randomly divided into two groups: research group and control group (n = 104, each). On the basis of general daily lifestyle intervention, subjects in the research group underwent 24-Style Simplified t'ai chi exercise for 3 months, whereas subjects in the control group underwent general daily lifestyle intervention. All subjects were followed up at the first and third month of intervention. The body mass index (BMI), blood pressure, blood lipid, and other indexes were measured before and after the intervention, and quality of life was evaluated., Results: (1) In the research group, after 1 month of exercise, systolic blood pressure (SBP), heart rate (HR), triglyceride (TG), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) significantly decreased (p < 0.05), while BMI, blood glucose (Glu), diastolic blood pressure (DBP), and pulse pressure (PP) did not significantly change. Furthermore, after 3 months of exercise, BMI, HR, SBP, DBP, PP, TG, TC, LDL-C, and Glu all significantly decreased (p < 0.05). (2) Moreover, the quality of life of subjects in the research group obviously improved after 3 months of t'ai chi exercise (p < 0.05)., Conclusions: t'ai chi exercise can reduce the level of blood pressure in young and middle-aged in-service staff with grade 1 hypertension, control weight, slow down the HR, improve metabolism, and improve quality of life. t'ai chi is an exercise suitable for in-service hypertension subjects.

Objectives: The aim of this study was to highlight features of pragmatic real-world integrative oncology research by applying the PRagmatic Explanatory Continuum Indicator Summary (PRECIS-2) criteria to an ongoing integrative oncology clinical trial. The ongoing trial is a preference-based randomized comparative effectiveness trial of mindfulness-based cancer recovery (MBCR) versus t'ai chi/qigong (TCQ) for cancer survivors (the Mindfulness and T'ai Chi for Cancer Health [MATCH] study). The primary outcome of the MATCH study is distress, and secondary outcomes are quality of life, sleep disturbance, and physical functioning. The clinical trial is being undertaken at tertiary care cancer centers across two sites in Canada: Calgary (AB) and Toronto (ON), with a sample of 600 cancer survivors who have finished all cancer treatments and are distressed., Methods and Results: The MATCH trial was scored on the explanatory-pragmatic continuum for each of the nine domains of the PRECIS-2 criteria on a scale of 1-5, and was rated as more explanatory than pragmatic, despite initial design efforts being more pragmatic. Areas that were least pragmatic were methods of recruitment, follow-up, and intervention delivery. The more pragmatic areas were setting, outcomes, and data analysis., Conclusions: More efforts toward conducting pragmatic trials are needed in the field of integrative oncology, as cancer-care institutions and policy makers are looking for sustainable interventions within already established treatment models. The PRECIS-2 criteria can help researchers meet these goals in the planning stages of trial development.

Background: Cardiovascular disease is a common health problem resulting from many factors, including dyslipidemia. T'ai chi is one of the interventions assigned to improve lipid profiles and other physical outcomes. However, conflicting results might be attributed to different study designs and interventional approaches. A systematic review and meta-analysis are needed to evaluate existing evidence., Objective: The aim of this systematic review and meta-analysis is to evaluate existing randomized clinical trials (RCTs) regarding the overall effect of t'ai chi exercise on lipid profiles., Methods: Electronic databases (MEDLINE and Cumulative Index to Nursing and Allied Health Literature) were searched. The authors included only English peer reviewed published RCTs that used a t'ai chi intervention and high-density lipoprotein cholesterol (HDL-C) as the primary outcome along with low-density lipoprotein cholesterol (LDL-C) and/or total cholesterol (TC) as secondary outcomes., Results: The authors identified 37 potentially eligible studies. Only eight RCTs were eligible for their qualitative review, and seven studies were eligible for meta-analysis. The included studies were rated as having a low risk of bias. Despite the overall low risk of bias, all studies failed to blind participants to group assignment and were generally unclear about whether they were selectively reporting data. A fixed effect model (I 2  = 38.16%) demonstrated a small positive effect of t'ai chi on HDL-C (Cohen d = 0.12; standard error [SE] = 0.067; p = 0.037). A random effect model demonstrated a medium effect and small effect for LDL-C (Cohen d = 0.47; SE = 0.347; p = 0.089) and TC (Cohen d = 0.34; SE = 0.225; p = 0.066), respectively., Conclusion: T'ai chi may potentially be beneficial on lipid profiles across different age groups and populations. Although there were conflicting results regarding the effect of t'ai chi on lipid profiles, the majority of studies had at least a small positive effect indicating a potential positive effect of t'ai chi on HDL-C, LDL-C, and/or TC. Therefore, further research is needed to confirm the small positive effect of t'ai chi on lipid profiles found in this review.

Objectives: The aim of this study was to investigate the effects of t'ai chi on blood serotonin levels, nicotine dependence, depression, and anger in hospitalized alcohol-dependent patients., Method: This study followed an experimental and nonequivalent control group in a non-synchronized design. It was performed in a hospital located in Young Ju city, Korea, from April to August 2013. Thirty-eight patients who were hospitalized with alcohol dependence were included. They were randomly divided into an experimental and a control group, with 19 patients in each group. Patients in the experimental group practiced the 24-posture yang style t'ai chi for 50 min three times per week for 8 weeks as part of the routine hospital rehabilitation program, and those in the control group followed only the routine hospital rehabilitation program. The effect of treatment was measured using blood serotonin levels and a questionnaire on nicotine dependence, depression, and anger. Both measurements were performed before and after 8 weeks of intervention. Data were analyzed using the t-test, chi-square test, and paired t-tests., Results: The experimental group showed a significantly increased blood serotonin level (p = 0.001) and significantly reduced nicotine dependence, depression, and anger (p = 0.001) than the control group did after 8 weeks of treatment., Conclusions: T'ai chi was shown to be an effective nursing intervention in hospitalized alcohol-dependent patients.

Introduction: T'ai chi chuan is a beneficial exercise of improving health and function. Biomechanical insights of t'ai chi chuan are less understood., Objectives: To study t'ai chi gait (TCG), a common form of t'ai chi chuan in order to quantify external knee adduction moment (EKAM) as a key indicator of mechanical loading of the medial compartment of the knee compared with normal walking (NW)., Design: A quantitative biomechanics approach to determine peak EKAM for NW and TCG., Results: There were a tri-modal pattern of EKAM during TCG and a bimodal pattern of EKAM during normal walking. In addition, subsequent analysis showed a 25%-47% reduction in peak EKAM during double support phases of TCG compared with NW; the peak EKAM of TCG during single-limb support phase showed significantly higher magnitude than the other two double-support phases., Conclusion: These results indicate that t'ai chi chuan might be a beneficial intervention for reducing the medial mechanical load at the knee joint, particularly during the first double-support phases of TCG, but the special consideration of higher peak EKAM of single-limb support phase is needed during regular t'ai chi chuan practice.

Objective: To investigate the acute effect of a t'ai chi chuan session on blood pressure and heart rate in patients with peripheral artery disease (PAD)., Design: Randomized crossover intervention study., Setting: Outpatient therapy center., Participants: Seven patients with PAD, aged 50-79 years, not using β-blockers, calcium-channel blockers, or nondihidropiridinic vasodilators., Intervention: T'ai chi chuan and control session (both sessions lasted 40 minutes)., Outcome Measures: Systolic and diastolic blood pressure and heart rate, which were evaluated before and after the intervention (10, 30, and 50 minutes)., Results: T'ai chi chuan exercise acutely decreased systolic blood pressure at 30 minutes after exercise (p = 0.042) and increased diastolic blood pressure at 50 minutes after exercise (p = 0.041). Heart rate did not change after t'ai chi chuan exercise., Conclusion: T'ai chi chuan acutely decreases systolic blood pressure in patients with PAD.

Objective: To explore the potential influence of curriculum, frequency of practice, and dietary quality on the health of experienced Taiji and qigong practitioners., Design: Theoretical and cross-sectional study., Methods: Responses from a volunteer sample of Taiji practitioners from across the United States were collected using an online survey. The instrument was designed to collect data on health-related quality of life, diet, and Taiji practice regimens. All experienced (≥4 years) practitioners (n = 94; mean age, 55.82 years [range, 24-83 years]) were included in the analysis. Relationships among self-reported health, diet, experience, practice frequency, and curricular complexity were analyzed., Results: Practitioners' health status did not show the typical negative association with age and was positively associated with complex curricula, practice, and high-quality diets. Significant interaction effects were seen between (1) curricular complexity and additional practice (p < 0.05) and (2) curricular complexity and diet (p < 0.05)., Conclusions: Intervention designers, Taiji teachers, and practitioners should consider the potential influence of curricula, out-of-class practice, and healthy diets for optimizing health-related gains and minimizing age-related losses in interventions and community-based programs.

Although numerous studies have linked t'ai chi chuan (TCC) practice with benefits for balance, reduction in the number of falls, and in the fear of falling, most of them did not address the causes of these benefits in depth. Some studies, however, sought to determine the causes from the biomechanical point of view. This article aims to thoroughly describe and critically review recent papers on foot-ground contact in TCC practice, one of the parameters involved in balance biomechanics in TCC performance. No previous review on this subject has been found. Nine electronic databases were searched for publications between 1996 and 2013. Studies were excluded if they were not published in English or were abstracts, posters, or summaries from conferences. From a total of 195 articles identified, 4 randomized controlled trials and 3 non-randomized controlled trials were eligible for the analysis. The number of studies that assessed foot-ground contact in TCC and effects on normal gait, postural control improvement, and fall prevention is still quite small. These studies were based on intervention protocols and used populations that were too heterogeneous to allow reliable comparisons. According to the studies analyzed, TCC practice clearly improved parameters associated with foot-ground contact. Nevertheless, the manner in which these benefits are transferred to daily displacement habits still remains unclear.

Health care professionals usually strive to reach turning points in therapeutic processes in order to help patients manage a problem or difficult situation. The professional aligns with the patient's needs through what can be described as "the art of doing almost nothing": listening, noticing, thinking, waiting, witnessing, and preventing harm. This process is similar to the Taijiquan principle of alignment illustrated in the yin-yang symbol taijitu. For both therapeutic process and Taijiquan, mastery is characterized through the phenomenon that the closer one gets to the turning point, the less visible are the practitioner's efforts in terms of observable action.

Purpose: The purpose of this study is to determine the effects of Chinese traditional exercise such as t'ai chi and qigong (TCQ) on patients with chronic obstructive pulmonary disease (COPD)., Methods: All prospective, randomized, controlled clinical trials, published in English or Chinese and involving the use of TCQ by patients with COPD, were searched in 10 electronic databases from their respective inceptions to July 2012. The methodological quality of all studies was assessed using the Jadad score. The selection of studies, data extraction, and quality assessment were performed independently by two raters., Results: In the results, 10 trials met the inclusion criteria and were reviewed. The meta-analysis demonstrated that compared with no exercise, TCQ had significant effects on 6-minute walk distance, forced expiratory volume in 1 second (FEV1), predicted FEV1 percentage, and St. George's Respiratory Questionnaire score. There were no significant differences in all outcomes between TCQ and other exercise training except 6-minute walk distance., Conclusions: In conclusion, TCQ might be beneficial with respect to physical performance, lung function, remission of dyspnea, and quality of life in patients with COPD; however, caution is needed to draw a firm conclusion because of the low methodological quality of the included trials.

Objective: To examine the additive effect of t'ai chi (TC) to diet education on the traditional coronary heart disease (CHD) risk factor low-density lipoprotein cholesterol (LDL-C) and on emerging CHD risk factors (apolipoprotein B and LDL particle size) in older obese women., Design: Ancillary study of a randomized clinical trial., Setting: University of Rhode Island., Participants: 26 obese women (mean age±standard deviation, 61.5±6.0 years; mean body mass index, 34.3±4.0 kg/m(2)) were enrolled and randomly assigned to the diet education group (n=13) or the diet education plus TC group (n=13)., Intervention: All participants received 45 minutes of diet education per week. The diet education plus TC group also received 45 minutes of TC three times per week for 16 weeks., Outcome Measures: Anthropometrics (height, weight, BMI, waist circumference, and hip circumference), clinical variables (blood pressure), and biochemical variables (standard lipid profile, apolipoprotein B, LDL particle size) were measured. The primary outcome was LDL-C, and the secondary outcomes were apolipoprotein B and LDL particle size., Results: Neither LDL-C nor apolipoprotein B improved in either group. Percentage of large LDL particles after the intervention was increased in the diet education plus TC group compared with the diet education group. Weight, waist circumference, and high-density lipoprotein cholesterol decreased in both groups from baseline to post-intervention. Triacylglycerol and dietary screening tool scores increased in both groups. Additional improvements were seen in the diet education plus TC group, including a significant increase in Dietary Approaches to Stop Hypertension score from baseline to post-intervention., Conclusion: The addition of TC to diet education is more effective than diet education alone at improving diet quality and emerging CHD risk factors, such as LDL particle size, in obese older women.

Objectives: A single bout of t'ai chi (TC) exercise was previously found to be associated with a significant increase in post-exercise adiponectin levels in individuals with cardiovascular risk factors. The objective of this study was to examine the long-term effects of 24-month habitual TC exercise on adiponectin levels, glucose homeostasis, lipid profile, and atherosclerotic burden in individuals with cardiovascular risk factors., Design: This was a prospective observational study., Settings/location: The study was conducted at a regional hospital in south Taiwan., Subjects: Participants of a TC exercise program held by the clinics of cardiology and cardiovascular surgery for individuals with cardiovascular diseases were recruited to the TC group. Individuals who did not join the program were recruited as controls. All study subjects had at least one cardiovascular risk factor., Interventions: Ninety-minute session of Yang's style TC at least once a week., Outcome Measures: Measurements on adiponectin, glucose homeostasis, lipid profile, and atherosclerotic burden were made at three time points-baseline, 12 months, and 24 months. Two-way repeated-measures general linear model was used to assess the changes over the study period between the TC and control groups., Results: Thirty-seven patients in both the TC and control groups completed the study. The TC group showed a greater increase in natural logarithmic transformed (Ln) adiponectin values than the control group over the study period (interaction effect p=0.009). Glucose homeostasis, lipid profile, risk of atherosclerosis, and atherosclerotic burden did not showed significant changes with TC compared with the controls over the 24-month period., Conclusions: The results of the present study indicate that for individuals with at least one cardiovascular risk factor, engaging in habitual TC exercise could lead to favorable changes in levels of adiponectin. The association between habitual TC and cardiovascular events and diabetic complications will require further investigations.

Background: Sixty percent (60%) to 80% of patients who visit chiropractic, osteopathic, or Chinese medicine practitioners are seeking pain relief., Objectives: This article aimed to identify the amount, quality, and type of complementary and alternative medicine (CAM) pain research in Australia by systematically and critically reviewing the literature., Methods: PubMed, Scopus, Australasian Medical Index, and Cochrane library were searched from their inception to July 2009. Australian and New Zealand Clinical Trial Registration and National Health and Medical Research Council databases were searched for human studies yet to be completed. Predefined search terms and selection criteria were used for data identification., Results: Of 204 studies selected, 54% were on chiropractic, 27% on Chinese medicine, 15% about multitherapy, and 4% on osteopathy. Chronic spinal pain was the most studied condition, with visceral pain being the least studied. Half of the articles in Chinese medicine or multitherapy were systematic reviews or randomized control trials. In comparison, only 5% of chiropractic and none of osteopathy studies were in these categories. Government funding was rare, and most studies were self-funded or internally funded. All chiropractic, osteopathic, and Chinese herbal medicine studies were conducted by the researchers of the professions. In contrast, half of the acupuncture studies and all t'ai chi studies were conducted by medical doctors or physiotherapists. Multidisciplinary collaboration was uncommon., Conclusions: The quantity and the quality of CAM pain research in Australia are inconsistent with the high utilization of the relevant CAM therapies by Australians. A substantial increase in government funding is required. Collaborative research examining the multimodality or multidisciplinary approach is needed.

Objectives: The objective of this study was to identify underlying mechanisms affecting smoking cessation among smokers taking t'ai chi classes. Smokers from t'ai chi classes had attributed t'ai chi practice as the primary reason for quitting smoking., Methods: Two (2) students from the community college population who had taken a t'ai chi class completed an open-ended questionnaire, to identify possible variables involved in motivations for smoking cessation. An Internet search identified a third student from a university program who had posted observations of how t'ai chi affected her efforts at smoking cessation. The three written responses were evaluated for correlating comments, to identify possible theoretical aspects of why t'ai chi would impact smoking cessation. All three identified increased awareness of smoking habits due to t'ai chi as the primary reason for quitting smoking. A review of literature was conducted to clarify the role of enhanced awareness as a mediator in modifying destructive behavior and addiction. Results from an unpublished study of a t'ai chi smoking cessation program were utilized as supporting data., Results: Two (2) primary areas of behavior modification focusing on the role of enhanced self-awareness are identified from the review of literature: Mindfulness Meditation (MM), and traditional Zen practice. Zen and MM are identified as readily adaptable to using t'ai chi as a form of moving meditation for dealing with addiction., Conclusions: T'ai chi, as a more dynamic form of meditation, can be an effective method for enhancing mindfulness and awareness for breaking cycles of addiction and habit. Possible effects on physical cravings were also identified. As a novel and unusual form of mind/body exercise, t'ai chi may be a particularly appealing adjunct to smoking cessation programs, particularly in light of the many ancillary health benefits of t'ai chi.

Purpose: The aim of this study was to determine the effects of Tai Chi exercise on glucose control, neuropathy scores, balance, and quality of life in patients with type 2 diabetes and neuropathy., Methods: A pretest-posttest design with a nonequivalent control group was utilized to recruit 59 diabetic patients with neuropathy from an outpatient clinic of a university hospital. A standardized Tai Chi for diabetes program was provided, which comprised 1 hour of Tai Chi per session, twice a week for 12 weeks. Outcome variables were fasting blood glucose and glycosylated hemoglobin for glucose control, the Semmes-Weinstein 10-g monofilament examination scores and total symptom scores for neuropathy, single leg stance for balance, and the Korean version of the SF-36v2 for quality of life. Thirty-nine patients completed the posttest measures after the 12-week Tai Chi intervention, giving a 34% dropout rate., Results: The mean age of the participants was 64 years, and they had been diagnosed with type 2 diabetes for more than 12 years. The status was significantly better for the participants in the Tai Chi group (n=20) than for their control (i.e., nonintervention) counterparts (n=19) in terms of total symptom scores, glucose control, balance, and quality of life., Conclusion: Tai Chi improved glucose control, balance, neuropathic symptoms, and some dimensions of quality of life in diabetic patients with neuropathy. Further studies with larger samples and long-term follow-up are needed to confirm the effects of Tai Chi on the management of diabetic neuropathy, which may have an impact on fall prevention in this population.

Background: Patients with chronic heart failure (HF) and with elevated depression symptoms are at greater risk of morbidity and mortality. Somatic symptoms of depression are particularly prevalent in HF and are related to worse disease prognosis. T'ai chi practice is related to increased emotional well-being in various clinical populations; however, relatively little is known about t'ai chi's effects on somatic versus cognitive symptom dimensions of depression in HF., Purpose: The objective of the study was to measure whether a t'ai chi intervention effectively reduces somatic and/or cognitive symptoms of depression in patients with HF., Methods: Patients with HF were assigned to either t'ai chi training (n=16) or a usual-care group (n=12). At baseline and after the 12-week intervention period, participants were evaluated for changes in depressive symptoms using Beck Depression Inventory (BDI) total scores (BDI-t) and subcategorized scores of BDI-somatic (BDI-s) and BDI-cognitive (BDI-c), and for symptoms of fatigue using the Multidimensional Fatigue Symptom Inventory-Short Form., Results: Patients with HF in the t'ai chi group compared to the usual-care group had reduced BDI-s (p≤0.017), but not BDI-c (p=0.50) scores from pre- to postintervention. Although t'ai chi did not significantly reduce fatigue, changes in physical fatigue (p≤0.05) were independently associated with changes in BDI-t scores., Conclusions: T'ai chi practice reduced somatic symptoms of depression, which have been linked to worse prognosis in HF. Reductions in fatigue appear to explain some but not all of the reductions in somatic symptoms of depression.

Purpose: The purpose of this study is to examine and compare health status across ages using a volunteer sample of U.S. Taijiquan and Qigong (TQG) practitioners (N=120; age range=24-83, M=54.77) and a nationally representative sample (N=414,629; age range=18-99, M=54.86) collected by the Centers for Disease Control and Prevention (CDC)., Design: The study design was cross-sectional, between-group comparisons., Methods: An online survey designed to collect data on health-related quality of life (HRQoL), lifestyle variables, and TQG practice regimens was administered to a volunteer sample of taijiquan practitioners. A link to the survey was e-mailed to registrants of the International T'ai Chi Symposium who further forwarded (snowballed) the link to other practitioners across the country and around the world. The HRQoL and demographic sections of the survey were adapted from the CDC's Behavioral Risk Factor Surveillance System (BRFSS). Taiji practitioner data and BRFSS data were then merged and three groups--No Exercise, Some Exercise, and TQG Exercise--were created for the analysis. Health status was regressed on age, exercise group membership, and the interaction between age and group membership while controlling for income and education., Results: After controlling for the effects of income and education, a significant interaction effect (p<0.001) was detected between age and group membership. Group membership was not a substantial predictor of health among younger individuals, but among older adults, substantive and significant between-group differences appeared, with the TQG group evincing the best average health trajectory across ages., Conclusions: Although this cross-sectional comparison cannot establish causality or rule out cohort effects, the extraordinary trajectory of health status among TQG practitioners in this U.S. sample is significantly better than average exercising and nonexercising U.S. Americans, even while controlling for the influence of income and education levels. Lifespan developmental theory is utilized to consider several factors beyond the physical exercise value of TQG that may be responsible for the exercise group differences.

Purpose: This article compares and contrasts two systematic reviews of t'ai chi (TC) interventions on bone mineral density in postmenopausal women. The aim is to examine how chosen quality rating instruments can impact systematic reviews of TC literature., Methods: The rating instruments in the reviews, the three-item scale of Jadad et al. and the ad hoc checklist of Wayne et al., were analyzed using Oxman's evaluation criteria for systematic reviews regarding inclusion of articles, interpretation of results, and overall implications for the efficacy of TC on bone mineral density., Results: According to Oxman's criteria, the Jadad scale did not address advances in statistical methods and was not comprehensive enough to adapt to the clinical context or topic. In contrast, the checklist by Wayne et al. was comprehensive, adaptable to clinical context and topical relevance, and compatible with recent developments in statistics and experimental design. These quality rating instruments were critical in the inclusion of studies, analyses, and overall conclusions summarizing the TC literature. The conclusions from the two systematic reviews were starkly opposing; Lee et al. found no convincing evidence, dismissing TC studies as low quality, while Wayne et al. stated that TC may be an effective, safe, and practical intervention., Conclusions: Readers must exercise caution concerning high or low ratings from systematic reviews of TC studies because the choice of quality rating tool can dramatically influence the summary and conclusions of the reviews. There is no consensus on quality rating standards at this time. Of the two, the Jadad scale was not only inadequate but also inappropriate for reviewing TC studies, potentially misleading researchers, clinicians and policymakers. Future systematic reviews of TC should utilize instruments that are updated to current scientific standards, comprehensive, adaptable to clinical context, and relevant to the research topic.

Background: T'ai chi chuan, the ancient Chinese martial art, is practiced by millions of people worldwide and is an activity of moderate intensity that involves slow, circular movements. Evidence of substantial health benefits of t'ai chi chuan is emerging, however, the physiologic mechanisms are not well-understood. T'ai chi chuan masters routinely report sensing qi or internal energy flow, particularly in the hands. The purpose of this case study was to determine whether physiologic responses normally associated with thermoregulation are activated during a basic t'ai chi chuan exercise., Methods: Trials consisted of three focus periods and one withdraw period (during which the subject withdrew internal energy in the hands), each followed by a rest period. Measurements included infrared-thermography (IR), thermocoupled temperature measures, and laser Doppler flowmetry., Results: Substantial increases in local palmar and face surface temperatures were observed with IR thermography during focus periods and substantial decreases were observed during the withdraw period. Fingertip surface baseline temperatures were 31.1°C for one trial, increased by 1.8°C during the focus period, and then decreased by 4.9°C during the withdraw period. A twofold increase in blood flow through fingertip regions paralleled changes in fingertip surface temperatures during focus periods., Conclusions: Changes in regional blood flow and surface temperatures closely paralleled onsets of focus, rest, and withdraw periods and appear to be volitional activations of known vasomotor mechanisms underlying non-hairy skin regions such as the hands and face. Changes in blood flow through these vascular structures are generally autonomic thermoregulatory responses, not normally under voluntary control, but may also represent a relaxation response.

Objective: This study aimed to validate the effects of a simplified, gentle form of t'ai chi chuan in patients with type 2 diabetes and who are also obese., Design: The study was designed to be a randomized controlled trial., Setting: This study was conducted in the department of metabolism and endocrinology at Cheng Ching Hospital, in Taichung, Taiwan., Subjects: The study subjects were hospital-based patients with type 2 diabetes and who were also obese (ages 40-70, with a body-mass index [BMI] range of 30-35). The patients were randomly selected and grouped into t'ai chi exercise (TCE) and conventional exercise (CE) groups., Interventions: After receiving instruction in t'ai chi, the TCE group and the CE group practiced three times per week, including one practice session lasting up to 1 hour, for 12 weeks., Outcome Measures: Hemoglobin A1C, serum lipid profile, serum malondialdehyde, and C-reactive protein were measured. Physical parameters of body weight and BMI were also measured. Diet and medications of participants were monitored carefully while biochemical and physical conditions were analyzed., Results: After 12 weeks, hemoglobin A1C values of the TCE group did not decrease (8.9 ± 2.7% : 8.3 ± 2.2%; p = 0.064). BMI (33.5 ± 4.8 : 31.3 ± 4.2; p = 0.038) and serum lipids, including triglyceride (214 ± 47 mg/dL : 171 ± 34 mg/dL; p = 0.012) and high density lipoprotein cholesterol (38 ± 16 mg/dL : 45 ± 18 mg/dL; p = 0.023) had significant improvements. Serum malondialdehyde tended to decrease from baseline (2.66 ± 0.78 μmol/L : 2.31 ± 0.55 μmol/L; p = 0.035), and C-reactive protein also decreased (0.39 ± 0.19 mg/dL : 0.22 ± 0.15 mg/dL; p = 0.014). No improvements occurred in BMI, lipids, and oxidative stress profiles in the CE group., Conclusions: T'ai chi exercise practiced by patients who are obese and have type 2 diabetes is efficient and safe when supervised by professionals and helps improve parameters, such as BMI, lipid profile, C-reactive protein, and malondialdehyde. Periodic monitoring of blood glucose, blood pressure, heart rate, breathing, physical fitness, and symptoms of discomfort of patients who exercise helps prevent injury. Simple, gentle TCE can be applied as regular daily exercise for patients with type 2 diabetes even when such patients are obese.

Objective: Complementary and alternative medicine (CAM) therapies have become increasingly popular and are used regularly by patients with osteoporosis in Australasia and worldwide. This study was done to determine the prevalence and patterns of use of CAM in an Australian osteoporosis clinic., Design, Setting, and Participants: This was a prospective, cross-sectional questionnaire-based study of 202 patients attending an academic osteoporosis clinic in Sydney, Australia., Results: Subject had a mean age of 68.5 +/- 10.9 years, 79.7% were female, and 55.9% were born overseas. CAM use was reported by 104 patients (51.5%) using the standard and 62 patients (30.7%) using the stringent definition of CAM. The most frequent CAM were multivitamins (24.0%), acupuncture (19.2%), t'ai chi (14.4%), and yoga (12.5%). Seventy-three percent (73%) did not consult a physician before starting CAM and 23.1% stated that their treating specialists were unaware of CAM use. The most common reasons for using CAM were having a holistic approach (53.0%) and inadequate pain control (29.0%). CAM users were associated with Asian country of birth (23.1% versus 12.2%, p = 0.03), more frequent clinic visits over a 12-month period (1.8 versus 1.5 times, p = 0.03), and a trend for a worse lumbar spine T-score (-2.35 versus -2.20 SD, p = 0.05) and higher rates of university education (26.0% versus 14.3%, p = 0.05). It is estimated that $696 million is spent annually on CAM by patients with osteoporosis., Conclusions: Patients attending osteoporosis clinics frequently use CAM. Physicians may need to routinely inquire about a history of CAM use to ensure better screening for possible adverse clinical interactions.

Background: The Cochrane Collaboration, an international not-for-profit organization that prepares and maintains systematic reviews of randomized trials of health care therapies, has produced reviews summarizing much of the evidence on Traditional Chinese Medicine (TCM). Our objective was to review the evidence base according to Cochrane systematic reviews., Methods: In order to detect reviews focusing on TCM, we searched the titles and abstracts of all reviews in Issue 4, 2008 of the Cochrane Database of Systematic Reviews. For each review, we extracted data on the number of trials included and the total number of participants. We provided an indication of the strength of the review findings by assessing the reviewers' abstract conclusions statement. We supplemented our assessment of the abstract conclusions statements with a listing of the comparisons and outcomes showing statistically significant meta-analyses results., Results: We identified 70 Cochrane systematic reviews of TCM, primarily acupuncture (n = 26) and Chinese herbal medicine (n = 42), and 1 each of moxibustion and t'ai chi. Nineteen (19) of 26 acupuncture reviews and 22/42 herbal medicine reviews concluded that there was not enough good quality trial evidence to make any conclusion about the efficacy of the evaluated treatment, while the remaining 7 acupuncture and 20 herbal medicine reviews and each of the moxibustion and t'ai chi reviews indicated a suggestion of benefit, which was qualified by a caveat about the poor quality and quantity of studies. Most reviews included many distinct interventions, controls, outcomes, and populations, and a large number of different comparisons were made, each with a distinct forest plot., Conclusions: Most Cochrane systematic reviews of TCM are inconclusive, due specifically to the poor methodology and heterogeneity of the studies reviewed. Some systematic reviews provide preliminary evidence of Chinese medicine's benefits to certain patient populations, underscoring the importance and appropriateness of further research. These preliminary findings should be considered tentative and need to be confirmed with rigorous randomized controlled trials.

Purpose: This study was to examine the effects of adherence to a 6-month t'ai chi exercise program on glucose control, diabetic self-care activities, and quality of life among individuals with type 2 diabetes., Method: The data from a quasi-experimental study at multisite health-promotion centers in Korea with pretest and 3- and 6-month post-test measures were used. Ninety-nine (99) adults diagnosed with type 2 diabetes and HbA1c 6.0 or higher were included in the analysis. The t'ai chi intervention consisted of 19 movements from Yang and Sun styles provided twice a week for 6 months. Sixty-two (62) subjects completed both pretest and post-test measures. To achieve the desired outcomes, subjects needed to complete 80% of the sessions of the t'ai chi program, and 31 subjects who met this criteria were compared to those who did not (n = 31). Outcome measures included glucose control (fasting blood sugar, HbA1c), diabetic self-care activities, and quality of life (36-Item Short Form Health Survey, version 2)., Results: Using repeated measure analysis of variance for baseline, 3 months, and 6 months, the adherent group had greater decline in fasting glucose (interaction effect F = 5.60, df = 2, p < 0.05) and HbA1c (interaction effect F = 4.15, df = 2, p < 0.05) than the nonadherers. The adherent group performed significantly more diabetic self-care activities (interaction effect F = 5.13, df = 2, p < 0.05), and had better quality of life in mental component summary, social functioning, mental health, and vitality as compared to the nonadherent group. The significant differences in quality of life remained after adjusting for self-care activities except for mental health, which was no longer significant., Conclusion: For those with type 2 diabetes, t'ai chi could be an alternative exercise intervention to increase glucose control, diabetic self-care activities, and quality of life. Whether t'ai chi can reduce or prevent diabetic complications requires further study.

Objective: To provide a descriptive overview of the clinical trials assessing meditation practices for health care., Design: Systematic review of the literature. Comprehensive searches were conducted in 17 electronic bibliographic databases through September 2005. Other sources of potentially relevant studies included hand searches, reference tracking, contacting experts, and gray literature searches. Included studies were clinical trials with 10 or more adult participants using any meditation practice, providing quantitative data on health-related outcomes, and published in English. Two independent reviewers assessed study relevance, extracted the data, and assessed the methodological quality of the studies., Results: Four hundred clinical trials on meditation (72% described as randomized) were included in the review (publication years 1956-2005). Five broad categories of meditation practices were identified: mantra meditation, mindfulness meditation, yoga, t'ai chi, and qigong. The three most studied clinical conditions were hypertension, miscellaneous cardiovascular diseases, and substance abuse. Psychosocial measures were the most frequently reported outcomes. Outcome measures of psychiatric and psychological symptoms dominate the outcomes of interest. Overall, the methodological quality of clinical trials is poor, but has significantly improved over time by 0.014 points every year (95% CI, 0.005, 0.023)., Conclusions: Most clinical trials on meditation practices are generally characterized by poor methodological quality with significant threats to validity in every major quality domain assessed. Despite a statistically significant improvement in the methodological quality over time, it is imperative that future trials on meditation be rigorous in design, execution, analysis, and the reporting of results.

The Agency for Healthcare Research and Quality (AHRQ) report is a major reference point for establishing where the research on meditation stands and where it should go from here. This commentary argues that double blinding, a major component of the report's evaluation criteria, is not an appropriate control for placebo in meditation research. A viable alternative is to make the treatment and control groups equivalent on nonspecific therapeutic attention factors and expectation. High quality meditation research must also use qualified instructors, have high compliance levels, insure proficient practice, use state-of-the-art measurement methodology, and make sure control subjects are not inadvertently practicing the same or another form of meditation. None of these determinants of research quality was assessed by the AHRQ report. It is noteworthy that whereas randomized controlled trials have their place in demonstrating clinical efficacy, few if any of the major ideas in the basic or behavioral sciences have come from randomized trails. A wide range of study designs have demonstrated that the traditional goal of meditation, a state of inner silence called "transcendental consciousness," has unique physiological characteristics with far ranging implications for health, cognition, and behavior. Such studies need to be included in future reviews of meditation techniques.

Although a growing body of clinical research has begun to evaluate the efficacy and safety of t'ai chi as a therapeutic tool for a variety of health conditions, little attention has been devoted to evaluating "how" t'ai chi is scientifically studied, and the advantages or limitations of different methodological approaches. In a companion to this paper (Part I), we argued that t'ai chi is a complex, multicomponent intervention, which poses unique challenges regarding the distinction of specific versus nonspecific effects and limitations regarding the use of reductionistic research frameworks. In this second, companion paper, we discuss additional obstacles inherent in precisely defining the t'ai chi intervention in an experimental paradigm. These challenges include t'ai chi's pluralism, the concept of t'ai chi dosage, and long- versus short-term evaluations of t'ai chi's efficacy and safety. To address these challenges, and with a goal to provide complete and unbiased evidence, we propose a pluralistic methodological approach to clinical research that includes controlled randomized trials of fixed protocols, community-based pragmatic trials, cross-sectional studies of long-term practitioners, and studies that integrate qualitative methods.

Objective: Previous studies have shown health benefits of T'ai Chi Chuan (TCC). In Taiwan, TCC is a form of exercise that is widely practiced by the elderly. The aim of this cross-sectional study was to investigate the effects of TCC on the health-related quality of life (HRQOL) in the senior population., Methods: Subjects who regularly practiced TCC in Taiwan were selected by random sampling and included 140 seniors (77 males and 63 females, aged 40-70 years). The questionnaire was separated into 2 parts: demographic information and the SF-36 questionnaire, which used 8 domains to evaluate the subjects' HRQOL. The results were compared with those of 560 age- and sex-matched control subjects that were taken from the general population (308 males and 252 females). Multiple regression analysis was used to compare the quality of life in each of the 8 domains between the 2 groups., Results: The TCC group showed significantly higher quality-of-life scores than the control group in each of the 8 domains with the exception of the bodily pain scales. Using multiple linear regression adjusted for covariates, the TCC group had significantly higher scores in physical functioning, physical roles, general health, vitality, and social-functioning scales than the control group. In most of the domains in both the TCC group and the control group, quality of life became worse with increased age, whereas the scores in vitality and social-functioning domains of the TCC group showed a reverse trend; they remained unchanged or even improved with increased age., Conclusions: Our study supports the hypothesis that TCC improves quality of life among the elderly in Taiwan, but further study must be conducted to more conclusively show the link between TCC and health-related QOL.

Objective: This study aimed to assess the usefulness of two interventions in a group rehabilitation medicine setting to determine strategies and exercise guidelines for long-term care of the HIV/AIDS population with human immunodeficiency virus (HIV) and/or acquired immunodeficiency syndrome (AIDS)., Design: This was a randomized clinical trial investigating the effects of tai chi (TC) and aerobic exercise (EX) on functional outcomes and quality of life (QOL) in patients with AIDS., Setting: Two outpatient infectious disease clinics in a mid-atlantic state were the setting., Subjects and Intervention: Thirty-eight (38) subjects with advanced HIV (AIDS) were randomized to one of three groups: TC, EX, or control. Experimental groups exercised twice weekly for 8 weeks., Outcome Measures: The primary outcomes included QOL as measured by the Medical Outcomes Short Form (MOS-HIV) and Spirituality Well-Being Scale (SWB). Functional measures included the functional reach (FR) for balance, sit and reach (SR) for flexibility, and sit-up (SU) test for endurance. The physical performance test (PPT) was used to determine overall function, and the Profile of Mood States (POMS) was used to evaluate psychologic changes. To consider the patients' explanations for these measurements, qualitative data were collected from subjects' journals, focus groups, and nonparticipant observation., Results: Thirty-eight (38) subjects were included in data analysis: 13 in the TC group, 13 in the EX group, and 12 in the control group. Results of analysis of covariance showed significant changes in the exercise groups in overall functional measures (p < 0.001). The MOS-HIV showed a significant difference on the subscale of overall health (p = 0.04). The POMS showed significant main effect for time in confusion-bewilderment (p = 0.000) and tension-anxiety (p = 0.005). Three dominant themes emerged from the qualitative data, including: positive physical changes, enhanced psychologic coping, and improved social interactions., Conclusions: This study shows that TC and EX improve physiologic parameters, functional outcomes, and QOL. Group intervention provides a socialization context for management of chronic HIV disease. This study supports the need for more research investigating the effect of other types of group exercise for this population. This study sets the stage for a larger randomized controlled trial to examine the potential short- and long-term effects of group exercise that may prove beneficial in the management of advanced HIV disease. Further research is warranted to evaluate additional exercise interventions that are accessible, safe, and cost-effective for the HIV population.

When multiple treatment choices are available, the question is not just "which treatment is the best?" but more importantly "best or better for whom, when, and why?" Aptitude (or attribute) by treatment interaction (ATI) is a research paradigm that attempts to examine exactly that--how outcome depends on the match or mismatch between patients' specific characteristics and the treatments they receive. The purpose of this two-part paper is to introduce ATI methods as a conceptual framework into complementary and Alternative medicine/integrative medicine (CAM/IM) outcome research. Part I presented key concepts in ATI research. Part II presents ATI research designs and discusses their applications to the examination of the relationships between individuals and therapies, and the illumination of the mechanisms that make therapies differentially effective. Based on this examination, we conclude that ATI research offers invaluable insights into the multifaceted package of care typically delivered in contemporary medicine and therefore should be included in the portfolio of all CAM/IM outcome research.