Intervention Treatment for Myocardial Infarction With Tai Chi: A Systematic Review and Meta-analysis

Published:March 28, 2020DOI:



      To assess the efficacy of Tai Chi (TC) in patients with myocardial infarction and provide up-to-date evidence for its application.

      Data Sources

      Three English databases (PubMed, Embase, and Cochrane Central Register of Controlled Trials) and 3 Chinese databases (China Knowledge Resource Integrated, Wanfang, Weipu) were screened for the time period between January 1, 1976 and May 31, 2019.

      Study Selection

      Seven randomized and controlled experiments were included.

      Data Extraction

      Two independent researchers under 2 independent advisors extracted and classified the data from all relevant studies based on the prespecified inclusion criteria and rules for data extraction.

      Data Synthesis

      A total of 615 patients were included in this study. The TC group was comprised of 294 patients, and the control group included 261 patients. The results revealed that TC has significant effects on the outcomes of the 6-minute walk (standardized mean difference, 1.30; 95% confidence interval, 0.50-2.11) and left ventricular ejection fraction (standardized mean difference, 1; 95% confidence interval, 0.43-1.57) compared with no or low-density exercise. Also, TC positively affected the quality of life, pro-B type natriuretic peptide, and short form-36. However, TC did not significantly affect activities of daily living (P=.060), sense of coherence-13 (P=.057) and N-terminal-pro-brain natriuretic peptide (P=.081). A moderate to high heterogeneity was observed across all comparisons.


      Compared with no exercise or other types of low-intensity physical activities, TC improved the outcome of the 6-minute walk, left ventricular ejection fraction, quality of life, and short form-36 scores, but reduced the outcome of pro-B type natriuretic peptide in patients with myocardial infarction. Therefore, TC could be an effective exercise option for cardiac rehabilitation. More research should be done to identify the effects of TC on academic functioning and to determine ways of motivating patients to use preventive TC interventions.


      List of abbreviations:

      6MWT (6-minute walk test), ADL (activities of daily living), CENTRAL (Cochrane Central Register of Controlled Trials), CI (confidence interval), CR (cardiac rehabilitation), GHO (Global Health Observatory), LVEDD (left ventricular end-diastolic dimension), LVEF (left ventricular ejection fraction), MAR (missing at random strategy), MD (mean difference), MI (myocardial infarction), NSTEMI (non–ST-segment elevation myocardial infarction), NT-proBNP (N terminal pro B type natriuretic peptide), PCI (percutaneous coronary intervention), Pro-BNP (pro-B type natriuretic peptide), QL-Index (quality of life index), QOL (quality of life), RCT (randomized controlled trial), SCO-13 (sense of coherence scale), SF-36 (Medical Outcomes Study Item Short From Health Survey), SMD (standardized mean difference), STEMI (ST-segment elevation myocardial infarction), TC (Tai Chi)
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        • Benjamin E.
        • Muntner P.
        • Alonso A.
        • et al.
        Heart disease and stroke statistics-2019 update: a report from the American Heart Association.
        Circulation. 2019; 139: e56-528
        • Cheng W.
        • Gao R.
        • Liu L.
        • Zhu M.
        • Wang W.
        • Wang Y.
        • et al.
        China cardiovascular disease report 2014-outline.
        CCJ. 2015; 30: 617-622
        • Anderson L.
        • Thompson D.R.
        • Oldridge N.
        • et al.
        Exercise-based cardiac rehabilitation for coronary heart disease.
        Cochrane Database Syst Rev. 2016; 5: CD001800
        • Ekblom O.
        • A1 Ek
        • Cider A.
        • Hambraeus K.
        • Börjesson M.
        Increased physical activity post-myocardial infarction is related to reduced mortality: results from the SWEDEHEART Registry.
        J Am Heart Assoc. 2018; 7e010108
        • Borjesson M.
        • Dellborg M.
        • Niebauer J.
        • et al.
        Recommendations for participation in leisure time or competitive sports in athletes-patients with coronary artery disease: a position statement from the Sports Cardiology Section of the European Association of Preventive Cardiology (EAPC).
        Eur Heart J. 2019; 40: 13-18
        • Nery R.M.
        • Zanini M.
        • de Lima J.B.
        • et al.
        Tai chi chuan improves functional capacity after myocardial infarction: a randomized clinical trial.
        Am Heart J. 2015; 169: 854-860
        • Lan C.
        • Lai J.S.
        • Chen S.Y.
        Tai chi chuan: an ancient wisdom on exercise and health promotion.
        Sports Med. 2002; 32: 217-224
        • Huston P.
        • McFarlane B.
        Health benefits of tai chi: what is the evidence?.
        Can Fam Physician. 2016; 62: 881-890
        • Chao M.
        • Wang C.
        • Dong X.
        • Ding M.
        The effects of tai chi on type 2 diabetes mellitus: a meta-analysis.
        J Diabetes Res. 2018; 2018: 7350567
        • Zou L.
        • Han J.
        • Li C.
        • et al.
        Effects of tai chi on lower limb proprioception in adults aged over 55: a systematic review and meta-analysis.
        Arch Phys Med Rehabil. 2019; 100: 1102-1113
        • Liu H.
        • Yeh N.
        • Wu Y.
        • et al.
        Effects of tai chi exercise on reducing falls and improving balance performance in Parkinson’s disease: a meta-analysis.
        Parkinsons Dis. 2019; 2019: 9626934
        • Lyu D.
        • Lyu X.
        • Zhang Y.
        • et al.
        Tai chi for stroke rehabilitation: a systematic review and meta-analysis of randomized controlled trials.
        Front Physiol. 2018; 9: 983
        • Wu S.
        • Chen J.
        • Wang S.
        • Jiang M.
        • Wang X.
        • Wen Y.
        Effect of tai chi exercise on balance function of stroke patients: a meta-analysis.
        Med Sci Monit Basic Res. 2018; 24: 210-215
        • Zou L.
        • Sasaki J.
        • Wei G.
        • et al.
        Effects of mind–body exercises (tai chi/yoga) on heart rate variability parameters and perceived stress: a systematic review with meta-analysis of randomized controlled trials.
        J Clin Med. 2018; 7: 404
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.
        PLoS Med. 2009; 6e1000100
        • Higgins J.
        • Thompson S.G.
        Quantifying heterogeneity in a meta-analysis.
        Stat Med. 2002; 21: 1539-1558
        • Higgins J.P.
        • Thompson S.G.
        • Deeks J.J.
        • Altman D.G.
        Measuring inconsistency in meta-analyses.
        BMJ. 2003; 327: 557-560
        • Borenstein M.
        • Higgins J.
        • Hedges L.V.
        • Rothstein H.R.
        Basics of meta-analysis: I2 is not an absolute measure of heterogeneity.
        Res Synth Methods. 2017; 8: 5-18
        • DerSimonian R.
        • Laird N.
        Meta-analysis in clinical trials.
        Control Clin Trials. 1986; 7: 177-188
      1. Higgins J.P.T. Green S. Cochrane Handbook for Systematic Reviews of Interventions. John Wiley & Sons, Chichester (UK)2011
        • Zhang S.Q.
        • Chen X.H.
        Effects of taijiquan exercise on rehabilitation in patients with acute myocardial infarction.
        Chin Manipul Rehabil Med. 2011; 7: 32-33
        • Ding F.M.
        • Wang J.H.
        • Wang X.K.
        • et al.
        Short-term prognosis of combined with tai chi exercise and jogging affecting percutaneous coronary intervention in patients with STEMI.
        Chin J Clin Res. 2013; 26: 126-127
        • Wang X.K.
        • Zhang X.L.
        • Ding F.M.
        • et al.
        Effect of taijiquan exercise on quality of life and brain natriuretic peptide in patients with STEMI after PCI.
        Guide Chin Med. 2013; 11: 659-661
        • Liu J.
        Patients with acute myocardial infarction after interventional exercise rehabilitation scheme of Construction and Empirical Research.
        The Second Military Medical University, Shanghai2017
        • Liu J.
        • Wang B.
        • Liang C.
        • et al.
        Influence of tai chi exercise program on cardiac rehabilitation in patients with myocardial infarction in patients with acute myocardial infarction undergoing percutaneous coronary intervention.
        Nurs Res Chin. 2017; 31: 1043-1048
        • Liu J.
        • Wang B.
        • Liang C.
        • et al.
        Effect of “cloud hand tai chi exercise” on cardiac rehabilitation after acute myocardial infarction.
        Shanghai Nurs. 2017; 17: 42-45
        • Deng X.J.
        • Yu D.M.
        • Zhang X.L.
        Effect of taichi on heart function and psychological state in MI patients with heart insufficiency.
        J North Sichuan Med Coll. 2018; 33: 545-547
        • Solway S.
        • Brooks D.
        • Lacasse Y.
        • Thomas S.
        A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain.
        Chest. 2001; 119: 256-270
        • Hassan A.K.
        • Dimitry S.R.
        • Agban G.W.
        Can exercise capacity assessed by the 6 minute walk test predict the development of major adverse cardiac events in patients with STEMI after fibrinolysis?.
        PLoS One. 2014; 9e99035
        • Reibis R.
        • Salzwedel A.
        • Bonaventura K.
        • Völler H.
        • Wegscheider K.
        Improvement of left ventricular ejection fraction in revascularized postmyocardial patients: indication for statistical fallacy.
        BMC Res Notes. 2017; 10: 244
        • Zhang Y.M.
        • Lu Y.
        • Tang Y.
        • et al.
        The effects of different initiation time of exercise training on left ventricular remodeling and cardiopulmonary rehabilitation in patients with left ventricular dysfunction after myocardial infarction.
        Disabil Rehabil. 2016; 38: 268-276
        • Piepoli M.F.
        • Corrà U.
        • Benzer
        • et al.
        Secondary prevention through cardiac rehabilitation: from knowledge to implementation. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation.
        Eur J Cardiovasc Prev Rehabil. 2010; 17: 1-17
        • Liu T.
        • Chan A.W.
        • Liu Y.H.
        • Taylor-Pillae R.E.
        Effects of tai chi-based cardiac rehabilitation on aerobic endurance, psychosocial well-being, and cardiovascular risk reduction among patients with coronary heart disease: a systematic review and meta-analysis.
        Eur J Cardiovasc Nurs. 2018; 17: 368-383
        • Bellet R.N.
        • Adams L.
        • Morris N.R.
        The 6-minute walk test in outpatient cardiac rehabilitation: validity, reliability and responsiveness--a systematic review.
        Physiotherapy. 2012; 98: 277-286
        • Chew D.S.
        • Heikki H.
        • Schmidt G.
        • et al.
        Change in left ventricular ejection fraction following first myocardial infarction and outcome.
        JACC Clin Electrophysiol. 2018; 4: 672-682
        • Ren Y.
        • Jia J.
        • Sa J.
        • et al.
        Association between N-terminal proB-type natriuretic peptide and depressive symptoms in patients with acute myocardial infarction.
        Chin Med J (Engl). 2017; 130: 542-548
        • James S.K.
        • Lindahl B.
        • Siegbahn A.
        • et al.
        N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease: a Global Utilization of Strategies To Open occluded arteries (GUSTO)-IV substudy.
        Circulation. 2003; 108: 275-281
        • Larkey L.
        • Jahnke R.
        • Etnier J.
        • Gonzalez J.
        Meditative movement as a category of exercise: implications for research.
        J Phys Act Health. 2009; 6: 230-238
        • Jahnke R.
        • Larkey L.
        • Rogers C.
        • Etnier J.
        • Lin F.
        A comprehensive review of health benefits of qigong and tai chi.
        Am J Health Promot. 2010; 24: e1-25
        • Ren X.
        • Li Y.
        • Yang X.
        • et al.
        The effects of tai chi training in patients with heart failure: a systematic review and meta-analysis.
        Front Physiol. 2017; 8: 989
        • Gu Q.
        • Wu S.
        • Zheng Y.
        • et al.
        Tai chi exercise for patients with chronic heart failure: a meta-analysis of randomized controlled trials.
        Am J Phys Med Rehabil. 2017; 96: 706-716