PURPOSE:To study changes in exercise performance, asthma control, airway inflammation and quality of life (QoL) following modified Tai Chi Qigong exercise training in moderate to severe persistent asthma.
METHODS:SUBJECTS: Persistent asthma, FEV1 ≤;70%predicted, with no exacerbation for ≥1 month and unchanged controller medication for ≥3 months. EXERCISE TRAINING: Series of 9 modified Tai Chi Qigong body movements integrated with pursed-lip breathing were used for exercise training. Patients attended supervised exercise once-weekly, followed by daily home-based exercise using the provided audio-visual guide for 6 weeks. STUDY PROTOCOL: Following a 4-week run-in period, patients were enrolled for the 6-week-exercise training program. Assessments were performed at run-in, pre- and post-exercise training. ASSESSMENTS: Assessed parameters included: 1) spirometry, 2) symptom limited cycle ergometer tests for maximum exercise capacity (incremental exercise, 5 or 10W/min) and maximum exercise endurance time (constant work rate exercise, 75% pre-training peak work-rate), 3) functional exercise capacity by 6-minute walking test (6-MWD, meters), 4) negative inspiratory pressure (NIP, cmH2O), 5) QoL using Saint George’s Respiratory Questionnaires (SGRQ), Asthma Control Test (ACT), peak-flow variability (min%max) and serum ECP and IL-6.
RESULTS:17 asthmatic patients(mean age 57±11.84 years, FEV1 57.06±11.2 %predicted) were recruited. After Tai Chi Qigong training, there were significant improvements of peak-flow variability, ACT score, NIP, 6-MWD and QoL[87.88 vs 83.24, p=0.03; 23.0±1.54 vs 20.65±3.10, p=0.002; 100.71±20.4 vs 92.24±20.02, p=0.001; 499.12±54.69 vs 457±46.38, p<0.001 and 16.03±9.53 vs 25.52±16.12, p=0.01 respectively]. Cycle ergometer tests demonstrated increased maximum work-rate (W), maximum oxygen consumption (VO2max, L/min), exercise endurance time (min), isotime VE and isotime Vt[85.64 vs 75.17, p<0.001; 1.067±0.24 vs 0.87±0.19, p=0.001; 14.84±10.4 vs 7.64±3.8, p=0.001; 27.36±9.12 vs 25.12±8.52, p=0.03 and 1.05±0.28 vs 0.92±0.32, p=0.03 respectively] while isotime IC and isotime RR remained unchanged.
CONCLUSION:In persistent asthma, Tai Chi Qigong training improved both maximum and functional exercise capacities without decreasing dynamic hyperinflation. The improved peak-flow variability and asthma control suggested reduced bronchial hyper-reactiveness. This, combined with the increased muscle strength, contributed to the improvement of exercise performances.
CLINICAL IMPLICATIONS:Tai Chi Qigong training could be an effective, non-pharmacologic, adjunctive therapy for persistent asthma to achieve better asthma control and QoL.
DISCLOSURE:Sumalee Kiatboonsri, No Financial Disclosure Information; No Product/Research Disclosure Information