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A Randomized Trial of Tai Chi on Preventing Hypertension and Hyperlipidemia in Middle-Aged and Elderly Patients

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A Randomized Trial of Tai Chi on Preventing Hypertension and Hyperlipidemia in Middle-Aged and Elderly Patients International Journal of Environmental Research and Public Health Article A Randomized Trial of Tai Chi on Preventing Hypertension and Hyperlipidemia in Middle-Aged and Elderly Patients Jiansheng Wen ∗,† and Min Su ∗,† Health Science Research Center of Tai Chi Association, Department of Physical Education, Northwestern Polytechnical University, Xi’an 710072, China * Correspondence: [email protected] (J.W.); [email protected] (M.S.) † These authors contributed equally to this work. Abstract: In our randomized controlled trial, we investigated whether Wu-style Tai Chi (Tai Chi combined with Daoyin) as a potential exercise prescription is more effective than simplified Tai Chi in the prevention and treatment of hypertension and hyperlipidemia in the middle-aged and elderly. We randomly assigned 66 patients with hypertension and hyperlipidemia to one of the two groups: the Wu-style Tai Chi group or the simplified Tai Chi group; the simplified Tai Chi group only exercised simplified Tai Chi three times a week for 6 weeks. The Wu-style Tai Chi group participated in 60 min of Wu-style Tai Chi three times a week for 6 weeks. Serum biochemical tests were conducted at baseline and at the end of the study. Measurements of blood pressure were performed at the same time. Primary outcomes were compared within and between groups at baseline and at 6 weeks. The participants in the Wu-style Tai Chi group performed, at 6 weeks, significantly better than baseline on all of the primary outcomes (p value ≤ 0.05). The results also show significant difference within the simplified Tai Chi group from baseline to 6 weeks in TCHO (mmol/L), SBP (mmHg), and LDL-C Citation: Wen, J.; Su, M. A (mmol/L) (p value < 0.05). From baseline to 6 weeks, the Wu-style Tai Chi group had significant Randomized Trial of Tai Chi on differences at more test indexes in serum and blood pressure than the simplified Tai Chi group. Preventing Hypertension and At 6 weeks, the Wu-style Tai Chi group had a significantly greater mean improvement in the SBP Hyperlipidemia in Middle-Aged and (mmHg) than did the simplified Tai Chi group (mean between-group difference, −5.80 (mmHg) Int. J. Environ. Res. Elderly Patients. [95% CI, −14.01 to 2.41]; p = 0.007). The results showed that, compared with simplified Tai Chi, Public Health 2021, 18, 5480. https:// Wu-style Tai Chi had a better effect on hypertension in the middle-aged and elderly. At 6 weeks in doi.org/10.3390/ijerph18105480 LDL-C (mmol/L), the Wu-style Tai Chi group had significantly greater improvement between the − − − p Academic Editors: Simona Mandini, two groups (means between-group difference, 0.45 (mmol/L) [95% CI, 0.89 to 0.17]; = 0.03). Gianni Mazzoni and Erica Menegatti The results showed that Wu-style Tai Chi protected the cardiovascular system of the middle-aged and elderly in improving LDL-C (mmol/L), and was more significant than simplified Tai Chi. After Received: 25 April 2021 6 weeks of exercise, Wu-style Tai Chi could effectively improve hyperlipidemia and hypertension. Accepted: 18 May 2021 The total effective rate of cardiovascular disease was 90.00%. There was significant difference in Published: 20 May 2021 the treatment effect of hypertension and hyperlipidemia between the two groups during 6 weeks (p = 0.039), showing that, in a small population of middle-aged and elderly subjects, Wu style Tai Chi Publisher’s Note: MDPI stays neutral could be useful in managing important CV risk factors, such as hypertension and hyperlipidemia. with regard to jurisdictional claims in published maps and institutional affil- Keywords: cardiovascular disease; Tai Chi; the middle-aged and elderly iations. 1. Introduction Copyright: © 2021 by the authors. Each year, 41 million people die from chronic diseases, which is equivalent to 71% of all Licensee MDPI, Basel, Switzerland. deaths globally [1]. Chronic diseases will become the first burden of diseases among middle- This article is an open access article aged and elderly people in the world. The main chronic diseases in middle-aged and old distributed under the terms and people are cardiovascular and cerebrovascular diseases [2]. Among them, cardiovascular conditions of the Creative Commons disease is the number one killer of the health of middle-aged and elderly people, especially Attribution (CC BY) license (https:// ischemic heart disease (IHD). IHD and ischemic stroke (IS) have become major causes of creativecommons.org/licenses/by/ death in China, and the number of deaths is still on the rise [3]. 4.0/). Int. J. Environ. Res. Public Health 2021, 18, 5480. https://doi.org/10.3390/ijerph18105480 https://www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2021, 18, 5480 2 of 14 Hypertension is an important risk factor for a variety of cardiovascular and cerebrovas- cular diseases, and with the increase of age, the prevalence of hypertension increases, and the risk of cardiovascular events increases significantly [4]. Serum LDL-C also plays an important role in the pathogenesis of atherosclerotic cardiovascular disease (ASCVD) [5]. It is another major risk factor for IHD and IS [6,7]. Hypertension, heart disease, cerebral thrombosis, arteriosclerosis, and other cardiovas- cular diseases have threatened the physical and mental health of middle-aged and elderly people all over the world for a long time. With the development of science and technology, people gradually realize the important role of Tai Chi exercise in health, prevention, and treatment of cardiovascular and cerebrovascular diseases. Tai chi is a kind of fitness activity guided by the mind. It combines exercise with static state, and is naturally relaxing and calming. At the same time, it is accompanied by breathing exercises. It plays an important role in the prevention and treatment of chronic diseases in most middle-aged and elderly people. At present, there have been many studies on Tai Chi for cardiopulmonary rehabilitation training of middle-aged and elderly people [8,9]. Steven et al., through a 48-week clinical randomized experiment, found that the cardiovascular function of the Tai Chi exercise group was significantly enhanced when compared to the health education group [10]. Further research found that Tai Chi can improve the sleep quality of patients with chronic heart failure, and that it has certain benefits on blood pressure, arrhythmia, and one’s quality of life [11]. David and other scholars conducted more in-depth research. The results showed that the psychological stress levels of subjects receiving decompression course education still existed, and the level of nuclear factor of kappa B (NF-κB) significantly increased, while the subjects in the Tai Chi group showed that the effects of psychological pressure decreased and the NF-κB level remaining unchanged. This shows that practicing Tai Chi can relieve mental pressure and improve the quality of life [12]. NF-κB is a transcription factor that regulates the expression of various cellular genes, and is involved in the pathological process of coronary heart disease, such as atherosclerosis and myocardial ischemia. Inhibition of NF-κB activation is expected to open up a new way for the prevention and treatment of coronary heart disease. Tai chi can also improve other risk factors of cardiovascular disease, such as blood glucose and proteinuria (common in patients with hypertension), which can affect the prognosis of these patients [13]. According to a meta-analysis conducted by researchers from Shanghai Sport Uni- versity in 2016, Tai Chi can benefit patients with cardiovascular disease, reduce blood pressure and blood lipid levels, and improve heart failure symptoms, physical strength, and mood [14]. However, compared with mature “medical means”, as an exercise prescrip- tion, Tai Chi has not been a mastered and targeted application. Meta analyses showed that, in terms of exercise intervention measures, simplified Tai Chi was the most used exercise intervention means in the study of Tai Chi, and the intervention time used in the study was mostly concentrated in 12 weeks (60 min/time, 3 times/week). However, this evidence should be due to the limitations of the method [15]. In future research, there are several directions worthy of improvement, such as the extraction of effective movement elements, and getting rid of the limitations of simplified Tai Chi. In this study, the blood pressure and blood lipids of the Wu-style Tai Chi group and simplified Tai Chi group were compared and observed. Wu style Tai Chi is used as a means of sports intervention. Compared with simplified Tai Chi, Wu style Tai Chi movements are softer and continuous. It is more suitable for the physiological characteristics of the cardiovascular system of middle-aged and elderly people. It belongs to the traditional Tai chi handed down from ancient China, which is different from simplified Tai chi created in 1956. In traditional Wu style Tai Chi, Daoyin (Combined with qigong and movement guidance, used in ancient Chinese medicine to treat diseases) is inherently included. This paper discusses whether Wu Style Tai Chi, as a potential exercise prescription, is more Int. J. Environ. Res. Public Health 2021, 18, 5480 3 of 14 effective than simplified Tai Chi in the prevention and treatment of hypertension and hyperlipidemia in middle-aged and elderly people. Sixty-six patients were randomly divided into two groups. The intervention time and weekly frequencies were the same: the simplified Tai Chi group (n = 33) 3 times a week, 60 min each time; the Wu-style Tai Chi group (n = 33) 3 times a week, 60 min each time; for a total of 6 weeks of observation. We analyzed the effects of two exercises on blood pressure and blood lipids of middle-aged and elderly people. 2. Methods 2.1. Study Design We designed a randomized clinical trial to compare the effects of exercise at 6 weeks in the Wu-style Tai Chi group with the effects in the simplified Tai Chi group.
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