1. BELLARMINE UNIVERSITY, LOUISVILLE, KY The Effects of Tai Chi vs. Cycling on Patients with Congestive Heart Failure Laura Stigler, Lauren Rouse, Megan Kaiser, Adam Fischer

2. BELLARMINE UNIVERSITY, LOUISVILLE, KY Background Endurance training has many aerobic benefits in individuals with CHF Tai Chi improves exercise tolerance and promotes hemodynamic stability –Kentucky Tai Chi and Qigong CenterKentucky Tai Chi and Qigong Center

3. BELLARMINE UNIVERSITY, LOUISVILLE, KY Clinical Significance Physical therapists must be able to effectively treat these patients Physical therapy is needed to prevent additional cardiopulmonary complications CHF is a chronic condition

4. BELLARMINE UNIVERSITY, LOUISVILLE, KY PICO Question Patient : Patients with CHF Intervention : Tai Chi training Comparison : Cycling Outcome : VO 2 Max 6MWT distance QOL http://www.easternhealingcenter.com/ En/essence_tai_chi.htm http://www.wpclipart.com/recreation/cycling/ bicycle_parts/bike_wheel.png.html

5. BELLARMINE UNIVERSITY, LOUISVILLE, KY TAI CHI ARTICLEDESIGNSUBJECTSINTERVENTIONS Yeh et al, 2009 RCT (Level 1b)  N=30  LVEF < 40%  Tai Chi + usual care  Usual care Pan et al, 2013 Systematic review (Level 1a)  N=242  Age=68.6 yrs.  CHF  Tai Chi group  Control group: pharmacological, cycling, walking, general exercise and education Barrow et al, 2007 RCT (Level 1b)  N=65  Age: 46-90 yrs.  CHF  Tai Chi group  Control group: exercise without rehab Wei and Liu, 2003RCT (Level 1b)  N=70  Age: 53-68 yrs.  CHF  Tai Chi + usual care  Usual care

6. BELLARMINE UNIVERSITY, LOUISVILLE, KY TAI CHI ARTICLEOUTCOME MEASURESCONCLUSIONS Yeh et al, 2009  Minnesota Living with Heart Failure Questionnaire (MLHFQ)  6MWT  MLHFQ sign. improved (p=0.001)  6MWT sign. improved (p=0.001) Pan et al, 2013  MLHFQ  6MWT  6MWT distance increased 25 m (MDIC) but was not sign. Barrow et al, 2007  MLHFQ  Symptom Checklist 90-R  MLHFQ sign. improved (p=0.01)  Symptom Checklist 90-R sig. improved (p<0.01) Wei and Liu, 2003  LVEF  LVEF sign. improved (p=0.01)

7. BELLARMINE UNIVERSITY, LOUISVILLE, KY Yeh et al, 2009 METHODS Usual Care group (n=15) –Pharmacologic therapy –Dietary and exercise counseling Tai Chi group (n=15) –12 weeks of Tai Chi + usual care –1 hr class 2x/week

8. BELLARMINE UNIVERSITY, LOUISVILLE, KY Yeh et al, 2009 RESULTS QOL (Minnesota Living with HF Questionnaire) significantly improved (p=0.001) Exercise capacity (6MWT) significantly improved (p=0.001)

9. BELLARMINE UNIVERSITY, LOUISVILLE, KY TAI CHI + CYCLING ARTICLEDESIGNSUBJECTS INTER- VENTIONS OUTCOME MEASURES CONCLUSIONS Caminiti et al, 2003 RCT (Level 1b)  N=60  Age= 73.8 yrs.  CHF  Exercise training group: cycling or walking  Combined training group: Tai Chi + cycling or walking  6MWT  MacNew QLML QOL question- naire  QOL sign. improved (p=0.026)  6MWT distance sign. increased (p=0.001)  SBP sign. decreased

10. BELLARMINE UNIVERSITY, LOUISVILLE, KY Caminiti et al, 2003 METHODS Exercise training: 30 min of cycling or walking at 60-70% VO 2 max Combined training: –Tai Chi for 30 min 2x/week –Cycling or walking for 30 min 2x/week 4 sessions/week for 12 weeks

11. BELLARMINE UNIVERSITY, LOUISVILLE, KY Caminiti et al, 2003 RESULTS QOL (MacNewQLML) significantly improved (esp social and emotional) (p=0.026) 6MWT distance increased from 214+32 m to 291+46 m (p=0.001) SBP significantly decreased (p=0.025)

12. BELLARMINE UNIVERSITY, LOUISVILLE, KY CYCLING ARTICLEDESIGNSUBJECTSINTERVENTIONS Smart et al, 2004 RCT (Level 1b)  N=30  Age=63.8 yrs  CHF  Weeks 1-16: cycling  Weeks 8-16: cycling + strengthening  Weeks 16-52: HEP only Giannuzzi et al, 2003 RCT (Level 1b)  N=90  LVEF < 35%  Exercise group: cycling  Control group: educational support Belardinelli et al, 1999 RCT (Level 1b)  N=94  Mean age: 59 yrs  CHF  LVEF < 40%  1st phase: 3x/week (cycling), 60% VO 2 max  2nd phase: 12 months, 2x/ week (cycling), 60% VO 2 max  Control group: no exercise

13. BELLARMINE UNIVERSITY, LOUISVILLE, KY CYCLING ARTICLE OUTCOME MEASURES CONCLUSIONS Smart et al, 2004  MLHFQ  Peak VO 2  QOL improved (p=0.1)  Peak VO 2 sign. improved (p=0.001) Giannuzzi et al, 2003  6MWT  QOL assessment  6MWT distance increased by 20%  LVEF increased 16%  SBP and RPP decreased  O 2 uptake increased at ventilatory threshold and peak exercise Belardinelli et al, 1999  MLHFQ  VO 2  Peak O 2 uptake improved 18% (p=0.01)  Ventilatory threshold improved 30%  MLHFQ sign. improved (p=0.001)

14. BELLARMINE UNIVERSITY, LOUISVILLE, KY Giannuzzi et al, 2003 METHODS Functional eval at baseline and 6 mo FU Exercise group: –30 min cycle ergometer > 3x/wk at 60% of peak VO 2 –> 30 min daily walk and calisthenics Control group: –Educational support

15. BELLARMINE UNIVERSITY, LOUISVILLE, KY Giannuzzi et al, 2003 RESULTS Ejection fraction increased in exercise group by 16% SBP and rate-pressure product at rest decreased slightly in exercise group O 2 uptake increased at ventilatory threshold and at peak exercise 6MWT distance increased by 20%

16. BELLARMINE UNIVERSITY, LOUISVILLE, KY Conclusion Research has not yet compared effects of cycling versus Tai Chi on patients with CHF Both resulted in improved QOL, 6MWT distance and VO 2 max Consider incorporating both interventions into POC for patients

17. BELLARMINE UNIVERSITY, LOUISVILLE, KY References Barrow DE, Bedford A. Ives G, OToole L, Channer KS. An evaluation of the effects of Tai Chi Chuan and Chi Kung training in patients with symptomatic heart failure: a randomised controlled pilot study. Postgrad Med J. 2007;83(985):717- 721. Belardinelli R, Georgiou D, Cianci G, Purcaro A. Randomized, controlled trial of long-term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome. Circulation. 1999;99:1173-1182. Caminiti G, Volterrani M, Marazzi G, Cerrito A, Massaro R, Arisi A, Franchini A, Sposato B, Rosano G. Tai Chi enhances the effects of endurance training in the rehabilitation of elderly patients with chronic heart failure. Rehab Research Prac. 2011;2011:1-6. Giannuzzi P, Temporelli PL, Corrà U, Tavazzi L. Antiremodeling effect of long- term exercise training in patients with stable chronic heart failure. Circulation. 2003;108:554-559.

18. BELLARMINE UNIVERSITY, LOUISVILLE, KY References Pan L, Yan JH, Guo YZ, Yan JH. Effects of Tai Chi training on exercise capacity and quality of life in patients with chronic heart failure: a meta-analysis. Eur J Heart Fail. 2013;15(3): 316-323. Smart N. A, Murison, R. Rate of change in physical fitness and quality of life and depression following exercise training in patients with congestive heart failure. Congestive Heart Failure. 2013; 19:1. Wei L, Liu HY. The effect of simplified Tai Chi on cardiovascular function in patients with heart failure. Chin J Clin Rehahil. 2003;7:1460-1461. Yeh GY, Wood MJ, Lorell BH, et al. Effects of Tai Chi mind-body movement therapy on functional status and exercise capacity in patients with chronic heart failure: a randomized controlled trial. Am J Med. 2004;117(8):541-548.