Tai Chi in Parkinson’s Disease: A Preliminary Randomized, Controlled, and Rater-Blinded Study

Roger Kurlan^1*, Roye Evans², Sandra Wrigley¹, Shannon McPartland¹, Rami Bustami³, Ann Cotter²

¹Atlantic Neuroscience Institute, Overlook Medical Center, Summit, NJ, USA.
²Integrative Medicine, Atlantic Health System, Morristown, NJ, USA.
³Biostatistics, Atlantic Health System, Morristown, NJ, USA.

DOI: 10.4236/apd.2015.41002                

Abstract

Background: Given the limited benefits of current treatments for Parkinson’s disease (PD), inter-ventions that might provide supplementary benefits would be of value. The traditional Chinese medicine practice of Tai Chi has been said to improve some aspects of PD, particularly imbalance. Methods: Preliminary randomized, controlled, and rater-blinded clinical trial of Tai Chi, focusing on its effects on global motor, daily function, mood and quality of life. Subjects continued their standard medical therapy and were randomly assigned to Tai Chi (16 weekly classes, expert trainer, practice at home between classes) or no Tai Chi (control group) in a 2:1 ratio. The primary outcome measure was the total motor score of the Unified Parkinson’s Disease Rating Scale (UPDRS) and this was scored by an experienced rater who was blinded to the treatment assignment. The same rater scored the Schwab and England Activities of Daily Living Scale. The patient-completed Geriatric Depression Scale, PD (quality of life) Questionnaire-39, and fall diary were also analyzed. Results: 44 subjects participated with 29 assigned to Tai Chi and 15 serving as controls. Tai Chi was well-tolerated. Seven subjects withdrew prior to completion (2 from Tai Chi, 5 from control). We found no significant difference between treatment groups in the change in scores from baseline to end of intervention for any of the scales. Trends toward a benefit of Tai Chi were observed for individual UPDRS items (depression, finger tapping, hand movements, posture). Conclusions: Tai Chi does not appear to improve global measures in patients with PD. The practice may have benefits for PD, but these appear to be largely restricted to specific motor tasks and perhaps mood rather than being a global functional response. More study is needed to clarify and establish efficacy.

Keywords

Parkinson’s Disease, Tai Chi, Mind-Body, Treatment

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Goodwin, V.A., Richards, S.H., Taylor, R.S., Taylor, A.H. and Campbell, J.L. (2008) The Effectiveness of Exercise Interventions for People with Parkinson’s Disease: A Systematic Review and Meta-Analysis. Movement Disorders, 23, 631-640. http://dx.doi.org/10.1002/mds.21922
[2]	Wahbeh, H., Elsas, E.-M. and Oken, B.S. 2008 () Mind-Body Interventions: Applications in Neurology. Neurology, 70, 2321-2328. http://dx.doi.org/10.1212/01.wnl.0000314667.16386.5e
[3]	Li, F., Harmer, P., McAuley, E., et al. (2001) Tai Chi, Self-Efficacy, and Physical Function in the Elderly. Prevention Science, 2, 229-239. http://dx.doi.org/10.1023/A:1013614200329
[4]	Li, F., Harmer, P., Fisher, K.J., et al. (2007) Tai Chi-Based Exercise for Older Adults with Parkinson’s Disease: A Pilot-Program Evaluation. Journal of Aging and Physical Activity, 15, 139-151.
[5]	Hackney, M.E. and Earhart, G.M. (2008) Tai Chi Improves Balance and Mobility in Patients with Parkinson’s Disease. Gait & Posture, 28, 456-460. http://dx.doi.org/10.1016/j.gaitpost.2008.02.005
[6]	Li, F., Harmer, P., Fitzgerald, K., et al. (2012) Tai Chi and Postural Stability in Patients with Parkinson’s Disease. New England Journal of Medicine, 366, 511-519. http://dx.doi.org/10.1056/NEJMoa1107911
[7]	Fahn, S. and Elton, R.L., Members of the UPDRS Development Committee (1987) Unified Parkinson’s Disease Rating Scale. In: Fahn, S., Marsden, C.D., Goldstein, M. and Calne, C.D., Eds., Recent Developments in Parkinson’s Disease, Volume II, Florham Park, 153-163.
[8]	Schwab, R.S. and England, A.C. (1969) Projection Technique for Evaluating Surgery in Parkinson’s Disease. In: Gillingham, F.J. and Donaldson, I.M.L., Eds., Third Symposium on Parkinson’s Disease, Edingurgh, Livingstone, 152- 157.
[9]	Sheikh, J.I. and Yesavage, J.A. (1986) Geriatric Depression Scale (GDS): Recent Evidence and Development of a Shorter Version. Journal of Mental Health and Aging, 5, 165-173.
[10]	Peto, V., Jenkinson, C. and Fitzpatrick, R. (1998) PDQ-39: A Review of the Development, Validation and Application of a Parkinson’s Disease Quality of life Questionnaire and Its Associated Measures. Journal of Neurology, 245, S10- S14. http://dx.doi.org/10.1007/PL00007730
[11]	Schrag, A., Sampaio, C., Counsell, N., et al. (2006) Minimal Clinically Important Change on the Unified Parkinson’s Disease Rating Scale. Movement Disorders, 21, 1200-1207. http://dx.doi.org/10.1002/mds.20914
[12]	Lavretsky, H., Alstein, L.L., Olmstead, R.E., et al. (2011) Complementary Use of Tai Chi Augments Escitalopram Treatment of Geriatric Depression: A Randomized Controlled Trial. The American Journal of Geriatric Psychiatry, 19, 839-850. http://dx.doi.org/10.1097/JGP.0b013e31820ee9ef