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- W2890722929 abstract "I read with interest the study by Polkey et al1Polkey M.I. Qiu Z.H. Zhou L. et al.Tai Chi and pulmonary rehabilitation compared for treatment-naive patients with COPD: a randomized controlled trial.Chest. 2018; 153: 1116-1124Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar in a recent issue of CHEST (May 2018). The suggestion that Tai Chi is an all-in-one substitute for a conventional exercise-based comprehensive pulmonary rehabilitation (PR) program is not supported by the data presented, unless to say that neither worked. There is no monopoly on the vehicle used for fitness training in patients with chronic respiratory conditions, provided it is prescribed using a pattern and dose to match the intended goals for endurance, strength, and flexibility. The population of active farmers selected with a baseline 6-min walk test averaging 537 ± 65 m and step count close to 8,000 steps per day1Polkey M.I. Qiu Z.H. Zhou L. et al.Tai Chi and pulmonary rehabilitation compared for treatment-naive patients with COPD: a randomized controlled trial.Chest. 2018; 153: 1116-1124Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar is not the group usually targeted for PR, which limits generalizability. There was no formal prospective power calculation for the stated hypothesis of equivalence, despite the minimal clinically important difference and variability of the St. George's Respiratory Questionnaire (SGRQ) having been established long ago. The retrospective reporting of power in the discussion is not re-assuring. They were randomized to undergo PR three times per week or Tai Chi five times per week, for 12 weeks. To be effective in training, the external challenge of exercise must be progressively increased, which occurred in the PR group but not in the Tai Chi group.1Polkey M.I. Qiu Z.H. Zhou L. et al.Tai Chi and pulmonary rehabilitation compared for treatment-naive patients with COPD: a randomized controlled trial.Chest. 2018; 153: 1116-1124Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar Indeed, the exercises in the latter group became less demanding as the users became more accomplished. Participants were encouraged to continue Tai Chi, either alone or via a community group, whereas in the PR group, there was no subsequent maintenance exercise prescription or supervision beyond the verbal encouragement to remain as physically active as possible. This approach is below the prevailing standard. There was no assessment of education or self-management, components integral to a full PR program. There was no formal physiological assessment of fitness. If change in quality of life is achieved through the process of fitness training, it is noteworthy that at the end of the 12-week intervention, the only measure of exercise used as an indicator that the exercise component had an effect, the 6-min walking distance, showed no practical change in either group.1Polkey M.I. Qiu Z.H. Zhou L. et al.Tai Chi and pulmonary rehabilitation compared for treatment-naive patients with COPD: a randomized controlled trial.Chest. 2018; 153: 1116-1124Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar Strength changed modestly in the Tai Chi group. There was no between-group difference in the primary outcome, the SGRQ, which improved similarly in both groups. It is therefore possible that the subsequent changes in SGRQ occurring some 3 months later in the Tai Chi group were related to a social component, expectations, or investigator attention. Other studies, not referenced, have shown a modest adjuvant effect on exercise capacity when Tai Chi was incorporated into PR.2Ng L. Chiang L.K. Tang R. et al.Effectiveness of incorporating Tai Chi in a pulmonary rehabilitation program for chronic obstructive pulmonary disease (COPD) in primary care—a pilot randomized controlled trial.Europ J Integr Med. 2014; 6: 248-258Abstract Full Text Full Text PDF Scopus (29) Google Scholar Moreover, there is growing evidence that short-form Tai Chi, versus control, improved the incremental and endurance shuttle walk times, measures of balance, and the total scores of the chronic respiratory questionnaire.3Leung R.W. McKeough Z.J. Peters M.J. Alison J.A. Short-form Sun-style t’ai chi as an exercise training modality in people with COPD.Eur Respir J. 2013; 41: 1051-1057Crossref PubMed Scopus (81) Google Scholar, 4Alison J.A. McKeough Z.J. Pulmonary rehabilitation for COPD: are programs with minimal exercise equipment effective?.J Thoracic Dis. 2014; 6: 1606-1614PubMed Google Scholar In this report,1Polkey M.I. Qiu Z.H. Zhou L. et al.Tai Chi and pulmonary rehabilitation compared for treatment-naive patients with COPD: a randomized controlled trial.Chest. 2018; 153: 1116-1124Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar such equivalence as may exist has not been shown. The information provided reflects two interventions, neither of which influenced fitness. From these data, the idea that Tai Chi can be substituted for PR is overstated and open to misunderstanding. Tai Chi and Pulmonary Rehabilitation Compared for Treatment-Naive Patients With COPD: A Randomized Controlled TrialCHESTVol. 153Issue 5PreviewIn COPD, functional status is improved by pulmonary rehabilitation (PR) but requires specific facilities. Tai Chi, which combines psychological treatment and physical exercise and requires no special equipment, is widely practiced in China and is becoming increasingly popular in the rest of the world. We hypothesized that Tai Chi is equivalent (ie, difference less than ±4 St. George’s Respiratory Questionnaire [SGRQ] points) to PR. Full-Text PDF Open AccessResponseCHESTVol. 154Issue 3PreviewWe thank Professor Goldstein for his interest in our article.1 We discuss his points in turn. Full-Text PDF" @default.
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- W2890722929 date "2018-09-01" @default.
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- W2890722929 title "Tai Chi Is Not Equivalent to Pulmonary Rehabilitation" @default.
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- W2890722929 doi "https://doi.org/10.1016/j.chest.2018.06.037" @default.
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