Journal of Rehabilitation Medicine 51-6 | Page 11

J Rehabil Med 2019; 51: 405–417 REVIEW ARTICLE EFFECTS OF TAI CHI ON PHYSIOLOGY, BALANCE AND QUALITY OF LIFE IN PATIENTS WITH TYPE 2 DIABETES: A SYSTEMATIC REVIEW AND META- ANALYSIS Zonglei ZHOU, MD 1 *, Ruzhen ZHOU, MD 2 *, Kunpeng LI, MD 3 , Yan ZHU, MD 3 , Zengqiao ZHANG, MD 4 , Yun LUO, MD 3 and Rongsheng LUAN, MD 1 From the 1 Department of Epidemiology and Health Statistic, West China School of Public Health, and West China Fourth Hospital, Sichuan University, Chengdu, 2 Department of Anorectal Surgery, Changhai Hospital of Shanghai, Shanghai, 3 Department of Neurorehabilitation, Shanghai Second Rehabilitation Hospital, 4 School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.*Those authors contributed equally to this work. Objective: To systematically synthesize and critically evaluate evidence on the effects of tai chi for pa- tients with type 2 diabetes mellitus. Data sources: Seven electronic databases (Wan Fang, SinoMed, China National Knowledge In- frastructure, VIP, PubMed, Embase, and Cochrane Library) were systematically searched from their in- ception to March 2018. Study selection: Randomized controlled trials in- vestigating the effects of tai chi on individuals with type 2 diabetes mellitus were eligible. Data extraction: Biomedical outcomes (fasting plas- ma glucose, glycosylated haemoglobin (HbA1c), fasting insulin, insulin resistance, body mass index, total cholesterol, blood pressure) as well as balance and quality of life-related outcomes were extracted independently by 2 reviewers. Stata 12.0 software was used to synthesize data if there was no or mo- derate heterogeneity across studies. Otherwise, nar- rative summaries were performed. Data synthesis: A total of 23 studies (25 articles) involving 1,235 patients were included in this me- ta-analysis. Significant changes in tai chi-related effects were observed in lowering fasting plasma glucose (standardized mean difference; SMD –0.67; 95% confidence interval (95% CI) –0.87 to –0.47; p  <  0.001), HbA1c (mean difference; MD–0.88%; 95% CI –1.45% to –0.31%; p  =0.002) and insu- lin resistance (MD –0.41; 95% CI –0.78 to –0.04; p  = 0.029). Beneficial effects of tai chi were also found in decreasing body mass index (MD –0.82 kg/ m 2 ; 95% CI –1.28 to –0.37 kg/m 2 ; p  < 0.001) and to- tal cholesterol (SMD –0.59; 95% CI –0.90 to –0.27; p  < 0.001). In addition, tai chi reduced blood pressu- re (systolic blood pressure (MD –10.03 mmHg; 95% CI –15.78 to –4.29 mmHg; p  = 0.001), diastolic blood pressure (MD –4.85 mmHg; 95% CI –8.23 to –1.47 mmHg; p  = 0.005)) and improved quality of life-rela- ted outcomes (physical function (MD 7.07; 95% CI 0.79–13.35; p  = 0.027), bodily pain (MD 4.30; 95% CI 0.83–7.77; p  =  0.015) and social function (MD 13.84; 95% CI 6.22–21.47; p  < 0.001)). However, no impact was exerted on fasting insulin (SMD –0.32; 95% CI –0.71 to 0.07; p  = 0.110) or balance (MD 2.71 s; 95% CI –3.29 to 8.71 s; p  = 0.376). Conclusion: Tai chi is effective in controlling biome- dical outcomes and improving quality of life-related outcomes in individuals with type 2 diabetes melli- tus, although no effects were observed on balance and fasting insulin. Further high-quality research is needed to elucidate the effects of different types of tai chi, the long-term effects of tai chi, the impact on respiratory function, and the association between tai chi and the risk of developing type 2 diabetes mel- litus in healthy individuals. Key words: tai chi; type 2 diabetes mellitus; meta-analysis; systematic review. Accepted Mar 22, 2019; Epub ahead of print Apr 10, 2019 J Rehabil Med 2019; 51: 405–417 Correspondence address: Rongsheng Luan, Department of Epidemio- logy and Health Statistic, West China School of Public Health, West China Fourth Hospital, Sichuan University, 17 Renminnan Road, Wu- hou District, Chengdu, Sichuan 610041, China. E-mail: three_sto- [email protected]; Kunpeng Li, Department of Neurorehabilitation, Shanghai Second Rehabilitation Hospital, 25 Changjiang Road, Baos- han District, Shanghai 200441, China. E-mail: [email protected] A review of research into the effects of tai chi for patients with type 2 diabetes mellitus was carried out. The results indicate that tai chi is favourable in improving outcomes in some areas, e.g. fast- ing plasma glucose, glycosylated haemoglobin (HbA1c), total cholesterol, balance, and quality of life. However, differences between study methods limit the conclusions regarding some outcomes. Tai chi might be a suitable complementary thera- py for individuals with type 2 diabetes mellitus. D iabetes mellitus (DM) is a metabolic disturbance characterized by an increase in blood glucose le- vels due to insulin deficiency and/or resistance. During the past decades, there has been a sharp increase in the prevalence of DM worldwide (1). In 2003, the World Health Organization (WHO) predicted that the number of patients with diabetes would increase to 370 mil- lion by 2030 (2). DM is regarded as one of the major threats to public health (3). There are 2 main types of DM: type 1 diabetes mellitus (T1DM), caused by the This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2555