Therapy in motion
Rheumatoid arthritis is a crippling and painful disorder that causes stiffness and joint swelling. Because joint movements are often painful, many sufferers eventually become seriously debilitated. Although current treatments can reduce pain and inflammation, and slow the chronic disease’s progression, these powerful medications can have unpleasant side effects and weaken the immune system.
Tai chi may help. UCLA researchers are investigating whether the ancient Chinese martial art can relieve symptoms and improve mobility, helping patients lead a relatively normal life.
“Tai chi combines both relaxation and mild physical exercise, which gets patients moving but in a gentle way,” says Perry Nicassio, a psychologist at UCLA who is conducting the research.
Rheumatoid arthritis is an autoimmune disorder that affects about 2.1 million Americans; the majority of sufferers are women. The illness usually causes aching, throbbing or stiffness of the joints and muscles, fatigue, low-grade fever, and a general sense of not feeling well.
Because they are in chronic pain, sufferers often have trouble sleeping, making them tired, depressed and irritable. They also tend to be quite sedentary, leading to a loss of strength, mobility, balance and endurance, all of which are vital for life’s daily activities. Eventually, even opening a jar or walking can be difficult.
“Their symptoms trigger a self-perpetuating cycle that leads to a downward spiral in their functioning,” says Jennifer Pike, a psychologist at UCLA’s Neuropsychiatric Institute who is involved in the tai chi studies.
Although medications such as Enbrel and Remicade can dampen the overactive immune response that sparks the condition, they don’t deal with the other problems such as depression, stress and progressive loss of muscle strength. This has prompted doctors to explore alternative methods to ease symptoms.
Recent research indicates that tai chi can preserve range of motion in people with rheumatoid arthritis, which could in turn reduce disability.
And a 2003 UCLA study demonstrated that a modified form of tai chi, known as tai chi chih, boosts the immune system’s response to a common virus and prevents outbreaks of shingles, a skin condition that strikes the elderly.
Two ongoing UCLA studies are evaluating whether tai chi chih can increase mobility in rheumatoid arthritis sufferers, and if it is better than current behavioral techniques in helping sufferers deal with their condition. Tai chi chih is a standardized series of 20 movements adapted from tai chi that combines meditation, relaxation and components of aerobic exercise, and can improve muscle tone, balance and concentration.
“This form of tai chi works best for older adults and people in chronic pain because it’s less jarring on the joints,” says Roberta Taggart, a Redondo Beach tai chi chih instructor who is working with the UCLA team.
One study will involve 210 volunteers; they will attend classes for 12 weeks in tai chi chih, health education or cognitive behavioral therapy, which teaches coping skills to manage RA symptoms. Another study, in which 60 subjects will attend classes for 16 weeks, will compare whether tai chi chih or relaxation training is better at helping patients cope and examine how well each method alleviates the severity of the disease.
Participants’ progress will be assessed by their feedback and objective measures of their functioning, such as a doctor’s evaluation of joint swelling and blood tests to measure the activity of inflammatory cells, known as cytokines, which are believed to trigger the disease.
Researchers say the exercises could not only improve physical strength and flexibility but also boost mood and relieve stress.
“Our goal is to teach patients how to manage their illness in ways that complement their medical treatment so they’re not completely dependant on drugs,” says Nicassio. “Hopefully, tai chi chih will make them feel less pessimistic about their circumstances and more in control.”
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With tai chi, better balance and mobility
Tai chi also appears to reduce the risk of falls in the elderly.
In a study in the June issue of the Journal of Advanced Nursing, South Korean researchers studied adults whose average age was 78 and who were prone to falls. Twenty-nine participants took a 12-week tai chi course three times a week, while 30 participants did not.
At the end of the study, the exercise group had stronger knee and ankle muscles, improved mobility and flexibility and better balance.
During the test period, 31% of the exercise group had a fall, compared with 50% of the control group.
