Efficacy of Tai Chi on lower limb function of Parkinson’s disease patients: A systematic review and meta-analysis

Background At present, the effect of Tai Chi (TC) on lower limb function in patients with Parkinson’s disease (PD) is controversial. Therefore, we conducted a meta-analysis on the influence of TC on lower limb function in PD patients. Methods According to the PRISMA guidelines, seven databases were searched. Randomized controlled trials (RCTS) were selected and screened according to inclusion and exclusion criteria. We assessed the quality of the studies using the Cochrane Risk of Bias tool and then extracted the characteristics of the included studies. The random effect model was adopted, and heterogeneity was measured by I2 statistic. Results A total of 441 articles were screened, and 10 high-quality RCTs were with a total of 532 patients with PD met Our inclusion criteria. Meta-analysis showed that compared To control groups TC improved several outcomes. TC significantly improved motor function (SMD = −0.70; 95% CI = −0.95, −0.45; p < 0.001; I2 = 35%), although The results were not statistically significant for The subgroup analysis of TC duration (SMD = −0.70; 95% CI = −0.95, −0.45; p = 0.88; I2 = 0%;). TC significantly improved balance function (SMD = 0.89; 95% CI = 0.51, 1.27; p < 0.001; I2 = 54%), functional walking capacity (SMD = −1.24; 95% CI = −2.40, −0.09; p = 0.04; I2 = 95%), and gait velocity (SMD = 0.48; 95% CI = −0.02, 0.94; p = 0.04; I2 = 78%), But Did Not improve endurance (SMD = 0.31; 95% CI = −0.12, 0.75; p = 0.16; I2 = 0%), step length (SMD = 0.01; 95% CI = −0.34, 0.37; p = 0.94; I2 = 29%), and cadence (SMD = 0.06; 95% CI = −0.25, 0.36; p = 0.70; I2 = 0%). Conclusion TC has beneficial effects on motor function, balance function, functional walking ability, and gait velocity, but does not improve walking endurance, stride length, and cadence.

[1]  Houeto Jean-Luc [Parkinson's disease]. , 2022, La Revue du praticien.

[2]  Yasser Salem,et al.  Effects of Tai Chi on Biomarkers and Their Implication to Neurorehabilitation – A Systemic Review , 2021, Innovation in Aging.

[3]  Z. Wang,et al.  Mechanisms of motor symptom improvement by long-term Tai Chi training in Parkinson’s disease patients , 2021, Translational neurodegeneration.

[4]  E. Mayo-Wilson,et al.  The PRISMA 2020 statement: an updated guideline for reporting systematic reviews , 2021, BMJ.

[5]  G. Zhang,et al.  Impaired Topographical Organization of Functional Brain Networks in Parkinson’s Disease Patients With Freezing of Gait , 2020, Frontiers in Aging Neuroscience.

[6]  Günther Deuschl,et al.  The burden of neurological diseases in Europe: an analysis for the Global Burden of Disease Study 2017. , 2020, The Lancet. Public health.

[7]  G. Ransmayr [Caregiver burden in patients with Parkinson's disease]. , 2020, Fortschritte der Neurologie-Psychiatrie.

[8]  Joan Guàrdia-Olmos,et al.  Functional interactions in patients with hemianopia: A graph theory-based connectivity study of resting fMRI signal , 2020, PloS one.

[9]  Sang Chul Lee,et al.  Effects of non-invasive brain stimulation on freezing of gait in parkinsonism: A systematic review with meta-analysis. , 2019, Parkinsonism & related disorders.

[10]  Y. Shao,et al.  Recent advances and perspectives of metabolomics-based investigations in Parkinson’s disease , 2019, Molecular Neurodegeneration.

[11]  B. Bloem,et al.  The Emerging Evidence of the Parkinson Pandemic , 2018, Journal of Parkinson's disease.

[12]  Shengdi Chen,et al.  Reduction of HIP2 expression causes motor function impairment and increased vulnerability to dopaminergic degeneration in Parkinson’s disease models , 2018, Cell Death & Disease.

[13]  Kirsten Hötting,et al.  Exercise-induced neuroplasticity: Balance training increases cortical thickness in visual and vestibular cortical regions , 2018, NeuroImage.

[14]  C. Tanner,et al.  Prevalence of Parkinson’s disease across North America , 2018, npj Parkinson's Disease.

[15]  Jeffrey M. Hausdorff,et al.  Tai Chi for Reducing Dual-task Gait Variability, a Potential Mediator of Fall Risk in Parkinson’s Disease: A Pilot Randomized Controlled Trial , 2018, Global advances in health and medicine.

[16]  J. Balschi,et al.  Tai Chi Improves Brain Metabolism and Muscle Energetics in Older Adults , 2018, Journal of neuroimaging : official journal of the American Society of Neuroimaging.

[17]  Teresa Socha,et al.  Motor assessment in Parkinson`s disease. , 2017, Annals of agricultural and environmental medicine : AAEM.

[18]  L. Bhatt,et al.  Biomarkers for Parkinson’s Disease: Recent Advancement , 2017, Neuroscience Bulletin.

[19]  M. Pau,et al.  ‘Timed up and go’ and brain atrophy: a preliminary MRI study to assess functional mobility performance in multiple sclerosis , 2017, Journal of Neurology.

[20]  Jeffrey M. Hausdorff,et al.  The impact of Tai Chi and Qigong mind-body exercises on motor and non-motor function and quality of life in Parkinson's disease: A systematic review and meta-analysis. , 2017, Parkinsonism & related disorders.

[21]  Y. Loh,et al.  Aberrations in Peripheral Inflammatory Cytokine Levels in Parkinson Disease: A Systematic Review and Meta-analysis. , 2016, JAMA neurology.

[22]  Eyal Oren,et al.  Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015 , 2016 .

[23]  R. Munhoz,et al.  Unusual motor and non-motor symptoms and signs in the early stage of Parkinson’s disease , 2016, Arquivos de Neuro-Psiquiatria.

[24]  N. Rezaei,et al.  Deciphering variability in the role of interleukin-1β in Parkinson’s disease , 2016, Reviews in the neurosciences.

[25]  Brian M. Sandroff,et al.  Validity of the Timed Up and Go Test as a Measure of Functional Mobility in Persons With Multiple Sclerosis. , 2016, Archives of physical medicine and rehabilitation.

[26]  Ashutosh Kumar Singh,et al.  Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015 , 2016, Lancet.

[27]  P. Harmer,et al.  Economic Evaluation of a Tai Ji Quan Intervention to Reduce Falls in People With Parkinson Disease, Oregon, 2008–2011 , 2015, Preventing chronic disease.

[28]  Georg Hettich,et al.  Visual contribution to human standing balance during support surface tilts , 2015, Human movement science.

[29]  Li Gong,et al.  Tai Chi for Improvement of Motor Function, Balance and Gait in Parkinson's Disease: A Systematic Review and Meta-Analysis , 2014, PloS one.

[30]  A. Destée,et al.  Prevalence, determinants, and effect on quality of life of freezing of gait in Parkinson disease. , 2014, JAMA neurology.

[31]  Jian-Wen Gu,et al.  Aerobic Exercise for Parkinson's Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials , 2014, PloS one.

[32]  Joe R. Nocera,et al.  The effect of Tai Chi exercise on gait initiation and gait performance in persons with Parkinson's disease. , 2013, Parkinsonism & related disorders.

[33]  S. Chung,et al.  Therapeutic Effects of Tai Chi in Patients with Parkinson's Disease , 2013, ISRN neurology.

[34]  L. King,et al.  Effects of exercise on mobility in people with Parkinson's disease , 2013, Movement disorders : official journal of the Movement Disorder Society.

[35]  J. Lai,et al.  Tai Chi Chuan in Medicine and Health Promotion , 2013, Evidence-based complementary and alternative medicine : eCAM.

[36]  P. Wayne,et al.  The Harvard Medical School Guide to Tai Chi: 12 Weeks to a Healthy Body, Strong Heart, and Sharp Mind , 2013 .

[37]  M. Falvo,et al.  Parkinson disease and exercise. , 2013, Comprehensive Physiology.

[38]  Elizabeth Eckstrom,et al.  Tai chi and postural stability in patients with Parkinson's disease. , 2012, The New England journal of medicine.

[39]  Barry R. Greene,et al.  Quantitative Falls Risk Assessment Using the Timed Up and Go Test , 2010, IEEE Transactions on Biomedical Engineering.

[40]  H. Liu,et al.  Tai Chi as a Balance Improvement Exercise for Older Adults: A Systematic Review , 2010, Journal of geriatric physical therapy.

[41]  M. Farrer,et al.  Missing pieces in the Parkinson's disease puzzle , 2010, Nature Medicine.

[42]  Kamiar Aminian,et al.  The instrumented timed up and go test: potential outcome measure for disease modifying therapies in Parkinson's disease , 2009, Journal of Neurology, Neurosurgery & Psychiatry.

[43]  Stephen R Lord,et al.  Clinical and physiological assessments for elucidating falls risk in Parkinson's disease , 2009, Movement disorders : official journal of the Movement Disorder Society.

[44]  F. Horak,et al.  Delaying Mobility Disability in People With Parkinson Disease Using a Sensorimotor Agility Exercise Program , 2009, Physical Therapy.

[45]  E. Ernst,et al.  Effectiveness of tai chi for Parkinson's disease: a critical review. , 2008, Parkinsonism & related disorders.

[46]  Gammon M Earhart,et al.  Tai Chi improves balance and mobility in people with Parkinson disease. , 2008, Gait & posture.

[47]  J. Jankovic,et al.  Parkinson's disease and movement disorders: moving forward , 2008, The Lancet Neurology.

[48]  M. Woollacott,et al.  How Tai Chi improves balance: biomechanics of recovery to a walking slip in impaired seniors. , 2007, Gait & posture.

[49]  J. Growdon,et al.  Molecular markers of early Parkinson's disease based on gene expression in blood , 2007, Proceedings of the National Academy of Sciences.

[50]  M. Chesney,et al.  Tai Chi Chuan: Mind-Body Practice or Exercise Intervention? Studying the Benefit for Cancer Survivors , 2006, Integrative cancer therapies.

[51]  M. Breteler,et al.  Epidemiology of Parkinson's disease , 2006, The Lancet Neurology.

[52]  L. Lundin-Olsson,et al.  Timed "Up & Go" test: reliability in older people dependent in activities of daily living--focus on cognitive state. , 2006, Physical therapy.

[53]  M. Woollacott,et al.  Neural mechanisms underlying balance improvement with short term Tai Chi training , 2006, Aging clinical and experimental research.

[54]  S. Mandel,et al.  Gene expression profiling of parkinsonian substantia nigra pars compacta; alterations in ubiquitin-proteasome, heat shock protein, iron and oxidative stress regulated proteins, cell adhesion/cellular matrix and vesicle trafficking genes , 2004, Journal of Neural Transmission.

[55]  Wei Liu,et al.  Spatial, temporal and muscle action patterns of Tai Chi gait. , 2004, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[56]  Youlian Hong,et al.  Effect of tai chi exercise on proprioception of ankle and knee joints in old people , 2004, British Journal of Sports Medicine.

[57]  J. Friedman,et al.  Effects of fatigue on physical activity and function in patients with Parkinson’s disease , 2003, Neurology.

[58]  A. Siderowf,et al.  Test–Retest reliability of the Unified Parkinson's Disease Rating Scale in patients with early Parkinson's disease: Results from a multicenter clinical trial , 2002, Movement disorders : official journal of the Movement Disorder Society.

[59]  Ge Wu,et al.  Evaluation of the Effectiveness of Tai Chi for Improving Balance and Preventing Falls in the Older Population—A Review , 2002, Journal of the American Geriatrics Society.

[60]  A. Zwinderman,et al.  Prospective assessment of falls in Parkinson's disease , 2001, Journal of Neurology.

[61]  F. Tang,et al.  Coordination exercise and postural stability in elderly people: Effect of Tai Chi Chuan. , 2001, Archives of physical medicine and rehabilitation.

[62]  M. Muenter,et al.  Frequency of levodopa‐related dyskinesias and motor fluctuations as estimated from the cumulative literature , 2001, Movement disorders : official journal of the Movement Disorder Society.

[63]  F. Tang,et al.  The effects of Tai Chi Chuan on postural stability in the elderly: preliminary report. , 2000, Chang Gung medical journal.

[64]  Diane Podsiadlo,et al.  The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons , 1991, Journal of the American Geriatrics Society.

[65]  Cheng-Qi He,et al.  Effect of repetitive transcranial magnetic stimulation on gait and freezing of gait in Parkinson's disease: a systematic review and meta-analysis. , 2020, Archives of physical medicine and rehabilitation.

[66]  M. Mak,et al.  Exercise for Parkinson's disease. , 2019, International review of neurobiology.

[67]  M. Toft,et al.  Found in transcription: accurate Parkinson's disease classification in peripheral blood. , 2013, Journal of Parkinson's disease.

[68]  A. Schrag,et al.  Levodopa-induced-dyskinesias clinical features, incidence, risk factors, management and impact on quality of life. , 2012, Journal of Parkinson's disease.

[69]  Li Ning Effect of Taijiquan on Motion Control for Parkinson's Disease at Early Stage , 2011 .

[70]  J. Lai,et al.  The exercise intensity of Tai Chi Chuan. , 2008, Medicine and sport science.

[71]  B. Bloem,et al.  [Falling in Parkinson disease: more often due to postural instability than to environmental factors]. , 2000, Nederlands tijdschrift voor geneeskunde.

[72]  Khan,et al.  Arachidonic acid metabolites alter G protein-mediated signal transduction in heart. Effects on muscarinic K+ channels , 1990, The Journal of general physiology.