Skip to main content

Advertisement

SpringerLink
Log in

Ameliorative effects of Tai Chi on cancer-related fatigue: a meta-analysis of randomized controlled trials

  • Review Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

This meta-analysis investigated the effectiveness of Tai Chi on cancer-related fatigue (CRF).

Methods

Nine databases (PubMed, Web of Science, Ovid, the Cochrane Library, Embase, and four Chinese databases) were searched to identify randomized controlled trials (RCTs) that evaluated the effects of Tai Chi on CRF. The reference lists given in the identified RCTs were also reviewed to identify potentially relevant studies.

Results

Six RCTs involving 373 patients were included. The change in short- and long-term CRF (SCRF and LCRF, respectively) was calculated as the change in the mean score for CRF from baseline to the end of intervention period and to the end of post-intervention follow-up, respectively. Pooled results suggested that Tai Chi had a significant positive effect on standard mean difference (i.e., SCRF; SMD = − 0.54; p < 0.0001), but the impact on LCRF remained unclear. Subgroup analyses of SCRF indicated positive effects of Tai Chi among patients with breast (SMD = − 0.81; p < 0.00001) and lung cancer (SMD = − 0.50; p = 0.002), but not prostate cancer (p = 0.98). Tai Chi also had effects on SCRF that were superior to physical exercise and psychological support (SMD = − 0.49 and − 0.84, respectively; both p < 0.05). A longer intervention time (8–12 weeks) benefited SCRF more than a shorter time (SMD = − 1.08 and − 0.36, respectively; both p < 0.05).

Conclusion

Tai Chi for more than 8 weeks has short-term ameliorative effects on CRF, especially among patients with breast and lung cancer. Its beneficial effects are superior to physical exercise and psychological support. It remains unclear whether there are long-term benefits, and further study is needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Stasi R, Abriani L, Beccaglia P, Terzoli E, Amadori S (2003) Cancer-related fatigue: evolving concepts in evaluation and treatment. Cancer 98(9):1786–1801. https://doi.org/10.1002/cncr.11742

    Article  PubMed  Google Scholar 

  2. Berger AM, Mooney K, Alvarez-Perez A, Breitbart WS, Carpenter KM, Cella D, Cleeland C, Dotan E, Eisenberger MA, Escalante CP, Jacobsen PB, Jankowski C, LeBlanc T, Ligibel JA, Loggers ET, Mandrell B, Murphy BA, Palesh O, Pirl WF, Plaxe SC, Riba MB, Rugo HS, Salvador C, Wagner LI, Wagner-Johnston ND, Zachariah FJ, Bergman MA, Smith C, National comprehensive cancer (2015) Cancer-related fatigue, version 2.2015. J Natl Compr Cancer Netw 13(8):1012–1039. https://doi.org/10.6004/jnccn.2015.0122

    Article  Google Scholar 

  3. Henry DH, Viswanathan HN, Elkin EP, Traina S, Wade S, Cella D (2008) Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S. Support Care Cancer 16(7):791–801. https://doi.org/10.1007/s00520-007-0380-2

    Article  PubMed  Google Scholar 

  4. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65(2):87–108. https://doi.org/10.3322/caac.21262

    Article  PubMed  Google Scholar 

  5. Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, Jemal A, Yu XQ, He J (2016) Cancer statistics in China, 2015. CA Cancer J Clin 66(2):115–132. https://doi.org/10.3322/caac.21338

    Article  PubMed  Google Scholar 

  6. Siegel RL, Miller KD, Jemal A (2017) Cancer statistics, 2017. CA Cancer J Clin 67(1):7–30. https://doi.org/10.3322/caac.21387

    Article  PubMed  Google Scholar 

  7. Miller AH, Ancoli-Israel S, Bower JE, Capuron L, Irwin MR (2008) Neuroendocrine-immune mechanisms of behavioral comorbidities in patients with cancer. J Clin Oncol 26(6):971–982. https://doi.org/10.1200/JCO.2007.10.7805

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Schubert C, Hong S, Natarajan L, Mills PJ, Dimsdale JE (2007) The association between fatigue and inflammatory marker levels in cancer patients: a quantitative review. Brain Behav Immun 21(4):413–427. https://doi.org/10.1016/j.bbi.2006.11.004

    Article  PubMed  CAS  Google Scholar 

  9. al-Majid S, McCarthy DO (2001) Cancer-induced fatigue and skeletal muscle wasting: the role of exercise. Biol Res Nurs 2 (3):186–197. doi:10.1177/109980040100200304

  10. Puetz TW, Herring MP (2012) Differential effects of exercise on cancer-related fatigue during and following treatment: a meta-analysis. Am J Prev Med 43(2):e1–24. https://doi.org/10.1016/j.amepre.2012.04.027

    Article  PubMed  Google Scholar 

  11. Goedendorp MM, Gielissen MF, Verhagen CA, Bleijenberg G (2009) Psychosocial interventions for reducing fatigue during cancer treatment in adults. Cochrane Database Syst Rev 1:CD006953. https://doi.org/10.1002/14651858.CD006953.pub2

    Article  Google Scholar 

  12. Ling WM, Lui LY, So WK, Chan K (2014) Effects of acupuncture and acupressure on cancer-related fatigue: a systematic review. Oncol Nurs Forum 41(6):581–592. https://doi.org/10.1188/14.ONF.581-592

    Article  PubMed  Google Scholar 

  13. Mao H, Mao JJ, Guo M, Cheng K, Wei J, Shen X, Shen X (2016) Effects of infrared laser moxibustion on cancer-related fatigue: a randomized, double-blind, placebo-controlled trial. Cancer 122(23):3667–3672. https://doi.org/10.1002/cncr.30189

    Article  PubMed  PubMed Central  Google Scholar 

  14. Cassileth BR, Vickers AJ (2004) Massage therapy for symptom control: outcome study at a major cancer center. J Pain Symptom Manag 28(3):244–249. https://doi.org/10.1016/j.jpainsymman.2003.12.016

    Article  Google Scholar 

  15. Bower JE, Garet D, Sternlieb B, Ganz PA, Irwin MR, Olmstead R, Greendale G (2012) Yoga for persistent fatigue in breast cancer survivors: a randomized controlled trial. Cancer 118(15):3766–3775. https://doi.org/10.1002/cncr.26702

    Article  PubMed  Google Scholar 

  16. Mustian KM, Alfano CM, Heckler C, Kleckner AS, Kleckner IR, Leach CR, Mohr D, Palesh OG, Peppone LJ, Piper BF, Scarpato J, Smith T, Sprod LK, Miller SM (2017) Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA oncol 3:961–968. https://doi.org/10.1001/jamaoncol.2016.6914

    Article  PubMed  PubMed Central  Google Scholar 

  17. Liu T, Li S (2004) Effect of shadow boxing on the cardiovascular exicitability, adaptability and endurance in middle-aged and elderly patients with hypertension. Zhongguo Lin Chuang Kang Fu 8(33):7508–7509. https://doi.org/10.3321/j.issn:1673-8225.2004.33.087

    Article  Google Scholar 

  18. Qiao X, Hao YF (2012) Qualitative research of the elderly real experience of long-term adherence to Tai Chi exercise. Zhong Xi Yi Jie He Xue Bao 10(12):1388–1393. https://doi.org/10.3736/jcim20121209

    Article  PubMed  Google Scholar 

  19. Hamasaki H (2016) Martial arts and metabolic diseases. Sports 4(2):28. https://doi.org/10.3390/sports4020028

    Article  PubMed Central  Google Scholar 

  20. Irwin MR, Olmstead R, Carrillo C, Sadeghi N, Nicassio P, Ganz PA, Bower JE (2017) Tai Chi Chih compared with cognitive behavioral therapy for the treatment of insomnia in survivors of breast cancer: a randomized, partially blinded, noninferiority trial. J Clin Oncol 35(23):2656–2665. https://doi.org/10.1200/jco.2016.71.0285

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mustian KM, Palesh OG, Flecksteiner SA (2008) Tai Chi Chuan for breast cancer survivors. Med Sport Sci 52:209–217. https://doi.org/10.1159/000134301

    Article  PubMed  PubMed Central  Google Scholar 

  22. Callahan LF, Cleveland RJ, Altpeter M, Hackney B (2016) Evaluation of Tai Chi program effectiveness for people with arthritis in the community: a randomized controlled trial. J Aging Phys Act 24(1):101–110. https://doi.org/10.1123/japa.2014-0211

    Article  PubMed  Google Scholar 

  23. Burschka JM, Keune PM, Oy UH, Oschmann P, Kuhn P (2014) Mindfulness-based interventions in multiple sclerosis: beneficial effects of Tai Chi on balance, coordination, fatigue and depression. BMC Neurol 14:165. https://doi.org/10.1186/s12883-014-0165-4

    Article  PubMed  PubMed Central  Google Scholar 

  24. Langhorst J, Klose P, Dobos GJ, Bernardy K, Hauser W (2013) Efficacy and safety of meditative movement therapies in fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials. Rheumatol Int 33(1):193–207. https://doi.org/10.1007/s00296-012-2360-1

    Article  PubMed  CAS  Google Scholar 

  25. Aeyong E (2007) Effects of a Tai Chi program for early mastectomy patients. Korean J Women Health Nurs 13(1):43–50. https://doi.org/10.4069/kjwhn.2007.13.1.43

    Article  Google Scholar 

  26. Jiang MY, Wang M, Song CA (2013) Influence of shadowboxing on improving cancer-related fatigue and sleeping quality of patients with advanced lung cancer. Zhongguo Hu Li Za Zhi 27(2):420–421. https://doi.org/10.3969/j.issn.1009-6493.2013.05.018

    Article  Google Scholar 

  27. Larkey LK, Roe DJ, Weihs KL, Jahnke R, Lopez AM, Rogers CE, Oh B, Guillen-Rodriguez J (2015) Randomized controlled trial of qigong/tai chi easy on cancer-related fatigue in breast cancer survivors. Ann Behav Med 49(2):165–176. https://doi.org/10.1007/s12160-014-9645-4

    Article  PubMed  PubMed Central  Google Scholar 

  28. McQuade JL, Prinsloo S, Chang DZ, Spelman A, Wei Q, Basen-Engquist K, Harrison C, Zhang Z, Kuban D, Lee A, Cohen L (2017) Qigong/tai chi for sleep and fatigue in prostate cancer patients undergoing radiotherapy: a randomized controlled trial. Psychooncology 26(11):1936–1943. https://doi.org/10.1002/pon.4256

    Article  PubMed  Google Scholar 

  29. Zhang LL, Wang SZ, Chen HL, Yuan AZ (2016) Tai chi exercise for cancer-related fatigue in patients with lung cancer undergoing chemotherapy: a randomized controlled trial. J Pain Symptom Manag 51(3):504–511. https://doi.org/10.1016/j.jpainsymman.2015.11.020

    Article  Google Scholar 

  30. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62(10):1006–1012. https://doi.org/10.1016/j.jclinepi.2009.06.005

    Article  PubMed  Google Scholar 

  31. Whitehead L (2009) The measurement of fatigue in chronic illness: a systematic review of unidimensional and multidimensional fatigue measures. J Pain Symptom Manag 37(1):107–128. https://doi.org/10.1016/j.jpainsymman.2007.08.019

    Article  Google Scholar 

  32. Higgins JPT, Green S (eds) (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration. Available from http://handbook.cochrane.org. Accessed 1 March 2017

  33. Fragkos KC, Tsagris M, Frangos CC (2014) Publication bias in meta-analysis: confidence intervals for Rosenthal’s fail-safe number. Int Sch Res Notices 2014: 825383. doi:https://doi.org/10.1155/2014/825383, 1, 17

  34. Cramp F, Byron-Daniel J (2012) Exercise for the management of cancer-related fatigue in adults. Cochrane Database Systematic Rev 11:Cd006145. https://doi.org/10.1002/14651858.CD006145.pub3

    Article  Google Scholar 

  35. Craft LL, Vaniterson EH, Helenowski IB, Rademaker AW, Courneya KS (2012) Exercise effects on depressive symptoms in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiol Biomark Prev 21(1):3–19. https://doi.org/10.1158/1055-9965.EPI-11-0634

    Article  Google Scholar 

  36. Schwartz AL (2000) Daily fatigue patterns and effect of exercise in women with breast cancer. Cancer Pract 8(1):16–24. https://doi.org/10.1046/j.1523-5394.2000.81003.x

    Article  PubMed  CAS  Google Scholar 

  37. Larkey L, Jahnke R, Etnier J, Gonzalez J (2009) Meditative movement as a category of exercise: implications for research. J Phys Act Health 6(2):230–238. https://doi.org/10.1123/jpah.6.2.230

    Article  PubMed  Google Scholar 

  38. Joseph CN, Porta C, Casucci G, Casiraghi N, Maffeis M, Rossi M, Bernardi L (2005) Slow breathing improves arterial baroreflex sensitivity and decreases blood pressure in essential hypertension. Hypertension 46(4):714–718. https://doi.org/10.1161/01.HYP.0000179581.68566.7d

    Article  PubMed  CAS  Google Scholar 

  39. Kristeller JL, Hallett CB (1999) An exploratory study of a meditation-based intervention for binge eating disorder. J Health Psychol 4(3):357–363. https://doi.org/10.1177/135910539900400305

    Article  PubMed  CAS  Google Scholar 

  40. Lillis J, Hayes SC, Bunting K, Masuda A (2009) Teaching acceptance and mindfulness to improve the lives of the obese: a preliminary test of a theoretical model. Ann Behav Med 37(1):58–69. https://doi.org/10.1007/s12160-009-9083-x

    Article  PubMed  Google Scholar 

  41. Kristeller JL, Wolever RQ (2011) Mindfulness-based eating awareness training for treating binge eating disorder: the conceptual foundation. Eat Disord 19(1):49–61. https://doi.org/10.1080/10640266.2011.533605

    Article  PubMed  Google Scholar 

  42. Carlson LE, Speca M, Faris P, Patel KD (2007) One year pre-post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients. Brain Behav Immun 21(8):1038–1049. https://doi.org/10.1016/j.bbi.2007.04.002

    Article  PubMed  CAS  Google Scholar 

  43. Mustian KM, Katula JA, Gill DL, Roscoe JA, Lang D, Murphy K (2004) Tai Chi Chuan, health-related quality of life and self-esteem: a randomized trial with breast cancer survivors. Support Care Cancer 12(12):871–876. https://doi.org/10.1007/s00520-004-0682-6

    Article  PubMed  Google Scholar 

  44. Janelsins MC, Davis PG, Wideman L, Katula JA, Sprod LK, Peppone LJ, Palesh OG, Heckler CE, Williams JP, Morrow GR, Mustian KM (2011) Effects of Tai Chi Chuan on insulin and cytokine levels in a randomized controlled pilot study on breast cancer survivors. Clin breast cancer 11(3):161–170. https://doi.org/10.1016/j.clbc.2011.03.013

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  45. Zeng Y, Luo T, Xie H, Huang M, Cheng AS (2014) Health benefits of qigong or tai chi for cancer patients: a systematic review and meta-analyses. Complement Ther Med 22(1):173–186. https://doi.org/10.1016/j.ctim.2013.11.010

    Article  PubMed  Google Scholar 

  46. Lu WA, Kuo CD (2003) The effect of Tai Chi Chuan on the autonomic nervous modulation in older persons. Med Sci Sports Exerc 35(12):1972–1976. https://doi.org/10.1249/01.MSS.0000099242.10669.F7

    Article  PubMed  Google Scholar 

  47. Campo RA, Light KC, O’Connor K, Nakamura Y, Lipschitz D, LaStayo PC, Pappas LM, Boucher KM, Irwin MR, Hill HR, Martins TB, Agarwal N, Kinney AY (2015) Blood pressure, salivary cortisol, and inflammatory cytokine outcomes in senior female cancer survivors enrolled in a Tai Chi Chih randomized controlled trial. J Cancer Surviv 9(1):115–125. https://doi.org/10.1007/s11764-014-0395-x

    Article  PubMed  Google Scholar 

  48. Sprod LK, Janelsins MC, Palesh OG, Carroll JK, Heckler CE, Peppone LJ, Mohile SG, Morrow GR, Mustian KM (2012) Health-related quality of life and biomarkers in breast cancer survivors participating in Tai Chi Chuan. J Cancer Surviv 6(2):146–154. https://doi.org/10.1007/s11764-011-0205-7

    Article  PubMed  Google Scholar 

  49. Irwin MR, Olmstead R, Breen EC, Witarama T, Carrillo C, Sadeghi N, Arevalo JM, Ma J, Nicassio P, Ganz PA, Bower JE, Cole S (2014) Tai chi, cellular inflammation, and transcriptome dynamics in breast cancer survivors with insomnia: a randomized controlled trial. J Natl Cancer Inst Monogr 2014(50):295–301. https://doi.org/10.1093/jncimonographs/lgu028

    Article  PubMed  PubMed Central  Google Scholar 

  50. Gulliford SL, Miah AB, Brennan S, McQuaid D, Clark CH, Partridge M, Harrington KJ, Morden JP, Hall E, Nutting CM (2012) Dosimetric explanations of fatigue in head and neck radiotherapy: an analysis from the PARSPORT Phase III trial. Radiother Oncol 104(2):205–212. https://doi.org/10.1016/j.radonc.2012.07.005

    Article  PubMed  Google Scholar 

  51. Jahnke R, Larkey L, Rogers C, Etnier J, Lin F (2010) A comprehensive review of health benefits of qigong and tai chi. Am J Health Promot 24(6):e1–e25. https://doi.org/10.4278/ajhp.081013-LIT-248

    Article  PubMed  PubMed Central  Google Scholar 

  52. Blake H, Hawley H (2012) Effects of Tai Chi exercise on physical and psychological health of older people. Curr Aging Sci 5(1):19–27. https://doi.org/10.2174/1874609811205010019

    Article  PubMed  Google Scholar 

  53. Schwartz AL, Thompson JA, Masood N (2002) Interferon-induced fatigue in patients with melanoma: a pilot study of exercise and methylphenidate. Oncol Nurs Forum 29(7):E85–E90. https://doi.org/10.1188/02.ONF.E85-E90

    Article  PubMed  Google Scholar 

  54. Jean-Pierre P, Morrow GR, Roscoe JA, Heckler C, Mohile S, Janelsins M, Peppone L, Hemstad A, Esparaz BT, Hopkins JO (2010) A phase 3 randomized, placebo-controlled, double-blind, clinical trial of the effect of modafinil on cancer-related fatigue among 631 patients receiving chemotherapy: a University of Rochester Cancer Center Community Clinical Oncology Program Research base study. Cancer 116(14):3513–3520. https://doi.org/10.1002/cncr.25083

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  55. Xiang Y, Lu L, Chen X, Wen Z (2017) Does Tai Chi relieve fatigue? A systematic review and meta-analysis of randomized controlled trials. PLoS One 12(4):e0174872. https://doi.org/10.1371/journal.pone.0174872

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  56. Ma HL, Tan JY, Yang L, Huang T, Liao QJ (2016) Current evidence on traditional Chinese exercises for cancer-related fatigue: a quantitative synthesis of randomized controlled trials. Eur J Integr Med 8(5):707–714. https://doi.org/10.1016/j.eujim.2016.05.007

    Article  Google Scholar 

  57. Larkey L, Ash D (2016) Effects of meditative movement (Qigong/Tai Chi easy) on fatigued breast cancer survivors. https://www.clinicaltrials.gov/ct2/show/NCT02690116?term=“Tai+Chi”+and+“fatigue”&rank=3. Accessed 27 February 2017

  58. Carlson L, Calgary Uo, Services AH, Centre TBC, Princess Margaret Hospital C (2016) The MATCH Study: mindfulness and Tai Chi for cancer health (MATCH). https://clinicaltrials.gov/ct2/show/NCT02801123?term=“Tai+Chi”+and+“fatigue”&rank=8. Accessed 27 February 2017

Download references

Funding

This study was financially supported by the National Natural Science Foundation of China (No. 81603434) and Shanghai Municipal Commission of Health and Family Planning Program (No. ZY3-CCCX-3-3038).

Author information

Author notes

  1. Shangjin Song and Jiahui Yu contributed equally to this work.

Authors and Affiliations

  1. Department of Traditional Chinese Medicine, Changzheng Hospital, Naval Medical University (Second Military Medical University), No.415 Fengyang Rd, Shanghai, 200003, China

    Shangjin Song, Jiahui Yu, Xuan Liu, Lijuan Xiu & Xiaoqiang Yue

  2. Department of Traditional Chinese Medicine, Changhai Hospital, Naval Medical University (Second Military Medical University), No. 168 Changhai Rd, Shanghai, 200433, China

    Yi Ruan

Authors
  1. Shangjin Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jiahui Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yi Ruan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xuan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lijuan Xiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiaoqiang Yue
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xiaoqiang Yue.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Appendix 1

Appendix 1

Literature search strategy in PubMed:

#1 “Tai Ji” [Mesh]

#2 tai ji or taiji or tai chi or taichi or taijiquan or tai ji quan or tai chi chuan or t’ai chi or tai-ji

#3 #1 or #2

#4 “Neoplasms” [Mesh]

#5 cancer or tumor or tumour or carcinoma or neoplasia or neoplasm or malignan*

#6 #4 or #5

#7 fatigue or cancer-related fatigue or CRF or chemotherapy-related fatigue or treatment-related fatigue

#8 “Fatigue” [Mesh]

#9 apathy or apathetic or lassitude or weakness or lethargy or lethargic or tired or weary or weariness or exhaustion or exhausted or lackluster

#10 #7 or #8 or #9

#11 #3 and (#6 or #10)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Song, S., Yu, J., Ruan, Y. et al. Ameliorative effects of Tai Chi on cancer-related fatigue: a meta-analysis of randomized controlled trials. Support Care Cancer 26, 2091–2102 (2018). https://doi.org/10.1007/s00520-018-4136-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-018-4136-y

Keywords

Search

Navigation