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Osteoporosis International

, Volume 27, Issue 10, pp 2901–2911 | Cite as

Effects of tai chi exercise on bone health in perimenopausal and postmenopausal women: a systematic review and meta-analysis

  • Z. Sun
  • H. Chen
  • M. R. Berger
  • L. Zhang
  • H. GuoEmail author
  • Y. Huang
Review Article

Abstract

Tai chi exercise may have positive effects on bone health in perimenopausal and postmenopausal women. This systematic review is the first to summarize evidence to clarify the efficacy of tai chi exercise in bone health. The benefits of tai chi exercise on bone health remain unclear; further studies are needed. Emerging randomized controlled trials (RCTs) exploring the efficacy of tai chi exercise on bone health among older women, but yielded inconclusive results. Our objective is to conduct a systematic review to evaluate evidence from RCTs to clarify the efficacy of tai chi exercise on bone mineral density (BMD), and bone turnover markers (BTM) in perimenopausal and postmenopausal women. Six electronic databases were searched, and reference lists of systematic reviews and identified studies from the search strategy were also screened. We included all RCTs that investigate tai chi exercise for bone health in perimenopausal and postmenopausal women. Data selection, extraction, and evaluation of risk of bias were performed independently by two reviewers. Ten trials detailed in 11 articles were included. Six of the 11 studies reported positive outcomes on bone health. Results of our meta-analysis showed a significant effect of tai chi exercise on BMD change at the spine compared with no treatment in perimenopausal and postmenopausal women. When tai chi exercise combined with a calcium supplement was compared with the calcium supplement alone, the result of BMD change at the spine showed no significant effect. Because the measurable effect observed was minimal, and due to the low quality of methodology of the studies, we conclude that the result is of limited reliability. Tai chi exercise may have benefits on bone health in perimenopausal and postmenopausal women, but the evidence is sometimes weak, poor, and inconsistent. Consequently, only limited conclusions can be drawn regarding the efficacy of tai chi exercise on bone health. Further well designed studies with low risk of bias are needed.

Keywords

Bone Bone mineral density Bone turnover markers Osteoporosis Perimenopausal Postmenopausal women Tai chi exercise 

Notes

Authors contributions

HG is the guarantor. ZS and HG contributed to the conception of the study. ZS drafted the manuscript of this protocol. The search strategy was developed by YH and will be performed by HC and LZ. Study selection, data extraction, assessed the risk of bias, and the quality of evidence were performed by HC and LZ. ZS conducted the data synthesis. ZS resolved all the disagreements. Michael R. Berger edited this manuscript. HG revised the manuscript. All authors have approved the publication of the article.

Compliance with ethical standards

Conflicts of interest

Zhenshuang Sun, Hao Chen, Michael R Berger, Lijun Zhang, Haiying Guo, and Ying Huang declare that they have no conflict of interest.

Supplementary material

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198_2016_3626_MOESM3_ESM.pdf (87 kb)
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References

  1. 1.
    Johnell O, Kanis JA (2004) An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int 15:897–902CrossRefPubMedGoogle Scholar
  2. 2.
    Holroyd C, Cooper C, Dennison E (2008) Epidemiology of osteoporosis. Best Pract Res Clin Endocrinol Metab 22(5):671–685CrossRefPubMedGoogle Scholar
  3. 3.
    Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22(3):465–475CrossRefPubMedGoogle Scholar
  4. 4.
    Kim DH, Vaccaro AR (2006) Osteoporotic compression fractures of the spine; current options and considerations for treatment. Spine J 6(5):479–487CrossRefPubMedGoogle Scholar
  5. 5.
    Nevitt MC, Ettinger B, Black DM, Stone K, Jamal SA, Ensrud K, Segal M, Genant HK, Cummings SR (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Int Med 128(10):793–800CrossRefPubMedGoogle Scholar
  6. 6.
    Chinese Medical Association of osteoporosis and bone mineral disease (2011) Practice guidelines of osteoporosis. Chin J Osteoporos Bone Miner Res 4(1):2–17Google Scholar
  7. 7.
    Haussler B, Gothe H, Gol D, Glaeske G, Pientka L, Felsenberg D (2007) Epidemiology, treatment and costs of osteoporosis in Germany – the Bone EVA Study. Osteoporos Int 18:77–84Google Scholar
  8. 8.
    Stevens JA, Corso PS, Finkelstein EA, Miller TR (2006) The costs of fatal and nonfatal falls among older adults. Inj Prev 12:290–295Google Scholar
  9. 9.
    Weycker D, Macarios D, Edelsberg J, Oster G (2007) Compliance with osteoporosis drug therapy and risk of fracture. Osteoporos Int 18:271–277CrossRefPubMedGoogle Scholar
  10. 10.
    Wiktorowicz ME, Goeree R, Papaioannou A, Adachi JD, Papadimitropoulos E (2001) Economic implications of hip fracture: health service use, institutional care and cost in Canada. Osteoporos Int 12:271–278CrossRefPubMedGoogle Scholar
  11. 11.
    Cryer B, Bauer DC (2002) Oral bisphosphonates and upper gastrointestinal tract problems: what is the evidence? Mayo Clin Proc 77:1031–1043CrossRefPubMedGoogle Scholar
  12. 12.
    Rossouw JE, Anderson GL, Prentice RL, Lacroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 288:321–333CrossRefPubMedGoogle Scholar
  13. 13.
    Vicente-Rodriguez G (2006) How does exercise affect bone development during growth? Sports Med 36:561–569CrossRefPubMedGoogle Scholar
  14. 14.
    Gomez-Cabello A, Ara I, Gonzalez-Aguero A, Casajus JA, Vicente-Rodriguez G (2012) Effects of training on bone mass in older adults: a systematic review. Sports Med 42:301–325CrossRefPubMedGoogle Scholar
  15. 15.
    Frost HM (1997) Why do marathon runners have less bone than weight lifters? A vital-biomechanical view and explanation. Bone 20:183–189CrossRefPubMedGoogle Scholar
  16. 16.
    Bass S, Pearce G, Bradney M, Hendrich E, Delmas PD, Harding A, Seeman E (1998) Exercise before puberty may confer residual benefits in bone density in adulthood: studies in active prepubertal and retired female gymnasts. J Bone Miner Res 13:500–507CrossRefPubMedGoogle Scholar
  17. 17.
    Wolf SL, Sattin RW, Kutner M, O’Grady M, Greenspan AI, Gregor RJ (2003) Intense tai chi exercise training and fall occurrences in older, transitionally frail adults: a randomized controlled trial. J Am Geriatr Soc 51:1693–1701CrossRefPubMedGoogle Scholar
  18. 18.
    Kirsteins A, Dietz F, Hwang S (1991) Evaluating the safety and potential use of a weight-bearing exercise, Tai-Chi Chuan, for rheumatoid arthritis patients. Am J Phys Med Rehabil 70:136–141CrossRefPubMedGoogle Scholar
  19. 19.
    Yeh GY, Wood MJ, Lorell BH, Stevenson LW, Eisenberg DM, Wayne PM, Goldberger AL, Davis RB, Phillips RS (2004) Effects of tai chi mind-body movement therapy on functional status and exercise capacity in patients with chronic heart failure: a randomized controlled trial. Am J Med 117:541–548CrossRefPubMedGoogle Scholar
  20. 20.
    Wilson C, Datta S (2001) Tai chi for the prevention of fractures in a nursing home population: an economic analysis. J Clin Outcome Manag 8:19–27Google Scholar
  21. 21.
    Li GP, Qin L, Chan KM (2001) Health benefits of Tai Chi Chuan in older individuals. In: Maffuli N (ed) Sports medicine for specific ages and abilities. Churchill Livingstone, Edinburgh, pp 315–324Google Scholar
  22. 22.
    American College of Sports Medicine Position Stand (1998) Exercise and physical activity for older adults. Med Sci Sports Exerc 30:992–1008Google Scholar
  23. 23.
    Chen KM, Snyder M (1999) A research-based use of tai chi/movement therapy as a nursing intervention. J Holistic Nurs 17:267–279CrossRefGoogle Scholar
  24. 24.
    Lan C, Chen SY, Lai JS, Wong AM (2013) Tai Chi Chuan in medicine and health promotion. Evid-Based Complement Altern Med 502131:17Google Scholar
  25. 25.
    Leung DP, Chan CK, Tsang HW, Tsang WW, Jones AY (2011) Tai chi as an intervention to improve balance and reduce falls in older adults: a systematic review and meta analysis. Altern Ther Health Med 17(1):40–48PubMedGoogle Scholar
  26. 26.
    Logghe IH, Verhagen AP, Rademaker AC, Bierma-Zeinstra SM, van Rossum E, Faber MJ, Koes BW (2010) The effects of tai chi on fall prevention, fear of falling and balance in older people: a meta-analysis. Prev Med 51(34):222–227CrossRefPubMedGoogle Scholar
  27. 27.
    Woo J, Hong A, Lau E, Lynn H (2007) A randomised controlled trial of tai chi and resistance exercise on bone health, muscle strength and balance in community-living elderly people. Age Ageing 36(3):262–268CrossRefPubMedGoogle Scholar
  28. 28.
    Wolfson L, Whipple R, Derby C, Judge J, King M, Amerman P, Schmidt J, Smyers D (1996) Balance and strength training in older adults: intervention gains and tai chi maintenance. J Am Geriatr Soc 44(5):498–506CrossRefPubMedGoogle Scholar
  29. 29.
    Chan K, Qin L, Lau M, Woo J, Au S, Choy W, Lee K, Lee S (2004) A randomized, prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women. Arch Phys Med Rehabil 85(5):717–722CrossRefPubMedGoogle Scholar
  30. 30.
    Qin L, Au S, Choy W, Leung P, Neff M, Lee K, Lau M, Woo J, Chan K (2002) Regular Tai Chi Chuan exercise may retard bone loss in postmenopausal women: a case–control study. Arch Phys Med Rehabil 83(10):1355–1359CrossRefPubMedGoogle Scholar
  31. 31.
    Rosado-Perez J, Santiago-Osorio E, Ortiz R, Mendoza-Nunez VM (2012) Tai chi diminishes oxidative stress in Mexican older adults. J Nutr, Health Aging 16:642–646CrossRefGoogle Scholar
  32. 32.
    Kutner NG, Barnhart H, Wolf SL, Mcneely E, Xu T (1997) Self-report benefits of tai chi practice by older adults. J Gerontol B Psychol Sci Soc Sci 52:242–246CrossRefGoogle Scholar
  33. 33.
    Tsai JC, Wang WH, Chan P, Lin LJ, Wang CH, Tomlinson B, Hsieh MH, Yang HY, Liu JC (2003) The beneficial effects of Tai Chi Chuan on blood pressure and lipid profile and anxiety status in a randomized controlled trial. J Altern Complement Med 9:747–754CrossRefPubMedGoogle Scholar
  34. 34.
    Li JX, Hong Y, Chan KM (2001) Tai chi: physiological characteristics and beneficial effects on health. Br J Sports Med 35:148–156CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Chang YK, Nien YH, Tsai CL, Etnier JL (2010) physical activity and cognition in older adults: the potential of Tai ChiChuan. J Aging Phys Act 18(4):451–472CrossRefPubMedGoogle Scholar
  36. 36.
    Li F, Fisher KJ, Harmer P, Irbe D, Tearse RG, Weimer C (2004) Tai chi and self-rated quality of sleep and daytime sleepiness in older adults: a randomized controlled trial. J Am Geriatr Soc 52(6):892–900CrossRefPubMedGoogle Scholar
  37. 37.
    Wang C, Collet JP, Lau J (2004) The effect of tai chi on health outcomes in patients with chronic conditions: a systematic review. Arch Intern Med 164:493–501CrossRefPubMedGoogle Scholar
  38. 38.
    Wayne PM, Kiel DP, Krebs DE, Davis RB, Savetsky-German J, Connelly M, Buring JE (2007) The effects of tai chi on bone mineral density in postmenopausal women: a systematic review. Arch Phys Med Rehabil 88(5):673–680CrossRefPubMedGoogle Scholar
  39. 39.
    Chang TJ, Ting YT, Sheu SL (2014) Effects of tai chi in postmenopausal women with osteoporosis: a systematic review. Hu Li Za Zhi 61(5):75–84PubMedGoogle Scholar
  40. 40.
    Xu S, Peng L (2012) A meta-analysis of the effect of tai chi on bone mineral density in postmenopausal women. Chin J Osteoporos 18(10):932–936Google Scholar
  41. 41.
    Higgins JPT, Green S (2015) Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0. http://handbook.cochrane.org/Google Scholar
  42. 42.
    Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924–926CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Zhou Y, Lee J, Chen YB, Gu JY (2005) Effect of tai chi pushing hand exercise and calcium supplement on bone mineral density of menopausal women. Chin J Sports Med 24:106–108Google Scholar
  44. 44.
    Mao H (2009) Effects of tai ji quan exercises combined with orally calcium supplement on postmenopausal women’s bone mineral density. Chin J Rehabil Med 24(9):814–816Google Scholar
  45. 45.
    Zhou Y (2004) Effect of traditional sports on bone density of postmenopause women. J Beijing Sport Univ 27(3):354–360Google Scholar
  46. 46.
    Zhou Y (2003) Effect of sport exercise on prevention lumbar L2-4 osteoporosis on postmenopausal women. Chin J SportsMed 22(1):72–74Google Scholar
  47. 47.
    Shen CL, Chyu MC, Yeh JK, Zhang Y, Pence BC, Felton CK, Brismee JM, Arjmandi BH, Doctolero S, Wang JS (2012) Effect of green tea and Tai Chi on bone health in postmenopausal osteopenic women: a 6-month randomized placebo-controlled trial. Osteoporos Int 23(5):1541–1552. doi: 10.1007/s00198-011-1731-x CrossRefPubMedGoogle Scholar
  48. 48.
    Shen CL, Chyu MC, Pence BC, Yeh JK, Zhang Y, Felton CK, Doctolero S, Wang JS (2010) Green tea polyphenols supplementation and tai chi exercise for postmenopausal osteopenic women: safety and quality of life report. BMC Complement Altern Med 10:76CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Du XX, Zhang MJ, Gou B, Lv Y, Zhou XY, Liu HG (2014) Influence of Tai ji softball on Estrogen and Bone Metabolism Index of perimenopausal period women. J Xi An Phys Educ Univ 31(4):459–463Google Scholar
  50. 50.
    Song R, Roberts BL, Lee EO, Lam P, Bae SC (2010) A randomized study of the effects of t’ai chi on muscle strength, bone mineral density, and fear of falling in women with osteoarthritis. J Altern Complement Med 16(3):227–233CrossRefPubMedGoogle Scholar
  51. 51.
    Wayne PM, Kiel DP, Buring JE, Connors EM, Paolo B, Yeh GY, Cohen CJ, Chiara M, Davis RB (2012) Impact of tai chi exercise on multiple fracture-related risk factors in post-menopausal osteopenic women: a pilot pragmatic, randomized trial. BMC Complement Altern Med 12:7CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Reid IR, Mason B, Horne A, Ames R, Reid HE, Bava U, Bolland MJ, Gamble GD (2006) Randomized controlled trial of calcium in healthy older women. Am J Med 119:777–785CrossRefPubMedGoogle Scholar
  53. 53.
    Bailey CA, Brooke-Wavell K (2010) Optimum frequency of exercise for bone health: randomised controlled trial of a high- impact unilateral intervention. Bone 46(4):1043–1049CrossRefPubMedGoogle Scholar
  54. 54.
    Asikainen TM, Kukkonen-Harjula K, Miilunpalo S (2004) Exercise for health for early postmenopausal women: a systematic review of randomised controlled trials. Sports Med 34:753–778CrossRefPubMedGoogle Scholar
  55. 55.
    Qin L, Au SK, Leung PC, Woo J, Choy WY, Hung WY, Dambacher MA, Leung KS (2002) Baseline BMD and bone loss at distal radius measured by peripheral quantitative computed tomography in peri- and postmenopausal Hong Kong Chinese women. Osteoporos Int 13:962–970CrossRefPubMedGoogle Scholar
  56. 56.
    Ruegsegger P (1996) Bone density measurement. In: Bro ¨ll H, Dambacher MA, editors. Osteoporos: Guide Diagn Treat 18:103–116Google Scholar
  57. 57.
    Enonen A, Halleen J, Fuerst T, Genant H, Vuori I (2003) Effect of alendronate and exercise on bone and physical performance of postmenopausal women: a randomized controlled trial. Bone 33:132–143CrossRefGoogle Scholar
  58. 58.
    Johnell O, Kanis J (2005) Epidemiology of osteoporotic fractures. Osteoporos Int 16(Suppl 2):S3–S7CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2016

Authors and Affiliations

  • Z. Sun
    • 1
  • H. Chen
    • 1
  • M. R. Berger
    • 1
  • L. Zhang
    • 2
  • H. Guo
    • 1
    Email author
  • Y. Huang
    • 1
  1. 1.The Second Clinical CollegeNanjing University of Chinese MedicineNanjingChina
  2. 2.Luoyang No.1 Hospital of TCMLuoyangChina

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