Ameliorative effects of Tai Chi on cancer-related fatigue: a meta-analysis of randomized controlled trials
This meta-analysis investigated the effectiveness of Tai Chi on cancer-related fatigue (CRF).
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.
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).
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.
KeywordsTai Chi Fatigue Neoplasms Meta-analysis
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 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 CrossRefGoogle 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:10.1177/109980040100200304Google 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 CrossRefPubMedPubMedCentralGoogle 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 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 CrossRefPubMedPubMedCentralGoogle 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 CrossRefPubMedGoogle 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 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 CrossRefPubMedPubMedCentralGoogle 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 CrossRefPubMedGoogle 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
- 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 CrossRefPubMedGoogle 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 CrossRefPubMedGoogle 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 CrossRefPubMedPubMedCentralGoogle 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 CrossRefPubMedGoogle 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 CrossRefPubMedGoogle 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 CrossRefPubMedGoogle 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 CrossRefPubMedPubMedCentralGoogle 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 CrossRefPubMedGoogle 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 CrossRefPubMedPubMedCentralGoogle 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 2017Google Scholar
- 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 2017Google Scholar