Efficacy of Tai Chi, brisk walking, meditation, and reading in reducing mental and emotional stress. The beneficial effects of Tai Chi exercise on endothelial function and arterial stiffness in elderly women with rheumatoid arthritis An evaluation of the effects of Tai Chi exercise on physical function among older persons: A randomized controlled trial Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. Evaluation of Tai Chi Program Effectiveness for People with Arthritis in the Community: A Randomized Controlled Trial. A randomized controlled trial of 8-form Tai chi improves symptoms and functional mobility in fibromyalgia patients EFFECTS OF HYDROXYCHLOROQUINE AND SULPHASALAZINE ON PROGRESSION OF JOINT DAMAGE IN RHEUMATOID ARTHRITIS Effects of Tai Chi on Pain and Muscle Activity in Young Males with Acute Low Back Pain Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale Balance and strength training in older adults: intervention gains and Tai Chi maintenance. Better Reporting of Harms in Randomized Trials: An Extension of the CONSORT Statement Effectiveness of a Tai Chi Intervention for Improving Functional Fitness and General Health Among Ethnically Diverse Older Adults With Self-Reported Arthritis Living in Low-Income Neighborhoods: A Cohort Study Longterm physical training in rheumatoid arthritis. A randomized trial with different training programs and blinded observers. Remission in a prospective study of patients with rheumatoid arthritis. American Rheumatism Association preliminary remission criteria in relation to the disease activity score. Defining the clinically important difference in pain outcome measures The efficacy of the ROM Dance Program for adults with rheumatoid arthritis. Physical training in rheumatoid arthritis: a controlled long-term study. I. The Atlanta FICSIT study: two exercise interventions to reduce frailty in elders. Tai Chi exercise and auricular acupressure for people with rheumatoid arthritis: an evaluation study. Tai Chi improves pain and functional status in adults with rheumatoid arthritis: results of a pilot single-blinded randomized controlled trial.
Tai Chi , a moving meditation , is examined for its efficacy in post-stressor recovery . Forty-eight male and 48 female Tai Chi practitioners were r and omly assigned to four treatment groups : Tai Chi , brisk walking , mediation and neutral reading . Mental arithmetic and other difficult tests were chosen as mental challenges , and a stressful film was used to produce emotional disturbance . Tai Chi and the other treatments were applied after these stressors . After all treatments , the salivary cortisol level dropped significantly , and the mood states were also improved . In general the stress-reduction effect of Tai Chi characterized moderate physical exercise . Heart rate , blood pressure , and urinary catecholamine changes for Tai Chi were found to be similar to those for walking at a speed of 6 km/hr . Although Tai Chi appeared to be superior to neutral reading in the reduction of state anxiety and the enhancement of vigour , this effect could be partially accounted for by the subjects ' high expectations about gains from Tai Chi . Approaches controlling for expectancy level are recommended for further assessment Background Rheumatoid arthritis ( RA ) has been known to be associated with increased risk of cardiovascular disease ( CVD ) . The aim of this study was to investigate the effects of Tai Chi exercise on CVD risk in elderly women with RA . Method In total , 56 female patients with RA were assigned to either a Tai Chi exercise group ( 29 patients ) receiving a 3-month exercise intervention once a week or a control group ( 27 patients ) receiving general information about the benefits of exercise . All participants were assessed at baseline and at 3 months for RA disease activity ( Disease Activity Score 28 and Routine Assessment of Patient Index Data 3 ) , functional disability ( Health Assessment Question naire ) , CVD risk factors ( blood pressure , lipids profile , body composition , and smoking ) , and three atherosclerotic measurements : carotid intima-media thickness , flow-mediated dilatation ( FMD ) , and brachial-ankle pulse wave velocity ( baPWV ) . Results FMD , representative of endothelial function , significantly increased in the Tai Chi exercise group ( initial 5.85 ± 2.05 versus 3 months 7.75 ± 2.53 % ) compared with the control group ( initial 6.31 ± 2.12 versus 3 months 5.78 ± 2.13 % ) ( P = 1.76 × 10−3 ) . Moreover , baPWV , representative of arterial stiffness , significantly decreased in the Tai Chi exercise group ( initial 1693.7 ± 348.3 versus 3 months 1600.1 ± 291.0 cm/s ) compared with the control group ( initial 1740.3 ± 185.3 versus 3 months 1792.8 ± 326.1 cm/s ) ( P = 1.57 × 10−2 ) . In addition , total cholesterol decreased significantly in the Tai Chi exercise group compared with the control group ( −7.8 ± 15.5 versus 2.9 ± 12.2 mg/dl , P = 2.72 × 10−2 ) ; other changes in RA-related characteristics were not significantly different between the two groups . Tai Chi exercise remained significantly associated with improved endothelial function ( FMD ; P = 4.32 × 10−3 ) and arterial stiffness ( baPWV ; P = 2.22 × 10−2 ) after adjustment for improvement in total cholesterol level . Conclusion Tai Chi exercise  improved endothelial dysfunction and arterial stiffness in elderly women with RA , suggesting that it can be a useful behavioral strategy for CVD prevention in patients with RA This study was design ed to determine whether a 6-month Tai Chi exercise program can improve self-reported physical functioning limitations among healthy , physically inactive older individuals . Ninety-four community residents ages 65 to 96 ( M age = 72.8 years , SD = 5.1 ) volunteered to participate in the study . Participants were r and omly assigned to either a 6-month experimental ( Tai Chi ) group ( n = 49 ) , which exercised twice per week for 60 min , or a wait-list control group ( n = 45 ) . A 6-item self-report physical functioning scale , assessing the extent of behavioral dysfunction caused by health problems , was used to evaluate change in physical functioning limitations as a result of Tai Chi intervention . Results indicated that compared to the control group , participants in the Tai Chi group experienced significant improvements in all aspects of physical functioning over the course of the 6-month intervention . Overall , the experimental group had 65 % improvement across all 6 functional status measures ranging from daily activities such as walking and lifting to moderate-vigorous activities such as running . It was concluded that the 6-month Tai Chi exercise program was effective for improving functional status in healthy , physically inactive older adults . A self-paced and self-controlled activity such as Tai Chi has the potential to be an effective , low-cost means of improving functional status in older persons Abstract Objectives To determine the effectiveness of tai chi interventions compared with aerobic exercise , a current core st and ard treatment in patients with fibromyalgia , and to test whether the effectiveness of tai chi depends on its dosage or duration . Design Prospect i ve , r and omized , 52 week , single blind comparative effectiveness trial . Setting Urban tertiary care academic hospital in the United States between March 2012 and September 2016 . Participants 226 adults with fibromyalgia ( as defined by the American College of Rheumatology 1990 and 2010 criteria ) were included in the intention to treat analyses : 151 were assigned to one of four tai chi groups and 75 to an aerobic exercise group . Interventions Participants were r and omly assigned to either supervised aerobic exercise ( 24 weeks , twice weekly ) or one of four classic Yang style supervised tai chi interventions ( 12 or 24 weeks , once or twice weekly ) . Participants were followed for 52 weeks . Adherence was rigorously encouraged in person and by telephone . Main outcome measures The primary outcome was change in the revised fibromyalgia impact question naire ( FIQR ) scores at 24 weeks compared with baseline . Secondary outcomes included changes of scores in patient ’s global assessment , anxiety , depression , self efficacy , coping strategies , physical functional performance , functional limitation , sleep , and health related quality of life . Results FIQR scores improved in all five treatment groups , but the combined tai chi groups improved statistically significantly more than the aerobic exercise group in FIQR scores at 24 weeks ( difference between groups=5.5 points , 95 % confidence interval 0.6 to 10.4 , P=0.03 ) and several secondary outcomes ( patient ’s global assessment = 0.9 points , 0.3 to 1.4 , P=0.005 ; anxiety=1.2 points , 0.3 to 2.1 , P=0.006 ; self efficacy=1.0 points , 0.5 to 1.6 , P=0.0004 ; and coping strategies , 2.6 points , 0.8 to 4.3 , P=0.005 ) . Tai chi treatment compared with aerobic exercise administered with the same intensity and duration ( 24 weeks , twice weekly ) had greater benefit ( between group difference in FIQR scores=16.2 points , 8.7 to 23.6 , P<0.001 ) . The groups who received tai chi for 24 weeks showed greater improvements than those who received it for 12 weeks ( difference in FIQR scores=9.6 points , 2.6 to 16.6 , P=0.007 ) . There was no significant increase in benefit for groups who received tai chi twice weekly compared with once weekly . Participants attended the tai chi training sessions more often than participants attended aerobic exercise . The effects of tai chi were consistent across all instructors . No serious adverse events related to the interventions were reported . Conclusion Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise , the current most commonly prescribed non-drug treatment , for a variety of outcomes for patients with fibromyalgia . Longer duration of tai chi showed greater improvement . This mind-body approach may be considered a therapeutic option in the multidisciplinary management of fibromyalgia . Trial registration Clinical Trials.gov NCT01420640 OBJECTIVE To evaluate the effects of two exercise approaches , Tai Chi ( TC ) and computerized balance training ( BT ) , on specified primary outcomes ( biomedical , functional , and psychosocial indicators of frailty ) and secondary outcomes ( occurrence of falls ) . DESIGN The Atlanta FICSIT ( Frailty and Injuries : Cooperative Studies of Intervention Techniques ) , a prospect i ve , r and omized , controlled clinical trial with three arms ( TC , BT , and education [ ED ] . Intervention length was 15 weeks , with primary outcomes measured before and after intervention and at 4-month follow-up . Falls were monitored continuously throughout the study . SETTING Persons aged 70 and older living in the community . PARTICIPANTS A total of 200 participants , 162 women and 38 men ; mean age was 76.2 . MEASUREMENTS Biomedical ( strength , flexibility , cardiovascular endurance , body composition ) , functional ( IADL ) , and psychosocial well-being ( CES-D scale , fear of falling question naire , self-perception of present and future health , mastery index , perceived quality of sleep , and intrusiveness ) variables . RESULTS Grip strength declined in all groups , and lower extremity range of motion showed limited but statistically significant changes . Lowered blood pressure before and after a 12-minute walk was seen following TC participation . Fear of falling responses and intrusiveness responses were reduced after the TC intervention compared with the ED group ( P = .046 and P = .058 , respectively ) . After adjusting for fall risk factors , TC was found to reduce the risk of multiple falls by 47.5 % . CONCLUSIONS A moderate TC intervention can impact favorably on defined biomedical and psychosocial indices of frailty . This intervention can also have favorable effects upon the occurrence of falls .  Tai Chi warrants further study as an exercise treatment to improve the health of older people OBJECTIVE Evaluate effectiveness of the Arthritis Foundation Tai Chi Program for community participants with arthritis . METHODS 343 individuals were r and omized to either the intervention or wait-list control group .  Performance and self-reported outcome ( SRO ) measures were assessed at baseline and eight weeks . At one year , SROs only were assessed . Adjusted means were determined using regression models adjusting for covariates , and effect sizes ( ES ) were calculated . RESULTS Average participant age was 66 years , 87 % were female , and 87 % were Caucasian . Among 284 ( 83 % ) participants who returned at eight weeks , balance by reach ( ES = 0.30 ) and helplessness , sleep , and role participation satisfaction ( ES = 0.24 - 0.54 ) improved significantly ; pain , fatigue , and stiffness improvement ( ES = 0.15 - 0.23 ) approached significance . No change was noted in mobility , lower extremity strength , or single-leg stance balance . At one year , improvements in pain , fatigue , stiffness , helplessness , and role participation satisfaction at eight weeks were maintained ; 30 % continued tai chi practice . CONCLUSION Moderate effectiveness of the Arthritis Foundation Tai Chi Program was confirmed Previous research ers have found that 10-form Tai chi yields symptomatic benefit in patients with fibromyalgia ( FM ) . The purpose of this study was to further investigate earlier findings and add a focus on functional mobility . We conducted a parallel-group r and omized controlled trial FM-modified 8-form Yang-style Tai chi program compared to an education control . Participants met in small groups twice weekly for 90 min over 12 weeks . The primary endpoint was symptom reduction and improvement in self-report physical function , as measured by the Fibromyalgia Impact Question naire ( FIQ ) , from baseline to 12 weeks . Secondary endpoints included pain severity and interference ( Brief Pain Inventory ( BPI ) , sleep ( Pittsburg sleep Inventory ) , self-efficacy , and functional mobility . Of the 101 r and omly assigned subjects ( mean age 54 years , 93 % female ) , those in the Tai chi condition compared with the education condition demonstrated clinical ly and statistically significant improvements in FIQ scores ( 16.5 vs. 3.1 , p = 0.0002 ) , BPI pain severity ( 1.2 vs. 0.4 , p = 0.0008 ) , BPI pain interference ( 2.1 vs. 0.6 , p = 0.0000 ) , sleep ( 2.0 vs. −0.03 , p = 0.0003 ) , and self-efficacy for pain control ( 9.2 vs. −1.5 , p = 0.0001 ) . Functional mobility variables including timed get up and go ( −.9 vs. −.3 , p = 0.0001 ) , static balance ( 7.5 vs. −0.3 , p = 0.0001 ) , and dynamic balance ( 1.6 vs. 0.3 , p = 0.0001 ) were significantly improved with Tai chi compared with education control . No adverse events were noted . Twelve weeks of Tai chi , practice twice weekly , provided worthwhile improvement in common FM symptoms including pain and physical function including mobility .  Tai chi appears to be a safe and an acceptable exercise modality that may be useful as adjunctive therapy in the management of FM patients . ( Clinical Trials.gov Identifier , NCT01311427 The effects of hydroxychloroquine and sulphasalazine on progression of joint damage shown by X-rays were compared in a double-blind , r and omised trial in 60 patients with rheumatoid arthritis not previously treated with slow-acting antirheumatic drugs .  X-rays of the h and s and feet at the start and after 24 and 48 weeks of treatment were available for 28 patients treated with hydroxychloroquine  and 22 treated with sulphasalazine .  Erosions and joint space narrowing were scored by a single observer unaware of treatment . At baseline there were no significant differences in demographic , clinical , or radiographic characteristics between the treatment groups . Patients withdrawn because of lack of effect were included in the analysis . The median number of erosions was lower in the sulphasalazine than the hydroxychloroquine group at 24 weeks of treatment ( 2.5 vs 10 ) and the difference was significant at 48 weeks ( 5 vs 16 ; p less than 0.02 ) . The difference in median total score of joint damage was significant at 24 weeks ( 6.5 vs 17 ; p less than 0.02 ) and at 48 weeks ( 8 vs 33 ; p less than 0.02 ) . The increase in number of erosions and total score was significantly greater in the hydroxychloroquine than the sulphasalazine group , both after 24 weeks and after 48 weeks of treatment [ Purpose ] This study was to examine the effects of tai chi on  low back pain in young males . [ Subjects and Methods ] Forty males in their 20s with low back pain were r and omly assigned to two groups . Tai chi was applied to one group , and stretching was applied to the other group . The subjects conducted exercise for one hour , three times per week for four weeks . They performed warm-up exercises for 10 min at the beginning and end of the sessions and conducted the main exercise for 40 minutes . Wireless surface electromyography ( sEMG ) and a visual analogue scale ( VAS ) were employed to measure muscle activity and pain , respectively . [ Results ] There were significant differences between the two groups in pain and muscle activity . The tai chi group ’s VAS decreased from 3.1 to 2.1 , and its muscle activity decreased from 21.5 % maximum voluntary isomeric contraction ( MVIC ) to 16.4 % MVIC . The stretching group ’s VAS decreased from 3.4 to 2.8 , and its muscle activity decreased from 24.1 % MVIC to 22.1 % MVIC . [ Conclusion ] Tai chi is more effective for low back pain in males in their 20s than stretching . Tai chi can be considered an effective method to reduce low back pain in males in their 20s & NA ;  Pain intensity is frequently measured on an 11‐point pain intensity numerical rating scale ( PI‐NRS ) , where 0=no pain and 10=worst possible pain . However , it is difficult to interpret the clinical importance of changes from baseline on this scale ( such as a 1‐ or 2‐point change ) . To date , there are no data driven estimates for clinical ly important differences in pain intensity scales used for chronic pain studies . We have estimated a clinical ly important difference on this scale by relating it to global assessment s of change in multiple studies of chronic pain . Data on 2724 subjects from 10 recently completed placebo‐controlled clinical trials of pregabalin in diabetic neuropathy , postherpetic neuralgia , chronic low back pain , fibromyalgia , and osteoarthritis were used . The studies had similar design s and measurement instruments , including the PI‐NRS , collected in a daily diary , and the st and ard seven‐point patient global impression of change ( PGIC ) , collected at the endpoint . The changes in the PI‐NRS from baseline to the endpoint were compared to the PGIC for each subject . Categories of ‘ much improved ’ and ‘ very much improved ’ were used as determinants of a clinical ly important difference and the relationship to the PI‐NRS was explored using graphs , box plots , and sensitivity/specificity analyses . A consistent relationship between the change in PI‐NRS and the PGIC was demonstrated regardless of study , disease type , age , sex , study result , or treatment group . On average , a reduction of approximately two points or a reduction of approximately 30 % in the PI‐NRS represented a clinical ly important difference . The relationship between percent change and the PGIC was also consistent regardless of baseline pain , while higher baseline scores required larger raw changes to represent a clinical ly important difference . The application of these results to future studies may provide a st and ard definition of clinical ly important improvement in clinical trials of chronic pain therapies . Use of a st and ard outcome across chronic pain studies would greatly enhance the comparability , validity , and clinical applicability of these studies OBJECTIVE To determine the effect on balance and strength of 3 months of intensive balance and /or weight training followed by 6 months of low intensity Tai Chi training for maintenance of gains . DESIGN R and omized control intervention . Four groups in 2 x 2 design : Control , Balance , Strength , Balance + Strength , using blinded testers . SETTING Exercise and balance laboratory at University of Connecticut Health Center . PARTICIPANTS Subjects were 110 healthy community dwellers ( mean age 80 ) who were free of dementia , neurological disease , and serious cardiovascular or musculoskeletal conditions . INTERVENTIONS Short-term training ( 3 months ) occurred 3 times/week ( 45 minutes Balance and Strength , 90 minutes Balance + Strength ) . Balance training included equilibrium control exercises of firm and foam surfaces and center-of-pressure biofeedback . Strengthening consisted of lower extremity weight-lifting . All subjects than received long-term group Tai Chi instruction ( 6 months , 1 hour , 1 time/week ) . MEASUREMENTS Losses of balance during Sensory Organization Testing ( LOB ) , single stance time ( SST ) , voluntary limits of stability ( FBOS ) , summed isokinetic torque of eight lower extremity movements ( ISOK ) , and usual gait velocity ( GVU ) . RESULTS AND CONCLUSIONS Balance training meaningfully improved all balance measures by restoring performance to a level analogous to an individual 3 to 10 years younger : LOB = -2.0 + /- 0.3 ( adjusted paired differences , P < .005 ANOVA ) ; SST = 7.0 + /- 1.2 sec ; and FBOS = 9.0 + /- 2.0 % of foot length ( P < .05 ) . Strengthening increased ISOK by 1.1 + /- 0.1 Nm kg-1 ( P < .005 ) . There was no interaction between balance and strength training . Significant gains persisted after 6 months of Tai Chi , although there was some decrement Reporting harms may cause more trouble and discredit than the fame and glory associated with successful reporting of benefits ( 1 ) . The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement , a checklist ( Table 1 ) flow diagram first published in 1996 and revised 5 years later ( 2 , 3 ) , is an effort to st and ardize , and thereby improve , published reports of r and omized , controlled trials ( RCTs ) . One of the additions to the 2001 revision was an item about reporting adverse events . This single item did not do full justice to the importance of harms-related issues . The CONSORT Group met in September 2001 to discuss how to correct this deficiency . We aim ed to provide evidence -based guidance on the reporting of harms in RCTs . First , we search ed MEDLINE , EMBASE , Web of Science , and the Cochrane Library using a wide array of terms related to harms and identified pertinent evidence . We also communicated with experts and review ed bibliographies of identified articles to find additional studies . At a meeting in Montebello , Quebec , Canada , in May 2003 , CONSORT Group members , including several journal editors and additional experts in related fields , held a structured discussion of recommendations about reporting of harms-related issues in RCTs . The discussion s led to a written document that we circulated among the team members for comment . The present manuscript describes our recommendations on the appropriate reporting of harms in RCTs . Table 1 . Original CONSORT Checklist The terminology of harms-related issues in RCTs is confusing and often misleading or misused ( see Glossary ) ( 4 , 5 ) . Safety is a reassuring term that may obscure the real and potentially major harms that drugs and other interventions may cause . We encourage authors to use the term harms instead of safety . In addition to misused terminology , reporting of harms in RCTs has received less attention than reporting of efficacy and effectiveness and is often inadequate ( 6 - 14 ) . In short , both scientific evidence and ethical necessity call for action to improve the quality of reporting of harms in RCTs ( 15 , 16 ) . Here , we present a set of recommendations and accompanying explanations for the proper reporting of harms in RCTs . These recommendations should complement the existing CONSORT statement ( Table 2 ) . Examples are presented on the Annals and CONSORT ( www.consort-statement.org ) Web sites . Table 2 . Checklist of Items To Include When Reporting Harms in R and omized , Controlled Trials Recommendations Title and Abstract Recommendation 1 . If the study collected data on harms and benefits , the title or abstract should so state . The title should mention harms if the study of harms was a key trial objective . Many phase I and phase II trials , some phase II/III trials , and most phase IV trials ( 17 , 18 ) target harms as primary outcomes . Yet , the title and abstract seldom contain the word harm . Among 375143 entries in the Cochrane Central Register of Controlled Trials ( Cochrane Library , issue 3 , 2003 ) , search ing titles with the search terms harm or harms yielded 337 references ( compared with 55374 for efficacy and 23415 for safety ) . Of the 337 , excluding several irrelevant articles on self-harm or harm reduction , only 3 trial reports and 2 abstract s contained the word harm in their titles . Authors should present information on harms in the abstract . If no important harms occurred , authors should so state . Explicit reference to the reporting of adverse events in the title or abstract is also important for appropriate data base indexing and information retrieval ( 19 ) . Introduction Background Recommendation 2 . If the trial addresses both harms and benefits , the introduction should so state . The introduction states the scientific background and rationale of an RCT . This requires a balanced presentation whereby the possible benefits of the intervention under investigation are outlined along with the possible harms associated with the treatment . R and omized , controlled trials that focus primarily on harms should clearly state this interest when describing the study objectives in the Introduction and in defining these objectives in the Methods . Methods Outcomes Recommendation 3 . List addressed adverse events with definitions for each ( with attention , when relevant , to grading , expected vs. unexpected events , reference to st and ardized and vali date d definitions , and description of new definitions ) . The Methods section should succinctly define the recorded adverse events ( clinical and laboratory ) . Authors should clarify whether the reported adverse events encompass all the recorded adverse events or a selected sample . They should explain how , why , and who selected adverse events for reporting . In trials that do not mention harms-related data , the Methods section should briefly explain the reason for the omission ( for example , the design did not include the collection of any information on harms ) . Authors should also be explicit about separately reporting anticipated and unexpected adverse events . Expectation may influence the incidence of reported or ascertained adverse events . Making participants aware in the consent form of the possibility of a specific adverse event ( priming ) may increase the reporting rate of the event ( 20 ) . Another example of priming is the finding that the rates of withdrawals due to adverse events and the rates of specific adverse events were significantly higher in trials of aspirin , diclofenac , or indomethacin with comparator drugs compared with placebo-controlled trials ( 21 ) . Presumably , participants were more eager to come forth and report an adverse event or to withdraw from treatment when they knew they could not be receiving inactive placebo . Authors should report whether they used st and ardized and vali date d measurement instruments for adverse events . Several medical fields have developed st and ardized scales ( 22 - 32 ) . Use of nonvali date d scales is common . The source document for well-established definitions and scales should be referenced . New definitions for adverse events should be explicit and clear . Authors should describe how they developed and vali date d new scales . For interventions that target healthy individuals ( for example , many preventive interventions ) , any harm , however minor , may be important to capture and report because the balance of harms and benefits may easily lean toward harms in a low-risk population . For other population s and for interventions that improve major outcomes ( for example , survival ) , severe and life-threatening adverse events may be the only ones that are important in the balance of benefits and harms . Recommendation 4 . Clarify how harms-related information was collected ( mode of data collection , timing , attribution methods , intensity of ascertainment , and harms-related monitoring and stopping rules , if pertinent ) . It is important to describe the question naires , interviews , and tests used to collect information on harms , as well as their timing during follow-up . Passive surveillance of harms leads to fewer recorded adverse events than active surveillance ( 4 ) . Open-ended questions may yield different information , both quantitatively and qualitatively , than structured question naires ( 33 ) . Studies of nonsteroidal , anti-inflammatory drugs ( NSAIDs ) exemplify how data collection methods can affect the detection and reporting of harms . When selective NSAIDs with fewer gastrointestinal adverse events became available , trials reported more than 10 times as many ulcers when comparing these drugs with older NSAIDs as when older NSAIDs were compared with placebo . In the newer trials , more ulcers were detected because participants had regular endoscopy , and the case definition of ulcers was more sensitive ( 34 ) . Authors should specify the time frame of surveillance for adverse events . Some investigators stop recording adverse events at the end of the intervention period or a certain number of days afterward ( for example , 30 days after discontinuation of drug therapy ) and miss events with long latency ( 35 ) . Surgical trials often capture only the adverse events that occur intraoperatively . Several important surgical complications are likely to occur later . Finally , in crossover trials , delayed events might occur while the patient is taking a subsequent assigned treatment . Attribution is the process of deciding whether an adverse event is related to the intervention . Whenever authors filter events through an attribution process , they should state who makes the attribution ( investigators , participants , sponsors , or combinations ) , whether the process is blinded to assigned treatment , and what definitions of adverse events they use ( 4 ) . Discontinuations and withdrawals due to adverse events are especially important because they reflect the ultimate decision of the participant and /or physician to discontinue treatment . Although treatment may occasionally be discontinued for mild or moderate adverse events , attributing discontinuation to a specific reason ( to toxicity , lack of efficacy , other reasons , or combinations of reasons ) may be difficult . For example , in psychopharmacology , dropouts may reflect treatment ineffectiveness as much as toxicity-related intolerance ( 36 ) . Trial reports should specify who gave the reasons for discontinuation ( participants or physicians ) and whether attribution was blinded to the assigned treatment . For example , even in blinded trials , participants and their clinicians are often unblinded before they decide whether to discontinue the intervention . It is important to report participants who are nonadherent or lost to follow-up because their actions may reflect their inability to tolerate the intervention . Moreover , authors should specify how they h and led withdrawals in the analyses of the data . R and omized , controlled trials should report any plan for monitoring for harms and rules for stopping the trial because of harms ( 37 ) . They should clarify whether stopping guidelines examine benefits and harms Background and Purpose : Tai Chi ( TC ) is a form of low to moderate physical activity that has been shown to significantly impact health and functional fitness among older adults ; the impact of TC on the health and functional fitness of older adults with arthritis is not well understood . The purpose of this study was to assess the effectiveness of a 16-week TC intervention for improving functional fitness and self-reported general health among older adults with arthritis who were born outside Canada and were residing in low-income neighborhoods . Methods : A 16-week intervention was conducted among older adults residing in 1 of 2 specified low-income neighborhoods in Canada . The analysis was limited to those who self-reported having arthritis ( n = 102 ) . Participants were encouraged to attend 2 moderate-intensity TC sessions per week for a total of 120 minutes . Functional fitness and health were assessed at baseline and at 16 weeks . Results : Average attendance was 1.1 sessions per week . Functional fitness assessment results indicated that right-h and grip strength ( 25.6 ± 8.2 to 26.7 ± 7.8 kg ) , left-h and grip strength ( 24.9 ± 7.3 to 26.8 ± 7.1 kg ) , 30-second arm curl ( 15.6 ± 5.0 to 18.6 ± 5.7 repetitions/30 s ) , Timed Up- and -Go ( 7.4 ± 2.6 to 6.9 ± 2.6 s ) , and 30-second chair st and ( 12.0 ± 3.9 to 15.4 ± 5.8 s ) improved significantly ( P < 0.05 ) from baseline to 16 weeks . Results from the Short Form-36 indicate that physical functioning ( 73.1 ± 19.9 to 80.3 ± 19.4 ; P = 0.001 ) , general health ( 61.5 ± 20.9 to 66.0 ± 20.4 ; P = 0.03 ) , vitality ( 61.5 ± 18.9 to 67.5 ± 20.2 ; P = 0.008 ) , and mental health ( 74.3 ± 16.5 to 78.5 ± 17.7 ; P = 0.04 ) also improved significantly over the intervention period . Improvements in physical health and physical function scores were clinical ly meaningful . Discussion and Conclusions : Participating in TC for 16 weeks led to significant improvements in functional fitness and components of physical and mental health among older adults with self-reported arthritis . Tai Chi seems to be a valuable mode of physical activity for this population The objective was to study the long-term effect ( 2 years ) of different training programs in patients with rheumatoid arthritis . The method was a r and omized trial with 75 patients participating . The measured variables included morning stiffness , a pain score , number of swollen joints , a health assessment score , a functional score , ESR , Hb , the cost of medicine , and progression using X-rays of h and s and feet . The results showed no effect of training on the disease activity or on the progression of the disease . The conclusion is that although most patients are in favour of training , the present study does not support that training lessons per se affect the disease activity or the progression of the disease In a prospect i ve follow-up study of patients with early-onset rheumatoid arthritis , the prevalence of remission according to the 1981 American Rheumatism Association ( ARA ) preliminary criteria was evaluated . A total of 227 patients with a median follow-up of 3.9 yr and a total of 2832 follow-up visits were studied . The ARA remission criteria were fulfilled in 9.5 % of these visits . The percentage of patients with at least one visit fulfilling the ARA criteria was for years 2 - 6 approximately 25 % . Each year , approximately 15 % of the patients were in remission for at least two consecutive visits . A comparison was made between the ARA remission criteria and the Disease Activity Score ( DAS ) . DAS < 1.6 corresponded with being in remission according to the ARA criteria . The DAS is being proposed as a tool to define remission because absence of disease activity should be measured using the same method as for higher levels of disease activity , preferably on a continuous scale & NA ; The purpose of this study was to determine the levels of change on st and ard pain scales that represent clinical ly important differences to patients . Data from analgesic studies are often difficult to interpret because the clinical importance of the results is not obvious . Differences between groups , as summarized by a change in mean values over time , can be difficult to apply to clinical care . Baseline scores vary widely and group mean differences could reflect large changes in a few patients , small changes in many patients , or any combination of these outcomes . Determination of the proportion of patients who have a clinical ly important improvement in their pain would provide a more interpretable result with direct clinical implication s. However , determining a clinical ly important outcome requires information about the degree of change over time that is clinical ly important . Data from the titration phase of a multiple cross‐over r and omized clinical trial of oral transmucosal fentanyl citrate ( OTFC )  for the treatment of cancer‐related breakthrough pain were re‐analyzed to examine the differences in pain scores between treatment episodes that did and did not yield adequate pain relief . The scales evaluated were absolute pain intensity difference ( PID , 0–10 scale ) , percentage pain intensity difference ( PID% , 0–100 % scale ) , pain relief ( PR , 0 ( none ) , 1 ( slight ) , 2 ( moderate ) , 3 ( lots ) , 4 ( complete ) ) , sum of the pain intensity difference ( SPID over 60 min ) , percentage of maximum total pain relief ( % Max TOTPAR over 60 min ) , and global medication performance ( 0 ( poor ) , 1 ( fair ) , 2 ( good ) , 3 ( very good ) , 4 ( excellent ) ) . Adequate relief was defined by the patient 's decision not to use another dose of opioid medication as a rescue , in addition to the study medication , to treat each painful episode . One hundred thirty OTFC naive patients contributed data on 1268 episodes of breakthrough pain . The scales that were converted to a percentage change yielded the best accuracy in predicting adequate relief , with balanced sensitivity and specificity . The best cut‐off point for both the % Max TOTPAR and the PID% was 33 % . The best cut‐off points for the absolute scales were absolute pain intensity difference of 2 , pain relief of 2 ( moderate ) , and SPID of 2 . The global medication performance of 2 ( good ) had excellent values as well . This study presents data ‐derived cut‐off points for the changes in several pain scales , each reflecting the clinical ly important improvement for patients treating breakthrough cancer pain episodes with OTFC . Confirmation in other patient population s and different pain syndromes will be needed . The use of consistent clinical ly important cut‐off points as the primary outcome in future pain therapy clinical trials will enhance their validity , comparability , and clinical applicability This study examined the efficacy of an exercise and relaxation program for adults with rheumatoid arthritis . The program integrates principles of occupational therapy and T'ai-Chi Ch'uan and was expected to be more effective than traditional exercise and rest regimens because of its expressive and pleasurable elements . There were significant differences between 17 experimental and 16 control subjects on two categories of dependent variables after the former group 's participation in the experimental program . These dependent variables were range of motion measures and subject self-reports of frequency , enjoyment , and benefits of home exercise and rest routines . Pretest , posttest , and 4-month follow-up data were analyzed . Program participants showed significantly greater upper extremity range of motion 4 months after completing the program although the reported frequency of exercise and rest was greater in the control group . Postprogram reports of enjoyment were significantly higher for experimental than for control subjects . If these initial results are confirmed in further studies , the efficacy of the use of purpose ful activity for exercise and rest will be supported . This study also supports the integration of Eastern and Western frames of reference in the treatment of patients with chronic illness Twenty-three patients with rheumatoid arthritis ( RA ) have been given physical training for 4 to 8 years . To compare , we have had a control group of equal size and with the same disease severity . The training program consisted of home-training and for most of the patients also group-training led by a physiotherapist . During the observation period we have found a significantly less pronounced progress of X-ray changes in the joints of the active patients compared with control patients . Physiological tests and clinical parameters , including sick-pension and sick-leave , show unanimously a better disease outcome in the active group of patients . There is probably a risk of overuse or disuse of the joints in RA but we believe that it is better to be overactive rather than the reverse . As in many other diseases , the general prescription of rest in RA is not adequate This study examines the effect of two different exercise approaches on balance and frailty measures among more than 200 community-dwelling individuals greater than 70 years of age .  Exercises are provided for 15 weekly sessions on an individual basis for participants r and omly assigned to a Balance Training group . Training consists of center-of-mass feedback displayed on a motor under static conditions , or , in later sessions , as the floor surface is moved , with eyes open or closed . This high technology interface provides instantaneous information about displacement of body weight in space so that balance can be enhanced . An alternative procedure is comparatively simple and requires little expense or space . Tai Chi Quan was originally developed as a martial arts form but has been used for centuries in China as an exercise among elderly citizens . Participants r and omly assigned to this intervention meet twice weekly for 15 weeks to learn a condensation of 108 Tai Chi forms into 10 that emphasize movement components often restricted or absent with aging . A third group serves as a control for exercise interventions by meeting weekly for 15 sessions to discuss topics of interest such as memory loss , drug management , and nutrition . All subjects are screened prior to assignment , and a host of physical , behavioral , and functional measures are assessed before and after the intervention as well as 4 months later . Measurements unique to the Atlanta site include : balance with eyes closed , programmed force-distribution changes when stance is perturbed , cardiovascular assessment s , WAIS , Affects Balance Scale , and a survey of home environment AIMS AND OBJECTIVES ( i ) To assess the effectiveness of Tai Chi exercise in people with rheumatoid arthritis ( RA ) . ( ii ) To ascertain if Tai Chi and auricular acupressure have a potentiation effect in controlling pain . ( iii ) To evaluate the acceptability and enjoyment of the classes . BACKGROUND Tai Chi has been suggested as a suitable exercise for people with arthritis and specific programmes have been developed . Auricular acupressure is a therapeutic method by which points on the ear are stimulated to treat various disorders . DESIGN A pragmatic non-r and omised before/after study to compare the effects of the interventions . METHODS People with RA ( n=21 ) were recruited and allocated into two groups . Both groups followed a Tai Chi exercise programme , twice a week for 12 weeks , but one group ( n=14 ) had , in addition , the auricular acupressure .  Physical symptoms and function , pain , quality of life and self-efficacy were measured in both groups before and after the programme . Acceptability and enjoyment were assessed at the end . RESULTS At 12 weeks , both groups had achieved statistically significant improvements in balance , grip strength , pinch strength , 50 foot walk time self reported joint pain , swollen joint count , tender joint count and in self efficacy in relation to pain control . All participants stated that they enjoyed the classes . There was no evidence to suggest that the auricular acupressure enhanced the effects of the Tai Chi intervention . CONCLUSION The classes appeared to be mentally as well as physically helpful to participants . RELEVANCE TO CLINICAL PRACTICE People with a chronic debilitating disease such as RA should be encouraged to undertake gentle strengthening exercise such as Tai Chi because of its potential for physical and psychological improvements BACKGROUND / AIMS Rheumatoid arthritis ( RA ) is a serious health problem result ing in significant morbidity and disability .  Tai Chi may be beneficial to patients with RA as a result of effects on muscle strength and ' mind-body ' interactions . To obtain preliminary data on the effects of Tai Chi on RA , we conducted a pilot r and omized controlled trial . Twenty patients with functional class I or II RA were r and omly assigned to Tai Chi or attention control in twice-weekly sessions for 12 weeks . The American College of Rheumatology ( ACR ) 20 response criterion , functional capacity , health-related quality of life and the depression index were assessed . RESULTS At 12 weeks , 5/10 patients ( 50 % ) r and omized to Tai Chi achieved an ACR 20 % response compared with 0/10 ( 0 % ) in the control ( p = 0.03 ) . Tai Chi had greater improvement in the disability index ( p = 0.01 ) , vitality subscale of the Medical Outcome Study Short Form 36 ( p = 0.01 ) and the depression index ( p = 0.003 ) . Similar trends to improvement were also observed for disease activity , functional capacity and health-related quality of life . No adverse events were observed and no patients withdrew from the study . CONCLUSION Tai Chi appears safe and may be beneficial for functional class I or II RA . These promising results warrant further investigation into the potential complementary role of Tai Chi for treatment of RA
BACKGROUND Rheumatoid arthritis ( RA ) is a chronic , systemic , inflammatory , autoimmune disease that results in joint deformity and immobility of the musculoskeletal system .
The major goals of treatment are to relieve pain , reduce inflammation , slow down or stop joint damage , prevent disability , and preserve or improve the person 's sense of well-being and ability to function .
Tai Chi , interchangeably known as Tai Chi Chuan , is an ancient Chinese health-promoting martial art form that has been recognized in China as an effective arthritis therapy for centuries .
This is an up date of a review published in 2004 .
OBJECTIVES To assess the benefits and harms of Tai Chi as a treatment for people with rheumatoid arthritis ( RA ) .