Tai Chi Outperforms Aerobic Exercise for Lowering Blood Pressure in Prehypertension

A study in JAMA Network Open China compared Tai Chi to aerobic exercise for reducing blood pressure in people with prehypertension. Both groups exercised 4 times a week for 12 months. After 12 months, the Tai Chi group had a significantly bigger drop in systolic blood pressure compared to the aerobic exercise group. They also had lower 24-hour and nighttime blood pressure readings. While some diastolic blood pressure reductions were observed, they weren't statistically significant at all time points

Key Points

Background: Having prehypertension (slightly elevated blood pressure) increases the risk of developing full-blown hypertension and other cardiovascular diseases. This study compared the effectiveness of Tai Chi and aerobic exercise in reducing blood pressure among people with prehypertension.

Methods: Researchers conducted a randomized clinical trial involving 342 adults aged 18–65 with prehypertension. Participants were randomly assigned to either a Tai Chi group (173 people) or an aerobic exercise group (169 people). Both groups participated in four, 60-minute supervised sessions per week for 12 months.

Outcomes: The primary outcome was the change in systolic blood pressure (SBP) measured in the office setting after 12 months. Secondary outcomes included SBP and diastolic blood pressure (DBP) measured at 6 and 12 months, and 24-hour ambulatory blood pressure readings at 12 months.

Results:

• The Tai Chi group had a significantly greater decrease in office SBP compared to the aerobic exercise group after 12 months (-7.01 vs. -4.61 mm Hg).

• Similar results were seen for office SBP at 6 months, 24-hour ambulatory SBP at 6 months, and nighttime SBP at 12 months.

• There were no significant differences observed in DBP between the groups.

Conclusions:

• This study suggests that Tai Chi may be more effective than aerobic exercise in reducing blood pressure among people with prehypertension.

• These findings could potentially aid in preventing cardiovascular diseases in this population.

Additional Notes:

• This study was conducted in China and may not be generalizable to other populations.

• More research is needed to confirm these findings and understand the mechanisms by which Tai Chi might lower blood pressure.

Prehypertension, a condition characterized by slightly elevated blood pressure levels, has emerged as a significant health concern globally. Defined as a systolic blood pressure (SBP) ranging from 120 to 139 mm Hg and/or diastolic blood pressure (DBP) ranging from 80 to 89 mm Hg, prehypertension was first introduced by the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in 2003. The prevalence of prehypertension is alarming, with approximately 50.9% of adults without a history of hypertension falling into this category, as revealed by the Chinese Adult Hypertension Survey published in 2021.

Risks Associated with Prehypertension

Prehypertension poses a considerable risk for the development of hypertension and cardiovascular diseases, including coronary heart disease, cerebrovascular disease, and myocardial infarction. Moreover, individuals with prehypertension are susceptible to target organ damage, such as early arteriosclerosis and left ventricular dysfunction. Recognizing these risks underscores the importance of early intervention and treatment strategies to mitigate the progression to hypertension and prevent organ damage.

Exercise as a Key Intervention

Mounting evidence supports the efficacy of exercise interventions in reducing blood pressure levels among individuals with hypertension or prehypertension. Guidelines advocate for exercise as a primary approach in the treatment and management of prehypertension, given its potential to enhance lifestyles and its cost-effectiveness compared to pharmacological interventions. While aerobic exercise is a recommended modality for blood pressure reduction, its implementation may be hindered by space requirements and potential joint strain.

Tai Chi: A Promising Alternative

Tai Chi, a traditional Chinese mind-body exercise, has garnered attention for its benefits in improving balance, cardiovascular health, and respiratory function. Unlike aerobic exercise, Tai Chi offers a low-impact, enjoyable, and economically accessible form of physical activity. Research indicates that Tai Chi interventions spanning 12 weeks to 12 months can effectively reduce blood pressure levels. Furthermore, Tai Chi emerges as a viable substitute for aerobic exercise, particularly for individuals with prehypertension.

Participants and Follow-Up:

• 342 participants with prehypertension were randomly assigned to Tai Chi or aerobic exercise groups.

• The study took place between July 2019 and January 2022 in hospitals in China.

• 59 participants (17%) dropped out, leaving 283 (83%) for analysis.

• The average follow-up time was 12 months for both groups.

Outcomes:

• Primary: Change in systolic blood pressure (SBP) after 12 months.

  The Tai Chi group had a significantly greater decrease in SBP compared to the aerobic exercise group (-7.01 vs. -4.61 mm Hg).

• Secondary: change in diastolic blood pressure (DBP) after 6 and 12 months.

  The Tai Chi group had a larger reduction in DBP after 6 months than the aerobic exercise group, but the difference wasn't statistically significant after 12 months.

• 24-hour ambulatory blood pressure readings at 12 months.

  The Tai Chi group had significantly lower 24-hour and nighttime ambulatory SBP compared to the aerobic exercise group.

Clinical Evidence Supporting Tai Chi

Clinical studies comparing Tai Chi with aerobic exercise have demonstrated favorable outcomes in blood pressure reduction. After 12 months of intervention, the mean reduction in office SBP was significantly greater in the Tai Chi group compared to the aerobic exercise group. Similarly, the Tai Chi group exhibited greater reductions in ambulatory SBP, particularly during nighttime measurements. These findings underscore the potential of Tai Chi as an effective strategy for managing prehypertension and reducing cardiovascular risk.

Implications for Clinical Practice

Incorporating Tai Chi into clinical practice holds promise for optimizing blood pressure management and cardiovascular health among individuals with prehypertension. Healthcare providers should consider Tai Chi as a valuable adjunct to conventional interventions, offering patients a holistic approach to blood pressure control. Additionally, promoting Tai Chi within community settings may enhance accessibility and adherence to physical activity recommendations, thereby reducing the burden of prehypertension-related complications.

The findings of a recent randomized clinical trial shed light on the comparative effectiveness of Tai Chi and aerobic exercise in managing prehypertension. Over 12 months, participants engaged in either Tai Chi or aerobic exercise interventions, with outcomes measured in terms of office and ambulatory systolic blood pressure (SBP) levels.

Tai Chi: A Multimodal Mind-Body Exercise

Tai Chi, characterized as a safe, moderate-intensity, multimodal mind-body exercise, offers a progressive approach centered on slow and fluid movements. Suitable for individuals of all ages and physical conditions, Tai Chi promotes body flexibility, balance, and cardiopulmonary function while reducing the risk of falls. Its implementation in community settings provides primary care access for populations with prehypertension, offering group support and hands-on feedback during skill acquisition.

Study Design and COVID-19 Considerations

Despite the challenges posed by the COVID-19 pandemic, the trial successfully maintained normal exercise activities throughout the intervention period. All participants received 12 months of exercise intervention, ensuring consistency in treatment delivery. These efforts align with recent systematic reviews and meta-analyses affirming the blood pressure-lowering effects of exercise interventions.

Comparative Effectiveness

The trial results indicate that Tai Chi demonstrated superior efficacy compared to aerobic exercise in reducing office SBP levels by 2.40 mm Hg. Furthermore, the Tai Chi group exhibited greater reductions in 24-hour and nighttime ambulatory SBP levels. Notably, Tai Chi intervention also led to a significant decrease in nighttime ambulatory pulse rate, potentially attributed to its role in reducing sympathetic excitability.

Implications and Recommendations

The observed benefits of Tai Chi extend beyond blood pressure reduction, encompassing improvements in cardiovascular risk factors such as pulse rate and blood pressure load. These findings underscore the potential of Tai Chi as a holistic approach to prehypertension management, with implications for cardiovascular disease prevention. However, caution is advised when interpreting cardiovascular risk predictions based on existing scoring systems, highlighting the need for further research in this area.

Strengths and Limitations

The study's strengths include a relatively large sample size and a 12-month intervention duration, enhancing scientific validity. However, limitations include the inability to detect potential effects in subgroups and the exploratory nature of secondary outcomes. These findings warrant further investigation to elucidate the long-term effects and potential subpopulation benefits of Tai Chi in prehypertension management.

Conclusion

Prehypertension presents a significant public health challenge, predisposing individuals to hypertension and cardiovascular diseases. Exercise interventions, particularly Tai Chi, offer a promising avenue for blood pressure management and cardiovascular risk reduction. Clinical evidence supports the efficacy of Tai Chi in lowering blood pressure levels and improving cardiovascular outcomes among individuals with prehypertension. Integrating Tai Chi into clinical practice and community-based initiatives can empower individuals to take proactive steps towards better cardiovascular health.

Reference Article

Li, X., Chang, P., Wu, M., Jiang, Y., Gao, Y., Chen, H., Tao, L., Wei, D., Yang, X., Xiong, X., Yang, Y., Pan, X., Zhao, R., Yang, F., Sun, J., Yang, S., Tian, L., He, X., Wang, E., . . . Xing, Y. (2024, February 9). Effect of Tai Chi vs Aerobic Exercise on Blood Pressure in Patients With Prehypertension. JAMA Network Open, 7(2), e2354937. https://doi.org/10.1001/jamanetworkopen.2023.54937

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