Over the past 4 decades, the prevalence of obesity in the U.S. has more than tripled to 31%, with over 61 million people currently affected. Obesity is a significant risk factor for death and disability worldwide and, although its prevalence has increased among all segments of the population, there is evidence that this burden is not borne equally by all. Native Hawaiians and Pacific Islanders (NHPI) have rates of obesity that are among the highest in the world (as high as 60%) and, with it, they carry a heavy burden of obesity-related conditions, including cardiovascular disease, diabetes, hypertension, respiratory ailments and cancer. Indeed, data suggest that obese subjects have a health-related quality of life (HRQOL) and functional capacity similar to patients with heart failure. ? The main goal for this pilot study is to evaluate the safety and efficacy of a low-intensity 12- week Tai Chi (TC) mind-body exercise program in a population of predominantly NHPIs with class II-III obesity (BMI>35 kg/m2) and at least one coronary artery disease risk factors. Specifically, our primary aims are to 1) Determine if individuals with obesity randomized to a TC program demonstrate better functional status and exercise tolerance, as measured by the six- minute walk test and cardiopulmonary stress test; and 2) Determine if a 12-week TC program improves HRQOL as measured by the Duke Activity Scale Index and SF-36. Additional aims are to examine the impact of TC on obesity-specific HRQOL (IWQOL-Lite), autonomic tone (heart rate variability), cardiovascular disease risk factors (fasting glucose, HbA1c, lipids, insulin resistance) and measures of obesity (leptin, weight, percent body fat). In addition, we plan to assess if changes observed at the end of the 12-week TC intervention are maintained at 24- weeks if subjects continue to independently practice TC at home daily. Control subjects will meet socially with a duration and frequency similar to the TC group. ? Our study builds on the infrastructure developed by a collaboration between The Queen's Medical Center and the Dept. of Native Hawaiian Health at the University of Hawaii, which is examining heart failure disparities among NHPI. We anticipate that results from this pilot study will enable us to plan a definitive study of the effectiveness and mechanism of action of a Tai Chi mind-body exercise program for obesity. ? Public Health Relevance: This study will evaluate whether a Tai Chi exercise program has beneficial effects compared to a informational group program for very obese patients, including a large percentage of Native Hawaiians/Pacific Islanders. We will evaluate ability to walk, quality of life, and risk factors for heart and vascular diseases, including weight, cholesterol, blood sugar, blood pressure, and exercise capacity. ? ? ?
