Heart failure is a major public health problem in the United States, affecting approximately 5 million adults. Despite recent advances in pharmacological therapy and technological devices, heart failure is the most common reason for hospitalization among Medicare patients and is reaching epidemic proportions as the population ages. New and inexpensive interventions that can improve functional capacity, quality of life, as well as delay disease progression, are needed. Tai Chi is a popular mind-body exercise that is a potential adjunctive treatment for heart disease. Tai Chi incorporates both gentle physical activity and meditation. It may be particularly suited to frail and deconditioned patients with heart failure, but has never been rigorously studied in this population. We conducted a feasibility study of Tai Chi in patients with heart failure (n=30) and found that those randomized to a Tai Chi program significantly improved their exercise capacity (six-minute walk distance), quality-of-life (Minnesota Living with Heart Failure score), and neurohormonal status (serum B-type natriuretic peptide levels) compared to patients who did not participate in Tai Chi. In this application, we propose a randomized controlled trial (n=150) over four years that compares a 12-week Tai Chi program with an education attention control. Patients with chronic stable heart failure (systolic dysfunction, left ventricular ejection fraction <40%, New York Heart Association Class I-IV) will be recruited from outpatient primary care and cardiology clinics. Our primary aim will be to examine Tai Chi's effects on functional capacity and quality-of-life. Secondary aims are designed to further elucidate the mechanism of Tai Chi's effects, including examination of cognitive-behavioral or psychosocial influences (e.g., mood, psychosocial functioning, self-efficacy, beliefs and expectations of mind-body medicine) and Heart Failure-specific physiologic/metabolic processes in response to meditative exercise (e.g., neurohormonal status, heart rate variability and markers of autonomic tone, myocardial structure and function). The results of our proposed research will help define the role of Tai Chi in current heart failure management, further our understanding of the mechanism of action, and provide preliminary analyses of the costs and benefits of treatment.

National Institute of Health (NIH)
National Center for Complementary & Alternative Medicine (NCCAM)
Research Project (R01)
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Special Emphasis Panel (ZRG1-RPHB-B (50))
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Stoney, Catherine
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Beth Israel Deaconess Medical Center
United States
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Yeh, Gloria Y; Mu, Lin; Davis, Roger B et al. (2016) Correlates of Exercise Self-efficacy in a Randomized Trial of Mind-Body Exercise in Patients With Chronic Heart Failure. J Cardiopulm Rehabil Prev 36:186-94
Yeh, Gloria Y; Chan, Caroline W; Wayne, Peter M et al. (2016) The Impact of Tai Chi Exercise on Self-Efficacy, Social Support, and Empowerment in Heart Failure: Insights from a Qualitative Sub-Study from a Randomized Controlled Trial. PLoS One 11:e0154678
Wilker, Elissa H; Yeh, Gloria; Wellenius, Gregory A et al. (2012) Ambient temperature and biomarkers of heart failure: a repeated measures analysis. Environ Health Perspect 120:1083-7
Yeh, Gloria Y; McCarthy, Ellen P; Wayne, Peter M et al. (2011) Tai chi exercise in patients with chronic heart failure: a randomized clinical trial. Arch Intern Med 171:750-7