Effects of Tai Chi on negative symptoms and activity participation in patients with schizophrenia: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Jiaqi ¹ , KAN Laidi ^{1,2, #} , TANG Xin ³ , KANG Youcun ^1,2 , MA Di ⁴ , HE Jiabei ^1,2 ,  WANG Pu ^1,2

1. School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, 610041, P.R.China;
2. Rehabilitation Medicine Center, West China Hospital of Sichuan University, Chengdu, 610041, P.R.China;
3. Interdisciplinary Division of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong, P.R.China;
4. Rehabilitation Medicine Department, Beijing Tsinghua Changgung Rehabilitation Hospital, Beijing, 102218, P.R.China;

Corresponding author：

WANG Pu, Email: wangpu_03@126.com

Keywords：

Tai Chi; Schizophrenia; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.201604054

Video：

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ObjectiveTo systematically review the effectiveness of Tai Chi for improving negative symptoms and activity participation in patients with schizophrenia. MethodsDatabases including PubMed, The Cochrane Library (Issue 3, 2016), EMbase, CBM, CNKI, VIP and WanFang Data were electronically searched to collect the randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCT) about Tai Chi for improving negative symptoms and activity participation in patients with schizophrenia from inception to Apirl 1^st 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. ResultsA total of three RCTs and two quasi-RCTs were included. The result of meta-analyses showed that no significant difference was found in negative symptom scores (MD=–0.95, 95% CI –3.78 to –1.89, P=0.51) and positive symptoms scores of PANSS (MD=–0.02, 95% CI –0.50 to 0.46, P=0.94) between two groups. However, the Tai Chi group was superior to the control group in items including attention, avolition, anhedonia-asociality, alogia and affective flattening/blunting of SANS (all P values<0.05). ConclusionTai Chi may have positively influence on various negative symptoms in patients with schizophrenia, but no evidence to support the Tai Chi's effects for activities participation. Larger and higher quality studies are needed.

Citation： ZHANGJiaqi, KANLaidi, TANGXin, KANGYoucun, MADi, HEJiabei, WANGPu. Effects of Tai Chi on negative symptoms and activity participation in patients with schizophrenia: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2017, 17(2): 206-212. doi: 10.7507/1672-2531.201604054 Copy

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2.	Schooler NR, Buchanan RW, Laughren T, et al. Defining therapeutic benefit for people with schizophrenia: focus on negative symptoms. Schizophr Res, 2015, 162(1-3): 169-174.
3.	Cara E, MacRae A. Psychosocial Occupational Therapy: An Evolving Practice, 3rd Edition. Delmar Cengage Learning: USA, 2012: 192-215.
4.	曹江. 精神分裂症的治疗策略进展. 医学理论与实践, 2015, 28(17): 2297-2299.
5.	Dlabac-de Lange JJ, Liemburg EJ, Bais L, et al. Effect of rTMS on brain activation in schizophrenia with negative symptoms: A proof-of-principle study. Schizophr Res, 2015, 168(1-2): 475-482.
6.	Brunoni AR, Shiozawa P, Truong D, et al. Understanding tDCS effects in schizophrenia: a systematic review of clinical data and an integrated computation modeling analysis. Expert Rev Med Devices, 2014, 11(4): 383-394.
7.	Vera-Garcia E, Mayoral-Cleries F, Vancampfort D, et al. A systematic review of the benefits of physical therapy within a multidisciplinary care approach for people with schizophrenia: An update. Psychiatry Res, 2015, 229(3): 828-839.
8.	Firth J, Carney R, Jerome L, et al. The effects and determinants of exercise participation in first-episode psychosis: a qualitative study. BMC Psychiatry, 2016, 16(1): 36.
9.	Vancampfort D, Rosenbaum S, Schuch FB, et al. Prevalence and predictors of treatment dropout from physical activity interventions in schizophrenia: a meta-analysis. Gen Hosp Psychiatry, 2016, 39: 15-23.
10.	Klein PJ, Adams WD. Comprehensive therapeutic benefits of Taiji: A critical review. Am J Phys Med Rehabil, 2004, 83(9): 735-745.
11.	Birdee GS, Cai H, Xiang YB, et al. Tai chi as exercise among middle-aged and elderly Chinese in urban China. J Altern Complement Med, 2013, 19(6): 550-557.
12.	Caldwell K, Emery L, Harrison M, et al. Changes in mindfulness, well-being, and sleep quality in college students through taijiquan courses: a cohort control study. J Altern Complement Med, 2011, 17(10): 931-938.
13.	Ding M, Zhang W, Li K, et al. Effectiveness of tai chi and qigong on chronic obstructive pulmonary disease: a systematic review and meta-analysis. J Altern Complement Med, 2014, 20(2): 79-86.
14.	Wang F, Lee EK, Wu T, et al. The Effects of Tai Chi on Depression, Anxiety, and Psychological Well-Being: A Systematic Review and Meta-Analysis. Int J Behav Med, 2014, 21(4): 605-617.
15.	Wang C, Bannuru R, Ramel J, et al. Tai Chi on psychological well-being: systematic review and meta-analysis. BMC Complement Altern Med, 2010, 10: 23.
16.	Wang J, Feng B, Yang XC, et al. Tai Chi for essential hypertension. Evid Based Complement Alternat Med, 2013, 2013: e215254.
17.	Morgan N, Irwin MR, Chung M, et al. The effects of mind-body therapies on the immune system: meta-analysis. PLoS One, 2014, 9(7): e100903.
18.	Lee MS, Choi TY, Lim HJ, et al. Tai chi for management of type 2 diabetes mellitus: a systematic review. Chin J Integr Med, 2011, 17(10): 789-793.
19.	谢焱, 杨丽, 张百军, 等. 太极拳运动疗法对慢性精神分裂症患者的康复疗效分析. 医学理论与实践, 2008, 21(1): 49-51.
20.	杨丽, 谢焱, 许祖年, 等. 运动疗法对慢性精神分裂症病人康复作用影响的研究. 护理研究, 2008, 22(12): 3317-3318.
21.	杨丽. 太极拳、乒乓球、多功能健身器械体育治疗与慢性精神分裂症患者康复. 医学理论与实践, 2009, 22(1): 100-101.
22.	杨丽, 谢焱, 许祖年, 等. 体育疗法对慢性精神分裂症患者的康复作用. 中国康复, 2009, 24(1): 65-66.
23.	祝希泉, 甘景梨, 段惠峰, 等. 太极拳训练对军人慢性精神分裂症患者事件相关电位 N400 的影响. 新乡医学院学报, 2009, 26(5): 465-467.
24.	甘景梨, 段惠峰, 高存友, 等. 太极拳训练对慢性精神分裂症患者事件相关电位 P300 和听觉诱发电位的影响. 中国神经精神疾病杂志, 2010, 36(2): 83, 87, 99.
25.	周清清. 太极拳训练对精神分裂症患者康复效果的观察. 护理与康复, 2011, 10(2): 97-99.
26.	Ho RT, Au Yeung FS, Lo PH, et al. Tai-chi for residential patients with schizophrenia on movement coordination, negative symptoms, and functioning: a pilot randomized controlled trial. Evid Based Complement Alternat Med, 2012, 2012: 923925.
27.	Ho RT, Fong TC, Wan AH, et al. A randomized controlled trial on the psychophysiological effects of physical exercise and Tai-chi in patients with chronic schizophrenia. Schizophr Res, 2016, 171(1-3): 42-49.
28.	钱维, 陆江波, 苏彬, 等. 无锡同仁国际康复医院精神科作业治疗服务模式介绍. 中国康复, 2015, 30(6): 434-435.
29.	陈彦方. 精神障碍的分类与诊断标准研究进展(一). 神经疾病与精神卫生, 2005, 5(1): 1-3.
30.	陈彦方. 精神障碍的分类与诊断标准研究进展(二). 神经疾病与精神卫生, 2005, 5(2): 83-85.
31.	Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. Cochrane Collaboration, 2008. Available at: www.cochrane-handbook.org.
32.	Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
33.	Scheewe TW, Backx FJ, Takken T, et al. Exercise therapy improves mental and physical health in schizophrenia: a randomised controlled trial. Acta Psychiatr Scand, 2013, 127(6): 464-473.
34.	Li JX, Hong Y, Chan KM. Tai chi: physiological characteristics and beneficial effects on health. Br J Sports Med, 2001, 35(3): 148-156.
35.	Peng PWH. Tai Chi and Chronic Pain. Regional Anesthesia and Pain Medicine, 2012, 37(4): 372-382.
36.	La Torre MA. The Role of Body Movement in Psychotherapy. Perspectives in Psychiatric Care, 2008, 44(2): 127-130.
37.	Li FZ, Fisher KJ, Harmer P, et al. Tai Chi and self-rated quality of sleep and daytime sleepiness in older adults: A randomized controlled trial. J Am Geriatr Soc, 2004, 52(6): 892-900.
38.	Kang R, Wu Y, Li Z, et al. Effect of Community-Based Social Skills Training and Tai-Chi Exercise on Outcomes in Patients with Chronic Schizophrenia: A Randomized, One-Year Study. Psychopathology, 2016, 49(5): 345-355.

1. Van Os J, Kapur S. Schizophrenia. Lancet, 2009, 374(9690): 635-645.
2. Schooler NR, Buchanan RW, Laughren T, et al. Defining therapeutic benefit for people with schizophrenia: focus on negative symptoms. Schizophr Res, 2015, 162(1-3): 169-174.
3. Cara E, MacRae A. Psychosocial Occupational Therapy: An Evolving Practice, 3rd Edition. Delmar Cengage Learning: USA, 2012: 192-215.
4. 曹江. 精神分裂症的治疗策略进展. 医学理论与实践, 2015, 28(17): 2297-2299.
5. Dlabac-de Lange JJ, Liemburg EJ, Bais L, et al. Effect of rTMS on brain activation in schizophrenia with negative symptoms: A proof-of-principle study. Schizophr Res, 2015, 168(1-2): 475-482.
6. Brunoni AR, Shiozawa P, Truong D, et al. Understanding tDCS effects in schizophrenia: a systematic review of clinical data and an integrated computation modeling analysis. Expert Rev Med Devices, 2014, 11(4): 383-394.
7. Vera-Garcia E, Mayoral-Cleries F, Vancampfort D, et al. A systematic review of the benefits of physical therapy within a multidisciplinary care approach for people with schizophrenia: An update. Psychiatry Res, 2015, 229(3): 828-839.
8. Firth J, Carney R, Jerome L, et al. The effects and determinants of exercise participation in first-episode psychosis: a qualitative study. BMC Psychiatry, 2016, 16(1): 36.
9. Vancampfort D, Rosenbaum S, Schuch FB, et al. Prevalence and predictors of treatment dropout from physical activity interventions in schizophrenia: a meta-analysis. Gen Hosp Psychiatry, 2016, 39: 15-23.
10. Klein PJ, Adams WD. Comprehensive therapeutic benefits of Taiji: A critical review. Am J Phys Med Rehabil, 2004, 83(9): 735-745.
11. Birdee GS, Cai H, Xiang YB, et al. Tai chi as exercise among middle-aged and elderly Chinese in urban China. J Altern Complement Med, 2013, 19(6): 550-557.
12. Caldwell K, Emery L, Harrison M, et al. Changes in mindfulness, well-being, and sleep quality in college students through taijiquan courses: a cohort control study. J Altern Complement Med, 2011, 17(10): 931-938.
13. Ding M, Zhang W, Li K, et al. Effectiveness of tai chi and qigong on chronic obstructive pulmonary disease: a systematic review and meta-analysis. J Altern Complement Med, 2014, 20(2): 79-86.
14. Wang F, Lee EK, Wu T, et al. The Effects of Tai Chi on Depression, Anxiety, and Psychological Well-Being: A Systematic Review and Meta-Analysis. Int J Behav Med, 2014, 21(4): 605-617.
15. Wang C, Bannuru R, Ramel J, et al. Tai Chi on psychological well-being: systematic review and meta-analysis. BMC Complement Altern Med, 2010, 10: 23.
16. Wang J, Feng B, Yang XC, et al. Tai Chi for essential hypertension. Evid Based Complement Alternat Med, 2013, 2013: e215254.
17. Morgan N, Irwin MR, Chung M, et al. The effects of mind-body therapies on the immune system: meta-analysis. PLoS One, 2014, 9(7): e100903.
18. Lee MS, Choi TY, Lim HJ, et al. Tai chi for management of type 2 diabetes mellitus: a systematic review. Chin J Integr Med, 2011, 17(10): 789-793.
19. 谢焱, 杨丽, 张百军, 等. 太极拳运动疗法对慢性精神分裂症患者的康复疗效分析. 医学理论与实践, 2008, 21(1): 49-51.
20. 杨丽, 谢焱, 许祖年, 等. 运动疗法对慢性精神分裂症病人康复作用影响的研究. 护理研究, 2008, 22(12): 3317-3318.
21. 杨丽. 太极拳、乒乓球、多功能健身器械体育治疗与慢性精神分裂症患者康复. 医学理论与实践, 2009, 22(1): 100-101.
22. 杨丽, 谢焱, 许祖年, 等. 体育疗法对慢性精神分裂症患者的康复作用. 中国康复, 2009, 24(1): 65-66.
23. 祝希泉, 甘景梨, 段惠峰, 等. 太极拳训练对军人慢性精神分裂症患者事件相关电位 N400 的影响. 新乡医学院学报, 2009, 26(5): 465-467.
24. 甘景梨, 段惠峰, 高存友, 等. 太极拳训练对慢性精神分裂症患者事件相关电位 P300 和听觉诱发电位的影响. 中国神经精神疾病杂志, 2010, 36(2): 83, 87, 99.
25. 周清清. 太极拳训练对精神分裂症患者康复效果的观察. 护理与康复, 2011, 10(2): 97-99.
26. Ho RT, Au Yeung FS, Lo PH, et al. Tai-chi for residential patients with schizophrenia on movement coordination, negative symptoms, and functioning: a pilot randomized controlled trial. Evid Based Complement Alternat Med, 2012, 2012: 923925.
27. Ho RT, Fong TC, Wan AH, et al. A randomized controlled trial on the psychophysiological effects of physical exercise and Tai-chi in patients with chronic schizophrenia. Schizophr Res, 2016, 171(1-3): 42-49.
28. 钱维, 陆江波, 苏彬, 等. 无锡同仁国际康复医院精神科作业治疗服务模式介绍. 中国康复, 2015, 30(6): 434-435.
29. 陈彦方. 精神障碍的分类与诊断标准研究进展(一). 神经疾病与精神卫生, 2005, 5(1): 1-3.
30. 陈彦方. 精神障碍的分类与诊断标准研究进展(二). 神经疾病与精神卫生, 2005, 5(2): 83-85.
31. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. Cochrane Collaboration, 2008. Available at: www.cochrane-handbook.org.
32. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
33. Scheewe TW, Backx FJ, Takken T, et al. Exercise therapy improves mental and physical health in schizophrenia: a randomised controlled trial. Acta Psychiatr Scand, 2013, 127(6): 464-473.
34. Li JX, Hong Y, Chan KM. Tai chi: physiological characteristics and beneficial effects on health. Br J Sports Med, 2001, 35(3): 148-156.
35. Peng PWH. Tai Chi and Chronic Pain. Regional Anesthesia and Pain Medicine, 2012, 37(4): 372-382.
36. La Torre MA. The Role of Body Movement in Psychotherapy. Perspectives in Psychiatric Care, 2008, 44(2): 127-130.
37. Li FZ, Fisher KJ, Harmer P, et al. Tai Chi and self-rated quality of sleep and daytime sleepiness in older adults: A randomized controlled trial. J Am Geriatr Soc, 2004, 52(6): 892-900.
38. Kang R, Wu Y, Li Z, et al. Effect of Community-Based Social Skills Training and Tai-Chi Exercise on Outcomes in Patients with Chronic Schizophrenia: A Randomized, One-Year Study. Psychopathology, 2016, 49(5): 345-355.

Chinese Journal of Evidence-Based Medicine

Effects of Tai Chi on negative symptoms and activity participation in patients with schizophrenia: a meta-analysis

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