Traditional Chinese medicine-based exercises tai chi and ba duan jin may improve biomedical and psychosocial well-being in adults with type 2 diabetes

Xingfeng Y, Chau JP, Lanting H. The effectiveness of traditional Chinese medicine-based lifestyle interventions on biomedical, psychosocial, and behavioral outcomes in individuals with type 2 diabetes: A systematic review with meta-analysis Int J Nurs Stud. 2018;80:165-180.

Review question

What is the effectiveness of traditional Chinese medicine (TCM)-based lifestyle approaches in individuals with type 2 diabetes?

Background

Diabetes prevalence has increased in recent years, as has the popularity of managing type 2 diabetes with TCM-based lifestyle approaches. The underlying philosophy of TCM is that health is improved and preserved by maintaining the flow of vital energy throughout the human body, as well as by finding balance between the Yin and Yang (e.g. opposing forces dark/light, negative/positive), and the five elements of the universe (wood, fire, water, metal and earth). TCM-based aerobic exercises – such as tai chi, ba duan jin, yi ren medical, ma wang dui dao yin – are done at low-moderate intensity and involve combining physical movement, meditation, and controlled breathing. Previous systematic reviews investigating the effects of TCM-based lifestyle approaches on biomedical, psychosocial, and behavioral outcomes in people with type 2 diabetes reported mixed results.

How the review was done

This is a systematic review of 22 randomized controlled trials and two controlled clinical trials published between 2006 and 2016, including a total of 1697 participants. Where feasible, studies were included in a meta-analysis.   

• Participants were adults who had been diagnosed with type 2 diabetes.
• Study participants took part in one of the following TCM-based lifestyle approaches, either alone or coupled with multiple strategies (e.g. usual care, diabetes education, relaxation): tai chi; ba duan jin; tai chi with ba duan; yi ren medical qigong; ma wang dui dao yin qigong; relaxation; or a TCM-based psychological approach. 
• The TCM-based lifestyle approaches varied in frequency (daily - weekly), duration (20 - ≥60 min), number of sessions (12 - ≥72), and length (6 weeks - 6 months). Some studies reported sessions being supervised or a mix of supervised and self-monitored.
• Researchers measured changes in biomedical outcomes (e.g. average blood sugar (HbA1c), fasting blood sugar, blood pressure, body mass index (BMI), and waist circumference), and psychosocial outcomes (e.g. depression and quality of life (the physical (e.g. bodily pain, physical functioning), mental (e.g. mental health), and social (e.g. social functioning) aspects)).
• Results were compared to people in control groups who received sham exercises (e.g. gentle stretching or gymnastics exercises), or usual care alone or in combination with diabetes education, progressive resistance training, or aerobic exercise. Some studies had no active control.
• The studies generally had a high risk of bias.

What the researchers found

Of the various TCM-based lifestyle approaches investigated, tai chi and ba duan jin produced the most promising results, and were evaluated most often. Overall, tai chi reduced fasting blood sugar and BMI, and improved the physical aspect of quality of life in adults with type 2 diabetes. Larger effects on fasting blood sugar and BMI were observed when tai chi was practiced at ≥150 minutes per week. Additionally, improvements in HbA1c and the mental aspect of quality of life were only seen at ≥150 minutes per week. Tai chi did not significantly improve blood pressure.

Overall, ba duan jin reduced fasting blood sugar, BMI, HbA1C (especially at ≥150 minutes per week), and depression. However, it did not have an effect on any aspects related to quality of life (i.e. physical, mental or social). Given the high risk of bias of the included studies, lack of long-term effectiveness data, and need for more comparisons against a greater variety of control groups, more research is required to determine optimal frequency and duration of TCM-based exercise, as well as the effect of other TCM-based lifestyle approaches.

Conclusion

In adults with type 2 diabetes, tai chi and ba duan jin may support weight management and glycemic control; with tai chi having potential added benefits on quality of life and ba duan jin on depression. Practicing tai chi or ba duan jin for ≥150 minutes per week appears most effective for various biomedical and psychosocial outcomes.