Tai Chi exercise is more effective than brisk walking in reducing cardiovascular disease risk factors among adults with hypertension: A randomised controlled trial

Abstract

Background: Physical inactivity is a major modifiable lifestyle risk factor associated with cardiovascular disease. Tai Chi is a safe and popular form of physical activity among older adults, yet direct comparisons are lacking between Tai Chi and brisk walking in their ability to reduce cardiovascular disease risk factors and improve psychosocial well-being.

Methods: 246 adults (mean age = 64.4 ± 9.8 years, age range = 30-91 years, 45.5% men) with hypertension and at least two but not more than three modifiable cardiovascular disease risk factors (diabetes, dyslipidaemia, overweight, physical inactivity and smoking) were randomly assigned to either Tai Chi (n = 82), brisk walking (n = 82) or control (n = 82) groups. The Tai Chi and brisk walking groups engaged in moderate-intensity physical activity 150 min/week for 3 months; daily home-based practice was encouraged for another 6 months. The primary outcome was blood pressure. Secondary outcomes were fasting blood sugar, glycated haemoglobin, total cholesterol, triglycerides, high- and low-density lipoprotein, body mass index, waist circumference, aerobic endurance, perceived stress, quality of life and exercise self-efficacy. Data were collected at baseline, post-intervention at 3 months and follow-up assessments at 6 and 9 months. Generalised estimating equation models were used to compare the changes in outcomes over time between groups.

Results: At baseline, the participants had an average blood pressure = 141/81 and average body mass index = 26; 58% were diabetics, 61% presented with dyslipidemia and 11% were smokers. No significant difference was noted between groups. Tai Chi significantly lowered blood pressure (systolic -13.33 mmHg; diastolic -6.45 mmHg), fasting blood sugar (-0.72 mmol/L), glycated haemoglobin (-0.39%) and perceived stress (-3.22 score) and improved perceived mental health (+4.05 score) and exercise self-efficacy (+12.79 score) at 9 months, compared to the control group. In the Tai Chi group, significantly greater reductions in blood pressure (systolic -12.46 mmHg; diastolic -3.20 mmHg), fasting blood sugar (-1.27 mmol/L), glycated haemoglobin (-0.56%), lower perceived stress (-2.32 score), and improved perceived mental health (+3.54 score) and exercise self-efficacy (+12.83 score) were observed, compared to the brisk walking group. No significant changes in the other cardiovascular disease risk indicators were observed over time between groups.

Conclusion: Nurses play a key role in promoting exercise to reduce cardiovascular disease risk and foster a healthy lifestyle among adults. Tai Chi is better than brisk walking in reducing several cardiovascular disease risk factors and improving psychosocial well-being, and can be recommended as a viable exercise for building a healthy life free of cardiovascular disease.

Keywords: Brisk walking; CVD risk factors; Cardiovascular disease; Exercise; Tai Chi.