This randomized, controlled trial shows that tai chi is potentially a useful therapy for patients with fibromyalgia. The effect was evident in the FIQ score, a well-validated, multidimensional instrument for the assessment of fibromyalgia, and in other measures of pain and quality of life and was consistent with both subjective and objective assessments. The observed benefits exceeded the specified thresholds for clinically significant improvement in the FIQ score30
and in the measures used to assess pain,31
and quality of life,28,33
and these benefits were sustained at 24 weeks. No adverse events were reported in the study participants, indicating that tai chi is probably a safe therapy for patients with fibromyalgia.
Our results are consistent with those of a previous, nonrandomized trial of tai chi for fibromyalgia, as well as with the findings in other studies showing the benefits of tai chi with regard to musculoskeletal pain, depression, and quality of life.13,34
Our findings are also consistent with observations from other clinical trials and meta-analyses that support the benefits of physical exercise and mind–body practice for symptom management in fibromyalgia. 35–41
The biologic mechanisms by which tai chi might affect the clinical course of fibromyalgia remain unknown. As a complex, multicomponent intervention, tai chi may act through many intermediate variables along the pathway to improved health outcomes. Physical exercise has been shown to increase muscle strength and blood lactate levels in some patients with fibromyalgia. 42
Mind–body interventions may improve psychosocial well-being, increase confidence, and help patients overcome fear of pain.43
Furthermore, controlled breathing and movements promote a restful state and mental tranquility, which may raise pain thresholds and help break the “pain cycle.” 44
All these components may influence neuroendocrine and immune function as well as neurochemical and analgesic pathways that lead to enhanced physical, psychological, and psychosocial well-being and overall quality of life in patients with fibromyalgia.40,45,46
Our study had some limitations. We did not use a double-blind study design, since this would have required the use of sham tai chi, for which no validated approach currently exists. Devising a sham mind–body intervention poses a set of unique challenges when one attempts to separate the various mind and body components. Nevertheless, the development of some form of sham intervention for use in future studies of tai chi is a desirable goal. To minimize the influence of preexisting beliefs and expectations with respect to tai chi (e.g., its possible placebo effect), we informed participants only that the study was designed to test the effects of two different types of exercise training programs, one of which was combined with education. Deemphasizing tai chi may have lessened participants’ expectations and minimized biases. Notably, the baseline outcome expectations of benefit from an exercise intervention were similar in the tai chi and control groups (3.7±0.8 and 3.9±0.7, respectively), indicating that our neutral presentation of the interventions may have been successful.
The fact that treatment was delivered by a single tai chi master at a single center also potentially limits the generalizability of our results. However, the group of patients with poor health status at baseline may in general resemble patients with fibromyalgia. For these reasons, it would be prudent to further explore the benefits of tai chi for fibromyalgia in other settings with other instructors. Since tai chi is a complex mind–body intervention with a variety of active ingredients, such as social support, relaxation, and cognitive behavioral elements,47
assessment of its placebo effect might require separate evaluations of these ingredients. Finally, we followed participants for only 24 weeks, so the long-term effectiveness of tai chi in patients with fibromyalgia remains to be determined.
In conclusion, our preliminary findings indicate that tai chi may be a useful treatment in the multidisciplinary management of fibromyalgia. Longer-term studies involving larger clinical samples are warranted to assess the generalizability of our findings and to deepen our understanding of this promising therapeutic approach.