This study shows that Tai-Chi exercise is potentially a useful therapy for women with FM. The main finding of the present study is that 28-week Tai-Chi training improved pain and functional capacity. The effects of Tai-Chi training were evident on symptomatology, depression, quality of life, active coping, self-esteem, and self-efficacy. The improvements persisted after the detraining phase in pain threshold, tender points count, algometer score, SF-36 subscales (physical functioning, bodily pain, general health, vitality, emotional role and mental health) and in VPMI-active coping subscale. The program was well tolerated and had not any deleterious effects on the patients' health.
The improvement in lower body flexibility concurs with our previous study [22
] performed in 6 men with FM (52.3 ± 9.3 years). In that study, we found a positive change in lower body flexibility after 16-week Tai-Chi training (3 times/week) that was maintained after 12 weeks of detraining period. However, in the present study, the gains of flexibility were not maintained after detraining period.
The results of this study suggest that a Tai-Chi long-term training could be an effective therapy for FIQ total score and the FIQ subscales: pain, fatigue, morning tiredness, stiffness, anxiety, and depression, as well as, on the following SF-36 subscales: physical function, physical role, bodily pain, general health, vitality, and mental health. Similarly, in a recent study, Wang et al. [24
] observed improvements on the FIQ total score, and on mental and physical component of the SF-36 after 12 weeks of Tai-Chi training (2 times/week) in 33 women with FM (49.7 ± 11.8 years). On the other hand, this study did not report the SF-36 and FIQ subscales scores or tender point count, and the assessment of functional test is very limited.
Similarly, Taggart et al. [23
] found significant changes on the FIQ subscale physical functioning, feel good, pain, morning tiredness, stiffness, and anxiety and in the SF-36 subscales physical functioning, bodily pain, general health, vitality, and emotional role, after 6 weeks of Tai-Chi training (2 times/week) in 21 FM patients (56.2 ± 11.9 years). However, this study did not show the effects of the Tai-Chi training in functional test or tender-point count.
In our study, the FM patients were able to walk greater distances (~40 meters) after Tai-Chi training on 6-min walk test. This finding concurs with the study of Wang et al. [24
] that also observed improvements on this test (~55.4 meters).
To note is that this is the first study that analyzed the effect of long-term Tai-Chi training in female FM patients and it is difficult to compare our results with those of other previous studies. However, the results of present study concur with other studies that have analyzed the effects of long-term Tai-Chi training in other diseases.
We observed improvements on aerobic capacity, dynamic balance, and lower-body strength. Similarly, Lan et al. [41
] found improvement in cardiorespiratory function in 9 adults patients with coronary artery bypass (56.5 ± 7.4 years) after 52 weeks of Tai-Chi training (45 minutes/every days). Lan et al. [42
] found improvements in aerobic capacity after 52 weeks of Tai-Chi training (3 times/week) in 53 patients (52.8 ± 9.4 years) with dyslipidemia. Likewise, Li and Manor [43
] observed improvements on aerobic capacity, dynamic balance, and lower-body strength in 25 patients (71±12 years) with peripheral neuropathy after 24 weeks (3 times/week) Tai-Chi training. However, it should be noted that these studies did not perform a detraining phase.
The biologic mechanics by which Tai-Chi might affect the clinical course of FM remains to be known. However, the degree of flexion at the hips and knees [44
] the constantly shift weight from one foot to the other, as well as the rotational movements of the head, trunk, and extremities [45
] performed during Tai-Chi practice could be related with the improvements found in strength, balance, and flexibility in our study. The interesting findings of the present study should be interpreted in the context of the following limitations. We were not able to conduct a randomized controlled trial with a control group, and it was not possible to control the changes in the FM pharmacological treatment during the training. In addition, we did not control the influence of preexisting beliefs and expectations with respect to Tai-Chi in FM patients. On the other hand, we have analyzed the effects of Tai-Chi training in variables that have not been previously explored in female FM patients, such as tender points, balance, flexibility, strength, depression, coping strategies, self-esteem, and self-efficacy. Moreover, our study analyzed the effects of 12 weeks detraining phase.
The effects of long-term Tai-Chi training need further randomized controlled trials especially focused in the biologic and psychological mechanics by which Tai-Chi exercise might affect the clinical course of FM.