The efficacy of Tai Chi and Qigong in reducing indicators of risk of Type 2 diabetes in adults with elevated blood glucose

Given the increasing worldwide prevalence of Type 2 diabetes, and the premature mortality, disability, complications, social and economic costs associated with it, prevention and management are of paramount importance to public health. Preliminary evidence suggests that Chinese medical exercises (Tai Chi/Qigong) may improve indicators of Type 2 diabetes among diabetic adults. The aim of this study was to assess the efficacy of a Tai Chi/Qigong exercise program in improving indicators of risk of Type 2 diabetes in adults with elevated blood glucose levels. Pilot study The pilot study was a single group pre-post design. Eleven adults (aged 42 to 65 years) with elevated blood glucose attended a 12 week Tai Chi/Qigong training program. Metabolic, behavioural and psychological variables were assessed immediately prior to and after the intervention. There were statistically significant improvements in body mass index, waist circumference, blood pressure, HbA1c, insulin resistance, metabolic clearance rate of glucose, leg strength, diabetic symptoms, psychological measures (stress, depression), and some aspects of quality of life (SF36 general health, mental health, vitality sub-scale scores, and SF36 mental component summary score). The pilot study showed that it was feasible to recruit participants, conduct the intervention and collect data on a wide range of measures. The participants were satisfied with the program and there were no adverse events during the intervention. Main study The main study was a six month two-group randomized cross-over controlled trial. Forty-one participants (aged 41 to 71 years) were randomly allocated to either the intervention group (Group A; N = 20) or to the 'waitlist' control group (Group B; N = 21). Participants in Group A attended three Tai Chi/Qigong training classes per week during the first 3 months, followed by a 3 month period of self-led home training with a DVD/video tape. Participants in Group B had no intervention during the first 3 months; this was followed by three Tai Chi/Qigong group training classes per week for the next 6 weeks, followed by self-led home training with the DVD/video tape during the remaining 6 weeks. Metabolic indicators were assessed at baseline, 12 weeks and 24 weeks. Physical, psychological, general health and well-being, and behavioural measures were taken at baseline, and at 6, 12, 18, and 24 weeks. The main research questions were: (1) After 12 weeks, are there favourable changes in indicators of metabolic syndrome and diabetes control, leg strength, psychological variables and general health and well-being in the Tai Chi/Qigong intervention group, relative to a 'usual care' control group? (2) Are favourable effects of the initial 12 week instructor-led group program (on the variables listed above) maintained in the intervention group after 12 weeks of self-led 'at home' Tai Chi/Qigong? (3) Are the effects of the combined Tai Chi/Qigong program (6 week instructor-led group + 6 week self-led ‘at home’) the same as those observed in the 12 week instructor-led group program? (4) If there are any statistically significant improvements in indicators of blood glucose control as a result of the intervention, what are the determinants of these changes? Over the first twelve weeks, the program resulted in statistically significantly greater improvements in body weight [-3.04 kg (95%CI: -4.42; -1.66), p< 0.001], body mass index [-1.17 kg/m2 (95%CI:-1.66; -0.67), p< 0.001], waist circumference [-4.78 cm (95%CI: -6.36; -3.20), p< 0.001], leg strength [+3 chair stands in 30s (95%CI: 1.12; 4.21), p< 0.01], 2 hour blood glucose [- 1.45 mmol/L (95%CI: -2.93; 0.03), p = 0.054], insulin resistance [HOMA, - 1.26 (95%CI: -2.17; -0.35), p< 0.01], physical functioning [+5.46 on the SF36 subscale (95%CI: 1.35; 9.57), p< 0.05], and vitality [+9.96 on the SF36 subscale (95%CI: 0.77; 19.15), p< 0.05] in the intervention group relative to the control group. Most of these effects were maintained in Group A during the second twelve weeks of self-led 'at home' practice. Small but statistically significant within-group improvements were also observed in Group B during their 12 week combined group and 'at home' program for body weight, body mass index, HbA1c, fasting blood insulin, 2 hour blood glucose, 2 hour blood insulin, insulin resistance, metabolic clearance rate, triglycerides, diastolic blood pressure, leg strength and general health. After adjustment for all potential covariates, the most statistically significant improvement in any of the indicators of blood glucose control, was in insulin resistance. Changes in BMI, waist circumference and leg strength were mediators of the intervention effect on insulin resistance. Implications This intervention program may have a role to play in improving risk factors which are associated with the progression of pre-diabetes to diabetes and the management of Type 2 diabetes. Given the dramatic increase in the prevalence of both metabolic syndrome and diabetes, both in Australia and throughout the world, a larger longer term controlled trial, with increased sample size, is urgently needed to further explore the promising effects achieved in this study