Tai Chi and stress : a randomised controlled trial and Chinese medicine pattern diagnostics

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Stress is a growing problem in modern society and in severe cases could potentially lead to hospitalisation. The ancient Chinese mind body exercise of Tai Chi (TC) is practiced worldwide by millions of people daily and is often accredited with a plethora of health benefits, including reduction of stress. There has been a growing interest in the scientific community to evaluate the efficacy of TC practice for a range of diseases and conditions, in particular the effects of TC in the improvement of psychological and mental health. However the term “stress” itself is a common diagnosis used by both patients and practitioners alike to describe a “condition” generally regarded as subjective in nature and as such each individual will likely present with varying somatic or cognitive signs and symptoms. Currently there are no definitive diagnosis or signs and symptoms for “stress” for both biomedicine and Chinese Medicine (CM). This thesis evaluates the efficacy of TC as an intervention for stress through a randomised controlled trial (RCT) and the use of a questionnaire to identify the CM diagnostic patterns associated with stress The RCT involved fifty participants who were randomly allocated into one of three groups; TC (n=17), exercise (n=16) or a wait list control group (WL) (n=16). Both TC and exercise groups were required to complete 5 hours per week of either TC or exercise for 12 weeks (total of 3600 minutes), whilst WL maintained their normal lifestyle. State Trait Anxiety Inventory (STAI) which assesses both state anxiety and trait anxiety was used as the primary outcome measure. Secondary outcome measures were the Perceived Stress Scale 14 (PSS14), blood pressure, heart rate variability, visual analogue scale and short form 36. Data were collected at baseline, midway at week 6 and at the completion of the trial at week 12. A two-way ANOVA with repeated measures followed by Bonferroni’s post-hoc test was used for statistical analysis. The stress questionnaire was constructed using the signs and symptoms for General Anxiety Disorder and commonly reported signs and symptoms for stress were cross referenced against TCM textbooks to relate each sign and symptom to possible patterns (zheng) and then cross referenced again against the signs and symptoms list to form two gender specific questionnaires. Pattern identification measurement was based on percentage of signs and symptoms present against possible number of signs and symptom per pattern for each gender. Results for the RCT showed that there were significant improvements from baseline for both TC and exercise groups for the outcomes of STAI, PSS14, VAS as well as mental health and vitality domains of the SF36. Furthermore there were significant differences between groups for TC and the wait list control group for both state and trait anxiety as well as the mental health domain. The stress questionnaire results indicate that the top three pattern for both genders were Heart Qi deficiency, Heart Blood deficiency and Liver Blood deficiency. This result is different to the commonly accepted idea that stress is associated with Liver Qi stasis, however despite the reliability of the instrument a larger cohort size will be needed to ascertain the validity of these findings. It is hoped that the results from these two studies will be incorporated into future research in both TC and stress diagnosis. The findings from the RCT revealed that TC effectively reduces stress levels in healthy individuals as early as week 6 and may provide a safer and less strenuous therapeutic alternative to exercise. Whilst the results from the stress questionnaire will hopefully help CM clinicians with their understanding of stress related symptoms the choosing the correct treatment principles for their patients.
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