打太極有助於年長膝關節炎病患減輕疼痛

作者：Laurie Barclay, MD  
出處：WebMD醫學新聞

　　【24drs.com】November 2, 2009 — 根據發表於11月關節炎照護研究期刊的一篇前瞻性、單盲、隨機控制試驗結果，打太極有助於年長的膝關節炎(osteoarthritis，OA)病患減輕疼痛。這項物理治療是一種傳統的中國武術，以緩慢而有韻律的動作促進心智放鬆，而改善平衡感、力量與靈活度。
　　
　　第一作者、麻州波士頓、Tufts大學醫學院的Chenchen Wang醫師在新聞稿中表示，太極是一種和心靈及身體都有關的方法，可以運用於年長膝關節炎病患的治療。我們的觀察強調，需要後續評估太極的生物機轉與使用方法，以將其利益更廣泛推廣。
　　
　　研究對象包括大波士頓區域確認有症狀的40名膝關節炎病患，他們的身體其他方面健康，平均年紀65歲、平均身體質量指數30.0 kg/m2。這些病患被隨機分派到太極組或者注意力控制組，兩組每週都有兩次課程、為期12週。使用治療意向分析，在第12、24、48週時進行評估。
　　
　　太極組包括60分鐘的楊家太極課程，每次包括10分鐘的自我按摩以及複習太極原則、30分鐘的太極動作、10分鐘的呼吸技術、10分鐘的放鬆。
　　
　　注意力控制組也有60分鐘的課程，每次包括40分鐘的關節炎教育、飲食與營養建議、關節炎的適當治療、生理和心理健康教育等。之後進行20分鐘的上半身、軀幹和下半身的伸展運動，每次伸展定格10到15秒。
　　
　　完成12週的介入之後，太極組的膝關節疼痛顯著比控制組少，根據西安大略及麥梅斯特大學骨性關節炎指標(Western Ontario and McMaster Universities Osteoarthritis Index，WOMAC)疼痛量表，與開始時相比為 –118.80 mm(95%信賴區間為 –183.66 至 –53.94; P = .0005)。
　　
　　生理功能、自我勝任感、憂鬱、膝關節炎健康狀態等次級結果方面，太極組也都顯著優於控制組。沒有觀察到嚴重不良反應。
　　
　　研究限制包括，注意力控制組有較多嚴重的膝關節炎患者、可能有未確認的干擾因素、研究樣本相對較少、未雙盲、因為只有使用單一種太極套路而在一般化有所限制。
　　
　　研究作者寫道，太極可減輕疼痛與改善生理功能、自我勝任感、憂鬱、以及健康相關生活品質。
　　
　　他們也指出，太極的生理動作符合目前對於OA的運動建議，包括動作範圍與可行性、肌肉訓練與有氧訓練。再者，他們認為，太極的心理面可以藉由改善心理健康、生活滿意度、對健康的認知而使長期疼痛的負面影響最小化。
　　
　　國家衛生研究院的國家輔助及另類醫學研究中心支持本研究，但結論僅代表研究作者的立場。研究作者皆宣告沒有相關財務關係。

Tai Chi May Help Reduce Pain of Knee Osteoarthritis in Older Patients

By Laurie Barclay, MD
Medscape Medical News

November 2, 2009 — Tai Chi exercise may help reduce the pain of knee osteoarthritis (OA) in older patients, according to the results of a prospective, single-blind, randomized controlled trial reported in the November issue of Arthritis Care Research. This physical discipline is a traditional style of Chinese martial arts using slow, rhythmic movements to promote mental relaxation and improve balance, strength, and flexibility.

"Tai Chi is a mind-body approach that appears to be an applicable treatment for older adults with knee OA," lead author Chenchen Wang, MD, MSc, from Tufts University School of Medicine in Boston, Massachusetts, said in a news release. "Our observations emphasize a need to further evaluate the biologic mechanisms and approaches of Tai Chi to extend its benefits to a broader population."

The study sample consisted of 40 patients from the greater Boston area who had confirmed, symptomatic knee OA but who were in good health otherwise. Mean age was 65 years, and mean body mass index was 30.0 kg/m2. Patients were randomly assigned to a Tai Chi group or to an attention control group, and both groups had sessions twice weekly for 12 weeks. Analysis was by intent-to-treat, and assessments were performed at 12, 24, and 48 weeks.

The Tai Chi intervention consisted of 60-minute Yang-style sessions, each of which included 10 minutes of self-massage and a review of Tai Chi principles, 30 minutes of Tai Chi movement, 10 minutes of breathing technique, and 10 minutes of relaxation.

The attention control group also had 60-minute sessions, each consisting of 40 minutes of education about OA, dietary and nutrition recommendations, appropriate therapies for OA, or physical and mental health education. This was followed by 20 minutes of stretching exercises for the upper body, trunk, and lower body, with each stretch held for 10 to 15 seconds.

After completion of the 12-week intervention, knee pain was significantly less in the Tai Chi group vs the control group, with a –118.80-mm difference in improvement from baseline on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale (95% confidence interval, –183.66 to –53.94; P = .0005).

Secondary outcomes of physical function, self-efficacy, depression, and health status for knee OA were also significantly better in the Tai Chi group vs the control group. No severe adverse events were observed.

Limitations of this study include more severe knee OA in the attention control group, possible unidentified confounding, relatively small sample size, incomplete blinding, and limited generalizability because instruction was given by a single Tai Chi master.

"Tai Chi reduces pain and improves physical function, self-efficacy, depression, and health-related quality of life," the study authors write.

They also note that physical components of Tai Chi meet current exercise recommendations for OA, including range-of-motion and flexibility exercises, muscle conditioning, and aerobic training. Furthermore, they suggest that the mental discipline of Tai Chi may minimize negative effects of chronic pain by improving psychological well-being, life satisfaction, and perceptions of health.

The National Center for Complementary ad Alternative Medicine of the National Institutes of Health supported this study, but the conclusions are solely those of the study investigators. The study authors have disclosed no relevant financial relationships.

Arthr Care Res. 2009;61:1545-1553.