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Chronic obstructive pulmonary disease
BEAM study (Breathing, Education, Awareness, Movement): a randomised controlled feasibility trial of tai chi exercise in patients with COPD
  1. Gloria Y. Yeh1,2,
  2. Daniel Litrownik1,
  3. Peter M. Wayne2,
  4. Douglas Beach3,
  5. Elizabeth S. Klings4,
  6. Harry Reyes Nieva5,
  7. Adlin Pinheiro1,
  8. Roger B. Davis1 and
  9. Marilyn L. Moy5,6
  1. 1Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  2. 2Osher Center for Integrative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  3. 3Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  4. 4Pulmonary and Critical Care Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
  5. 5Harvard Medical School, Boston, Massachusetts, USA
  6. 6Pulmonary and Critical Care Section, Department of Medicine, Veterans Administration Boston Healthcare System, Boston, Massachusetts, USA
  1. Correspondence to Dr Gloria Y. Yeh; gyeh{at}hms.harvard.edu

Abstract

Background Despite therapeutic advances, the management of chronic obstructive pulmonary disease (COPD) remains complex. There is growing interest in multidimensional, mind-body exercises to improve both physical and psychosocial aspects of COPD burden. Few US data are available in this population on tai chi (TC) a mind-body exercise incorporating physical activity, breathing and mindful awareness. We explored feasibility and preliminary efficacy of TC in COPD in an US academic medical setting.

Methods Patients with COPD Global Obstructive Lung Disease (GOLD) stages 2–4 were randomised to a 12-week TC programme or education control. At 12 weeks, those in TC were randomised again to continue in maintenance classes or not to further explore optimal duration. All groups were followed to 24 weeks. Feasibility/safety parameters were analysed descriptively. Preliminary between-group differences were estimated in symptoms (dyspnoea, fatigue), health-related quality-of-life (Chronic Respiratory Questionnaire CRQ), cognitive-emotional measures (mood, COPD self-efficacy) and functional status (6 min walk test, lower body strength, flexibility, physical activity).

Results Ninety-two subjects were randomised (N=61 TC, N=31 education). Mean age was 68±8 years, 66% male, mean forced expiratory volume in 1 s % predicted 57±13, 28% were GOLD stage 3–4. Overall retention was 85%. Nineteen adverse events occurred, most being study-unrelated COPD exacerbations. From baseline to 12 weeks, there were between-group improvements favouring TC, in CRQ-total (Cohen’s d effect size (ES)=0.46; adj mean diff (AMD)=0.31), CRQ-emotion (ES=0.54; AMD=0.49), Centre for Epidemiologic Studies Depression (ES=−0.37; AMD=2.39) and Patient-Reported Outcome Measurement Information System (PROMIS)-fatigue (ES=−0.34; AMD=−0.17). From baseline to 24 weeks, there was an improvement favouring TC in CRQ-dyspnoea (ES=0.41; AMD=0.46). Among TC participants, there was a positive effect of maintenance classes on self-efficacy (ES=−0.69; AMD=−0.40), 6 min walk (ES=0.56; AMD=49.26 feet), PROMIS-fatigue (ES=−0.41; AMD=−0.28) and chair stand (0.43; AMD=0.56).

Conclusion TC in patients with COPD is feasible and safe. Preliminary analyses support a potential modest role in improving quality-of-life, cognitive-emotional health and function that should be further studied.

Trial registration number NCT01551953.

IRB reference BIDMC 2010P-000412; VA 2540.

  • exercise
  • complementary medicine
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjresp-2020-000697

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    Footnotes

    • RBD and MLM are joint senior authors.

    • Contributors GY: conceptualisation/design, analysis and interpretation of data, implementation, manuscript writing. DL: implementation, acquisition of data. PW: design, analysis and interpretation of data, manuscript writing and review. DB and EK: interpretation of data, implementation, manuscript review. HRN and AP: analysis and interpretation of data. RD: analysis and interpretation of data, manuscript review. MM: design, analysis and interpretation of data, implementation, manuscript writing and review.

    • Funding This study was supported by an award from the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health (NIH) (R01AT005436). GY was supported by K24AT009465. PW was supported by K24AT009282.

    • Disclaimer Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NCCIH or the NIH.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval All study procedures followed HIPAA guidelines and were approved by each institution’s human subjects review board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request.