Mechanisms of motor symptom improvement by long-term Tai Chi training in Parkinson’s disease patients

Abstract

Background Tai Chi has been shown to improve motor symptoms in Parkinson’s disease (PD), but its long-term effects and the related mechanisms remain to be elucidated. In this study, we investigated the effects of long-term Tai Chi training on motor symptoms in PD and the underlying mechanisms. Methods Ninety-five early-stage PD patients were enrolled and randomly divided into Tai Chi (n = 32), brisk walking (n = 31) and no-exercise (n = 32) groups. At baseline, 6 months and 12 months during one-year intervention, all participants underwent motor symptom evaluation by Berg balance scale (BBS), Unified PD rating-scale (UPDRS), Timed Up and Go test (TUG) and 3D gait analysis, functional magnetic resonance imaging (fMRI), plasma cytokine and metabolomics analysis, and blood Huntingtin interaction protein 2 (HIP2) mRNA level analysis. Longitudinal self-changes were calculated using repeated measures ANOVA. GEE (generalized estimating equations) was used to assess factors associated with the longitudinal data of rating scales. Switch rates were used for fMRI analysis. False discovery rate correction was used for multiple correction. Results Participants in the Tai Chi group had better performance in BBS, UPDRS, TUG and step width. Besides, Tai Chi was advantageous over brisk walking in improving BBS and step width. The improved BBS was correlated with enhanced visual network function and downregulation of interleukin-1β. The improvements in UPDRS were associated with enhanced default mode network function, decreased L-malic acid and 3-phosphoglyceric acid, and increased adenosine and HIP2 mRNA levels. In addition, arginine biosynthesis, urea cycle, tricarboxylic acid cycle and beta oxidation of very-long-chain fatty acids were also improved by Tai Chi training. Conclusions Long-term Tai Chi training improves motor function, especially gait and balance, in PD. The underlying mechanisms may include enhanced brain network function, reduced inflammation, improved amino acid metabolism, energy metabolism and neurotransmitter metabolism, and decreased vulnerability to dopaminergic degeneration. Trial registration This study has been registered at Chinese Clinical Trial Registry (Registration number: ChiCTR2000036036; Registration date: August 22, 2020).

Efficacy of Traditional Chinese Exercise in Improving Gait and Balance in Cases of Parkinson's Disease: A Systematic Review and Meta-analysis

“…Table 1 lists the characteristics of each of the included studies, which were published between 2006 and 2022. Seven studies were conducted in China (Gao et al, 2014;Zhang et al, 2015;Liu et al, 2016;Wan et al, 2021;Li et al, 2022), four in the USA (Hackney and Earhart, 2008;Li et al, 2012;Amano et al, 2013;Vergara-Diaz et al, 2018), two in Korea (Choi et al, 2013;Lee et al, 2018), one in Germany (Schmitz-Hübsch et al, 2006), and one in Turkey (Kurt et al, 2018). The TCE program was used to treat PD in all experimental groups, with nine studies using Tai Chi and six studies using Qigong.…”

“…The quality of the studies ranged between fair and good (score range: 5-9 points), with 80% of studies being classified as good quality and 12% as fair quality. Nine studies used a concealed allocation procedure (Schmitz-Hübsch et al, 2006;Li et al, 2012Li et al, , 2022Gao et al, 2014;Zhang et al, 2015;Kurt et al, 2018;Lee et al, 2018;Vergara-Diaz et al, 2018;Wan et al, 2021), and all reported random assignment. We could not blind patients and therapists because this was an interventional movement study.…”

“…We could not blind patients and therapists because this was an interventional movement study. However, 10 trials blinded the outcome assessors (Schmitz-Hübsch et al, 2006;Hackney and Earhart, 2008;Li et al, 2012Li et al, , 2022Amano et al, 2013;Choi et al, 2013;Gao et al, 2014;Zhang et al, 2015;Lee et al, 2018). Five studies had a dropout rate of >85% (Hackney and Earhart, 2008;Liu et al, 2016;Lee et al, 2018;Wan et al, 2021;Li et al, 2022).…”

“…However, 10 trials blinded the outcome assessors (Schmitz-Hübsch et al, 2006;Hackney and Earhart, 2008;Li et al, 2012Li et al, , 2022Amano et al, 2013;Choi et al, 2013;Gao et al, 2014;Zhang et al, 2015;Lee et al, 2018). Five studies had a dropout rate of >85% (Hackney and Earhart, 2008;Liu et al, 2016;Lee et al, 2018;Wan et al, 2021;Li et al, 2022). Nine studies in particular did not analyze missing data using intent-totreat analyses (Hackney and Earhart, 2008;Amano et al, 2013;Choi et al, 2013;Gao et al, 2014;Liu et al, 2016;Kurt et al, 2018;Vergara-Diaz et al, 2018;Wan et al, 2021).…”

Utilization of Mind–Body Intervention for Integrative Health Care of COVID-19 Patients and Survivors

“…Another detrimental neurodegenerative disorder, Parkinson’s disease (PD), also exhibits higher peripheral concentrations of inflammatory markers—including IL-6, TNF, IL-1β, IL-2, IL-10, CRP and regulated upon activation, normal T cell expressed and presumably secreted (RANTES)—according to a meta-analysis that included 25 studies [ 80 ]. In an RCT with early-stage PD patients, tai chi practice significantly reduced IL-1β, IL-7, IL-9 compared to usual care; however, the effects were equivalent to brisk walking [ 59 ]. For MBI studies with PD patients reporting inflammatory outcomes, there was only one study; therefore, more RCTs are expected to discuss the effects of MBI on inflammation in PD conditions.…”