The Impact of Tai Chi Exercise on Self-Efficacy, Social Support, and Empowerment in Heart Failure: Insights from a Qualitative Sub-Study from a Randomized Controlled Trial

Abstract

ObjectiveTo qualitatively explore perceived physical and psychosocial effects and overall patient experience associated with a 12-week tai chi (TC) intervention and an education group in a clinical trial of patients with chronic heart failure (HF).Subjects and MethodsWe randomized 100 patients with chronic systolic HF (NYHA Class 1–3, ejection fraction≤40%) to a 12-week group TC program or an education control. At 12-weeks, semi-structured interviews were conducted on a random subset (n = 32; n = 17 in TC, n = 15 in control), audiorecorded and transcribed verbatim. Two independent reviewers extracted information using grounded-theory methods for emergent themes. We explored similarities and differences in themes/sub-themes between the groups, and examined qualitative association with changes from baseline to post-intervention in previously reported quantitative measures (e.g., Minnesota Living with HF, Cardiac Exercise Self Efficacy and Profile of Mood States).ResultsThe mean age (±SD) of participants was 68±9 years, baseline ejection fraction 29±7%, and median New York Heart Association class 2 HF. We idenitifed themes related to the patient’s experience of illness, perceptions of self, and relationship to others. Specific psychosocial and physical benefits were described. Common themes emerged from both groups including: social support and self-efficacy related to activity/exercise and diet. The tai chi group, however, also exhibited a more global empowerment and perceived control. Additional themes in TC included mindfulness/self-awareness, decreased stress reactivity, and renewed social role. These themes mirrored improvements in previously reported quantitative measures (quality-of-life, self-efficacy, and mood) in TC compared to control. Patients in TC also reported physical benefits (e.g., decreased pain, improved energy, endurance, flexibility).ConclusionPositive themes emerged from both groups, although there were qualitative differences in concepts of self-efficacy and perceived control between groups. Those in tai chi reported not only self efficacy and social support, but overall empowerment with additional gains such as internal locus of control, self-awareness and stress management. Future studies of mind-body exercise might further examine perceived control, self-efficacy, and locus-of-control as potential mediators of effect.

A mixed methods study of Tai Chi exercise for patients with chronic heart failure aged 70 years and older

“…Many participants emphasized their improved balance, which is in line with earlier research. In a qualitative study, CHF patients reported among other things improvement in self‐efficacy, specifically in performing exercise and also feelings of empowerment and control (Yeh, Chan, Wayne, & Conboy, ). The social engagement of the group and the influence of the leader was reported to be important.…”

Tai chi and yoga in residential aged care: Perspectives of participants: A qualitative study

“…() and Yeh et al. () where participants reported experiencing enhanced awareness and greater unity between mind and body.…”

“…These forms of emotional embodiment are related to wellness, a subjectively embodied experience incorporating bodily harmony and balance (Duay & Bryan, 2006). Participants of other studies of yoga and tai chi have reported similar perceptions relating to physical and psychological benefits (Middleton et al, 2017;Van Puymbroeck et al, 2013;Yeh et al, 2016). The active engagement of mind and body stimulated the The interventions offered the participants an opportunity to rediscover their potential to do exercise.…”

“…Qualitative research studies that have examined perceptions of middle-to old-aged adults with long-term conditions on yoga and tai chi interventions report increased self-confidence, self-efficacy, stress relief, feeling of calmness, compliance (Middleton et al, 2017;Van Puymbroeck, Burk, Shinew, Kuhlenschmidt, & Schmid, 2013), perceived alleviation of symptoms such as pain, improved energy, sleep quality (Waite-Jones, Hale, & Lee, 2013;Zheng et al, 2017), increased body awareness and mindfulness (Yeh, Chan, Wayne, & Conboy, 2016). The tai chi and yoga programmes were also viewed as feasible, meaningful and appropriate (Hägglund, Boman, & Brännström, 2018;Waite-Jones et al, 2013).…”

Sessão de Tai Chi Chuan promove hipotensão pós-exercício e redução da sobrecarga cardiovascular em idosos hipertensos

“…Os movimentos são integrados por meio de respiração profunda e concentração mental, o praticante pode adquirir um estado de harmonia entre corpo e mente, e o esforço para realização das aulas possuem característica de intensidade moderada. 20 A literatura demonstra inúmeros benefícios aos praticantes do TCC, dentre eles: melhora da função físi-ca, 21,22 melhora psicossocial, 20,23 melhora da aptidão cardiorrespiratória 24,25,26 e redução da pressão arterial. 27,28 Em relação ao tratamento da HAS, principalmente em idosos, pouco se conhece a respeito do comportamento de variáveis cardiovasculares e hemodinâmicas como a PAS, PAD, pressão arterial média (PAM), frequência cardíaca (FC) e duplo produto (DP) frente à prática do TCC, mesmo sendo uma modalidade de exercícios com alta participação da população de idosos.…”