For people who have a heart attack, chances are high that if they don’t do much to change their lifestyle and health habits, they will have another one—possibly even a fatal one—in a few years.
But the dietary and exercise changes that doctors recommend are often too intimidating and frightening for patients. Most heart rehabilitation programs include regular treadmill sessions several times a week at a hospital or heart facility, but nearly two-thirds of heart attack patients don’t participate in these programs. For people who are overweight or obese and are not in the habit of exercising, such regimens are off-putting and stressful, since they are afraid that the exercise will trigger another heart attack.
Dr. Elena Salmoriago-Blotcher, assistant professor of medicine and epidemiology at Brown University’s Warren Alpert School of Medicine & Public Health, wanted to find an alternative for people like this. In a small new study published in the Journal of the American Heart Association, she and her colleagues found that tai chi might be a useful way to introduce reluctant people to exercise.
In the study, 29 men and women who had recently had a heart attack were randomly assigned to two tai chi groups. One practiced tai chi twice a week for 12 weeks by attending sessions at the hospital, while the other group did it three times a week for 24 weeks. All of the volunteers were also given DVDs to help them continue practicing tai chi at home.
After three months, Salmoriago-Blotcher found that the people in the group doing tai chi more frequently were more physically active than those doing less of the exercise. After six months, the differences were more pronounced. Not only were the people in the more intensive group practicing tai chi more often, but they were also doing more physical activity outside of their sessions, such as riding their bikes and climbing up and down stairs in their homes that they were afraid to use before.
“People like it, and they came,” says Salmoriago-Blotcher. “We retained pretty much everybody for the length of the study. And there is a preliminary indication that the longer program may improve physical activity. We changed behavior.”
The study, which was funded by the National Center for Complementary and Integrative Health, wasn’t designed to see if tai chi could actually replace the traditional exercise programs associated with cardiac rehab, but to see if people who are averse to exercising would accept tai chi as a way to get more physically active. The study didn’t include enough people to see if it changed their fitness levels and other measures of metabolic health, for example. But getting previously inactive people to move more is the first hurdle, says Salmoriago-Blotcher.
The results suggest that for people who don’t do cardiac rehab, tai chi may be a way to entice them to start exercising in a gentle, less intimidating way. It may also act as a gateway to other types of more traditional and intensive exercise that have been shown to improve fitness and potentially lower risk of having further heart attacks. “Tai chi is an interesting, promising exercise option,” says Salmoriago-Blotcher. “I think based on what we found, it’s a reasonable and safe step to offer tai chi within cardiac rehab. If someone says they are afraid of exercising, we could ask if they are interested in doing tai chi.”
Once people start to move more using tai chi, she says, doctors can revisit the possibility of switching them to a more intensive traditional cardiac rehab program.
The benefits of offering tai chi to the people who aren’t getting cardiac rehab now could be enormous, since it’s a gentle way to become physically active. Unlike other forms of exercise, including working out on a treadmill and even yoga, tai chi is non-striving, says Salmoriago-Blotcher, meaning there is no set goal or pose that needs to be reached: just moving for the sake of moving. By its nature, people who practice tai chi “are not going anywhere, and not wanting to achieve [physical goals],” she says. “We tell people to just do it without thinking about goals. They should just enjoy the movement and the practice.”
Tai chi is also customizable. For people who can’t arrange transportation to come to regular rehab sessions at a hospital, tai chi can also be easily done at home without equipment, which might also encourage more people to exercise. It can also be adjusted to be more or less strenuous, depending on how it’s practiced. Salmoriago-Blotcher is hoping to study tai chi further in heart attack survivors by upping the intensity and seeing, through heart rate monitors, if that actually helps improve their physical fitness. If it does, then tai chi might be on its way to being an alternative to the treadmill as a way to improve heart health.