Fibromyalgia and Tai Chi: Getting Mindful and Physical

Fibromyalgia patients are forever being told to exercise, and aerobic exercise is arguably the most commonly prescribed non-pharmacologic fibromyalgia treatment.

But is this emphasis on the body leaving the mind behind?

After all, fibromyalgia is associated with fatigue and neurocognitive (“fibro fog”) complaints, as well as depression. These “mind components” can make aerobic exercise a challenge for many fibromyalgia patients: a particularly rigorous exercise session one day can leave a patient physically and emotionally drained the next. This reality has led to many providers of care to the fibromyalgia community to focus on trying to work with the psychological components of chronic pain; and among these have been proponents of tai chi, as well as clinical trials of tai chi that at least suggest that this ancient form of exercise has a positive impact on both physical and mental health.

Recently, investigators sought to find the duration and frequency of tai chi, heretofore unknown, that would most likely lead to optimal benefit in the management of fibromyalgia. In this case, fibromyalgia patients were enrolled in a single-blind comparative effectiveness trial, comparing supervised aerobic exercise to supervised tai chi interventions. The study was designed to not only measure improvement in a fibromyalgia questionnaire, but also assess anxiety, depression, self-efficacy, and coping strategies, among other endpoints.

Interestingly, subjects assigned to the tai chi treatment group were more compliant with attendance compared to those assigned to the aerobic exercise group. Tai chi, with its low-impact, “meditative sequence of movements,” appeared to be more appealing to the average fibromyalgia patient.

As for the results of this study, while all subjects experienced an improvement in the fibromyalgia questionnaire compared to baseline, and used less pain medication over time, there was a greater improvement in the subjects assigned to the tai chi intervention.

With the same intensity and duration (24 weeks, twice weekly), tai chi showed a larger clinically important effect for the primary outcome and significant effects for many secondary outcomes compared with aerobic exercise. Notably, a longer duration of tai chi (24 weeks) had more benefit than a shorter duration (12 weeks). At 24 weeks, participants in the 24-week tai chi groups had significantly more improvement in FIQR score than those in the 12-week groups.

Maybe it is time to not just get physical, but a little mindful as well.