BMJ. 2018 Mar 21;360:k851. doi: 10.1136/bmj.k851.

Effect of tai chi versus aerobic exercise for fibromyalgia:
comparative effectiveness randomized controlled trial.
Wang C1, Schmid CH2, Fielding RA3, Harvey WF4, Reid KF3, Price LL5, Driban JB4, Kalish R6, Rones R7, McAlindon T4.

Abstract
OBJECTIVES:
To determine the effectiveness of tai chi interventions compared with aerobic exercise, a current core
standard treatment in patients with fibromyalgia, and to test whether the effectiveness of tai chi depends
on its dosage or duration.

DESIGN:
Prospective, randomized, 52 week, single blind comparative effectiveness trial.

SETTING:
Urban tertiary care academic hospital in the United States between March 2012 and September 2016.

PARTICIPANTS:
226 adults with fibromyalgia (as defined by the American College of Rheumatology 1990 and 2010criteria) were included in the intention to treat analyses: 151 were assigned to one of four tai chi groups
and 75 to an aerobic exercise group.

INTERVENTIONS:
Participants were randomly assigned to either supervised aerobic exercise (24 weeks, twice weekly) or
one of four classic Yang style supervised tai chi interventions (12 or 24 weeks, once or twice weekly).
Participants were followed for 52 weeks. Adherence was rigorously encouraged in person and bytelephone.

MAIN OUTCOME MEASURES:
The primary outcome was change in the revised fibromyalgia impact questionnaire (FIQR) scores at 24weeks compared with baseline. Secondary outcomes included changes of scores in patient's global
assessment, anxiety, depression, self efficacy, coping strategies, physical functional performance,functional limitation, sleep, and health related quality of life.

1/2RESULTS:
FIQR scores improved in all five treatment groups, but the combined tai chi groups improved statisticallysignificantly more than the aerobic exercise group in FIQR scores at 24 weeks (difference between
groups=5.5 points, 95% confidence interval 0.6 to 10.4, P=0.03) and several secondary outcomes(patient's global assessment=0.9 points, 0.3 to 1.4, P=0.005; anxiety=1.2 points, 0.3 to 2.1, P=0.006; self
efficacy=1.0 points, 0.5 to 1.6, P=0.0004; and coping strategies, 2.6 points, 0.8 to 4.3, P=0.005). Tai chi
treatment compared with aerobic exercise administered with the same intensity and duration (24 weeks,twice weekly) had greater benefit (between group difference in FIQR scores=16.2 points, 8.7 to 23.6,
P<0.001). The groups who received tai chi for 24 weeks showed greater improvements than those who
received it for 12 weeks (difference in FIQR scores=9.6 points, 2.6 to 16.6, P=0.007). There was no
significant increase in benefit for groups who received tai chi twice weekly compared with once weekly.
Participants attended the tai chi training sessions more often than participants attended aerobic exercise.
The effects of tai chi were consistent across all instructors. No serious adverse events related to theinterventions were reported.

CONCLUSION:
Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic
exercise, the current most commonly prescribed non-drug treatment, for a variety of outcomes forpatients with fibromyalgia. Longer duration of tai chi showed greater improvement. This mind-body
approach may be considered a therapeutic option in the multidisciplinary management of fibromyalgia.

TRIAL REGISTRATION:
ClinicalTrials.gov NCT01420640.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence)
please go to http://group.bmj.com/group/rights-licensing/permissions.
PMID:29563100
PMCID:PMC5861462

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