Evaluation of Energy Expenditure and Cardiovascular Health Effects From Tai Chi and Walking Exercise
Condition: Physical Activity
Study type: Interventional

Summary: 
      Cardiovascular diseases (CVD) accounted for major mortality and morbidity rates in Hong Kong
      (HK) other than cancer. Increasing energy expenditure through regular exercise participation
      has been found to lower the risk of CVD such as hyperlipidemia and obesity. Healthcare
      professionals often prescribe lifestyle exercises for disease prevention, rehabilitation, and
      health maintenance purposes. Previous study revealed that Tai Chi and walking were widely
      practice by HK citizens. However, limited studies are found to compare the health benefits
      between Tai Chi and walking. Do Tai Chi and walking have equally effective in raising
      metabolic rate and reducing CVD risks? The difference in energy cost between a single bout of
      Tai Chi and walking has not been documented. Limited studies report the effects of Tai Chi in
      lowering the CVD risk. Since walking and Tai Chi are being heavily promoted in HK in recent
      years, there is an urgent need to document the evidence of these two common forms of exercise
      in terms of reducing CVD risks. Therefore, the purpose of the present study was to
      investigate the energy costs as well as CV health benefits, in terms of aerobic fitness, body
      composition, blood pressure, and blood lipid profiles, from the walking and Tai Chi exercise
      in a sample of HK Chinese adults, and to compare the effects between these two exercises. The
      investigators hypothesized that Tai Chi and walking had similar effects on improving energy
      cost and reducing CVD risks.
    

Detailed description: 
      An influential medical report released in 1996 confirmed that daily accumulation of 30
      minutes of moderate physical activity would significantly lower the risks of many chronic
      diseases (Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: U.S.
      1996). The report also recommended walking as one of the best forms of exercise that suitable
      for both healthy and patient population in all ages. To meet the daily 30 minutes exercise
      guidelines, a popular health promotion campaign -- 10,000 steps of walking per day, has been
      widely implemented in western countries, and has been recently promoted by the Health
      Info-World of HK Hospital Authority. Some studies demonstrated various health benefits from
      regular walking. The most recent study by Murphy et al. (Med Sci Sports Exerc. 2002) provided
      an excellent example that, in a 6-week walking program (5 days per week), one single bout of
      continuous 30 minutes of walking per day yielded similar health benefits as three 10-minute
      walks per day. The exercise intensity for both walking exercises was 70-80% of maximal heart
      rate, and resulted in significant increase in HDL-cholesterol, and decreases in triglycerides
      and total cholesterol. Both walking exercises improved body composition significantly.
      Moreover, tension/anxiety were also decreases significantly. Similar health benefits were
      also noted by several other studies (Moreau KL, et al. Med Sci Sports Exerc 2001. Wullink M
      et al. Med Sci Sports Exerc 2001. O'Hara RB et al. ACSM's Health Fitness J 2000). In these
      studies, the walking intervention periods varied from 6 weeks to 24 weeks, and daily walking
      times varied from 20 minutes to 50 minutes. Exercise intensities varied from 50% to 70% of
      VO2max. However, the energy cost of a typical walking bout of HK adults is not clear. Since
      body composition of HK Chinese is different from those reported for westerners, it is
      reasonably believe that the energy expenditure of walking for HK Chinese is different from
      those found in the literature. The CVD benefits result from walking have not been reported
      for the Chinese population. These outcome measures derived from walking and Tai Chi have not
      been compared.

      Tai Chi is an ancient form of Chinese fitness exercise. A number of studies have investigated
      the positive health improvement effects from Tai Chi for patients (Channer KS et al. Postgrad
      Med J 1996. Fontana JA et al. Nurs Clin North Am 2000. Lan C et al. Med Sci Sports Exerc
      1999), as well as for healthy individuals (Lan C et al. Med Sci Sports Exerc 1998. Zhuo D et
      al. Can J Appl sport Sci 1984). These health benefits include an improvement of aerobic
      fitness (Lai JS et al. J Am Geriatr Soc 1995. Hong YL et al. Br J Sport Med 2000) and energy
      metabolism (Zhuo D et al. Can J Appl sport Sci 1984. Schneider D et al. Int J Sport Med
      1991), muscular strength and balance (Hong YL et al. Br J Sport Med 2000. Chan WW et al. Phys
      Occup Ther Geriatr 2000. Schaller KJ et al. J Gerontol Nurs 1996), as well as mental control
      (Jin P. J Psycho-som Res 1992. Fasko Jr D et al. Clin Kinesiol 2001). Compared to walking, it
      is intuitively perceived that Tai Chi is characterized by lower exercise intensity and
      metabolic cost. But surprisingly, Lan et al. reported that the exercise intensity of a
      typical session of Tai Chi (24 minutes Yang style) exceeded 70% of maximal heart rate (Lan C
      et al. Arch Phys Med Rehabil 1996). However, the energy cost of this single bout of Tai Chi
      has not been investigated. Tai Chi and walking seem to provide similar benefits but has not
      been compared simultaneously except in one study. Jin reported that heart rate, blood
      pressure, and urinary catecholamine changes for Tai Chi were similar to walking at a speed of
      6 km/h (Jin P. J Psycho-som Res 1992). However, the energy cost and CVD risk measures were
      not investigated in this study. Although both walking and Tai Chi are believe to have
      positive health benefits, the extents to which these exercises contribute to raising the
      energy metabolism as well as CV health improvement have not been documented. Which form of
      exercise would elicit higher energy demand and produce greater CV health effects? Currently
      no scientific data available to report such results for HK Chinese. Results from this study
      will be valuable for practitioners to provide quantifiable prescriptions for obese
      individuals for weight control, as well as for those who need to improve CV health.

      AIMS

      Increasing energy expenditure has been considered a crucial role for reducing obesity.
      Raising the level of energy expenditure has also been found to produce improvement in
      cardio-respiratory fitness and lowering CVD risks. However, the energy cost from Tai Chi and
      walking have not been fully studied and their training effects on CVD risks have not been
      compared. The purpose of the present study was to examine the level of energy expenditure of
      Tai Chi and walking, and to compare the training effects from Tai Chi and walking in terms of
      lowering CVD risks. Specific aims of the project were as follows:

        1. To evaluate the changes of energy expenditure, aerobic fitness, body composition, SF-12,
           blood serum lipid profiles (total, LDL, and HDL-cholesterols), fasting blood glucose,
           dietary habits and physical fitness after the 12 weeks of Tai Chi and walking training,
           respectively.

        2. to compare the effects of Tai Chi and walking exercises on improving energy expenditure,
           aerobic fitness, body composition, SF-12, blood serum lipid profiles (total, LDL, and
           HDL-cholesterols), fasting blood glucose, dietary habits and physical fitness after the
           12 weeks of Tai Chi and walking training.

        3. compare the energy metabolism during these two exercises at similar practice intensity
           (approximately at 50-70% of age-predicted maximal heart rate, and 30 minutes of exercise
           bout).
    

Intervention name(s): 12-week instructor-led Tai Chi training program; 12-week instructor-led brisk walking training program
Intervention type(s): Behavioral; Behavioral
Intervention description(s): A 12-week (45 min per day, 5 days per week) instructor-led Tai Chi training program was conducted in the Tai Chi group. Of the 5 days of exercise, 3 days were led by qualified instructors, and 2 other days for self-practice. Each session consisted of a 10-min standard warm-up, 30-min of Tai Chi exercise, and 5-min cool down stretching. The modified 32 Yang-style Tai Chi Chuan was used, because it could be learned within a relatively short time, and has been widely promoted in HK community. An exercise log was used to record the actual implementation of the training (instructor-led & self-practice).; A 12-week (45 min per day, 5 days per week) instructor-led brisk walking training program was conducted in the walking group. Of the 5 days of exercise, 3 days were led by qualified instructors, and 2 other days for self-practice. Each session consisted of a 10-min standard warm-up, 30-min of walking exercise, and 5-min cool down stretching. An exercise log was used to record the actual implementation of the training (instructor-led & self-practice).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Tai Chi; Walking; Physical activity; Randomized controlled trial; Chinese population; Exercise; Body composition; Cardiovascular risk factor; Energy expenditure; Fitness; SF-12