A single-blind, randomised trial from the USA has found that tai chi significantly improves the health-related quality of life of patients with fibromyalgia.

A total of 66 tertiary care patients were randomised to tai chi or a control intervention. Both groups attended two one-hour sessions a week over a period of 12 weeks. The control intervention consisted of 40-minute lectures on various aspects of fibromyalgia followed by 20 minutes of stretching exercises.

The primary outcome measure was the change in the Fibromyalgia Impact Questionnaire (FIQ) score over the 12-week intervention period. The FIQ incorporates measures of: physical functioning; work status; symptoms; mood and overall wellbeing. The scores range from 0 to 100 and can be categorised as mild (0-38), moderate (39-58) and severe (>59) impact.

The mean baseline FIQ scores for the tai chi and control groups were 62.9 and 68.0 respectively. The respective mean 12-week scores were 35.1 and 58.6. The improvement seen in the tai chi group (-27.8 points) was significantly better than the improvement seen in the control group (-9.4 points), and the difference between the groups (-18.4) was clinically relevant.

Participants also completed the 36-item short form health survey (SF-36). Again, patients from the tai chi group improved significantly more than those from the control group, both physically and mentally (differences between the groups were 7.1 points and 6.1 points respectively).

Patients in the tai chi group had a lower mean baseline depression score than patients in the control group (CES-D scores of 22.6 and 27.8 respectively) but adjustment for this did not affect the results.

The mean baseline FIQ scores suggest that this group of patients were severely affected by their fibromyalgia. Patients seen in primary care are likely to have milder symptoms and might be expected to derive a correspondingly smaller benefit from the intervention.

Tai chi is a gentle form of group exercise and stretching. Participants move slowly and gracefully from one posture to another, co-ordinating the rhythm of movement with their breathing to achieve a sense of inner calm.

A meta-analysis of the effects of tai chi on psychological wellbeing found evidence of a moderate reduction of stress, anxiety and depression, but the trials were heterogeneous and mostly of poor quality.1 The baseline scores in the fibromyalgia trial suggest a high prevalence of depression in the study population (a CES-D score of 16-26 suggests mild depression and a score ≥ 27 suggests moderate-severe depression). It is possible, therefore, that much of the observed benefit was due to an effect on coexisting depression, rather than the fibromyalgia itself.

It is unclear whether there is a specific benefit from tai chi, or whether other forms of group exercise will be equally effective. A randomised controlled trial which compared a three-month group exercise intervention (treadmill walking and exercise bikes) with relaxation therapy found that twice as many fibromyalgia patients from the exercise group rated themselves as much or very much better at three months, but the difference between groups in the FIQ (-4) was clinically insignificant.2 Social partnered dance is, perhaps, a more comparable activity: I am not aware of any trials with fibromyalgia patients but a recent small pilot study has suggested that a 10-week programme of salsa dance lessons can improve both mood and mobility for patients with severe and enduring mental illness.3

Should we advocate tai chi for our patients with fibromyalgia and/or depression?

I am even tempted to suggest that GPs might benefit from tai chi between consultations, although this may disconcert our receptionists!

I think the answer is that any form of group exercise is likely to be beneficial, and the choice will probably be determined by what is available locally.

Dr Phillip Bland