Complementary and Alternative Exercises for Management of Osteoarthritis

Table 1

Effects of Tai Chi on management of osteoarthritis reported in randomized controlled trials.

First author (year) [ref.]	Subjects	Exercise intervention	Control intervention	Results
Brismée (2007) [24]	Older persons (≥50 yr) with OA at knee in US, 𝑁=41 with 18% attrition in TC and 32% attrition in attention control.	24-form Yang style TC (40 min/session × 3 sessions/week × 6 weeks followed by home-based TC practice at 3 sessions/week × 6 weeks), 𝑁=22 (70.8 ± 9.8 yr).	Attention control program (40 min health lecture × 3 lectures/week × 6 weeks followed by no activity for 6 weeks), 𝑁=19 (68.8 ± 8.9 yr).	Compared to the attention control group, TC group; (i) reduced pain (VAS, WOMAC),; (ii) improved physical function (WOMAC),; (iii) showed no difference in stiffness (WOMAC),; (iv) showed no difference in knee range of motion for flexion and extension assessed by goniometry.
Song (2003) [35]	Older women (≥55 yr) with OA at multiple sites in South Korea, 𝑁=72 with 43% attrition in TC, 39% attrition in control.	12-form Sun style TC modified for arthritis (60 min/session × 3 sessions/week × 2 weeks, then 60 min/session × 1 session/week × 10 weeks), 𝑁=22 (64.8 ± 6.0 yr).	Telephone-contact control (usual care), 𝑁=21 (62.5 ± 5.6 yr).	Compared to the control group, TC group; (i) reduced pain (K-WOMAC),; (ii) showed no difference in knee muscle strength and endurance,; (iii) improved trunk flexion and abdominal muscle strength (increased frequency of situps),; (iv) perceived fewer difficulties in physical functioning of daily living (ADL),; (v) decreased joint stiffness (K-WOMAC),; (vi) showed no difference in upper-body flexibility,; (vii) improved balance by standing longer on one foot.
Fransen (2007) [36]	Older persons (ages 59–85 years) with OA at hip or knee in Australia, 𝑁=152 with 7% attrition in TC, 5% attrition in hydrotherapy, no dropout in control.	24-form Sun style TC modified for arthritis (60 min/session × 2 sessions/week × 12 weeks), 𝑁=56 (70.8 ± 6.3 yr).	Waiting list control, 𝑁=41 (69.6 ± 6.1 yr).	Compared to the waiting list control group, TC group; (i) showed no difference in pain reduction (WOMAC),; (ii) improved physical function (WOMAC),; (iii) showed no difference in quality of life (SF-12),; (iv) showed no difference in depression, anxiety, and stress (DASS 21).
Hartman (2000) [37]	Older person with OA at multiple sites (hip, knee, ankles, foot) in US, 𝑁=35 with 6% attrition in TC.	9-form Yang style TC (60 min/session × 2 sessions/week × 12 weeks), 𝑁=17 (68.6 ± 7.9 yr).	Attention control program (usual physical activity, routine care, total 3 times group meeting, and telephone discussion every 2 weeks), 𝑁=16 (67.5 ± 6.1 yr).	Compared to the control group, TC group; (i) showed no difference in pain reduction (arthritis pain self-efficacy),; (ii) reduced level of tension (AIMS II),; (iii) improved self-efficacy for arthritis symptom (Arthritis Self-Efficacy Scale) and total arthritis self-efficacy,; (iv) improved satisfaction with general health including improved walking speed, bending ability, arm function, self-care activities, and household tasks (AIMS II).
Wang (2009) [38]	Older persons (≥55 yr) with OA at knee in US, 𝑁=40 with no dropout.	10-form Yang style TC (60 min/session × 2 sessions/week plus 20 min/day home-based TC for 12 weeks, followed by home-based TC practice for 48 weeks), 𝑁=20 (63 ± 8.1 yr).	Attention control program (60 min/session of health lecture plus stretching exercise × 2 sessions/week × 12 weeks), 𝑁=20 (68 ± 7.0 yr).	Compared to the attention control group, TC group; (i) reduced pain (WOMAC, VAS),; (ii) improved physical function (WOMAC, chair stand time),; (iii) showed no difference in performance for 6-minue walking test,; (iv) reduced stiffness (WOMAC),; (v) showed no difference in balance score,; (vi) improved self-efficacy,; (vii) improved health-related quality of life (SF-36),; (viii) improved depression scale (Center for Epidemiologic Studies depression scale).
Song (2007) [39]	Older women (≥55 yr) with OA at multiple sites in South Korea, 𝑁=72 with 43% attrition in TC, 39% attrition in control.	12-form Sun style modified TC for arthritis (60 min/session × 3 sessions/week × 2 weeks, then 60 min/session × 1 session/week × 10 weeks), 𝑁=22 (64.8 ± 6.0 yr).	Telephone-contact control (usual care), 𝑁=21 (62.5 ± 5.6 yr).	Compared to the control group, TC group; (i) reduced pain (K-WOMAC),; (ii) decreased joint stiffness (K-WOMAC),; (iii) showed no difference in perceived self-efficacy including perceived benefits/barriers and emotional salience (motivation scale for health Behaviors),; (iv) perceived more health benefits,; (v) performed better health behaviors, especially for diet behavior and stress management (health behavior scale).
H. Y. Lee (2008) [40]	Older person with OA at knee in Korea, 𝑁=46 (75.4 ± 6.2 yr).	24-form Sun style TC (60 min/session × 2 sessions/week × 12 weeks), 𝑁=22.	No treatment, 𝑁=24.	Compared to the control group, TC group; (i) reduced pain (WOAMC),; (ii) reduced stiffness (WOAMC),; (iii) improved joint motion of knee and knee rising time,; (iv) improved balance (single leg test),; (v) decreased fears of falling,; (vi) showed no difference in disability and falls efficacy.
Song (2010) [41]	Older women (≥55 yr) with OA at multiple sites in South Korea, 𝑁=82 with 24% attrition in TC, 15% attrition in control.	31-form Wu style TC modified for arthritis (60 min/session × 2 sessions/week × 3 weeks, then 60 min/session × 1 session/week × 6 months), 𝑁=30 (63.0 ± 7.2 yr).	Self-help education program (2 hours/session × 1 session/month × 6 months), 𝑁=35 (61.2 ± 7.9 yr).	Compared to the control group, TC group; (i) improved knee extensor endurance,; (ii) showed no difference in knee extensor and flexor strength,; (iii) reduced fear of falling during daily activities.

ADL: activities of daily living; AIMS: Arthritis Impact Measurement Scale; TC: Tai Chi; WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index; VAS: visual analogue scale.