TaiChi and Qigong for Depressive Symptoms in Patients with Chronic Heart Failure: A Systematic Review with Meta-Analysis

Table 1

Characteristics of included studies.

Source (country)	Populations				Types of TQPs (time/frequency; duration)	Control	RM^a	Depression severity			Risk of bias^b
	NYHA subtype	Sample size (drop out) (I/C), #	Male (I/C), %	Age, yrs. (I/C) mean ± SD				Instrument	Baseline mean (I/C)	Changes mean (I/C)
Barrow et al. (2007) [29] (UK)	II∼III HFrEF	65 (32/33) (13 (7/6))	81%/82%	68.4 ± NA^c/67.9 ± NA^c	III. TaiChi & Qigong (55 mins/twice per week; 16 wks)	—	TDs	SCL-90R^d, DEP subscale	Mild 58.3/60.2	−6.8/−2.9 (neutral)^e	Unclear; unclear; high; high; low; unclear
Redwine et al. (2012) [30] (US)	II HFpEF & HFrEF	24 (12/12) (4 (4/0))	83%/92%	72.6 ± 6.2/63.9 ± 12.0	I. TaiChi (60 min/twice per week; 12 wks)	—	TDs	BDI^d, DEP specific	Mild 8.0/9.2	NA/NA^c (positive)^f	Unclear; unclear; high; high; unclear; unclear
Yeh et al. (2011) [31] (US)	I∼III HFrEF	100 (50/50) (4 (1/3))	56%/72%	68.1 ± 11.9/66.6 ± 12.1	I. TaiChi (60 min/twice per week; 12 wks)	Education	TDs; dietary, exercise advice	PMOS-full^d, DEP subscale	Unclear^g 2.0/3.0	−2.0/1.0 (neutral)^e	Low; unclear; unclear; unclear; low; high
Yeh et al. (2013) [32] (US)	I∼III HFpEF	16 (8/8) (0)	50%/50%	68.0 ± 11.0/63.0 ± 11.0	I. TaiChi (60 min/twice per week; 12 wks)	Aerobic exercise^h	TDs; dietary, exercise advice	PMOS-brief^d, DEP subscale	Unclear^i 4.0/1.3	−1.7/+1.7 ()^e	Low; unclear; low; low; low; unclear
Yuan et al. (2016) [26] (China)	II∼III HFrEF	60 (30/30) (0)	57%/53%	66.3 ± 5.6/67.5 ± 3.8	I. TaiChi (20–40 min/5 times per week; 12 wks)	—	TDs; education; antidepressants	HAM-D^d, DEP specific	Moderate^j 19.9/19.5	−5.6/−3.9 (positive)^e	Low; unclear; high; low; low; unclear
Deng et al. (2018) [27] (China)	I∼III HFrEF	113 (57/56) (2 (2/0))	54%/52%	64.7 ± 4.2/67.2 ± 4.9	I. TaiChi (40∼60 min/≥5 times per week; 24 wks)	—	TDs; daily life advice	HAM-D^d, DEP specific	Moderate 22.6/21.3	−8.7/−2.1 (positive)^e	Unclear; unclear; high; unclear; low; unclear
Redwine et al. (2019) [33] (US)	NA^d HFrEF & HFpEF	45 (25/23/22) (7 (4/0/3))	92%/86%/87%	63.0 ± 9.0/67.0 ± 7.0/65.0 ± 9.0	I. TaiChi (60 min/twice per week; 16 wks)	−/resistance band^k	TDs; usual care	BDI^d, DEP specific	Mild 9.6/8.0/11.9	−3.5/−1/−3.3 (positive)^f	Low; low; unclear; unclear; low unclear
Cheng et al. (2018) [28] (Taiwan)	II NA^c	91 (41/44) (9 (3/6))	72%/70%	62.2 ± 15.1/66.6 ± 12.7	II. Qigong (Chan-Chuang) (≥15 min/2∼3 times per day; 12 wks)	—	TDs	HADS^d, DEP specific	Mild 7.2/7.3	−1.1/−0.2 (positive)^f	Low; low; high; high; unclear; unclear

NYHY: New York Heart Association; I: intervention group; C: control group; SD: standard deviation; TQPs: TaiChi and/or Qigong practices; RM: routine management; HFrEF: heart failure with reduced ejection fraction; HFpEF: heart failure with perceived ejection fraction; NA: not available; wks: weeks; TDs: therapeutic drugs (prescribed according to heart failure management guideline); DEP: depression; SCL-90-R: Symptom Checklist-90-Revised; BDI: Beck Depression Inventory; PMOS: Profile of Mood States; HAM-D: Hamilton Rating Scale for Depression; HADS: Hospital Anxiety and Depression Scale. ^aRoutine management provided as a consistent cointervention to both groups. ^bRisk of bias tool domains: (1) random sequence generation; (2) allocation concealment; (3) blinding of patients and personnel; (4) blinding of outcome assessors for primary outcomes; (5) incomplete outcome data; (6) selective reporting, respectively. ^cLVEF was not measured. ^dLower sum scores denote improvement. ^eBetween-group comparisons. ^fGroup-by-time interaction. ^gThe classification or the cutoff points of the scale (PMOS) were not found, but 30% of the subjects had depression as a comorbidity. ^hAerobic exercise: 60 min/twice per week. ⁱThe classification or the cutoff points of the scale (PMOS) were not found, but 37% of the subjects had depression as a comorbidity. ^jClinically diagnosed depression according to the CCMD-3 classification scheme and diagnostic criteria of Chinese psychosis. ^kResistance band training: 60 min/twice per week.