SYDNEY, Australia—Older, sedentary individuals with chronic hip or knee osteoarthritis (OA) who participate in either hydrotherapy or Tai Chi show greater improvements in physical function and joint pain than what has been seen with traditional recreational physical activities, according to a new study in Arthritis & Rheumatism.¹

"This study demonstrated that access to 12 weeks of hydrotherapy classes or Tai Chi classes for fairly sedentary older individuals (>59 years of age) with chronic symptomatic knee or hip OA resulted in clinical benefits that were sustained a further 12 weeks," conclude researchers led by Marlene Fransen, MPH, PhD, with the George Institute for International Health at the University of Sydney, in Australia.

Patients assigned to hydrotherapy most likely to attend

While participants in both groups experienced improvements in joint pain and physical function, those in the hydrotherapy group were more likely to attend sessions than those assigned to Tai Chi. Specifically, 81% of participants randomized to hydrotherapy completed at least half of the available 24 classes, compared with 61% in the Tai Chi group. OA patients in the hydrotherapy group also experienced significant improvements in such physical performance measurements as the Up and Go test, the timed 50-foot walk test, and the timed stair climb test, compared to the Tai Chi group.

"[H]ydrotherapy classes appeared to be more acceptable (higher attendance), appeared to provide greater relief of joint pain, and resulted in larger improvements in objective measurements of physical performance," Dr. Fransen and colleagues conclude.

The researchers randomly assigned 55 people to hydrotherapy classes, 56 to Tai Chi classes, and 41 to a waiting list control group. Classes lasted an hour and were offered twice a week for 12 weeks. After 12 weeks, there were significant improvements on scores measuring pain and physical function in both groups as assessed using the Western Ontario and McMaster Universities Osteoarthritis Index. Participants in the hydrotherapy group showed improvements of 6.5 for pain and 10.5 for physical function scores, compared with their counterparts on the waiting list. Participants in the Tai Chi group showed improvements of 5.2 in pain and 9.7 in physical function score, compared with controls.

Both groups also demonstrated improvements in physical performance scores, but these improvements were significant only in the hydrotherapy group. The follow-up assessment at 24 weeks showed that the two groups were still treatment responders.

Is Tai Chi ready for prime time?

"We know that exercise helps OA, but we are not clear about what types are best," Chen Chen Wang, MD, assistant professor of medicine at Tufts University School of Medicine and rheumatologist at the Tufts-New England Medical Center in Boston, told CIAOMed. "Sometimes high-impact exercises will damage the joints, so we need to find a good exercise which can be combined with [a patient's] lifestyle and is gentle on the joints."

Previous studies have shown that Tai Chi improves muscle strength and balance in people with OA and rheumatoid arthritis (RA). "It also has mental benefits, and we need to investigate which factors really help arthritis patients," she added.

The new report "extends findings of previous studies on the benefits of Tai Chi, but more study is needed." Dr. Wang has published studies on Tai Chi and arthritis and she is currently conducting a study on the effectiveness of Tai Chi in knee OA.

Reference

1. Fransen M, Nairn L, Winstanley J, et al. Physical activity for osteoarthritis management: a randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes. Arthritis Rheum. 2007;57:407-414.