Therapeutic Interventions to Improve Static Balance in Type 2 DiabetesMellitus: A Systematic Review and Meta-Analysis.

INTRODUCTION: Diabetes mellitus (DM) is a metabolic disorder characterized by an abnormal increase in blood glucose levels resulting from insulin secretion and/or dysfunctional activity that can lead to several serious complications in addition to decreased postural balance. OBJECTIVE: This study aimed to identify and analyze the main interventions used to improve static balance in patients with DM. METHODS: For the selection of articles, a bibliographic search was performed using PubMed, Scopus, Web of Science, Embase, and Cochrane databases. Only clinical trials that investigated the effect of training on static balance in adults with type 2 DM were selected, and 34 studies were included. RESULTS: The search resulted in the identification of 2681 articles, and of these, 31 were eligible for the study. The identified interventions were proprioceptive, aerobic, resistance training on platforms, in virtual reality, and Tai Chi. The main results obtained were an increase in time in the one-leg stance, Romberg test, and tandem position, a significant increase in the Berg Balance Scale score and balance index, and a reduction in the variables of postural sway. CONCLUSION: There are a variety of effective training methods for improving static balance, and the choice of intervention to be applied goes beyond proven effectiveness, depending on reproducibility and/or financial cost.

[Motor intervention strategies on postural control in children and youth with autism spectrum disorder: A systematic review]. / Estrategias de intervención motora sobre el control postural en niños y jóvenes con trastorno del espectro autista: una revisión sistemática.

Autism spectrum disorder (ASD) has varied characteristics with an impact at the social, communicative and sensorimotor (SM) level. An SM feature is postural control (PC) problems. There are various motor intervention strategies (MIS), but the benefit over LC is something that has been analyzed less extensively. The objective was to describe the MIS and its results on the PC of children and adolescents with ASD. A search of PubMed, Scopus, Web of Science and Cochrane was performed. A total of eight articles met the eligibility criteria. All MIS showed beneficial results on the improvement of PC. The MIS were of a varied nature (dance practice, personalized physical activity, video games, Tai Chi Chuan, Taekwondo and virtual reality). It is necessary to improve the designs and consider the risks of bias, since they limit the scope of the results.

Taichí como intervención terapéutica en la rehabilitación respiratoria de la enfermedad pulmonar obstructiva crónica. Estudio piloto / Tai Chi as a therapeutic intervention in pulmonary rehabilitation of chronic obstructive pulmonary disease. Pilot study / Tai-chi como intervenção terapêutica na reabilitação respiratória da Doença Pulmonar Obstrutiva Crônica. Estudo piloto

Introducción: investigaciones recientes con la práctica del taichí mostraron beneficios en la funcionalidad, capacidad de ejercicio y calidad de vida de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC). La falta de estudios en nuestro medio y la necesidad de nuevas modalidades de tratamiento impulsó la realización de este trabajo. El objetivo fue valorar el impacto del taichí en un programa de rehabilitación respiratoria de la EPOC. Material y método: estudio piloto, aleatorizado, prospectivo y abierto. Se trabajó con 17 pacientes portadores de EPOC, 7 en el grupo control (CNTL) y 10 en el grupo tratamiento (TCm). Recibieron un programa de rehabilitación respiratoria durante 12 semanas. El grupo TCm con taichí como intervención terapéutica. Se comparó la similitud de las variables sociodemográficas y clínicas. Resultados: los grupos analizados fueron similares en la mayoría de las variables (edad, sexo, sociodemográficas, Gold, Charson, índice tabáquico IPA). En cuanto a las variables resultado, todas las categorías analizadas en los cuestionarios del índice PROMIS previo al inicio, al mes y a los tres meses, evidenciaron una mejoría entre los valores iniciales y finales en ambos grupos, siendo mayor en TCm, aunque no estadísticamente significativo, con valores p ≤ 0,05. En el cuestionario SGRQ, el análisis de los resultados no mostró diferencias significativas entre CNTL vs TCm al mes (44±5 vs 46±5 p 0,742) y a los tres meses (44±5 vs 40±6 p 0,916), con mejoras a favor en los valores del grupo TCm. El índice BODE registró valores menores, evidencia de una mejoría en grupo TCm a los tres meses (2±0,6 vs 3±0,4 p 0,889), sin ser estadísticamente significativa (p ≤ 0,05). Conclusiones: el beneficio del taichí dentro de un programa de rehabilitación tradicional mostró mejoras no significativas en funcionalidad y calidad de vida relacionada con la salud, su inclusión aparece como promisoria, requiriendo una mayor investigación futura.

Recent studies involving Tai Chi have shown benefits in the functionality, exercise capacity, and quality of life of patients with COPD. The lack of studies in our region and the need for new treatment modalities prompted this study. The objective was to assess the impact of Tai Chi in a Pulmonary Rehabilitation Program for COPD. Method: Pilot, randomized, prospective, and open-label study; with two similar groups of patients with COPD, who were included in a Pulmonary Rehabilitation program for 12 weeks; one of them with Tai Chi as a therapeutic intervention. The similarity of sociodemographic and clinical variables was compared. Results: The analyzed groups were similar in most variables (age, sex, sociodemographic, GOLD, Charlson, smoking index IPA). Within the outcome variables in the self-administered PROMIS index prior to the start, at one month, and at three months, all categories analyzed showed an improvement between the initial and final values in both groups, with a greater improvement in the TCm group, although not statistically significant with p-values ≤ 0.05. In the SGRQ questionnaire, the analysis of the results showed no significant differences between the CNTL and TCm groups at one month (44±5 vs. 46±5, p 0.742) and three months (44±5 vs. 40±6, p 0.916); with better values in the TCm group. The BODE Index recorded lower values, indicating an improvement in the TCm group at three months (2±0.6 vs. 3±0.4, p 0.889), although not statistically significant (p ≤ 0.05). Conclusions: The benefit of Tai Chi within a traditional rehabilitation program showed non-significant improvements in functionality and health-related quality of life. Its inclusion appears promising, requiring further future research.

Estudos recentes com Tai-chi mostraram benefícios na funcionalidade, capacidade de exercício e qualidade de vida em pacientes com DPOC. A falta de estudos em nosso meio e a necessidade de novas modalidades de tratamento motivaram o estudo. O objetivo foi avaliar o impacto do Tai-chi em um Programa de Reabilitação Respiratória para DPOC. Método: Estudo piloto, randomizado, prospectivo e aberto, com dois grupos semelhantes de pacientes com DPOC, que receberam um programa de reabilitação respiratória por 12 semanas; um deles com o Tai-chi como intervenção terapêutica. A similaridade das variáveis sociodemográficas e clínicas foi comparada. Resultados: Os grupos analisados foram semelhantes na maioria das variáveis (idade, sexo, dados sociodemográficos, GOLD, Charson, índice de tabagismo IPA). Dentro das variáveis de resultado no índice PROMIS autoadministrado na linha de base, em um mês e em 3 meses, todas as categorias analisadas mostraram uma melhora entre os valores iniciais e finais em ambos os grupos, sendo maior no grupo TCm, embora não estatisticamente significativa com valores de p ≤ 0,05. No questionário SGRQ, a análise dos resultados não mostrou diferenças significativas entre os grupos control e TCm em 1 mês (44±5 vs 46±5, p 0,742) e 3 meses (44±5 vs 40±6, p 0,916), com melhores valores no grupo TCm. O índice BODE registrou valores mais baixos, evidência de uma melhora no grupo TCm aos 3 meses (2±0,6 vs 3±0,4, p 0,889), sem ser estatisticamente significativo (p ≤ 0,05). Conclusões: O benefício do Tai-chi dentro de um programa de reabilitação tradicional mostrou melhorias não significativas na funcionalidade e na qualidade de vida relacionada à saúde; sua inclusão parece promissora e requer mais pesquisas.

A prática de Tai Chi na saúde de diabéticos e hipertensos: uma revisão integrativa / The Tai Chi practice on the health of diabetic and hypertensive patients: an integrative review

Este estudo teve como objetivo sistematizar os resultados das pesquisas que investigaram a relação entre a prática de TC e a saúde de indivíduos com Hipertensão Arterial Sistêmica (HAS) e Diabetes Mellitus (DM). Realizou-se uma revisão integrativa da literatura e foram realizadas buscas nas bases de dados PubMed, SciELO, LILACS e BVS. Foram incluídos estudos publicados nos últimos 20 anos em inglês, português e espanhol, que discorreram sobre a temática da prática de TC em indivíduos com HAS e DM. Foram excluídos estudos que não atenderam a temática proposta, não disponíveis na íntegra, duplicatas, revisões, anais de congresso, literatura cinzenta e livros. Foram identificados 21 estudos, com delineamentos diversos, realizados em sua maioria na China (n=12), que demonstraram o impacto positivo do engajamento na prática de TC na saúde de indivíduos com HAS e DM, como redução da pressão arterial, controle glicêmico e lipídico. Foram descritos também benefícios em outros aspectos físicos e psicossociais importantes para a manutenção do bem-estar e melhor qualidade de vida. Alguns estudos não descreveram resultados significantes associados à prática de TC . Em contrapartida, a maior parte dos estudos revisados relataram benefícios à saúde de indivíduos com HAS e DM associados à prática de Tai Chi.

This study aimed to systematize the results of research that investigated the relationship between the practice of TC and the health of individuals with Systemic Arterial Hypertension (SAH) and Diabetes Mellitus (DM). This is an integrative review in whicha search was conducted in the PubMed, SciELO, LILACS, and BVS databases. Studies published in the last 20 years, in English, Portuguese and Spanish, which discussed the theme of the practice of Tai Chi in individuals with SAH and DM, were included. Studies that did not meet the proposed theme, not available in full, duplicates, reviews, conference proceedings, gray literature and books were excluded. Twenty-one studies were identified, with different designs, carried out mostly in China (n=12), which demonstrated the positive impact of engaging in this bodily practice on the health of hypertensive and diabetic patients, such as blood pressure reduction, glycemic and lipid control. Benefits in other physical and psychosocial aspects that are important for the maintenance of well-being and better quality of life were also described. Some studies did not describe significant results associated with the practice of CT. In contrast, most of the studies reviewed reported health benefits for individuals with SAH and DM associated with the practice of Tai Chi.

Effects of Exercise on Sleep in Older Adults: An Overview of Systematic Reviews and Meta-Analyses.

We aimed to systematically analyze reviews of randomized clinical trials that investigate the overall effect of exercise and of different types of exercise on sleep in older adults. Meta-analysis was performed to obtain the standardized mean difference of the effect of the different types of exercise. Twenty systematic reviews published between 2012 and 2020 met the inclusion criteria of this overview. Moderate significant effects of exercise were observed on overall sleep quality and its subjective components (quality, duration, latency, habitual efficiency, medication use, and daytime dysfunction). Among the types of exercise, sensitivity analysis revealed significant effects of Pilates, Tai Chi, and Baduanjin Qigong on sleep quality. Exercise has a positive effect on sleep quality in older people. Our findings are extremely important, especially for decision makers in the health area, permitting the planning of actions and evidence-based decision making. PROSPERO registration number: CRD42020222469.

A Call to Use the Multicomponent Exercise Tai Chi to Improve Recovery From COVID-19 and Long COVID.

Approximately 10% of all COVID patients develop long COVID symptoms, which may persist from 1 month up to longer than 1 year. Long COVID may affect any organ/system and manifest in a broad range of symptoms such as shortness of breath, post-exercise malaise, cognitive decline, chronic fatigue, gastrointestinal disorders, musculoskeletal pain and deterioration of mental health. In this context, health institutions struggle with resources to keep up with the prolonged rehabilitation for the increasing number of individuals affected by long COVID. Tai Chi is a multicomponent rehabilitation approach comprising correct breathing technique, balance and neuromuscular training as well as stress- and emotional management. In addition, practicing Tai Chi elicits the relaxation response and balances the autonomic nervous system thus regulating respiration, heart rate, blood pressure and vitality in general. Moreover, Tai Chi has been shown to increase lung capacity, improve cognitive status and mental health, and thereby even the quality of life in diseases such as chronic obstructive pulmonary disease (COPD). Hence, we advocate Tai Chi as potent and suitable rehabilitation tool for post-COVID-19-affected individuals.

Eficacia y seguridad del Tai-Chí como terapia en condiciones clínicas seleccionadas / Efficacy and safety of Tai Chi as therapy in selected clinical conditions

NOMBRE DE LA TÉCNICA CON PRETENDIDA FINALIDAD SANITARIA Eficacia y seguridad del Tai-Chí como terapia en condiciones clínicas seleccionadas. DEFINICIÓN DE LA TÉCNICA E INDICACIONES CLÍNICAS Desde el punto de vista fisiológico, lo que parece claramente establecido es que el Tai-Chí sería un tipo de ejercicio con el que se puede trabajar todos los músculos del cuerpo, potenciando fuerza, flexibilidad y equilibrio y con menos problemas de sobrecarga muscular y riesgo de lesiones asociados a otras disciplinas deportivas. CALIDAD DE LA EVIDENCIA Las RS evaluadas en este informe tienen una calidad moderada-alta en la elaboración de la revisión y en la inclusión de publicaciones detectadas. No obstante, los estudios que han encontrado publicados sobre Tai-Chí en que se basan sus resultados son de calidad moderada-baja por lo que existe poca confianza en los resultados obtenidos. RESULTADOS CLAVE Teniendo en cuenta que los estudios incluidos en las RS analizadas son de moderada-baja calidad para generar una suficiente confianza en los resultados, podemos resumir que el Tai-Chí como actividad física realizada en diversas patologías, sobre todo las del área osteomuscular, resulta beneficioso respecto al bienestar percibido y a la reducción del dolor. En las patologías no directamente relacionadas con el aparato osteomuscular, los datos pueden ser positivos, a pesar de las limitaciones de los estudios y su diseño, en la mejoría de algún aspecto de la calidad de vida de los pacientes con cáncer, demencia, deterioro cognitivo e insomnio. También se encontraron beneficios en la rehabilitación del ictus y el EPOC equiparables al ejercicio. No se ha podido demostrar beneficio en la esclerosis múltiple ni en la esquizofrenia. Todo ello, dadas las características del tipo de ejercicio, con un riesgo bajo de efectos adversos. Aun así, hay una clara infra notificación de dicho aspecto en los estudios evaluados. CONCLUSIÓN FINAL La mejoría percibida o el efecto neutro en diversas patologías, cuando se compara con otras modalidades de ejercicio adecuado al problema tratado, sugiere que el beneficio va ligado a la realización de una actividad física en estos pacientes.

NAME OF THE TECHNIQUE WITH HEALTH PURPOSES Efficacy and safety of Tai Chi as a therapy in selectedclinical conditions. DEFINITION OF THE TECHNIQUE AND CLINICAL INDICATIONS From a physiological point of view, what seems to be clearly established is that Tai Chi would be a type of exercise that can work all the muscles of the body, enhancing strength, flexibility and balance and with fewer problems of muscle overload and risk of injury associated with other sports disciplines. QUALITY OF THE EVIDENCE The SRs evaluated in this report have a moderate-high quality in the preparation of the review and in the inclusion of detected publications, however the studies that have been found published on Tai Chi on which their results are based are of moderate-low quality due to what there is little confidence in the results obtained. KEY RESULTS Bearing in mind that the studies included in the SRs analyzed are of moderate-low quality to generate sufficient confidence in the results, we can summarize that Tai Chi as a physical activity performed in various pathologies, especially those of the musculoskeletal area, is beneficial in terms of perceived well- being and pain reduction. In pathologies not directly related to the musculoskeletal system, the data may be positive, despite the limitations of the studies and their design, in the improvement of some aspect of the quality of life of patients with cancer, dementia, cognitive impairment and insomnia. Benefits were also found in stroke and COPD rehabilitation comparable to exercise. No benefit has been demonstrated in multiple sclerosis or schizophrenia. All this, given the characteristics of the type of exercise, with a low risk of adverse effects. Even so, there is a clear underreporting of this aspect in the studies evaluated. FINAL CONCLUSION The perceived improvement or neutral effect in various pathologies, when compared to other exercise modalities appropriate to the problem treated, suggests that the benefits linked to the performance of physical activity in these patients.

Effect of Tai Chi on Markers of Oxidative Stress: Systematic Review and Meta-Analysis.

BACKGROUND: This study aimed to synthesize the evidence of the effect of practicing Tai Chi on oxidative stress markers (OxSM). METHODS: This systematic review and meta-analysis was conducting using the MEDLINE, Cochrane Library, ScienceDirect, Scopus, Epistemonikos, Lilacs, and Ovid databases to identify randomized (RCT) and non-randomized (NRCT) clinical trials that evaluated the Tai Chi effect on OxSM compared to sedentary behavior, walking or yoga. Pooled mean differences (MDs) with 95% confidence intervals (95%CI) were estimated using the inverse variance method to determine the effect of Tai Chi on OxSM. PROSPERO register: CRD42019138362. RESULTS: Five RCT and five NRCT were included. Compared to sedentary behavior, regular Tai Chi practice increases the levels of the enzymes superoxide dismutase (MD = 34.97 U/mL, (95%CI, 9.45 to 60.48), 344 participants) and catalase (MD = 15.63 U/mL, (95%CI, 4.05 to 27.22), 110 participants), as well as reducing the levels of lipoperoxides (MD = -0.02 µmol/L, (95%CI, -0.04 to -0.00), 234 participants). For comparisons with walking or yoga, only one study per activity was identified comparing the effect on OxSM. CONCLUSIONS: Regular Tai Chi practice increases the levels of superoxide dismutase and catalase, as well as reducing the levels of lipoperoxides. More studies are necessary to determine the effect of Tai Chi on OxSM when compared to other physical activities.

Evidence for the efficacy of Tai Chi for treating rheumatoid arthritis: an overview of systematic reviews

ABSTRACT BACKGROUND: Rheumatoid arthritis (RA) is a chronic disease with higher prevalence among women aged between 30 and 50 years and general prevalence of 1% worldwide. Interventions promoting improvement of quality of life for individuals with RA are required. Tai Chi appears to be a low-cost alternative, with studies showing positive results from this technique. However, regarding aspects of RA such as pain and sensitivity, studies remain inconclusive. OBJECTIVES: To compare the effectiveness of the Tai Chi method for treating patients diagnosed with rheumatoid arthritis, among systematic reviews. DESIGN AND SETTING: Overview of systematic reviews with Cochrane and non-Cochrane methodology. METHODS: Systematic reviews involving quasi-randomized and randomized clinical trials (RCTs) on use of Tai Chi, with no restrictions regarding the date and language of publication, were included. RESULTS: Three systematic reviews were included. The effects of Tai Chi associated with education and stretching exercises versus education and stretching were evaluated in these reviews. They showed that improvements in the variables of mood, depression and functional index were associated with use of Tai Chi. CONCLUSIONS: The findings suggest that clinical improvement was achieved, although not statistically significant with regard to pain and disease pattern, as assessed using the ACR20 measurement. Improvements relating to disability and quality of life were also seen. There was a low level of evidence and therefore caution in data analysis is recommended. The three studies included showed poor reliability for providing an accurate and complete summary of use of Tai Chi among people diagnosed with rheumatoid arthritis. PROSPERO: CRD42019125501.

Evidence for the efficacy of Tai Chi for treating rheumatoid arthritis: an overview of systematic reviews.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic disease with higher prevalence among women aged between 30 and 50 years and general prevalence of 1% worldwide. Interventions promoting improvement of quality of life for individuals with RA are required. Tai Chi appears to be a low-cost alternative, with studies showing positive results from this technique. However, regarding aspects of RA such as pain and sensitivity, studies remain inconclusive. OBJECTIVES: To compare the effectiveness of the Tai Chi method for treating patients diagnosed with rheumatoid arthritis, among systematic reviews. DESIGN AND SETTING: Overview of systematic reviews with Cochrane and non-Cochrane methodology. METHODS: Systematic reviews involving quasi-randomized and randomized clinical trials (RCTs) on use of Tai Chi, with no restrictions regarding the date and language of publication, were included. RESULTS: Three systematic reviews were included. The effects of Tai Chi associated with education and stretching exercises versus education and stretching were evaluated in these reviews. They showed that improvements in the variables of mood, depression and functional index were associated with use of Tai Chi. CONCLUSIONS: The findings suggest that clinical improvement was achieved, although not statistically significant with regard to pain and disease pattern, as assessed using the ACR20 measurement. Improvements relating to disability and quality of life were also seen. There was a low level of evidence and therefore caution in data analysis is recommended. The three studies included showed poor reliability for providing an accurate and complete summary of use of Tai Chi among people diagnosed with rheumatoid arthritis. PROSPERO: CRD42019125501.

Mind-Body Therapies From Traditional Chinese Medicine: Evidence Map.

Background: The mind-body therapies of traditional Chinese medicine include several intervention types and combine physical poses with conscious relaxation and breathing techniques. The purpose of this Evidence Map is to describe these different interventions and report related health outcomes. Methods: This evidence map is based on the 3iE Evidence Gap Map methodology. We searched seven electronic databases (BVS, PUBMED, EMBASE, PEDro, ScienceDirect, Web of Sciences, and PschyInfo) from inception to November 2019 and included systematic reviews only. Systematic reviews were analyzed based on AMSTAR 2. We used Tableau to graphically display quality assessment, the number of reviews, outcomes, and effects. Results: The map is based on 116 systematic reviews and 44 meta-analyses. Most of the reviews were published in the last 5 years. The most researched interventions were Tai Chi and Qi Gong. The reviews presented the following quality assessment: 80 high, 43 moderate, 23 low, and 14 critically low. Every 680 distinct outcome effect was classified: 421 as potential positive; 237 as positive; 21 as inconclusive/mixed; one potential negative and none no effect. Positive effects were related to chronic diseases; mental indicators and disorders; vitality, well-being, and quality of life. Potential positive effects were related to balance, mobility, Parkinson's disease, hypertension, joint pain, cognitive performance, and sleep quality. Inconclusive/mixed-effects justify further research, especially in the following areas: Acupressure as Shiatsu and Tuiná for nausea and vomiting; Tai Chi and Qi Gong for acute diseases, prevention of stroke, stroke risk factors, and schizophrenia. Conclusions: The mind-body therapies from traditional Chinese medicine have been applied in different areas and this Evidence Map provides a visualization of valuable information for patients, professionals, and policymakers, to promote evidence-based complementary therapies.

Tai Chi na qualidade de vida do idoso: revisão sistemática / Tai Chi in the quality of life of the elderly: a systematic review

A crescente longevidade vem sendo demarcada por doenças crônicas e consequentemente, causado um grande impacto na qualidade de vida do idoso. É diante disso, que a prática do Tai Chi se constitui como uma estratégia para melhorar a qualidade de vida relacionada à saúde (QVRS). Objetivo: Avaliar o efeito da prática de Tai Chi na qualidade de vida do idoso. Método. A presente Revisão Sistemática analisou estudos primários publicados na língua inglesa e portuguesa, entre 2015 a 2020, nas bases de dados Pubmed e BVS. Considerou-se ensaios clínicos superior a três meses, com idosos, avaliados pelos instrumentos de QVRS: genéricos e específicos; as variáveis física, mental e social, adicionado aos desfechos dos sintomas, em várias modalidades de Tai Chi. Orientada conforme as recomendações da Cochrane e o checklist PRISMA. Resultados: Incluiu-se 5 ensaios clínicos, envolvendo 1.372 participantes, com 955 no grupo intervenção e 417 no grupo controle, sendo 64,4% do sexo masculino e 35,6% feminino, com a população idosa entre 60 a 77 anos. Um estudo foi realizado no Brasil, três na China e um nos Estados Unidos, em diferentes cenários/diagnósticos. Utilizando os instrumentos (Kansas City, SF-36, SF-12 e SF-8) e outras medidas de desfechos. Comparado ao grupo controle, o domínio físico foi mais prevalente, o mental apresentou-se em dois estudos, o social foi o menos prevalente, apresentando de forma direta em um estudo. Nos desfechos dos sintomas, um estudo não apresentou resultados significativos. Conclusões: A maioria dos resultados sugerem que os idosos que participaram da intervenção do Tai Chi com diferentes diagnósticos tiveram uma influência significativa na QVRS nos domínios físicos, mental e social e um impacto positivo nos sintomas das doenças de bases.

The growing longevity has been demarcated by chronic diseases and consequently causing a great impact on the quality of life of the elderly. It is in front of this that the practice of Tai Chi constitutes a strategy to improve the quality of life related to health (QVRS). Objective: To evaluate the effect of Tai Chi practice on the quality of life of the elderly. Method: This Systematic Review analyzed primary studies published in English and Portuguese between 2015 and 2020 in the Pubmed and VHL databases. It was considered clinical trials over three months, with elderly, evaluated by QVRS instruments: generic and specific. The physical, mental and social variables, added to the symptom outcomes, in several Tai Chi modalities. Oriented according to Cochrane recommendations and the PRISMA checklist. Results: 5 clinical trials were included, involving 1,372 participants, with 955 in the intervention group and 417 in the control group, 64.4% male and 35.6% female, with the elderly population between 60 and 77 years. One study was conducted in Brazil, three in China and one in the United States, in different scenarios/diagnostics. Using the instruments (Kansas City, SF-36, SF-12 and SF-8) and other outcome measures. Compared to the control group, the physical domain was more prevalent, the mental one was presented in two studies, the social one was the less prevalent, presenting directly in one study. In symptom endpoints, one study did not show significant results. Conclusions: Most results suggest that the elderly who participated in Tai Chi intervention with different diagnoses had a significant influence on QVRS in the physical, mental and social domains and a positive impact on the symptoms of underlying diseases.

Tratamiento conservador de la artrosis de cadera / Conservative treatment of hip osteoarthritis

Ante un escenario clínico de coxalgia por artrosis de cadera se planteó la necesidad de conocer los tratamientos con-servadores más seguros y efectivos para el manejo del dolor. El tratamiento de la artrosis requiere un enfoque integral e individualizado en función de las preferencias del paciente para lograr el máximo beneficio clínico. Existen numerosas estrategias útiles para el manejo del dolor en pacientes con artrosis de cadera siendo fuertemente recomendados de inicio la actividad física, los antiinflamatorios no esteroideos (AINE) orales y en ciertos casos los corticoides intraarticulares, tramadol o duloxetina, siempre asociado con la actividad física. Los ejercicios más recomendados son los aeróbicos y el Tai Chi o yoga. (AU)

Faced with a clinical scenario of coxalgia due to hip osteoarthritis, the need to know the safest and most effective conservative treatments for pain management arose. The treatment of osteoarthritis requires a comprehensive and individualised approach based on the patient's preferences to achieve maximum clinical benefit. There are numerous useful strategies for pain management in patients with hip osteoarthritis being strongly recommended from the beginning such as physical activity, oral non-steroidal anti-inflammatory drugs (NSAID) and in certain cases intra-articular corticosteroids, tramadol or duloxetine, always associated with physical activity. The most recommended exercises are aerobics and Tai Chi or yoga. (AU)

Usuários de práticas corporais: qualidade de vida e motivos de procura pelas práticas integrativas e complementares / Users of bodily practices: quality of life and reasons for seeking integrative and complementary practices

Trata-se de um estudo exploratório e analítico de abordagem quantitativa, realizado no Serviço Integrado de Saúde (SIS), no período de junho a novembro de 2014. O SIS é um serviço público de saúde que funciona como Unidade de Referência em Práticas Integrativas e Complementares, como Programa de Extensão da Universidade Federal de Pernambuco (UFPE) e como Núcleo Comunitário de Cultura, Comunicação e Saúde, uma parceria entre UFPE e a Secretaria Municipal de Saúde do Recife. Foi implantado no início de 2013 e é referência em Práticas Integrativas para a rede de saúde do município de Recife-PE, principalmente para as Unidades de Saúde da Família. O serviço conta com aproximadamente 23 profissionais de diversas áreas: Terapia Comunitária, Tai Chi Chuan, Lian Gong, Automassagem, Aromoterapia, Flexibilidade, Bioenergética, Yoga, Biodança, Dança Circular, Psicomotricidade Relacional para jovens, Constelação Familiar e Arte Terapia para mulheres; Terapias individuais (Nutrição em alimentação saudável, Auriculoacupuntura, Osteopatia e Terapia do crânio­sacral) e outros programas terapêuticos (Programa Saúde da Coluna, Programa Saúde da Voz e Programa de Arte Terapia para problemas de obesidade).

Effectiveness of Tai chi exercise on overall quality of life and its physical and psychological components among older adults: a systematic review and meta-analysis.

With the aging of the world's population, the quality of life of older adults is becoming more important. There are many studies on the use of Tai chi exercise, a popular form of mind-body exercise practiced by older adults. However, the effectiveness of Tai chi exercise on the quality of life of older adults is unclear. For this systematic review and meta-analysis, six databases (PubMed, CENTRAL, CINAHL, EMBASE, Scopus, CNKI) were searched in English and Chinese languages to screen for relevant randomized controlled trials (RCT), and their risk of bias was assessed by two independent reviewers. The results of quality of life, physical component, and psychological component among older adults were meta-analyzed using RevMan5.3 software. The search retrieved 2577 records. After screening, a total of 10 RCTs were included in this evaluation, with a total of 1170 participants. The meta-analysis showed that compared with the control group, Tai chi exercise had a significant impact on the overall quality of life (SMD=1.23; 95%CI: 0.56-1.98; P<0.0001), and on the physical component of quality of life (MD=5.90; 95%CI: 1.05-10.75; P=0.02), but no significant impact on the psychological component of quality of life. This study had high heterogeneity. The results of this study suggest the potential use of Tai chi exercise as an activity for increased quality of life in older adults. Future research may enhance experimental rigor and explore the rationale behind Tai chi exercise.

Práticas Corporais da Medicina Tradicional Chinesa no tratamento de obesidade em adultos e idosos: qual é a eficácia e a segurança das práticas corporais da Medicina Tradicional Chinesa (MTC) para o tratamento de obesidade em adultos e/ou idosos? / Body Practices of Traditional Chinese Medicine in the treatment of obesity in adults and the elderly: what is the effectiveness and safety of body practices in Traditional Chinese Medicine (TCM) for the treatment of obesity in adults and/or the elderly?

As práticas corporais da Medicina Tradicional Chinesa (MTC) envolvem movimento ou manipulação corporal, atitude mental e respiração com intuito de equilibrar o Qi ou energia vital. As práticas da MTC são recomendadas para promoção, manutenção e recuperação da saúde, bem como prevenção de agravos e doenças. As práticas corporais da MTC, no Brasil, incluem acupuntura,lian gong, chi gong (qigong,chi kung); tui-naetai chi chuan. Estas práticas foram incorporadas no SUS mediante Portaria no 971, de 03 de maio de 2006. Qual é a eficácia/efetividade e a segurança das práticas corporais da Medicina Tradicional Chinesa (MTC), exceto acupuntura, no tratamento da obesidade em adultos e/ou idosos? As buscas foram realizadas inicialmente por revisões sistemáticas, mas nenhuma atendeu aos critérios de elegibilidade. Novas buscas foram realizadas em seis bases de dados sem restrição de ano de publicação, para identificar ensaios clínicos randomizados(ECR). Desta forma, foram incluídos ensaios clínicos randomizados em inglês, português e espanhol que avaliaram os efeitos das práticas MTC no tratamento de obesidade na população adulta e idosa. A avaliação da qualidade metodológica foi realizada por meio da ferramenta de risco de viés da Cochrane, feita por uma pesquisadora e revisada por outra. Nesta revisão rápida, produzida em três dias, foram utilizados atalhos metodológicos, de maneira que apenas o processo de seleção foi realizado em duplicidade e de forma independente. A acupuntura, embora faça parte das práticas da MTC, não foi incluída porque está sendo analisada separadamente em outras revisões realizadas por esta mesma equipe. De 1.435 publicações recuperadas nas bases de dados, foram incluídos três ensaios clínicos randomizados que atenderam aos critérios de elegibilidade. A avaliação metodológica dos ECR demonstrou risco de viés, de forma que os resultados devem ser interpretados com cautela. Os estudos mostraram não haver diferença nos resultados entre Taichi e a maioria dos comparadores, com relação aos desfechos IMC, circunferência da cintura, peso corporal, massa corporal, gordura corporal e sensação de fome. O único estudo sobre Qigong não apresentou resultados favoráveis quanto a sua eficácia na redução do peso corporal. Um estudo relatou não ter identificado eventos adversos com a prática de Taichi. Embora existam alguns resultados favoráveis a prática de Taichi, é pequena a evidência de eficácia e segurança da prática no tratamento da obesidade em adultos e idosos. Devido à escassez de evidências não é possível afirmar os reais benefícios do uso dessas tecnologias para o tratamento da obesidade.

Tai Chi versus routine exercise in patients with early- or mild-stage Parkinson's disease: a retrospective cohort analysis.

Parkinson's disease cannot be cured but symptoms can be improved by making use of physical therapy. The objective of the study was to compare the effect of routine exercises and Tai Chi on physical and clinical performance in elderly people suffering from Parkinson's disease. Data from interviews, physical and clinical performance, and levodopa consumption of 500 patients with confirmed Parkinson's disease (severity level I to III) were collected and analyzed. Participants who received 80 min/day Tai Chi 3 times/week for 2 months were included in the Tai Chi (TC) group (n=250) and those who received 90 min/day routine exercise 3 times/week for 2 months were included in routine exercise (RE) group (n=250). Timed up-and-go, 50-foot speed walk, and functional reach were improved by Tai Chi and routine exercise (P<0.05 for all) but intensities of Tai Chi for improvement of such parameters was higher than routine exercise. Incidence of falls was decreased by both physical therapies (P<0.05 for all) but more for the TC group (P<0.0001, q=38.512). In the TC group, at the end of follow-up, 22 (9%) patients were successful in withdrawal of levodopa treatment. Also, the dose of levodopa was decreased in patients of the TC group who had to continue levodopa. Tai Chi had the potential to slow down the progression of symptoms of Parkinson's disease and delayed the introduction of levodopa (level of evidence: III).

Obesidade e Diabetes Mellitus / Obesity and Diabetes Mellitus

As Práticas Integrativas e Complementares em Saúde (PICS), denominadas como Medicinas Tradicionais, Complementares e Integrativas (MTCI) pela Organização Mundial de Saúde (OMS), foram instituídas por meio da Política Nacional de Práticas Integrativas e Complementares no SUS (PNPIC), em maio de 2006. Estas práticas são transversais em suas ações no Sistema Único de Saúde (SUS) e estão presentes em todos os pontos da Rede de Atenção à Saúde (RAS), prioritariamente na Atenção Primária à Saúde (APS), com grande potencial de atuação em rede. As PICS são ferramentas terapêuticas potentes quando aliadas ao tratamento complementar de diversas condições crônicas. Além disso, são abordagens que ampliam o olhar dos profissionais sobre o processo saúde e doença e sobre as ofertas terapêuticas de cuidado à população. Nesse contexto, as PICS são importantes aliadas, contribuindo para a promoção, prevenção e reabilitação da saúde e manejo clínico das doenças crônicas, potencializando o projeto terapêutico singular por meio de seus benefícios. Considerando a necessidade de ampliar a resolutividade do cuidado a partir de práticas seguras, eficazes e socialmente sustentáveis, este documento tem por objetivo divulgar as evidências científicas no campo das PICS de forma a apoiar os gestores na tomada de decisão, para as condições de obesidade e diabetes mellitus. Neste contexto, evidências científicas de alto grau metodológico apontam que as PICS possuem eficácia no tratamento de indivíduos com DM. A prática do yoga auxilia na melhora dos resultados glicêmicos e de outros fatores de risco da DM. A meditação tem efeito indireto sobre a redução da hemoglobina glicada (HbA1c), além de melhorar os efeitos psicológicos que perpassam as várias condições crônicas de saúde, incluindo a DM.