The Impact of a Tai Chi Exercise Program on Patients with Chronic Heart Failure: Qualitative Analysis from a Randomized Controlled Trial

Abstract

Purpose: To explore patient experiences, perceived changes, and health benefits associated with a tai chi (TC) program in a clinical trial of patients with heart failure (HF). Methods: We randomized 100 patients with chronic systolic HF (NYHA Class 1-3, ejection fraction (less-than or equal to) 40%) to a 12-week group TC program or an education control. At 12 weeks, semi-structured interviews were conducted on a random subset (n = 32; n = 17 in TC, n = 15 in control), audiorecorded and transcribed verbatim. Two independent reviewers extracted information using grounded-theory methods for emergent themes. We explored differences in themes/sub-themes between the groups, and examined qualitative association with changes from baseline to post-intervention in previously reported measures (e.g., Minnesota Living with HF, Cardiac Exercise Self Efficacy and Profile of Mood States). Results: The mean age ((plus or minus) SD) was 67 (plus or minus) 11 years, baseline EF 29 - 8%, median NYHA class 2. We idenitifed themes related to illness perspective, relationship to self, physical and psychosocial benefits, and relationship to others (e.g., spouse). Common themes emerged from both groups including: acceptance of illness, hope, motivation to improve health, and self-efficacy related to activity/exercise and diet. However, the groups differed in the source of patients' locus-of-control, with those in education more external (e.g., gain hope from family/friends) versus those in TC more internal (e.g., gain hope/optimism from within one's self). Additional themes in TC included self-awareness, pride, calm, life appreciation, decreased stress reactivity. These themes mirrored improvements in quantitative measures (quality- of-life, self-efficacy, and mood) in TC compared to control. Patients in TC also reported physical benefits (e.g., improved balance, endurance). Conclusion: Positive themes emerged from both groups, although there were qualitative differences in concepts such as locus-of-control and self-efficacy. Those in tai chi reported additional gains such as self-awareness, stress reduction, and balance. Future studies of mind-body exercise might further examine locus-of-control and self-efficacy as potential mediators of effect.