The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region.
Int J Nurs Stud. 2018 Dec;88:44-52. doi: 10.1016/j.ijnurstu.2018.08.009. Epub 2018 Aug 24.
Physical inactivity is a major modifiable lifestyle risk factor associated with cardiovascular disease. Tai Chi is a safe and popular form of physical activity among older adults, yet direct comparisons are lacking between Tai Chi and brisk walking in their ability to reduce cardiovascular disease risk factors and improve psychosocial well-being.
246 adults (mean age = 64.4 ± 9.8 years, age range = 30-91 years, 45.5% men) with hypertension and at least two but not more than three modifiable cardiovascular disease risk factors (diabetes, dyslipidaemia, overweight, physical inactivity and smoking) were randomly assigned to either Tai Chi (n = 82), brisk walking (n = 82) or control (n = 82) groups. The Tai Chi and brisk walking groups engaged in moderate-intensity physical activity 150 min/week for 3 months; daily home-based practice was encouraged for another 6 months. The primary outcome was blood pressure. Secondary outcomes were fasting blood sugar, glycated haemoglobin, total cholesterol, triglycerides, high- and low-density lipoprotein, body mass index, waist circumference, aerobic endurance, perceived stress, quality of life and exercise self-efficacy. Data were collected at baseline, post-intervention at 3 months and follow-up assessments at 6 and 9 months. Generalised estimating equation models were used to compare the changes in outcomes over time between groups.
At baseline, the participants had an average blood pressure = 141/81 and average body mass index = 26; 58% were diabetics, 61% presented with dyslipidemia and 11% were smokers. No significant difference was noted between groups. Tai Chi significantly lowered blood pressure (systolic -13.33 mmHg; diastolic -6.45 mmHg), fasting blood sugar (-0.72 mmol/L), glycated haemoglobin (-0.39%) and perceived stress (-3.22 score) and improved perceived mental health (+4.05 score) and exercise self-efficacy (+12.79 score) at 9 months, compared to the control group. In the Tai Chi group, significantly greater reductions in blood pressure (systolic -12.46 mmHg; diastolic -3.20 mmHg), fasting blood sugar (-1.27 mmol/L), glycated haemoglobin (-0.56%), lower perceived stress (-2.32 score), and improved perceived mental health (+3.54 score) and exercise self-efficacy (+12.83 score) were observed, compared to the brisk walking group. No significant changes in the other cardiovascular disease risk indicators were observed over time between groups.
Nurses play a key role in promoting exercise to reduce cardiovascular disease risk and foster a healthy lifestyle among adults. Tai Chi is better than brisk walking in reducing several cardiovascular disease risk factors and improving psychosocial well-being, and can be recommended as a viable exercise for building a healthy life free of cardiovascular disease.
身体活动不足是与心血管疾病相关的主要可改变的生活方式风险因素。太极拳是老年人中一种安全且流行的体育活动形式，但在降低心血管疾病风险因素和改善心理社会健康方面，太极拳与快步走之间的直接比较尚缺乏研究。
246 名成年人（平均年龄=64.4±9.8 岁，年龄范围=30-91 岁，45.5%为男性）患有高血压，且至少有两个但不超过三个可改变的心血管疾病风险因素（糖尿病、血脂异常、超重、身体活动不足和吸烟），被随机分配到太极拳组（n=82）、快步走组（n=82）或对照组（n=82）。太极拳和快步走组每周进行 150 分钟的中等强度体育活动，持续 3 个月；鼓励每天在家中进行练习，持续 6 个月。主要结局指标是血压。次要结局指标包括空腹血糖、糖化血红蛋白、总胆固醇、甘油三酯、高低密度脂蛋白、体重指数、腰围、有氧耐力、感知压力、生活质量和运动自我效能感。在基线、干预后 3 个月和 6 个月及 9 个月的随访评估时收集数据。使用广义估计方程模型比较组间随时间变化的结局变化。
基线时，参与者的平均血压为 141/81mmHg，平均体重指数为 26kg/m²；58%患有糖尿病，61%存在血脂异常，11%为吸烟者。各组间无显著差异。与对照组相比，太极拳组在 9 个月时血压（收缩压-13.33mmHg；舒张压-6.45mmHg）、空腹血糖（-0.72mmol/L）、糖化血红蛋白（-0.39%）和感知压力（-3.22 分）显著降低，感知心理健康（+4.05 分）和运动自我效能感（+12.79 分）显著提高。与快步走组相比，太极拳组血压（收缩压-12.46mmHg；舒张压-3.20mmHg）、空腹血糖（-1.27mmol/L）、糖化血红蛋白（-0.56%）、感知压力（-2.32 分）显著降低，感知心理健康（+3.54 分）和运动自我效能感（+12.83 分）显著提高。各组间其他心血管疾病风险指标在随访期间均无显著变化。
护士在促进成年人进行运动以降低心血管疾病风险和培养健康生活方式方面发挥着关键作用。与快步走相比，太极拳在降低多种心血管疾病风险因素和改善心理社会健康方面更具优势，可作为一种可行的运动方式，帮助人们建立无心血管疾病的健康生活。
