Holistic Enhancement

A study, led by Research Assistant Professor Dr Naomi Takemura and supervised by Professor Lin Chia-chin, Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, both from the School of Nursing, found that engaging in tai chi regularly enhanced patients’ sleep quality, and improved their psychological outlook and circadian rhythms.

“My interest in studying sleep disturbances in advanced lung cancer patients arose due to their significant impact on health-related quality of life and survival rates,” said Dr Takemura. “Despite their high prevalence and negative consequences, sleep disturbances are often overlooked and inadequately managed by both patients and healthcare professionals. The pharmacological approach, though common, can lead to side effects that exacerbate cancer-related fatigue.

“Given the chronic and long-term nature of sleep disturbances in cancer patients, I believe it is crucial to develop non-pharmacological interventions targeting this issue and was intrigued by the growing interest in using exercise for cancer patients. Exercise offers a safe and affordable alternative for enhancing their overall well-being.”

The researchers recruited 226 patients from public hospitals for the study which took place over four years, from 2018 to 2022. The patients, whose ages ranged from 35 to 78 years, were assigned randomly to one of three groups – tai chi, aerobic exercise, or a self-managed control group. Over a 16-week period, the tai chi group attended classes twice a week, while the aerobic exercise group attended classes twice a month.

“Participants were also encouraged to engage in at least 150 minutes of aerobic exercise per week at home and perform two to three sets of resistance exercises every other day,” said Dr Takemura. “Tai chi participants were advised to dedicate at least 90 minutes per week to practise tai chi at home.”

Introducing tai chi

Previous studies on symptom management in cancer patients have typically focussed on conventional forms of physical exercise, such as aerobic and resistance exercises, or a combination of both. Dr Takemura wanted to introduce tai chi into the study for its mind-body approach and also because it is a popular practice among the elderly in Hong Kong.

“Tai chi is a low-intensity exercise that combines slow, gentle movements with conscious regulation of breathing and a focus on thoughts, attention, imagery, and sensation,” she said. “We designed our study to incorporate this culturally accepted and suitable mind-body exercise, alongside a conventional aerobic exercise, to explore their effects on symptom management in patients with advanced lung cancer.”

Compared to the control group, both the tai chi and aerobic exercise groups demonstrated significant improvement in sleep quality, cardiorespiratory and physical function, step count, and circadian rhythm at both week 16 and week 52. Tai chi also demonstrated superior benefits over aerobic exercise in terms of a lessening of sleep disturbances, fatigue and improvement in balance.

The study assessed one-year survival rates and found that the patients doing tai chi had a remarkable 65 per cent lower chance of dying compared to those in the control group, suggesting that engaging in this exercise may potentially offer hope of longer survival for patients with advanced lung cancer.

The team also credited the tai chi exercises with enhancing the patients’ circadian rhythm. “This can have several positive effects on their overall well-being,” said Dr Takemura. “Circadian rhythm regulates the physical fitness, mood, appetite and sleep of an individual. An improved circadian rhythm could reflect improved host control of tumour growth, and has been found to be associated with better prognosis. As a biomarker, circadian rhythm is an independent prognostic factor of overall survival in cancer patients.”

Given the positive outcomes of the study, there are plans to introduce similar exercise regimes to patients with other advanced cancer types. Dr Takemura said: “The holistic approach of tai chi, which encompasses physical activity, mindfulness meditation, breathing regulation, relaxation and qi circulation, can be used more widely in symptom management in medicine.”

Since the study results were published in JAMA Oncology in February 2024, Dr Takemura has been proactively approached by the chairman of an NGO from Hong Kong, as well as a tai chi master, who expressed interest in promoting tai chi in the community for its potential benefits to cancer patients.

“This research highlights the importance of addressing the symptom burden and holistic well-being of patients with advanced stage cancer, even though it is an incurable condition,” said Dr Takemura. “As healthcare professionals, our primary goal is to improve patients’ quality of life by mitigating their symptoms and enhancing their overall well-being. The results of this study suggest that incorporating holistic interventions like tai chi into the treatment of chronically ill patients could be a valuable addition to conventional treatment plans.”