Tai chi proved to be safe and enjoyable in a small study of patients who declined traditional cardiac rehabilitation, suggesting the Chinese martial art could be an alternative exercise option.

Researchers enrolled 29 patients in one of two tai chi programs—one with 24 classes over 12 weeks and one with 52 classes over 24 weeks. Participants were also given a DVD with the same sequence of exercises and encouraged to practice tai chi at home.

Patients with the longer-term intervention (PLUS) averaged 100.3 additional minutes of moderate to vigorous physical activity at three months when compared to the shorter-term group (LITE). At six months, the difference in moderate to vigorous physical activity grew to 111.6 minutes per week.

Lead author Elena Salmoirago-Blotcher, MD, PhD, assistant professor of medicine at Brown University, and colleagues published these findings in the Journal of the American Heart Association.

“We found that participation in a longer tai chi program improved both moderate and light PA, effects that trended toward significance at 9 months in the PLUS group,” Salmoirago-Blotcher et al. wrote. “Such a trend is important because it suggests a more enduring behavioral change that persisted even when support from the instructor and group was no longer present. This finding is particularly remarkable considering that our population was clearly resistant to behavioral change, as shown by the high proportion of current smokers and obese individuals in our study population.”

Importantly, the researchers found tai chi to be safe, with no adverse events related to the exercise. The study’s participants included eight women and 21 men, with an average age of 67.9.

“Overall, this was a high‐risk population: half of the study participants were diabetic, two thirds had high cholesterol levels or hypertension, more than half were obese, and one third were smoking at enrollment,” the researchers wrote. “More than 60% had a history of myocardial infarction, and 80% had had a percutaneous coronary intervention.”

Cardiac rehab is declined by more than 60 percent of people following a heart attack, Salmoirago-Blotcher and colleagues noted. In their study, the most common reasons for declining traditional rehab were a dislike of intensive exercise and a perception of cardiac rehab as dangerous.

But tai chi—with its gentle movement and focus on relaxation techniques—may curb those fears, according to the researchers.

“During training, participants are constantly reminded they do not need to strive or struggle to achieve predetermined goals in terms of heart rate or exercise intensity,” the authors wrote. “Instead, they are invited to focus their attention on the breath and/or on the movements of the body. As a result, participants do not see tai chi exercise as threatening, and this may result in improvements in exercise self‐efficacy.”

Ninety-five percent of the patients said they enjoyed tai chi and 100 percent said they would recommend it to a friend.

Although amount of moderate to vigorous physical activity improved in the group with the long-term intervention, aerobic fitness didn’t improve in either group. The researchers said their exercise protocol may not have been intense enough to observe these changes.

They also noted tai chi shouldn’t be seen as a replacement to cardiac rehab, but as a supplement or a better-than-nothing alternative.

“On its own, tai chi wouldn’t obviously replace other components of traditional cardiac rehabilitation, such as education on risk factors, diet and adherence to needed medications,” Salmoirago-Blotcher said in a press release. “If proven effective in larger studies, it might be possible to offer it as an exercise option within a rehab center as a bridge to more strenuous exercise, or in a community setting with the educational components of rehab delivered outside of a medical setting.”