Heart patients who feel gloomy should try tai chi, according to research published today in the European Journal of Cardiovascular Nursing, a journal of the European Society of Cardiology (ESC). The mind-body exercise was linked with a boost in both mood and quality of life.

"If you've had a heart attack or stroke, or are affected by another heart condition, I would strongly recommend adding tai chi to your recovery and rehabilitation," said study author Dr. Ruth Taylor-Piliae of the University of Arizona. "There are physical benefits like improved balance and it's good for mental health too."

Cardiovascular diseases are lifelong chronic illnesses. After a heart attack, for example, people live with coronary heart disease or heart failure for the rest of their lives. Many patients experience unpleasant feelings or emotions that affect their ability to live life to the fullthe medical term is "psychological distress" and includes depression, anxiety, and stress.

Depressive symptoms, for instance, affect approximately 20% of patients with coronary heart disease, 20% of patients with heart failure, 27% of those with high blood pressure, and more than one-third (35%) of stroke survivors.

Tai chi combines a series of set movements, such as "wave hands like clouds," with relaxation and breathing. It's a mind-body exercise because it requires concentration on posture, relaxation and breathing.

Studies of this activity in patients with cardiovascular disease have generally been small. This is the first combined analysis of clinical trials from the past decade examining the effect of tai chi on psychological wellbeing in adults with coronary heart disease, heart failure, hypertension, and stroke. A total of 1,853 patients from 15 clinical trials were included in the analysis. The average age of participants was 66 and 44% were women.

Tai chi was linked with less psychological distress as a whole. It was also associated with a reduction in depression. The connection with anxiety was not statistically significant, possibly due to insufficient numbers of patients (depression was more frequently studied).

Patients with cardiovascular disease often have poor quality of life due to unpleasant symptoms (for example shortness of breath) or disability. The study found that tai chi was also associated with better quality of life. This included mental health quality of life (how they felt, ability to go out and socialise, etc.) and physical health quality of life (walking, ability to do daily activities, etc.).

There were differences according to the type of diagnosisnotably, tai chi did not have a significant impact on wellbeing in stroke survivors. Dr. Taylor-Piliae said: "This is because there were very few studies on psychological wellbeing or quality of life variables in this group. There is a lot of research on tai chi in stroke survivors but nearly all of them looked at physical function such as balance and gait."

More research is needed on how this mind-body activity exerts its mental health benefits. But Dr. Taylor-Piliae said: "I think it's the synergy between postures and breathing. During tai chi you have good body posture, and research has shown that this enhances mood. We also know that holding your breath can cause stress and anxiety."

She cautioned against learning the movements from scratch online, since incorrect foot placements could cause knee pain. "During the COVID lockdown, you could search for where there are some group-based tai chi classes so you're ready to enrol when they restart," she said.

Dr. Taylor-Piliae concluded: "Tai chi is well suited for people of any age or exercise ability and can be safely adapted for anybody. People with low tolerance to exercise or breathing problems can do it in a chair. Group classes for others with cardiovascular disease are a positive place for social support and camaraderiethere is no judgement; you just do what you can."