In this case, many of our criticisms could have been addressed simply by referring to the editorial that accompanied the study or by citing the study authors’ own comments in the discussion section of the paper. (Note: The study being discussed was published in the Archives of Internal Medicine, not in JAMA, as the blog post erroneously reported.)
Better medical care has reduced the number of people who die each year from heart attacks. However, more people are now living longer with damaged hearts that can’t pump enough blood to supply their needs. Heart failure, as this condition is known, can be a very burdensome affliction both in terms of the human suffering it causes and its financial impact on patients and society. People with heart failure often feel they can’t do much physical activity and they have a high incidence of depression as well. Any treatment that could potentially lighten this load — especially one as simple as tai chi — is worth looking into.
How much would it cost to replicate the experience of participants in this study who received tai chi training? And would the classes be covered by insurance? These are important questions for people with heart failure, who tend to be older and are often living on fixed incomes. But the story doesn’t tell us. It wouldn’t have been hard to estimate cost ranges for a 12 week course that meets twice weekly as in the intervention.
Not detailed enough. The story says that participants in the tai chi group “scored significantly higher” on a quality of life questionnaire and “reported an improvement in mood.” Readers deserve to have these benefits quantified in absolute terms so they can judge for themselves how “significant” the findings are. The story also failed to mention that tai chi had no effect on participants’ peak oxygen uptake or performance on a six-minute walk test, which are objective measures of functional capacity. While it is useful and important to know that heart patients “feel” better after tai chi, as the quality of life measures suggest, it’s also key to point out that patients should not expect to function more effectively just because they’re taking a tai chi class.
Although evidence increasingly shows that patients with heart failure benefit from physical activity, exercise is not without risk. Some patients with heart failure may experience worsening symptoms or cardiac arrhythmias related to exercise. There’s also the potential for falls. The story should have noted that in this study, tai chi did not provoke any adverse events and seemed to be very safe for this group of patients with mostly mild heart failure.
The story didn’t adequately explain the experiment’s design and there was really no attempt to provide any critical analysis. As the study authors themselves pointed out in their paper, patients enrolled in the study were not masked to the intervention as they would have been in a placebo-controlled medication study involving pills. So we can’t be sure if the benefits observed in the tai chi group were entirely due to the tai chi itself or perhaps to an expectation of benefit (i.e. a placebo effect) in these patients. Similarly, the control group patients may have fared worse than usual because they were disappointed to be assigned to the education group and not a more active form of treatment. Another limitation is that only 100 of the 2351 patients who were eligible to participate in the study agreed to enroll in it. This suggests that many patients with heart failure are unwilling to try tai chi and would be unlikely to join a class. Furthermore, it raises the possibility that those who are willing to try tai chi may differ from the average heart failure patient in ways that might have affected the outcome of the study.
This story didn’t exaggerate the consequences of heart failure or otherwise engage in disease mongering.
There were no independent perspectives provided in the story. At the very least, the story could have incorporated some comments from an editorial that accompanied the study (subscription required), which raised questions about the size and statistical power of the study as well as other issues.
The story should have discussed how the results stack up against traditional exercise training regimens, which were tested recently in a much larger clinical trial. It also could have discussed how the benefits of tai chi compare with those of medication, which is the mainstay of heart failure treatment.
The story suggests that tai chi is widely practiced in China, but it didn’t discuss the availability of classes in the United States. While it isn’t hard to find trained instructors in a city such as Boston, where the study being covered was conducted, readers from rural areas might find it difficult to locate classes led by someone experienced in this form of therapy. Someone with heart failure may also have trouble finding transportation to a class. The story should have mentioned these issues.
The story notes that tai chi is an ancient form of movement that has recently become interesting to Western medicine due to its potential health benefits. And while the story is correct to note that this study is the first large trial to test tai chi for heart failure (although we might quibble with the use of “large” to describe a study involving only 100 patients), it could have noted that previous studies have reported benefits for tai chi in patients with heart failure. In addition, the story didn’t attempt to explain why tai chi might have different effects compared with traditional exercise regimens that are already recommended for heart failure patients.
A close call, but since the story did a reasonable job of putting this research in the appropriate historical context and didn’t portray it as exceedingly novel, we’ll award a satisfactory.
The story doesn’t appear to have lifted anything from this press release put out by Beth Israel Deaconess Medical Center. (In fact, the release included many details that would have been useful to include in the story, but weren’t covered.) Since the story includes no independent perspectives, however, we can’t be sure to what extent it may have relied on this or some other news release.