Tai Chi as a mind-body exercise modulates endothelial function in coronary artery disease: A randomized clinical trial

OBJECTIVES: Tai Chi (TC), a mind-body aerobic exercise, has emerged as a potential alternative therapeutic modality for patients with coronary artery disease (CAD). Endothelial function is an important prognostic indicator in CAD. However, the effects of TC on endothelial function in CAD patients compared to aerobic exercise (AE) remain understudied. DESIGN: A parallel-group, assessor-blinded, randomized clinical trial (RCT). SETTING: Wanjie Rehabilitation Hospital and Anzhen Community Health Service Centre. PARTICIPANTS: The present study enrolled 48 patients diagnosed with coronary artery disease (CAD), of whom 37 completed the 12-week intervention, 17 in the Tai Chi (TC) group and 20 in the aerobic exercise (AE) group. INTERVENTIONS: Both groups received supervised training three times a week at 40-60 % heart rate reserve (HRR), an intensity corresponding to the ventilatory anaerobic threshold (VO₂AT). Each 60-75-minute session consisted of four phases: 10-15 min of warm-up, 20-30 min of moderate-intensity Tai Chi's Bafa Wubu (Eight Methods and Five Steps) or structured aerobic exercise (AE), 10-15 min of moderate-intensity Tai Chi elastic band exercises or resistance training, and 10-15 min of cool-down. MAIN OUTCOME MEASURES: The primary outcome was endothelial function, assessed by biomarkers including nitric oxide (NO), endothelin (ET), vascular cell adhesion molecule-1 (VCAM-1), and intercellular adhesion molecule-1 (ICAM-1). Secondary outcomes included lipid profiles measured by high-density lipoprotein (HDL), total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL). RESULTS: Baseline characteristics were not significantly different between groups (P > 0.05). After 12 weeks, both TC and AE groups showed significant improvements in endothelial function: NO levels increased, while ET, VCAM-1, and ICAM-1 decreased (P < 0.05). HDL levels increased only in the AE group (P < 0.05). TC, TG, and LDL remained unchanged in both groups (P > 0.05). CONCLUSIONS: Tai Chi, as a mind-body exercise, may improve endothelial function in patients with CAD, even when serum lipid levels remain unchanged, providing benefits comparable to those of aerobic exercise (AE) despite different effects on high-density lipoprotein (HDL). This trial has been registered on ClinicalTrials.gov (registration number: NCT03936504).