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Tai chi may be a suitable alternative for high-risk patients who refuse full cardiac rehabilitation after an MI, according to a small randomized study.

Elena Salmoirago-Blotcher, MD, PhD, of The Miriam Hospital in Providence, Rhode Island, and colleagues recruited patients with coronary heart disease who refused to enroll in cardiac rehabilitation (mean age 67.9%, 26.9% women) into their trial. The setup: two groups, one randomized to lower-frequency tai chi (two sessions per week for 12 weeks; n=16) and one to high-frequency tai chi (three sessions per week for 12 weeks, with subsequent maintenance classes once every other week for 24 additional weeks; n=13).

What they found was that the more-frequent tai chi group performed more moderate-to-vigorous physical activity at 3 months (100.33 more minutes per week, P=0.04) and 6 months (111.62 more minutes per week, P=0.02), the researchers reported online in the .

The advantage shrank by month 9, however, to the point where it was no longer statistically significant.

Still, "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," the authors wrote.

By the 9-month mark, 94% were still in the lighter tai chi regimen and 88% in the more-frequent one -- although just 69% and 39%, respectively, attended at least 70% of planned classes.

Salmoirago-Blotcher's group ultimately called both interventions "safe, acceptable, and feasible" with the exception of class attendance, which was worse in higher-frequency tai chi.

"Both fear of exercise and the perception of cardiac rehabilitation as dangerous were the most commonly reported reasons for declining participation in cardiac rehabilitation. Tai chi can clearly overcome these barriers because it is a different form of exercise. 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. 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," the authors suggested.

Given that cardiac rehabilitation is so underutilized, Krishna Aragam, MD, MS, and colleagues of Massachusetts General Hospital in Boston suggested teasing out which parts of cardiac rehabilitation are most beneficial to which patients.

"Ultimately, it may become possible to attribute the benefits of cardiac rehabilitation to its different components, and it may be prudent to prescribe the particular component (or equivalent alternative) most needed and/or preferred by each patient, especially for those unable or unwilling to participate in a comprehensive cardiac rehabilitation program," they wrote in an accompanying editorial.

The small trial by Salmoirago-Blotcher and colleagues recorded no serious adverse events related to tai chi. They had participants wear accelerometers and found that at baseline, the higher-intensity group was already more likely to do more moderate-to-vigorous physical activity (134.6 versus 61.8 minutes).

Neither group experienced an improvement in aerobic fitness after tai chi.

Besides a small sample size, the trial had few women and minorities included, according to the authors.