Tai Chi Chih Therapy May Boost Cell-Mediated Immunity in Patients With Shingles

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Tai Chi Chih Therapy May Boost Cell-Mediated Immunity in Patients With Shingles

News Author: Laurie Barclay, MDCME Author: Désirée Lie, MD, MSEd

April 13, 2007 — Tai Chi Chih therapy boosted cell-mediated immunity in patients with shingles to levels comparable to those achieved with the herpes zoster vaccine, according to the results of a randomized controlled trial reported in the April issue of the Journal of the American Geriatrics Society.

"Cell-mediated immunity (CMI) to varicella zoster virus (VZV) is thought to be pivotal in determining the risk of herpes zoster," write R. Irwin, MD, from the University of California in Los Angeles, and colleagues. "Efforts to elicit increases in VZV-specific CMI might provide protection against herpes zoster and postherpetic neuralgia."

The objective of this study was to evaluate the effects of a behavioral intervention, the traditional Chinese martial art of Tai Chi, on resting and vaccine-stimulated levels of CMI to VZV and on health functioning in older adults. Tai Chi Chih, a westernized, standardized version of Tai Chi, was used.

In 2 urban US communities between 2001 and 2005, 112 healthy older adults aged 59 to 86 years were randomized to Tai Chi Chih or health education for 25 weeks. After 16 weeks of intervention, subjects were vaccinated with VARIVAX (Merck & Co Inc), the live attenuated Oka/Merck VZV vaccine licensed to prevent varicella.

The main outcome was a quantitative measure of VZV-CMI, and secondary outcomes were scores on the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36).

Compared with the health education group, the Tai Chi Chih group had higher levels of VZV-CMI (P < .05) and a rate of increase nearly twice as high (P < .001). Tai Chi Chih alone was associated with an increase in VZV-CMI that was comparable in magnitude to that induced by varicella vaccine, and the 2 were additive. Tai Chi Chih plus vaccine was associated with a substantially higher level of VZV-CMI than was vaccine alone. The Tai Chi Chih group also showed improvements in SF-36 scores for physical functioning, bodily pain, vitality, and mental health (P < .05).

Study limitations include the possibility that observed increases in memory T-cells could reflect redistribution, rather than increases in total pool size; lack of generalizability to older adults with significant medical morbidity or with lower levels of treatment adherence; nonblinding of subjects; and inability to determine whether Tai Chi Chih decreased the incidence of shingles.

"Tai Chi augments resting levels of VZV-specific CMI and boosts VZV-CMI of the varicella vaccine," the authors write. "The capacity of TCC [Tai Chi Chih] to increase the number of circulating VZV-specific memory T-cells may generalize to memory T-cells specific for antigens of other pathogens that cause severe disease in older adults, such as influenza viruses and Streptococcus pneumoniae. Furthermore, for infectious diseases for which no vaccine is yet available (e.g., human immunodeficiency virus, avian influenza), the capacity of a behavioral intervention such as TCC to increase resting levels of memory T-cells may offer unique benefits."

The National Institute of Aging and the National Center for Complementary and Alternative Medicine supported this study. The authors have disclosed no relevant financial relationships.

J Am Geriatr Soc. 2007;55:511-517.

Learning Objectives for This Educational ActivityUpon completion of this activity, participants will be able to:

Compare the effect of Tai Chi Chih vs health education on VZV-CMI in older adults. Describe the effect of Tai Chi Chih on quality of life in older adults.

Clinical Context

According to the authors of the current study, herpes zoster or shingles results from reactivation of latent VZV, and incidence and severity increase with age with more than half of those with herpes zoster are aged 60 years or older. CMI is believed to affect susceptibility to zoster infection and can be measured as the frequency of peripheral mononuclear cells and memory T-cells. Tai Chi Chih is a westernized, standardized version of the traditional Chinese martial art Tai Chi. It incorporates aerobic activity, relaxation, and meditation, all of which boost immune responses, according to the authors.

This is a clinical trial comparing the effect of Tai Chi Chih with health education on VZV-CMI induced by the licensed live attenuated varicella vaccine VARIVAX.

Study Highlights

Included were older adult patients who received a single dose of VZV vaccine after 16 weeks of randomization to Tai Chi Chih or health education who had a prior history of varicella confirmed by VZV-CMI responses. Subjects were recruited by community newspaper advertisement. Excluded were those who were immunocompromised and those with chronic liver or kidney disease, receipt of immunizations within 1 month, or acute disease. 59 subjects were assigned to Tai Chi Chih consisting of 40-minute sessions in small groups 3 times weekly. The sessions included meditation and repetitive physical activity with 20 exercises and were supervised by masters-level Tai Chi Chih instructors. 53 subjects were assigned to health education consisting of similar number of hours of education with 16 didactic presentations on health-related themes given by a clinician or clinical psychologist in group settings. Primary outcome was VZV-CMI (assessed at baseline and at weeks 8, 12, 16, and 25 [9 weeks after sessions ended]) expressed as VZV responder cell frequency. The SF-36 was used to evaluate general health status and the Beck Depression Inventory was used to evaluate severity of depressive symptoms, administered at baseline and at weeks 8, 12, 16, and 25. At the end of the 16-week intervention, subjects received a single dose of varicella vaccine, 0.5 mL subcutaneously. Mean age was 70 years, 60% were women, 81% were white, 47% were married, and mean years of education were 16. Tai Chi Chih subjects showed a significant increase in number of minutes spent at home practicing Tai Chi Chih, from 111 minutes at week 8 to 213 minutes at week 16 and 149 minutes at week 25. Overall physical activity did not increase in the Tai Chi Chih group, suggesting that Tai Chi Chih substituted for other physical activity. The 2 interventions were perceived as similarly credible as determined by evaluations of confidence by subjects. Baseline levels of VZV responder cell frequency were similar. At weeks 8, 12, 16, and 25, VZV responder cell frequency levels were significantly greater in the Tai Chi Chih group vs the health education group. The rate of increase of VZV responder cell frequency in the Tai Chi Chih group was nearly twice the rate in the health education group and was statistically significant, whereas the rate of increase in the health education group was not significant. The Tai Chi Chih group achieved a level of VZV responder cell frequency postvaccination that was similar to those reported in healthy adults 30 years younger. By week 16, the Tai Chi Chih group showed a significant 24% increase in VZV responder cell frequency, whereas the health education group showed a nonsignificant 13% increase. After the intervention plus vaccination, the Tai Chi Chih group showed an overall increase of 38% in VZV responder cell frequency vs a 28% increase from baseline in the health education group. Both groups showed significant improvements in severity of depressive symptoms. Both groups showed improvements in SF-36 scores, with significant improvements in physical functioning, bodily pain, vitality, and mental health in the Tai Chi Chih but not the health education group. For role emotional, a worsening was seen in the health education group but not the Tai Chi Chih group.

Pearls for Practice

Tai Chi Chih compared with health education for 16 weeks before a single dose of VZV vaccine is associated with improved VZV-CMI as expressed by VZV responder cell frequency in older adults. Tai Chi Chih compared with health education for 16 weeks is associated with significant improvements in physical functioning, bodily pain, vitality, and mental health SF-36 scores in older adults.

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