Ameliorative effects of Tai Chi on cancer-related fatigue: a meta-analysis
of randomized controlled trials
Received: 11 November 2017 /Accepted: 25 February 2018 /Published online: 21 March 2018
Springer-Verlag GmbH Germany, part of Springer Nature 2018
Purpose This meta-analysis investigated the effectiveness of Tai Chi on cancer-related fatigue (CRF).
Methods Nine databases (PubMed, Web of Science, Ovid, the Cochrane Library, Embase, and four Chinese databases) were
searched to identify randomized controlled trials (RCTs) that evaluated the effects of Tai Chi on CRF. The reference lists given in
the identified RCTs were also reviewed to identify potentially relevant studies.
Results Six RCTs involving 373 patients were included. The change in short- and long-term CRF (SCRF and LCRF, respec-
tively) was calculated as the change in the mean score for CRF from baseline to the end of intervention period and to the end of
post-intervention follow-up, respectively. Pooled results suggested that Tai Chi had a significant positive effect on standard mean
difference (i.e., SCRF; SMD = − 0.54; p < 0.0001), but the impact on LCRF remained unclear. Subgroup analyses of SCRF
indicated positive effects of Tai Chi among patients with breast (SMD = − 0.81; p < 0.00001) and lung cancer (SMD = − 0.50;
p = 0.002), but not prostate cancer (p = 0.98). Tai Chi also had effects on SCRF that were superior to physical exercise and
psychological support (SMD = − 0.49 and − 0.84, respectively; both p < 0.05). A longer intervention time (8–12 weeks) benefited
SCRF more than a shorter time (SMD = − 1.08 and − 0.36, respectively; both p <0.05).
Conclusion Tai Chi for more than 8 weeks has short-term ameliorative effects on CRF, especially among patients with breast and
lung cancer. Its beneficial effects are superior to physical exercise and psychological support. It remains unclear whether there are
long-term benefits, and further study is needed.
Keywords Tai Chi
Cancer and its treatments commonly cause fatigue (Bcancer-
related fatigue^), with an incidence of 80–93% . The
National Comprehensive Cancer Network (NCCN)  de-
scribes cancer-related fatigue (CRF) as a Bdistressing, persis-
tent, subjective sense of physical, emotional, and/or cognitive
tiredness or exhaustion related to cancer or cancer treatment
that is not proportional to recent activity and interferes with
usual functioning.^ CRF is reported to be more distressing
than vomiting, nausea, or pain . As the societal burden of
cancer is increasing alongside its incidence [4–6], anticancer
therapy and the care of patients with cancer are major issues
for healthcare providers and researchers. Management of CRF
is an important issue that has the potential to substantially
improve quality of life in cancer patients.
There is some evidence that the occurrence of CRF corre-
lates with both physical and social-psychological factors [7–9].
However, the precise pathophysiological mechanism(s) under-
lying its development remain unclear. Standard or specific treat-
ment options for CRF are lacking. The NCCN Clinical Practice
Guidelines in Oncology recommends non-pharmacological
over pharmacologic interventions for CRF because there is little
evidence to support the latter and pharmacotherapy may be
accompanied by adverse side effects . Clinical studies of
CRF have suggested beneficial effects of physical exercise
, psychological support , and complementary therapies
Shangjin Song and Jiahui Yu contributed equally to this work.
* Xiaoqiang Yue
Department of Traditional Chinese Medicine, Changzheng Hospital,
Naval Medical University (Second Military Medical University),
No.415 Fengyang Rd, Shanghai 200003, China
Department of Traditional Chinese Medicine, Changhai Hospital,
Naval Medical University (Second Military Medical University), No.
168 Changhai Rd, Shanghai 200433, China
Supportive Care in Cancer (2018) 26:2091–2102