Type 2 diabetes: Tai chi improves cognitive health more than walking

• A study shows that people with type 2 diabetes-related mild cognitive impairment experienced a slowing of their cognitive decline after participating in Tai chi chuan sessions.
• The session lasted for 24 weeks, during which another group performed an equivalent amount of brisk walking.
• Compared to walking, Tai chi chuan’s benefits were greater after 36 weeks.
• One hypothesis for Tai chi chuan’s larger effect is its emphasis on continual learning through the constant memorization and ongoing refinement of positions and movements.

Tai chi chuan helped delay cognitive decline in people with mild cognitive impairment associated with type 2 diabetes, according to a new study, especially when compared to brisk walking. Researchers at the Fujian University of Traditional Chinese Medicine in Fuzhou, China conducted a randomized clinical trial that demonstrated the cognitive value of the ancient martial art.

Researchers found that Tai chi chuan slowed the advance of cognitive impairment in people with type 2 diabetes more than an equivalent amount of walking exercise.

Type 2 diabetes (T2D) is frequently accompanied by a form of mild cognitive impairment (MCI) that is separate from age-related cognitive decline.

The study was published in JAMA Network Open.

Comparing walking and Tai chi

The study involved 328 individuals over 60 who had been clinically diagnosed with T2D and MCI. All participants took a 30-minute diabetes self-management class once every four weeks for 24 weeks.

Participants were randomly assigned to one of three groups. The first group received instruction in 24-form simplified Tai chi chuan, or “Tai chi.” The second group was trained in moderate-intensity fitness walking. The two groups each took part in 60-minute supervised tai chi or walking sessions three times a week for 24 weeks.

The third group, the control group, did not receive any Tai chi or fitness-walking training.

The Tai chi and walking groups earned better scores in cognitive tests than the control group after 24 weeks and again at 36 weeks.

The two exercise groups’ scores were essentially the same at 24 weeks. However, by the 36-week mark, the Tai chi group’s cognitive performance significantly bested that of the fitness walking group, suggesting Tai chi may provide a longer-lasting benefit.

Using the 30-point Montreal Cognitive Assessment (MoCA) scale to rank global cognition, Tai chi participants’ scores improved by 1.90 points compared to the control group after 36 weeks, 0.84 points better than the fitness walking group.

What is Tai chi?

Tai chi is technically a martial art, though it is practiced throughout China as a non-combat form of activity especially popular among the elderly. In a Tai chi session, an instructor leads participants through a series of positions, smoothly transitioning from one pose to another. The form of Tai chi used in the study involved 24 such poses, or forms.

A Tai chi student is encouraged to partake in a continual refinement of poses and the transitions between them, making it a calm, gentle activity particularly well-suited to middle-aged and older people.

“The study refers to Tai chi as exercise. Tai chi is not exercise per se, but movement that exercises the body while practicing the movements of Tai chi,” said Pamela Kelley Elend of the Seattle School of Tai Chi.

Metabolic equivalent of fitness walking

Ryan Glatt, of the Pacific Neuroscience Institute, noted that this study involves individuals whose MCI is tied to T2D, and said, “So there’s probably something metabolically going on.”

Walking at a moderately brisk pace — about four miles an hour — is a form of exercise widely recommended by health experts.

“I think if you ask most people they’re going to think that the walking would naturally be more intense metabolically, but they seem to be equivalent in metabolics, which is interesting,” pointed out Glatt.

He noted that the authors of the study found their Tai chi sessions were equivalent to four metabolic equivalents, the same as sessions of fitness walking.

A connection between Tai chi and cognition

“We are kind of left to assume that it must be the cognitive demands of Tai chi, where you’re memorizing choreography, you’re paying attention, you’re constantly refining your detail. So you’re really engaging your focus, whereas with walking, you’re probably able to space out a little bit more,” said Glatt.

“There are multiple studies out there that prove that keeping the brain active through the learning of new skills creates and improves connections throughout the brain,” noted Kelley Elend.

She added that Tai chi “allows movement to initiate from the body — as opposed to the brain driving movement.”

“[Tai chi] allows the mind to attain and remain in a soft relaxed state where it can take in new information, create new connections, all while receiving circulated energy from throughout the body.”
— Pamela Kelley Elend

Glatt also cited the study authors’ suggestion that Tai chi may release certain growth factors, such as brain-derived neurotrophic factors.

How Tai Chi offers cognitive benefits

The manner in which the cognitive benefits of Tai chi eclipsed fitness walking at 36 weeks, but not 24 weeks, is worthy of note, said Glatt.

On one hand, he said, “More thoughtful exercise or more cognitively engaging exercise will be more cognitively beneficial over time.”

He wondered, however, if the MoCA test used in the study was fine-grained enough to accurately reflect differences in the effects of Tai chi and walking at 24 weeks or 36 weeks.

“They could have used better measures to maybe elucidate some of the changes. If they use different measures, they could probably see an improvement sooner, and maybe be able to better differentiate. It’s not surprising to me if they use that way of assessing their cognition that it took so long to show an improvement,” he said.

There is another manner in which Tai chi may be a more sustainable intervention for T2D-related MCI.

“It may also be the case that movement is sustainable over time, [while] exercise is not, in the same way that a diet is not sustainable over time,” Kelley Elend said.

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