The Effects of Tai Chi on

Symptoms of Depression:
Evidence-Based Nursing
Practice
Peyton Brown

Introduction
According to the World Health Organization,
depression can be defined as a common mental
disorder, characterized by sadness, loss of interest
or pleasure, feelings of guilt or low self-worth,
disturbed sleep or appetite, feelings of tiredness,
and poor concentration. Depression can be long
lasting or recurrent, and at its most severe,
depression can lead to suicide.

Introduction
According to the National Center for
Complementary and Integrative
Health, tai chi is a centuries-old mind
and body practice involving postures
and gentle movements with
breathing, relaxation, and mental
focus.

PICOT Question
Will implementing a weekly tai chi routine
in patients experiencing depressive
symptoms be effective in increasing
overall well-being and reducing depressive
symptoms when compared to care that
does not incorporate tai chi?

Current Practice
Depression Treatment Goal
Coordination of short-term strategies to induce remission, combined with

longer term maintenance designed to prevent relapse.

Antidepressants
Selective Serotonin Reuptake Inhibitors (SSRIs)
Monoamine Oxidase Inhibitors (MAOIs)
Tricyclics (TCAs)
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Electroconvulsive Therapy (ECT)

Transcranial Magnetic Stimulation (TMS)

Efficacy of Traditional
Depression Treatment
Although antidepressant medication is the single most effective
intervention, a more efficacious multidisciplinary depression intervention
consists of:

Personalized patient antidepressant medication combined with psychotherapy e.g.

individual, group, family or cognitive therapy; to help with the patients coping with
decreased self-esteem and demoralization issues

Efficacy of Traditional
Depression Treatment Cont.

Increased intensity and frequency of psychotherapy during the first 4-6

weeks of treatment as approximately 40% of individuals will cease
therapy if symptomatic improvement is not noted within a month

Provide supplemental educational materials to the patient for reference at

home

Additional psychiatric consultations as needed

Incidence of Depression
Worldwide: 350 million (5% of the worlds population)
U.S.: 16 million
Arizona: There are 394,872 residents of Arizona that are
depressed, that is 5.8% have been diagnosed with clinical
depression

Antidepressant Use
U.S.: In 2013 1 in 10 Americans ages 12 and up were
prescribed antidepressants.
Arizona: 58% of Arizona residents diagnosed with
depression are currently taking medications for clinical
depression.

Synopsis of Articles
Tai chi has many positive psychosocial and

physiologic effects.

Multiple studies found that the

implementation of tai chi coupled with

some pharmacologic interventions allowed
for remission of depressive symptoms as
well as overall well being of the patient.

Synopsis (cont.)
Physiologic changes
Increased balance
Increased flexibility
Increased cardiopulmonary functioning
Decreased blood
pressure
Decreased heart rate.

Psychological changes
Decreased depressive
thoughts
Decreased stress
Positive mental health
Increased self-efficacy
and self-esteem
Increased focus
Improvements in
quality of sleep

Synopsis (cont.)
It was found across multiple studies that the quality
of life for patients receiving TC as supplemental
therapy is vastly improved
It is important to note that patient perception of
health is critical for the effectiveness of tai chi.
Perceived health and well being will encourage the
patients to exercise and improve their overall
health outside of just the hospital setting.
The practice of TC is multifaceted, low risk, and easy
to implement into care for patients.

Strengths
Test-retest reliability
Clinical trials were conducted on a wide variety of participants

Nurses
Pregnant women
Heart failure pts
College students
Parkinsons pts
Elderly
Stroke pts

Participants experienced improvements in many areas in addition

to depressive symptoms
Level II evidence

Limitations

Small sample size

All under 300 participants

One as low as 14

Selection bias

Participants chosen based on their availability & their interest

in tai chi

Reporting bias

Scales of depression are very subjective, depression may be

affected by outside forces

Evidence-Based
Recommendations

Best Practice

Tai chi has multiple health benefits, and has been shown to
improve depression, anxiety, and self-reported quality of life
12 weeks of tai chi
1 class per week guided by experienced instructor
3 sessions a week lasting 20 minutes at home
Adjunct to pharmacologic therapy
Begins as an inpatient therapy program, and transitions to
outpatient
Information about instructed classes and resources in community
will be provided to patients upon discharge

Support for Best Practice

Study consisting of Parkinsons patients showed higher
adherence rate to this exercise regimen than other traditional
exercises
Patients with multiple sclerosis reported improved life satisfaction
and scored lower depression scores after only 6 months of tai chi
4 times a week
Pregnant women in 2nd and 3rd trimesters practiced tai chi for
12 weeks for only 20 minutes each week. Depression, anxiety,
and sleep disturbances were greatly reduced.

Support for Best Practice

Patients with osteoarthritis participated in 12 week tai chi session
2 times a week for 1 hour. Patients exhibited greater mobility,
decreased depression, and better health.
A group of nurses participated in a 15 week tai chi class once a
week for 45 minutes, and for 10 minutes at home 4 times a
week. The nurses in the tai chi group had a 3% rise in
productivity, and improved self-reported mental health.
College students subjected to 12 weeks of tai chi for 60 minute
workout sessions 5 days a week. After intervention, students
reported feeling less depressed, improved quality of life, and
higher self-esteem.

Support for Best Practice

Short tai chi exercises can improve quality of life, and reduce
depression.
Tai chi is a relatively easy exercise to incorporate into a wide
variety of individuals daily regimens.
Has been shown to improve lives of a wide variety of individuals
from a host of different backgrounds.

Application/Implementation

In order to implement evidence based practice, medical

staff must be educated about tai chi, must have access to

information and organizational support.
Step 1: Present evidence based findings (see best
practice findings) for approval of tai chi program in
medical facility. Team meeting to establish evaluation
methods
Step 2: Obtain appropriate funding for tai chi practice
within medical facility
Room, instructor

Application/Implementation
Step 3: Educate the medical team.Pre-training for

staff to establish guidelines of tai chi practice

S/S of depression r/t disease process requiring
further tai chi intervention.
Change in mood or affect, inability to sleep or
concentrate, changes in appetite, and
decreased energy not related to primary
disease process.
How to educate patients about the benefits of tai
chi program in hospital/medical facility

Application/Implementation
Step 4: Preparation for program

instructor, appropriate setting (date,

time, location)

Step 5: Implementation of tai chi program

within 3-4 months of step 1.

Application/Implementation
Step 6: Re-evaluation of tai chi program
Interview/Questionnaire for pts. before

participation in tai chi program vs. participation

after tai chi intervention.

Interview/questionnaire for pts. participating in

inpatient program vs. pts. participating in

outpatient

Re-evaluation determines continuation of program

in hospital facility.

Overall success of tai chi pilot program and

recommendations

Cost of Medication

Many variables: brand, dose, frequency, insurance

coverage

10 mg Fluoxetine (Prozac) once a day costs $22 a

month for generic, or $227 for brand name

300 mg Bupropion (Wellbutrin) sustained release BID

costs $166 for generic or $499 for brand name

Cost of Tai Chi

A 12-week tai chi class once a week costs approx. $198
($16/class or $67/month)
Costs can be higher or lower based on skill level, geographical
location, and frequency of classes
Free classes are available in community
Most insurance companies will not cover tai chi

Cost Analysis to Patient

Tai Chi Cost:
$67/month x 12 months= $804/year
Medication Cost:
$22/month (Fluoxetine) x 12
months=$264/year
$499/month (Wellbutrin) x 12 months=
$5,988/year

Cost Analysis to Hospital

Instructor $20/hr (Five 1-hour classes/week=$100
week, $5,200/year)
Medication Cost:
400 people x $22 (Fluoxetine) x 12
months=$105,600/year
400 people x $499 (Wellbutrin) x 12 months=

$2,395,200/year

Benefits of Tai Chi

Proven effective to decrease depression as well

as anxiety, sleep disturbances, balance issues,
and stress
Self-paced form of exercise
Can be done anywhere and anytime (no supplies
necessary)
Virtually no side effects
One instructor can teach multiple classes for
many patients

Risks of Tai Chi

Insurance typically does not cover

cost
Possibility of injury
Time commitment
It is not appropriate for all
populations

Evaluation
Hamilton Depression Rating Scale
24 multiple item questionnaire
Handwritten
Guilt, anxiety, insomnia, weight, paranoia,
somatic symptoms, agitation, work and activities
Scale of 0 - 4

Evaluation

Given at admission for baseline

Reassess at 12 week follow up
Scores of 0 - 7 indicate no depression
Scores of 20 or higher indicated moderate,
severe, or very severe depression

Evaluation
By the end of the 12 week tai chi program, the
participants will report an increased self report of quality
of life using the Hamilton Depression Rating Scale.
By the end of the 12 week tai chi program, participants

will report a decrease in depression and anxiety on the

Hamilton Depression Rating Scale.

Summary

Is depression an issue? What is currently being done to treat it?

Our recommendation is the use of tai chi, a mind body practice, in

combination with the current practice for better results.

What did our group look at?

We analyzed 9 different articles and their findings

The major finding of our articles found that tai chi reduces depressive
symptoms

Summary cont.

We have determined that the benefits outweigh the risks and

that it is cost effective for both hospital and patient
Additionally, we have outlined a plan of action on how we would
implement a tai chi program into facilities both inpatient and
outpatient
The outcome of our groups research found that a weekly tai chi
routine in patients experiencing depressive symptoms is effective
at increasing overall well-being and reducing depressive
symptoms
Furthermore, in combination with current practice, depressive
symptoms can be treated even more effectively

As long as one has three square feet of space, one

can take a trip to paradise and stay there to enjoy
life for thirty minutes without spending a single
cent.
Master T.T. Liang Tai Chi Chuan for Health and
Self Defense

Video
https://www.youtube.com/watch?v=T
BvF6r6DOvc

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