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Complementary and Integrative Health for Older Adults:
What the Science Says

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April 2015
Clinical Guidelines, Scientific Literature, Info for Patients: 

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Osteoarthritis

Mind and Body Practices for Osteoarthritis

In 2012, the American College of Rheumatology issued recommendations (95KB PDF) for using pharmacologic and nonpharmacologic approaches for OA of the hand, hip, and knee:

  • The guidelines conditionally recommend tai chi, along with other non-drug approaches such as manual and thermal therapies, self-management programs, and walking aids, for managing knee OA.
  • Acupuncture is also conditionally recommended for those who have chronic moderate-to-severe knee pain and are candidates for total knee replacement but are unwilling or unable to undergo surgical repair.

Acupuncture for Osteoarthritis

Studies of acupuncture for OA have focused primarily on OA of the knee. There is also evidence that acupuncture may help to improve pain and function in other joints such as the hip.

The Evidence Base

  • The best evidence on the efficacy of acupuncture for OA consists of a few systematic reviews and one meta-analysis, as well as the 2012 American College of Rheumatology guidelines (98KB PDFfor pharmacologic and nonpharmacologic approaches for OA of the hand, hip, and knee, which conditionally recommend acupuncture for people with chronic moderate-to-severe knee pain and are candidates for total knee replacement but can’t or won’t undergo the procedure.

Efficacy

  • A 2009 NCCIH-funded review of meta-analyses and systematic reviews on acupuncture for chronic back pain, OA, and headache found that acupuncture generally appears better than standard care or wait list controls for people with OA but may not provide additional benefit for people with OA who are receiving advice and exercise.
  • In a 2008 systematic review of 10 randomized controlled trials of acupuncture for OA of the knee in 1,456 patients, the authors concluded that these studies provide evidence that acupuncture is an effective treatment for pain and physical dysfunction associated with OA of the knee.
  • A 2010 systematic review of 16 trials of 3,498 patients examined the effects of acupuncture in OA in peripheral joints and found that although acupuncture, when compared to a sham treatment, showed statistically significant, short-term improvements in osteoarthritis pain, the benefits were small and not clinically relevant. In contrast, acupuncture, when compared to a waiting list control, showed statistically significant and clinically relevant benefits in people with peripheral joint OA.

Safety

  • There are few complications associated with acupuncture, but adverse effects such as minor bruising or bleeding can occur; infections can result from the use of nonsterile needles or poor technique from an inexperienced practitioner.

Massage for Osteoarthritis

Although there has been much research on massage therapy for pain, there are very few studies that specifically examine the effects of massage therapy on OA symptoms.

The Evidence Base

  • The best evidence on the efficacy of massage therapy for OA comes from small randomized controlled trials. Very few studies have examined massage therapy for OA specifically.

Efficacy

  • Results of a 2006 randomized controlled trial of 68 adults with OA of the knee who received standard Swedish massage over 8 weeks demonstrated statistically significant improvements in pain and physical function.

Safety

  • Massage therapy appears to have few risks if it is used appropriately and provided by a trained massage professional.

Tai Chi for Osteoarthritis

A few studies of tai chi for OA have been promising for managing symptoms of OA of the knee.

The Evidence Base

  • The best evidence on the efficacy of tai chi consists of a few small randomized controlled trials, as well as the 2012 American College of Rheumatology guidelines (95KB PDF) for pharmacologic and nonpharmacologic approaches for OA of the hand, hip, and knee, which conditionally recommend tai chi, along with other non-drug approaches such as self-management programs and walking aids, for managing knee OA.

Efficacy

Safety

  • Tai chi is considered to be a safe practice.

Natural Products for Osteoarthritis

Glucosamine, Chondroitin Sulfate, or the Combination

Glucosamine and chondroitin sulfate—taken separately or together—are marketed for supporting joint health. They have also been widely used for treating OA. The preponderance of evidence indicates little or no meaningful effect on pain or function. Independent clinical practice guidelines published in 2012 by the American College of Rheumatology (ACR) (95KB PDF) and in 2010 by the American Academy of Orthopaedic Surgeons (AAOS) recommend not using glucosamine or chondroitin for OA. Recommendations from Osteoarthritis Research Society International (OARSI) published in 2014 conclude that current evidence does not support use of glucosamine or chondroitin in knee OA for disease-modifying effects, but leave unsettled the question of whether either may provide symptomatic relief.

The Evidence Base

  • The evidence base on the effects of glucosamine and chondroitin sulfate for osteoarthritis is of sufficient size and quality to permit independent systematic reviews and meta-analyses, and inclusion of specific recommendations in independent clinical practice guidelines.

Efficacy

  • A 2009 Cochrane systematic review of 25 studies found evidence of improvement in pain and function in studies using one manufacturer’s preparation of glucosamine, not in studies using preparations from other companies.
  • Three reports from the NIH-funded Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) compared glucosamine, chondroitin sulfate, the two in combination, celecoxib, and placebo. There were no clinically significant differences in pain or function following 6 months and 2 years of treatment. There was also no evidence that glucosamine, chondroitin, or the combination could prevent the progression of OA, based on joint space width measurements.
  • A 2007 meta-analysis considered 20 controlled clinical trials comparing chondroitin with placebo or n treatment in 3846 patients with OA of the hip or knee. The investigators concluded that “large-scale, methodologically sound trials indicate that the symptomatic benefit of chondroitin is minimal or nonexistent. Use of chondroitin in routine clinical practice should therefore be discouraged.”
  • A 2010 network meta-analysis analyzed 10 glucosamine and chondroitin trials involving 3,803 patients with knee or hip OA published similar results. The investigators concluded that glucosamine, chondroitin, or a combination did not significantly reduce pain or change joint space compared to placebo.
  • A 2014 double-blind randomized placebo-controlled trial compared glucosamine, chondroitin, the combination, or placebo in 605 patients with knee osteoarthritis. While symptomatic improvement was seen in all four groups over the study period, there were no differences in symptomatic improvement. A very small but statistically significant reduction in joint space narrowing was seen in the glucosamine–chondroitin combination group at 2 years.

Safety

Glucosamine and chondroitin appear to be relatively safe and well tolerated when used in suggested doses over a 2-year period. In a few specific situations, however, possible side effects or drug interactions should be considered:

  • No serious side effects have been reported in large, well-conducted studies of people taking glucosamine, chondroitin, or both for up to 3 years. However, glucosamine or chondroitin may interact with warfarin.
  • Although recent studies conducted by the U.S. Food and Drug Administration show that high doses of glucosamine hydrochloride taken by mouth in rats may promote cartilage regeneration and repair, this dose was also found to cause severe kidney problems in the rats—a serious side effect of the treatment.

Cognitive Decline and Alzheimer’s Disease

Natural Products for Cognitive Decline and Alzheimer’s Disease

Although a few trials of natural products for the prevention of cognitive decline or dementia have shown some modest effects, direct evidence is lacking.

The Evidence Base

  • The evidence base on efficacy of natural products for cognitive function and dementia, including Alzheimer’s disease, consists of many randomized controlled trials, particularly on omega-3 fatty acids and ginkgo biloba supplementation.

Efficacy

  • Fish Oil/Omega-3s. Among the nutritional and dietary factors studied to prevent cognitive decline in older adults, the most consistent positive research findings are for omega-3 fatty acids, often measured as how much fish people consumed. However, a 2012 Cochrane review of three randomized controlled trials involving more than 3,500 participants concluded that available evidence shows no benefit of omega-3 supplementation on the cognitive functioning of older people without dementia.
  • Ginkgo. The Ginkgo Evaluation of Memory (GEM) study, a 6-year trial of the well-characterized ginkgo supplement EGb-761 in more than 3,000 older adults, found that it didn’t lower the incidence of dementia, including Alzheimer's disease, in older adults. Further analysis of the same data showed that ginkgo did not slow cognitive decline, lower blood pressure, or reduce the incidence of hypertension.

Safety

  • Omega-3 fatty acid supplements usually do not have negative side effects. When side effects do occur, they typically consist of minor gastrointestinal symptoms. Omega-3 supplements may extend bleeding time. People who take anticoagulants or nonsteroidal anti-inflammatory drugs, should use caution.
  • Side effects of ginkgo supplements may include headache, nausea, gastrointestinal upset, diarrhea, dizziness, or allergic skin reactions. More severe allergic reactions have occasionally been reported. There are some data to suggest that ginkgo can increase bleeding risk.

Sleep Disorders

Mind and Body Practices for Sleep Disorders

Relaxation Techniques

Relaxation techniques include progressive relaxation, guided imagery, biofeedback, self-hypnosis, and deep breathing exercises. The goal is similar in all: to consciously produce the body’s natural relaxation response, characterized by slower breathing, lower blood pressure, and a feeling of calm and well-being. Relaxation techniques are also used to induce sleep, reduce pain, and calm emotions.

Evidence suggests that using relaxation techniques before bedtime can be helpful components of a successful strategy to improve sleep habits. Other components include maintaining a consistent sleep schedule; avoiding caffeine, alcohol, heavy meals, and strenuous exercise too close to bedtime; and sleeping in a quiet, cool, dark room.

The Evidence Base

  • The best evidence on the efficacy of relaxation techniques for insomnia consists of independent systematic reviews and meta-analyses, and inclusion of specific recommendations in independent clinical practice guidelines of the American Academy of Sleep Medicine (AASM).

Efficacy

  • A 2006 systematic review of 37 studies found evidence that psychological and behavioral therapies, including relaxation techniques, produced reliable changes in several sleep parameters of participants with primary insomnia or insomnia associated with medical and psychiatric conditions. Relaxation was one of five treatments that met criteria for empirically-supported psychological treatments for insomnia. This review was conducted by a task force commissioned by the American Academy of Sleep Medicine (AASM) in order to update its practice parameters on psychological and behavioral therapies for insomnia.
  • The accompanying 2006 practice parameter report published by the AASM concluded that several psychological and behavioral interventions, including relaxation training, stimulus control therapy, and cognitive behavioral therapy are effective, and recommended inclusion of at least one in initial treatment strategies for chronic primary and comorbid (secondary) insomnia.
  • A 2009 meta-analysis of five randomized controlled trials evaluating the efficacy of music-assisted relaxation for sleep quality in adults found that music-assisted relaxation had moderate benefits.

Safety

  • Relaxation techniques are generally considered safe. There have been rare case reports of worsening of symptoms in people with epilepsy or certain psychiatric conditions, or with a history of abuse or trauma.
  • Relaxation techniques are generally used as components of a treatment plan, and not as the only approach for potentially serious health conditions.

Other Mind and Body Practices for Sleep Disorders

Other mind and body practices which have been studied for their effects on insomnia and other sleep disorders include mindfulness-based stress reduction, yoga, massage therapy, and acupuncture. Current evidence of these therapies is either too preliminary or inconsistent to draw conclusions about whether they are helpful for sleep disorders.

The Evidence Base

  • The best evidence on the efficacy of mindfulness-based stress reduction, yoga, and massage therapy consists of clinical trials reports, mostly from small preliminary studies.
  • While there have been many studies of acupuncture for insomnia, the evidence base suffers from trials of poor methodological quality, and high levels of publication bias and heterogeneity in study design.

Efficacy

  • A 2011 randomized trial involving 30 adults with primary chronic insomnia reported initial evidence that mindfulness-based stress reduction was comparable in effectiveness to eszopicolone by a variety of measures. The authors concluded that mindfulness-based stress reduction is a viable treatment for chronic insomnia.
  • A 2013 randomized controlled trial evaluated the effect of mindfulness-based stress reduction on sleep quality in 336 Danish women with breast cancer. The investigators reported a small statistically significant improvement in sleep quality just after the intervention, but no long-term effect. An earlier uncontrolled study involving people with different types and stages cancer reported similar findings.
  • A small 2012 trial evaluated the effects of yoga, passive stretching, or standard care on insomnia in 44 postmenopausal women in Brazil. The investigators found that participants in the yoga group had significantly lower post-treatment scores for insomnia, compared to the other two groups. They also reported significantly improved post-treatment scores for severity of climacteric symptoms, quality of life, and resistance phase of stress in the yoga group compared to control.
  • A small 2011 study compared the effects of Chinese therapeutic massage (Tui na), passive movement, or control (not specified) in 44 postmenopausal women with insomnia in Brazil. The investigators reported evidence of improvements in subjective insomnia scores, as well as scores for anxiety, depression, and quality of life in the group of women treated with massage, compared to those in a passive movement or a control (treatment not specified) group.
  • A 2012 Cochrane systematic review considered the evidence from 33 randomized trials of needle acupuncture, electroacupuncture, and acupressure for insomnia. The investigators found evidence that needle acupuncture (but not electroacupuncture) as an adjunct to other treatment might marginally increase the proportion of people with improved sleep quality. Overall they concluded that current evidence is not sufficiently rigorous to support or refute acupuncture for treating insomnia.

Safety

  • Meditation is considered to be safe for healthy people. There have been rare reports that meditation could cause or worsen symptoms in people who have certain psychiatric problems, but this question has not been fully researched. People with physical limitations may not be able to participate in certain meditative practices involving physical movement. Individuals with existing mental or physical health conditions should speak with their health care providers prior to starting a meditative practice and make their meditation instructor aware of their condition.
  • Overall, clinical trial data suggest yoga as taught and practiced in these research studies under the guidance of skilled teacher has a low rate of minor side effects. However, injuries from yoga, some of them serious, have been reported in the popular press. People with health conditions should work with an experienced teacher who can help modify or avoid some yoga poses to prevent side effects.
  • Massage therapy appears to have few risks when performed by a trained practitioner. However, massage therapists should take some precautions with certain health conditions. In some cases, pregnant women should avoid massage therapy. Forceful and deep tissue massage should be avoided by people with conditions such as bleeding disorders or low blood platelet counts, and by people taking anticoagulants. Massage should not be done in any potentially weak area of the skin, such as wounds. Deep or intense pressure should not be used over an area where the patient has a tumor or cancer, unless approved by the patient’s health care provider.
  • Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Reports of serious adverse events related to acupuncture are rare, but include infections and punctured organs.

Natural Products for Sleep Disorders

Melatonin

Melatonin is a hormone known to shift circadian rhythms. Current evidence suggests that melatonin may be useful in treating several sleep disorders, such as jet lag, delayed sleep phase disorder, and sleep problems related to shift work.

The Evidence Base

  • The best evidence on efficacy of melatonin for sleep disorders consists of several systematic reviews and meta-analyses, and inclusion of recommendations in independent clinical practice guidelines of the American Academy of Sleep Medicine (AASM).

Efficacy

  • A 2007 practice parameter report issued by the American Academy of Sleep Medicine (AASM) includes the recommendation of melatonin supplements to promote daytime sleep among night shift workers. Studies that support this recommendation found that melatonin administration prior to daytime sleep after night work shifts improved daytime sleep quality and duration, and caused a shift in circadian phase in some but not all participants. It did not enhance alertness at night.
  • The AASM guidelines also include the recommendation of melatonin supplements to reduce symptoms of jet lag and improve sleep following travel across multiple time zones. A 2009 Cochrane review supporting this recommendation assessed the effectiveness of oral melatonin for alleviating jet lag after air travel across several time zones, and concluded that melatonin is remarkably effective in preventing or reducing jet lag, and that occasional short-term use appears to be safe.
  • Adults and teens with delayed sleep disorder have trouble falling asleep before 2 a.m. and have trouble waking up in the morning. In a 2007 review, the authors suggested that a combination of melatonin supplements, a behavioral approach to delay sleep and wake times, and reduced evening light may even out sleep cycles in people with this disorder.
  • A 2014 Cochrane review of three randomized controlled trials involving 209 people with moderate to severe dementia found no evidence that melatonin improved sleep.
  • A 2013 meta-analysis of 19 randomized placebo-controlled trials involving 1863 participants with primary sleep disorders found evidence of small but statistically significant improvements in sleep onset latency, total sleep time, and overall sleep quality with melatonin use. These effects do not appear to dissipate with continued melatonin use. The investigators concluded that although the absolute benefit of melatonin compared to placebo is smaller than other pharmacological treatments for insomnia, melatonin may have a role in the treatment of insomnia given its relatively benign side-effect profile compared to these agents.
  • A 2007 study of 170 participants with insomnia, aged 55 years or older, found that prolonged-release melatonin significantly improved quality of sleep and behavior following wakefulness (BFW), compared with placebo. The authors concluded that the improvements in quality of sleep and BFW were strongly correlated, suggesting a beneficial treatment effect on the restorative value of sleep.

Safety

  • Melatonin supplements appear to be relatively safe for short-term use, although modest adverse effects on mood were seen with melatonin use in elderly people (most of whom had dementia) in one study. The long-term safety of melatonin supplements has not been established.
  • Melatonin can have additive effects with alcohol and other sedating medications, and older people should be cautioned about its use.

Menopausal Symptoms

Mind and Body Practices for Menopausal Symptoms

Overall, evidence suggests that some mind and body approaches, such as yoga, tai chi, and meditation-based programs may provide some benefit in reducing common menopausal symptoms.

The Evidence Base

  • The evidence base on the efficacy of mind and body practices for the symptoms of menopause consists of a few reviews of randomized controlled trials.

Efficacy

  • A 2010 review of 21 papers assessed mind and body therapies for menopausal symptoms. The researchers found that yoga, tai chi, and meditation-based programs may be helpful in reducing common menopausal symptoms including the frequency and intensity of hot flashes, sleep and mood disturbances, stress, and muscle and joint pain.
  • A 2013 Cochrane review of 16 randomized controlled trials involving 1,155 women found that when acupuncture was compared with sham acupuncture, there was no evidence of difference in their effect on hot flashes. However, when acupuncture was compared with no treatment, there appeared to be some benefit from acupuncture. Acupuncture was less effective than hormone therapy. The low quality of evidence and lack of control with sham acupuncture for some of the studies led the reviewers to conclude that there is insufficient evidence to determine whether acupuncture is effective for controlling menopausal vasomotor symptoms.
  • A study funded by NCCIH found that hypnosis significantly improved various measures of hot flashes in a group of postmenopausal women. Although the mechanism of how clinical hypnosis works is unknown, the women in this same study who practiced hypnosis had significantly greater levels of satisfaction than the control group. An earlier study found that hypnosis appears to reduce perceived hot flashes in breast cancer survivors and may have additional benefits such as improved mood and sleep

Safety

  • Meditation is considered to be safe for healthy people. There have been rare reports that meditation could cause or worsen symptoms in people who have certain psychiatric problems, but this question has not been fully researched. People with physical limitations may not be able to participate in certain meditative practices involving physical movement. Individuals with existing mental or physical health conditions should speak with their health care providers prior to starting a meditative practice and make their meditation instructor aware of their condition.
  • Overall, clinical trial data suggest yoga as taught and practiced in these research studies under the guidance of skilled teacher has a low rate of minor side effects. However, injuries from yoga, some of them serious, have been reported in the popular press. People with health conditions should work with an experienced teacher who can help modify or avoid some yoga poses to prevent side effects.
  • Tai chi is considered to be a safe practice.
  • There are few complications associated with acupuncture, but adverse effects such as minor bruising or bleeding can occur; infections can result from the use of nonsterile needles or poor technique from an inexperienced practitioner.

Natural Products for Menopausal Symptoms

Many natural products have been studied for their effects on menopausal symptoms, but there is little evidence that they are useful. While some herbs and botanicals are often found in over-the-counter formulas and combinations, many of these combination products have not been studied. Further, because natural products used for menopausal symptoms can have side effects and can interact with other botanicals or supplements or with medications, research in this area is addressing safety as well as efficacy.

Black Cohosh (Actaea racemosa, Cimicifuga racemosa)

The Evidence Base

  • The evidence base on efficacy of black cohosh for menopausal symptoms consists of many randomized controlled trials and a 2012 Cochrane review.

Efficacy

  • A 2012 Cochrane systematic review on black cohosh for menopausal symptoms concludes that its efficacy has yet to be demonstrated.
  • Other research suggests that black cohosh does not act like estrogen, as once was thought.

Safety

  • United States Pharmacopeia experts suggest that women should discontinue use of black cohosh and consult a health care practitioner if they have a liver disorder or develop symptoms of liver trouble, such as abdominal pain, dark urine, or jaundice.
  • There have been several case reports of hepatitis, as well as liver failure, in women who were taking black cohosh. It is not known if black cohosh was responsible for these problems. Although these cases are very rare and the evidence is not definitive, there is concern about the possible effects of black cohosh on the liver.

Benign Prostatic Hyperplasia (BPH)

Natural Products for Benign Prostatic Hyperplasia (BPH)

Although several small studies have suggested modest benefit of saw palmetto for treating symptoms of BPH, a large study evaluating high doses of saw palmetto and a Cochrane review found that saw palmetto was not more effective than placebo for treatment of urinary symptoms related to BPH.

The Evidence Base

The evidence base on efficacy of saw palmetto (Serenoa repens) for benign prostatic hyperplasia consists of several randomized controlled trials and systematic reviews.

Efficacy

  • A 2011 double-blind, placebo-controlled, randomized trial in 369 older men demonstrated that saw palmetto extract administered at up to three times the standard daily dose (320 mg) did not reduce the urinary symptoms associated with BPH more than placebo. In addition, a 2009 Cochrane review of nine trials concluded that saw palmetto has not been shown to be more effective than placebo for this use.

Safety

  • Saw palmetto appears to be well tolerated by most users. It may cause mild side effects, including stomach discomfort.

Age-Related Macular Degeneration

Natural Products for Age-Related Macular Degeneration

There is some evidence that natural products such as antioxidant vitamins and minerals may delay the development of advanced age-related macular degeneration (AMD) in people who are at high risk for the disease. However, other studies of vitamin E and beta carotene supplementation did not show benefit in preventing the onset of AMD.

The Evidence Base

  • The evidence base on the efficacy of dietary supplements on preventing or slowing the progression of age-related macular degeneration consists of a few randomized controlled trials and a few systematic reviews.

Efficacy

  • Antioxidant vitamins and mineral supplements. The large NIH-sponsored trial, Age-Related Eye Disease Study (AREDS), which involved 3,640 older adults, found that supplementation with a combination of antioxidant vitamins (vitamins C and E and beta carotene) and zinc helped to prevent age-related macular degeneration from progressing from the intermediate stage to the advanced stage. However, a 2012 Cochrane review of four large, high quality randomized controlled trials involving 62,520 people found evidence that taking vitamin E and beta carotene supplements is unlikely to prevent the onset of AMD.
  • Another 2012 Cochrane review of 13 randomized controlled trials involving 6,150 participants found that supplementation with antioxidants and zinc may be of modest benefit in delaying the progression of AMD.
  • Dietary supplement of vitamins and zinc plus omega-3. A follow up study on supplements and age-related macular degeneration, AREDS2, indicated that supplements containing EPA and DHA did not slow the progression of AMD in people who were at high risk of developing the advanced stage of the disease.
  • Ginkgo biloba. Two small randomized controlled trials have suggested beneficial effects of ginkgo biloba on vision, but a 2013 Cochrane review suggests that larger trials in longer duration are needed to provide a more robust measure of the effect of ginkgo biloba on AMD.

Safety

  • Although generally regarded as safe, vitamin supplements may have harmful effects, and clear evidence of benefit is needed before they can be recommended.
  • Omega-3s appear to be safe for most adults at low-to-moderate doses. The FDA has concluded that omega-3 dietary supplements from fish are “generally recognized as safe.” Fish oil supplements may cause minor gastrointestinal upsets, including diarrhea, heartburn, indigestion, and abdominal bloating.
  • Side effects of ginkgo supplements may include headache, nausea, gastrointestinal upset, diarrhea, dizziness, or allergic skin reactions. More severe allergic reactions have occasionally been reported. There are some data to suggest that ginkgo can increase bleeding risk.

Herpes zoster (Shingles)

Mind and Body Practices for Herpes zoster

There have only been a few studies on the effects of tai chi on cell-mediated immunity to varicella zoster virus following vaccination, but the results of these studies have shown some benefit. Other interventions such as acupuncture, cupping, neural therapy, and intravenous vitamin C (ascorbic acid) have been studied for their effects on duration of neuropathic pain and post-herpetic neuralgia due to herpes zoster, but these studies have been small.

Tai Chi

The Evidence Base

  • The evidence base on efficacy of tai chi for shingles immunity and health functioning consists of only a few small randomized controlled trials.

Efficacy

  • A 2007 randomized controlled trial in more than 100 healthy older adults found that those people who participated in a 16-week tai chi program had higher levels of cell-mediated immunity to varicella zoster virus following shingles vaccination than those who received the same vaccine but participated in a health education program instead of tai chi.

Safety

  • Tai chi is considered to be a safe practice.

References

Osteoarthritis

Cognitive Decline and Alzheimer’s Disease

Sleep Disorders

Menopausal Symptoms

BPH

Age-Related Macular Degeneration

Herpes zoster (Shingles)

NCCIH Clinical Digest is a service of the National Center for Complementary and Integrative Health, NIH, DHHS. NCCIH Clinical Digest, a monthly e-newsletter, offers evidence-based information on complementary health approaches, including scientific literature searches, summaries of NCCIH-funded research, fact sheets for patients, and more.

The National Center for Complementary and Integrative Health is dedicated to exploring complementary health products and practices in the context of rigorous science, training complementary health researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCIH's Clearinghouse toll-free at 1-888-644-6226, or visit the NCCIH Web site at nccih.nih.gov. NCCIH is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.

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This page last modified November 20, 2018