Stress Reduction with Tai Chi for Elderly Hispanics with Diabetes

Background: Research has shown that type 2 diabetes (T2D) disproportionately affects Hispanic/Latino (H/L) minorities and older adults in the US and is associated with poor health outcomes. Psychosocial stress can negatively impact glycemic control but research on stress management in minorities with T2D is limited. Although physical activity (PA) can reduce stress, research has often shown low adherence to PA in H/L groups. Tai Chi (TC) is an ancient Chinese practice that involves slow movements and facilitates reduction of glycemic levels and stress. I examined the feasibility and impact of a TC intervention on H/L older adults with T2D. Methods: This was a randomized controlled pilot study with crossover design comparing TC to a wait-list control group receiving health information. Forty nine men and women were recruited from churches and community organizations in Chicago. Participants were 50 years of age or older, self-identified as H/L, with self-reported diagnosis of T2D and absence of cognitive/terminal disease. Bi-weekly 1-hour classes were led by a bilingual, certified instructor for 12 weeks. Main outcomes (A1C, blood pressure and psychosocial stress), and covariates (diet, PA, quality of life, self-efficacy and social support) were measured at baseline and post-test. Receptivity to TC and intention to practice were assessed. Data analysis included a linear mixed model examining the effect of TC on main outcome variables, and regression analyses on main outcome variables. Pre-post-test analyses using t-tests were conducted for 31 participants who received TC. Results: For the randomized controlled pilot, no significant differences were found between TC and control groups in any of the main outcome variables. However, pre-post-test analyses of all those receiving TC showed significant reduction on A1C (p=.017), diabetes-related stress (p=.046) and immigration-related stress (p=.0055). Regression analyses showed that A1C was predicted by TC practice time at post-test. Attrition (32.5%) and acceptability of TC practice (64%) were high. All participants reported intention to continue practice on their own. Acceptability was associated with logistical (accessibility, instruction, transportation) and cultural factors (language, friendly environment). Conclusions: TC can be successfully implemented with potential benefits for H/L older adults with T2D. Further research is warranted.