Effects of Tai Chi on fatigue and resting-state brain activity in chronic fatigue syndrome: a randomized controlled...

Chronic fatigue syndrome (CFS) is a complex disorder characterized by persistent fatigue, sleep disturbance, and cognitive impairment. It substantially impairs both physical and mental health. Tai Chi, a traditional Chinese mind-body exercise, may improve symptoms in patients with CFS. However, its neural mechanisms remain unclear. This study investigated the effects of Tai Chi on spontaneous brain activity in patients with CFS using resting-state functional magnetic resonance imaging (rs-fMRI) and amplitude of low-frequency fluctuations (ALFF).

Sixty patients with CFS were randomly assigned in a 1:1 ratio to either a Tai Chi group or a health education group; 57 participants completed both fMRI scans and fatigue assessments and were included in the complete-case analysis. Both groups underwent a 12-week intervention consisting of three 60-min sessions per week. Adherence was monitored using weekly logs. Fatigue severity was assessed before and after the intervention using the Multidimensional Fatigue Inventory (MFI-20). Resting-state fMRI data were acquired at both time points. Preprocessing included motion correction, normalization to Montreal Neurological Institute space, and spatial smoothing. ALFF was calculated to quantify regional spontaneous neural activity. Correlation analyses were performed to assess associations between changes in ALFF and MFI-20 scores. Harms were monitored throughout the intervention period.

Fifty-seven participants were included in the complete-case analysis (Tai Chi, n = 29; health education, n = 28). Compared with health education, Tai Chi produced greater reductions in MFI-20 total score from baseline to week 12 (between-group change difference, -9.50 points; 95% CI, -12.31 to -6.70; Cohen's d = -1.83; P < 0.001). Greater improvements were also observed in overall fatigue, physical fatigue, mental fatigue, activity reduction, and interest reduction, with between-group differences ranging from -1.26 to -2.44 points. In imaging analyses, Tai Chi was associated with increased ALFF in prefrontal, hippocampal/striatal, and supplementary motor regions and decreased ALFF in occipital and temporal regions, using voxel-level P < 0.001 and cluster-level family-wise error correction. Exploratory brain-behavior analyses showed that increases in ALFF in the left medial superior frontal gyrus and left dorsolateral superior frontal gyrus were associated with greater reductions in MFI-20 scores, whereas decreases in ALFF in the left inferior occipital gyrus were associated with fatigue improvement. No falls, injuries, severe post-exertional malaise, or intervention-related medical events were reported through weekly participant logs or supervised-session monitoring.

A 12-week Tai Chi intervention was associated with greater fatigue improvement than health education and with region-specific changes in resting-state spontaneous brain activity in patients with CFS. Tai Chi was associated with reduced fatigue and altered spontaneous brain activity in prefrontal, hippocampal, motor, and sensory-related regions in patients with CFS. These findings suggest that Tai Chi may modulate fatigue-related brain function, which may contribute to improvements in fatigue severity. Future studies should replicate and extend existing network-level findings using prespecified, adequately powered connectivity and mediation analyses with active exercise comparators and longer-term follow-up.

https://www.chictr.org.cn/showproj.html?proj=223860, ChiCTR2400082268; March 26, 2024.