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A systematic review of the health benefits of Tai Chi for students in higher education

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      Abstract

      Background

      The poor health consequences of stress are well recognized, and students in higher education may be at particular risk. Tai Chi integrates physical exercise with mindfulness techniques and seems well suited to relieve stress and related conditions.

      Methods

      We conducted a systematic review of the health benefits of Tai Chi for students in higher education reported in the English and Chinese literature, using an evidence hierarchy approach, allowing the inclusion of studies additional to randomized controlled trials.

      Results

      Sixty eight reports in Chinese and 8 in English were included — a combined study sample of 9263 participants. Eighty one health outcomes were extracted from reports, and assigned evidence scores according to the evidence hierarchy. Four primary and eight secondary outcomes were found. Tai Chi is likely to benefit participants by increasing flexibility, reducing symptoms of depression, decreasing anxiety, and improving interpersonal sensitivity (primary outcomes). Secondary outcomes include improved lung capacity, balance, 800/1000m run time, quality of sleep, symptoms of compulsion, somatization and phobia, and decreased hostility.

      Conclusions

      Our results show Tai Chi yields psychological and physical benefits, and should be considered by higher education institutions as a possible means to promote the physical and psychological well-being of their students.

      Highlights

      • We reviewed the benefits of Tai Chi in 9263 tertiary students from 76 studies.
      • Tai Chi is likely to yield psychological and physical benefits for tertiary students.
      • Physical benefits include improved flexibility, lung capacity and balance.
      • Psychological benefits include reduced symptoms of depression and anxiety.
      • Education institutions should consider such benefits for the well-being of students.

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      Most cited references 44

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      Evidence based medicine: what it is and what it isn't.

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        Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students.

        To systematically review articles reporting on depression, anxiety, and burnout among U.S. and Canadian medical students. Medline and PubMed were searched to identify peer-reviewed English-language studies published between January 1980 and May 2005 reporting on depression, anxiety, and burnout among U.S. and Canadian medical students. Searches used combinations of the Medical Subject Heading terms medical student and depression, depressive disorder major, depressive disorder, professional burnout, mental health, depersonalization, distress, anxiety, or emotional exhaustion. Reference lists of retrieved articles were inspected to identify relevant additional articles. Demographic information, instruments used, prevalence data on student distress, and statistically significant associations were abstracted. The search identified 40 articles on medical student psychological distress (i.e., depression, anxiety, burnout, and related mental health problems) that met the authors' criteria. No studies of burnout among medical students were identified. The studies suggest a high prevalence of depression and anxiety among medical students, with levels of overall psychological distress consistently higher than in the general population and age-matched peers by the later years of training. Overall, the studies suggest psychological distress may be higher among female students. Limited data were available regarding the causes of student distress and its impact on academic performance, dropout rates, and professional development. Medical school is a time of significant psychological distress for physicians-in-training. Currently available information is insufficient to draw firm conclusions on the causes and consequences of student distress. Large, prospective, multicenter studies are needed to identify personal and training-related features that influence depression, anxiety, and burnout among students and explore relationships between distress and competency.
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          Systematically reviewing qualitative and quantitative evidence to inform management and policy-making in the health field.

          Policy-makers and managers have always used a wide range of sources of evidence in making decisions about policy and the organization of services. However, they are under increasing pressure to adopt a more systematic approach to the utilization of the complex evidence base. Decision-makers must address complicated questions about the nature and significance of the problem to be addressed; the nature of proposed interventions; their differential impact; cost-effectiveness; acceptability and so on. This means that Cochrane-style reviews alone are not sufficient. Rather, they require access to syntheses of high-quality evidence that include research and non-research sources, and both qualitative and quantitative research findings. There is no single, agreed framework for synthesizing such diverse forms of evidence and many of the approaches potentially applicable to such an endeavour were devised for either qualitative or quantitative synthesis and/or for analysing primary data. This paper describes the key stages in reviewing and synthesizing qualitative and quantitative evidence for decision-making and looks at various strategies that could offer a way forward. We identify four basic approaches: narrative (including traditional 'literature reviews' and more methodologically explicit approaches such as 'thematic analysis', 'narrative synthesis', 'realist synthesis' and 'meta-narrative mapping'), qualitative (which convert all available evidence into qualitative form using techniques such as 'meta-ethnography' and 'qualitative cross-case analysis'), quantitative (which convert all evidence into quantitative form using techniques such as 'quantitative case survey' or 'content analysis') and Bayesian meta-analysis and decision analysis (which can convert qualitative evidence such as preferences about different outcomes into quantitative form or 'weights' to use in quantitative synthesis). The choice of approach will be contingent on the aim of the review and nature of the available evidence, and often more than one approach will be required.
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            Author and article information

            Affiliations
            [a ]Centre for Medical and Health Sciences Education and Department of Anaesthesiology, University of Auckland, Private Bag 92-019, Auckland 1142, New Zealand
            [b ]Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
            [c ]Department of Psychology, Auckland University of Technology, Auckland, New Zealand
            [d ]Medical Programme Directorate, University of Auckland, Auckland, New Zealand
            Author notes
            [* ]Corresponding author. c.webster@ 123456auckland.ac.nz
            Contributors
            Journal
            Prev Med Rep
            Prev Med Rep
            Preventive Medicine Reports
            Elsevier
            2211-3355
            23 December 2015
            June 2016
            23 December 2015
            : 3
            : 103-112
            26844196
            4733099
            S2211-3355(15)00178-3
            10.1016/j.pmedr.2015.12.006
            © 2015 The Authors

            This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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            Review Article

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