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Raising resistance


In this age of the Internet, patients can - and frequently do - research what they have, or, rather, what they think they have. How do physicians deal with patients who are inclined to do their own medical research about what ails them?

Key Points

National report - To date, short of the varicella vaccine, there has been little that dermatologists can offer patients to help them avoid shingles.

But researchers have now found that an easy-to-learn form of tai chi, called tai chi chih, helps boost older people's immunity to the virus.

Older adults who are vaccinated and who practice tai chi have shingles immunity comparable to that of adults 20 years younger, according to a new study.

Dr. Irwin, lead author of a study on tai chi and shingles published earlier this year, was one of the researchers who studied the varicella vaccine developed last year, and he found that about 50 percent of older adults who received the vaccine still went on to develop shingles and postherpetic neuralgia.

"So there is a tremendous need to prevent shingles," Dr. Irwin tells Dermatology Times.

Dr. Irwin and colleagues zeroed in on tai chi because it is an exercise that most seniors can do and enjoy doing. It offers two important components: exercise and meditation. Tai chi chih is a simplified tai chi, featuring 20 exercises.

"We found in a previous study that tai chi could boost shingles immunity. The important question we had in this study was whether the magnitude of increase following the administration of tai chi was comparable to the vaccine," he says.

Study details

The tai chi study involved 112 healthy adults, ages 59 to 86, whom researchers randomized into either a tai chi group - which participated in tai chi classes three times a week for 16 weeks - or an active control group, which received health education about lifestyle issues, diet, exercise, stress management and more, but no formal exercise program.

Researchers measured the two groups' immune responses to shingles repeatedly during the 16 weeks, then administered the vaccine to all subjects, following up nine weeks later to evaluate vaccine response.

"What we found was that during the course of the trial, the tai chi group significantly increased shingles immunity compared with the health education group. We compared the magnitude of increase with the vaccine response and found it was comparable to the vaccine response. It was biologically and potentially clinically significant," Dr. Irwin says.

There was also an increase in immune response in the health education group, but that was much lower than in the tai chi group, he says. After six months, the percent increase of shingles immunity in the tai chi group was twice as high as that found in the health education group.

"One of the most striking findings is that the combination of tai chi and vaccine boosted shingles immunity to a level comparable to that found in middle-aged people (who have a substantially lower risk of developing shingles)," he says. "Together, tai chi and vaccine brought older adults' immune responses back to the level found in people 20 years younger."

When treating older patients, dermatologists should keep in mind the power of physical activity, Dr. Irwin says.

"This particular study demonstrates that a simple exercise called tai chi chih that has an exercise and aerobic component does increase shingles immunity, and - more importantly from the public health standpoint - adds to the benefit of the varicella vaccine," he says.

"It is important to note that tai chi practitioners also have significant improvements in key indicators of health functioning, such as walking."

Promising, not definitive

The message, according to Andrew Monjan, Ph.D., chief of the Neurobiology of Aging branch of the National Institute on Aging, Bethesda, Md., which funded the study, does not necessarily focus on tai chi but rather on the necessity of maintaining one's health later in life.

While the study is promising, researchers would have to conduct a much larger study to see if people would actually be less likely to develop the clinical disorder, he says.

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