News Release

Tai chi about equal to conventional exercise for reducing belly fat in middle aged and older adults

Embargoed News from Annals of Internal Medicine

Peer-Reviewed Publication

American College of Physicians

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.

1. Tai chi about equal to conventional exercise for reducing belly fat in middle-aged and older adults

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A randomized controlled trial found that tai chi is about as effective as conventional exercise for reducing waist circumference in middle-aged and older adults with central obesity. Central obesity, or weight carried around the midsection, is a major manifestation of metabolic syndrome and a common health problem in this cohort. The findings are published in Annals of Internal Medicine.

Tai chi is a form of mind-body exercise often described as "meditation in motion." It is practiced in many Asian communities and is becoming increasingly popular in Western countries, with more than 2 million people practicing it in the United States. While it is known to be a suitable activity for older people including those who are not active, there previously has been little evidence on tai chi's health benefits.

Researchers from the University of Hong Kong randomly assigned more than 500 adults over 50 with central obesity to a regimen of tai chi, conventional exercise, or no exercise over 3 months. Participants in the tai chi and exercise groups met for instructor-led workouts for 1 hour 3 times a week for 12 weeks. The tai chi program consisted of the Yang style of tai chi, the most common style adopted in the literature, and the conventional exercise program consisted of brisk walking and strength training activities. Waist circumference and other indicators of metabolic health were measured at baseline, 12 weeks, and 38 weeks. The researchers found that both the tai chi intervention and conventional exercise intervention group had reductions in waist circumference, relative to control. The reduction in waist circumference had a favorable impact on HDL cholesterol, or so-called good cholesterol, but did not translate into detectable differences in fasting glucose or blood pressure.

According to the study authors, their findings are good news for middle-aged and older adults who have central obesity but may be averse to conventional exercise due to preference or limited mobility.

Media contacts: For an embargoed PDF, please contact Angela Collom at To speak with the corresponding author, Parco M. Siu, PhD, please email

2. COVID-19 disease and cost burden especially high among older adults, particularly those of color



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A retrospective observational study found that the COVID-19 disease burden among adults aged 65 years or older was substantially higher than in the general U.S. population, especially among those of non-White race/ethnicity. The findings are published in Annals of Internal Medicine.

Researchers from the Centers for Disease Control and Prevention (CDC) used Medicare claims data for 28.1 million fee-for-service beneficiaries to examine the characteristics and medical costs of older adults who were diagnosed with COVID-19 from April through December 2020. The data showed that the hospitalization rate was more than 60 times higher, and the mortality rate was 2.5 times higher (4.2%) for older adults compared to the general population. The average cost per COVID-19-related hospitalization was considerable ($21,752) among those older adults, but the costs of COVID-19-related hospitalization decreased with age for the 5 medical outcomes considered. According to the authors, possible reasons include higher mortality rates among older patients, resulting in shorter hospital stays and lower costs (inpatient length of stay was shorter among patients aged ?75 years than among those aged 65 to 74 years); the lower likelihood of younger adults to become seriously ill (those who reached the point of hospitalization may have had substantial risks and complications); and less aggressive care with increasing age.

The data also showed that people of color accounted for a disproportionate share of hospitalizations and deaths during the pandemic. Black, Hispanic, and Asian/Pacific Islander older adults had higher probability of death and receiving ventilator support during hospitalization than non-Hispanic White patients. This finding highlights the importance of identifying effective strategies to promote COVID-19 vaccine uptake among non-White persons aged 65 years or older to mitigate the increased disease and economic burden.

Media contacts: For an embargoed PDF, please contact Angela Collom at To speak with the corresponding author, Yuping Tsai, PhD, please contact Kristen Nordlund at

3. Financial penalties not associated with improvements in quality of outpatient dialysis centers


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An observational study found that performance-based financial penalties under the Centers for Medicare & Medicaid Services (CMS) End-Stage Renal Disease Quality Incentive Program (ESRD-QIP) were not associated with improvement in the quality of outpatient dialysis centers. The penalties also did not seem to affect any of the individual outcome measures studied. The findings are published in Annals of Internal Medicine.

There are 500,000 patients on dialysis in the United States today. CMS spends about $100,000 per person/year for patients on dialysis, which is about 6-7% of the total Medicare budget and almost 1% of the total federal government budget. In 2012, the CMS started levying performance-based financial penalties against outpatient dialysis centers under the mandatory ESRD-QIP program. For many reasons, including the complexity of the program, it's effect on quality has never been measured.

Researchers from the Center for Healthcare Outcomes and Policy and the University of Michigan studied publicly available Medicare data to determine whether penalization was associated with improvement in dialysis center quality. The data showed that 1,109 (19.0%) outpatient dialysis centers received penalties in 2017 based on performance in 2015. Penalization was not associated with improvement in total performance scores in 2017 or 2018. This was consistent across a range of different types of centers and individual quality metrics included in the program's total performance score. According to the authors, these findings are significant because they can help Medicare improve the program, which has broad implications for the quality of outpatient dialysis in the United States.

Media contacts: For an embargoed PDF, please contact Angela Collom at To speak with the corresponding author, Kyle H. Sheetz, MD, MSc, please contact Kara Gavin at


Also new in this issue:

Medical Schools as Racialized Organizations

Nguemeni Tiako

Academia and the Profession


SGLT-2 Revisited: Diabetes Management in Chronic Kidney Disease


Annals On Call


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