Chi Running did not lead to less injuries

One of the narratives of the various running ‘cults’ is just to make stuff up about the benefits of it and then wish it was true (the wishful thinking fallacy). The claims may or may not be true, but to make them up and wish that they are true is to paint targets on themselves for the skeptics and those who believe in the evidence and science. As so many claims get made, with many being contradictory, we need to rely on the science and not the unsupported and unsubstantiated claims that people wish were true. The body of literature and the narrative surrounding Chi running is fertile ground for the fallacies that underpin this type of narrative. For example, the cover of the Chi Running books claim you get less injuries from running that way, but nowhere is there any data actually supporting that. Vibram FiveFingers did this, but took it one step further to also say that there was “ample evidence” for what they were claiming, when there wasn’t. That had legal consequences.

In that context, this latest study involving Chi Running, caught my eye:

Training in ChiRunning to reduce blood pressure: a randomized controlled pilot study
Kelly McDermott, Deepak Kumar, Veronica Goldman, Haojun Feng, Wolf Mehling, Judith T. Moskowitz, Richard B. Souza and Frederick M. Hecht
BMC Complementary and Alternative Medicine 2015, 15:368 doi:10.1186/s12906-015-0895-x
People with prehypertension (120–130/80–90 mmHg) are at increased risk of progressing to hypertension. Recommendations for prehypertension include engaging in regular physical activity. We aimed to assess feasibility and acceptability and collect preliminary outcome data on ChiRunning for people with elevated blood pressure. ChiRunning is a commercially available running program based on the mindful movements of Tai Chi, which is aimed at decreasing injury by both increasing body awareness and modifying running form.
We enrolled adults with elevated systolic (130–150 mmHg) or diastolic (80–100 mmHg) blood pressure in a 12-week pilot trial. Participants were randomized 2:1:1 to 8 weeks of: 1) intervention—a trainer-led ChiRunning group (n = 10); 2) active control—a trainer-led running group (n = 6); or 3) educational control—a self-directed running group (n = 6) and followed for 4 more weeks. The active control and educational control groups were combined for analysis.
This study was feasible, meeting recruitment, retention and adherence goals, and acceptable to participants. Systolic and diastolic blood pressure did not change significantly over the study for either the ChiRunning or control groups. Changes in BMI over time were significantly different from zero in the ChiRunning group (p = 0.04) but not in the control group (slope for ChiRunning −0.05 [−0.1 to −0.002] vs. control −0.01 [−0.06 to 0.04], between slope difference, p = 0.22). Self-reported running-related injury (i.e. discomfort leading to a decrease in running) was similar between groups (ChiRunning, 4 [1.2 to 8.4] vs. control, 3 [0.7 to 7.1] injuries per 100 h of running, p = 0.72) although self-reported running-related discomfort (i.e. discomfort that does not lead to changes in running) trended higher in the ChiRunning group (ChiRunning, 10 [5.4 to 16.8] vs. control, 4 [1.5 to 9] reports of discomfort per 100 h of running, p = 0.06).
ChiRunning appears to be a feasible and acceptable exercise program for people with elevated blood pressure. We did not find that ChiRunning had a significant impact on blood pressure or self reported injury, but did see a positive change in BMI over time. ChiRunning warrants further investigation in a larger trial.

Firstly, this was a pilot study to determine the feasibility of using Chi Running as a method to reduce blood pressure and the primary outcome measure reflects that. It was the secondary outcome measure of there being no differences in injury rates between the groups that was of interest to me, as this study showed that using Chi running does not lead to less injuries in contrast to the claims being made by those that promote Chi running (and may even lead to more).

What was really good about this study?

  • They complied with the CONSORT guidelines for the reporting of trials which so many recent studies I have reviewed did not do
  • They registered the clinical trial (here) which so many of the lower quality trials I reviewed did not do. This is important for transparency purposes. (And yes I did compare what they registered to what they reported and they did match up, so that’s a big tick)

What don’t I like?

  • I am going to disagree with the authors conclusions of “but did see a positive change in BMI over time“. The within groups stats for the Chi running group on BMI had a p value of 0.042 (which appears to be significant as it is below the traditional 0.05), but a within groups analysis is not how you analyse a trial. The correct between groups analysis on the BMI was p=0.218, so not close to be statistically significant, but somehow the authors still consider this as a positive finding.
  • HOWEVER, they did many many multiple comparisons and did not do a Bonferroni correction to an acceptable level of p well below the traditional 0.05, so the above 0.042 would not be statistically significant.

I do find it somewhat interesting that they played up this change in BMI, but did not mention that the injury rate in the Chi running group was per 100hr of running was 10 [95% CI: 5.4 to 16.8] and in the control group was 4 [95% CI:1.5 to 9] which is quite a difference indicating that there was a trend to more injuries in those that adopted Chi running. However, the p value was not significant at 0.06 and I would not give a lot of weight to that due to the Bonferroni correction issues I just mentioned.

Of course this study has an issue with sample size, which I am not going to critique it on as the authors where quite explicit in the publication and trial registration about the pilot nature of the study. Would a larger study have detected differences? Who knows?, but if you look at trends, then maybe a larger study would have detected a difference with more injuries in the Chi running group!

I look forward to those in the Chi running community having egg on their face if they dish this study over its sample size. There were many blog and forum posts in the Chi running community over this study which only had 9 participants. They liked that study, so why not like the above study based on its sample size? You can not have it both ways.

As always, I go where the evidence takes me until convinced otherwise…and it does not look like you get less injuries if you take up Chi running.

McDermott K, Kumar D, Goldman V, Feng H, Mehling W, Moskowitz JT, Souza RB, & Hecht FM (2015). Training in ChiRunning to reduce blood pressure: a randomized controlled pilot study. BMC complementary and alternative medicine, 15 (1) PMID: 26471194

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3 Responses to Chi Running did not lead to less injuries

  1. Jørn Lüttge Jensen October 24, 2015 at 3:03 pm #

    You incorrectly quote the figures for injuries. Those that you use are for running-related discomfort as it appears quite clearly in your quote above.

    You should have included this comment from the authors:
    In the ChiRunning group, the RRI was mostly attributed to a single participant with a previously undiagnosed medical condition aggravated by the increased activity. The participant stopped running but remained enrolled in the study reporting a total of 22 days of RRI and 0 days of RRD. When this participant was excluded from analysis, the average RRI in the ChiRunning group drops by more than than half (ChiRunning 1.9 ± 3.6 vs. control 2.8 ± 2.5, p = 0.54).

    If you intended to write about “running-related discomfort” and the “injury” was just a typing error you should have included this very sensible explanation from the authors:

    “There was a trend of higher self-reported RRD in the
    ChiRunning group (p =0.06). This may have been the
    effect of increased awareness leading to increased sensi-
    tivity for RRD, which may play a significant role in injury
    “Increased body awareness may prevent injury by bringing
    early attention to bodily cues allowing the individual to
    take injury prevention measures [25]. Thus, self reporting
    RRD more frequently is not necessarily indicative of a
    higher injury rate, rather it could indicate a lower thresh-
    old for body sensing and by promoting early prevention
    measures, this sensing may lead to decreased injury over

    Jørn Lüttge Jensen, Certified ChiRunning Instructor in Denmark.

    • Craig Payne October 24, 2015 at 7:35 pm #

      Whoops; you are right I copied the wrong figures. Will edit the above tomorrow to reflect that. Thanks.

      However, it still shows that you do not get less injuries with Chi running in contrast to all the claims made by those who promote Chi running.

  2. Jørn Lüttge Jensen October 26, 2015 at 8:42 pm #

    Commenting on the present study (as you are) the actual figures after the elimination of a participant with a medical condition show less injury for the ChiRunning group.

    Statistical inference from this study might just as well be “ChiRunners free of injury” as your headline, since just as the mean of days RRI reported by the ChiRunning group (1.9) is not statistically different from the days reported by the control group (2.8), it is neither statistically different from the zero hypothesis (p = 0.17).

    Using the Poisson distribution to test difference between the two groups is probably not justified, since events like running injuries cannot be assumed to be independent of each other. In the ChiRunning group the only combination of days of injury reported by the 4 participants, that comes close to the means and standard deviations provided by the authors seems to be 1, 1, 3 and 10 days, which is a very unlikely outcome if the events were independent.

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