Figure 1

Conceptual model of tai chi and mind-body breathing and potential mechanistic pathways to improved patient-centered outcomes in chronic obstructive pulmonary disease (COPD). Physical activity, breathing training, and mindful awareness are the key elements of tai chi relevant to COPD. The potential mechanistic pathways through which tai chi may affect outcomes include skeletal muscle conditioning, cardiopulmonary dynamics, pulmonary mechanics, psychosocial factors (mood, self-efficacy, social support), and stress management. Favorable changes in these domains may then impact patient-centered outcomes of quality of life, symptoms, and exercise capacity. The mind-body breathing intervention contains similar key elements, although with less emphasis on physical activity (for example, less aerobic and no lower extremity or core strength training). The BEAM study includes the main patient-centered outcomes as well as secondary measures (quantitative or qualitative assessments) that inform each of the mechanistic pathways depicted in the center oval.