Tai chi is practiced by more than 20 percent of the world's population and is fast becoming the most popular form of exercise in the world.1 Emerging from the ancient practice of qigong, tai chi has a number of health benefits, as demonstrated by recent studies. Most widely recognized among these benefits are improved balance and less fear of falling in older adults. Tai chi is by no means limited to older practitioners, however, and classes for children and adults of all ages are becoming increasingly popular.
Qigong originated in China more than 3,000 years ago and has developed into a healing form of activity. It is a system of self-cultivation developed specifically as a means by which each individual may take full responsibility to protect their health, promote their vitality and prolong their life, while cultivating spiritual awareness and philosophy.2 Though usually associated with medicine, monks and martial artists, qigong was also practiced by in traditional China by ministers of state and judicial magistrates, among others, each of whom utilized its power to cultivate their own particular talents, improve their professional performance, protect their health, enhance energy and prolong life.
Most forms of tai chi / qigong involve various degrees of gentle movement or stillness of the body, balanced with rhythmically regulated breathing, all quietly harmonized by a calm, unhurried and clearly focused mind. Soft, slow movement of the body prevents the stiffness and stagnation that lead to degeneration and death. These principles are emphasized in the classical Chinese philosophy of Lao Tse and Confucius. Like the ebb and flow of the waves of the sea and the cyclic turns of day and night, movement and stillness constitute the essential yin and yang poles and comprise the complementary cornerstones of tai chi and qigong practice.2
Qi (pronounced chi) means breath and air. By extension, it also denotes energy and vitality. Tai chi and qigong are thus translated as breathing exercise, as well as energy work. The subtle skill of breath control is the key to cultivating control over the flow and balance of energies in the body. Qi is considered the basic life force of all three levels of human existence: body, energy and mind.
Versatile Wellness Tools
In today's highly stressful world, tai chi / qigong's versatility as a personal tool has greater potential for the individual and society than ever. In the Western world, qigong is sometimes taught in conjunction with tai chi, but the latter is more commonly practiced as a form of martial arts and an exercise program, without the emphasis on its spiritual roots.
Tai chi chuan is the most popular form of tai chi practiced throughout the world today. It is a graceful, rhythmic form of qigong exercise. It consists of a seamless sequence of movement and postures, like a slow-motion dance, and is thought to have originated as a form of martial arts taught at the Shaolin Monastery in China. Tai chi is offered by many martial arts studios, but is increasingly offered in a variety of venues, including community programs, hospitals, and schools. Workplace programs help improve workers' health and encourage creativity and relaxation. Programs in hospitals provide cost-effective therapy for many conditions.
The health benefits for older adults make taichi ideal as a means for people with poor fitness levels to achieve significant health benefits, including improved cardiorespiratory function, flexibility and body composition.3 Studies have also demonstrated a reduction in blood pressure, improved gait and an increase in bone mineral density.4-6 One of the most important benefits of regular tai chi practice for older people is improved balance, which reduces the incidence of fall injuries.7 Individuals who have less fear of falling in turn become more physically active.
The many benefits of tai chi and qigong may make it sound like snake oil, but studies are increasingly demonstrating the positive effects of regular practice. The health promotion and wellness benefits produced (without side effects) make it a truly worthwhile pursuit. The following studies are just a sample of the evidence that is accumulating.
Cardiorespiratory Function: A hospital-based study conducted in an exercise physiology laboratory demonstrated greater cardiorespiratory function in older adults (mean age: 69).3 The tai chi chuan group included 22 men and 19 women. The sedentary control subjects consisted of 18 men and 17 women matched for age and body size. The tai chi chuan group had practiced regularly for an average of 12 years, ranging from one to four times a week. The men in the tai chi chuan group showed a 19 percent higher peak oxygen uptake in comparison with their sedentary counterparts, while the women in the tai chi chuan group showed an 18 percent higher peak oxygen intake than their sedentary counterparts. Overall, the study group also showed higher oxygen uptake at the ventilatory threshold compared to sedentary controls.
Flexibility: In addition to cardiorespiratory function, flexibility of the thoracolumbar spine was measured by an electronic inclinometer, and body fat composition was calculated from biceps and subscapular skinfolds. The tai chi chuan group demonstrated greater flexibility and lower percentage of body fat in comparison with their sedentary counterparts. The authors concluded that tai chi chuan training has benefits for fitness and that it may be prescribed as a suitable conditioning exercise for the elderly.3
Blood Pressure: In a prospective study, subjects with at least one major cardiovascular (CVD) risk factor attended a tai chi intervention three times a week for 12 weeks. A two-minute step-in-place test assessed endurance. BP and heart rate, measured at rest and within one minute after the step test. Subjects had hypertension, hypercholesteremia and/or diabetes. Subjects were sedentary at baseline, and they had a statistically significant improvement in aerobic endurance over time. At baseline, the average BP at rest was 150/86, while BP in response to the step test was 178/99. Clinically significant reductions in BP at rest (131/77) and in response to the step test (164/82) were found over the 12 weeks of tai chi. No significant change in heart rate was observed. The authors concluded that tai chi has the potential to reduce expenditures associated with CVD by facilitating a lifestyle that promotes physical activity, while remaining a low-tech, low-cost alternative to other forms of exercise.4
A study was conducted in 2005 to establish if the reported beneficial physiologic effects of tai chi when performed under stringent experimental conditions can be generalized to the community. The intervention consisted of tai chi practice three times weekly for 12 weeks. Outcome measures included lung function, resting heart rate, blood pressure, oxygen saturation, hand grip strength, flexibility, and balance. This study concluded that a community-based tai chi program produced beneficial effects comparable to those reported from experimental laboratory trials, and that it should therefore be considered as a public health strategy.14
Immune System: Perhaps the most exciting study evaluated the effects of tai chi on the immune system.8 The objective of the study was to evaluate influence on resting and vaccine-stimulated levels of cell-mediated immunity (CMI) to varicella zoster virus (VZV). and on health functioning in older adults. A prospective, randomized controlled trial was conducted with allocation to two arms (tai chi and health education) for 25 weeks. After 16 weeks of intervention, subjects were vaccinated with VARIVAX, the live attenuated VZV licensed to prevent varicella.
The tai chi group showed higher levels of VZV cell-medicated immunity than did the health education group, with a significant rate of increase nearly twice that found in the health education group. Tai chi alone induced an increase in VZV-CMI that was comparable in magnitude with that induced by the varicella vaccine. Tai chi with the vaccine produced a substantially higher level of VZV-CMI than the vaccine alone. The tai chi group also showed significant improvements in SF-36 scores for physical functioning, pain, vitality and mental health. The study concluded that tai chi augments resting levels of VZV-specific CMI and boosts VZV-CMI of the varicella vaccine.
Other Benefits: In addition to tai chi / qigong programs for general health, programs have been developed for specific conditions. These often combine several different forms of tai chi for maximum benefit.9 Among the most popular is tai chi for arthritis, with improved function, balance and pain relief in patients suffering from osteoarthritis.10-11 A study of tai chi for fall prevention involving 700 older people demonstrated a 70 percent reduction in recurrent falls.12 Other programs include tai chi for diabetes, which showed improved HbA1C, improved quality of life and decreased blood pressure.13 A study of tai chi chuan exercises showed enhanced bone mineral density in active seniors.6 Tai chi for back pain is a variation of tai chi for arthritis that can be done sitting down.9 This variation is also beneficial for wheelchair-bound patients. Tai chi for kids is designed specifically for teaching children and uses imagery techniques, along with plenty of meaningful positive feedback and a minimum emphasis on correctness of the forms.
A Global Exercise
The implications for chiropractic physicians interested in promoting health and wellness is that tai chi / qigong classes can safely and effectively be recommended for patients of all ages and all levels of physical fitness. The popularity of this form of exercise is exemplified by World Tai Chi Day, which is recognized by the World Health Organization, practitioners of tai chi around the world join together to perform tai chi at 10:00 a.m. in their respective time zones on the same day. This event, to be held on April 25 this year, demonstrates the universal nature of this form of exercise. Indeed, tai chi /qigong programs for health promotion and wellness are a safe, enjoyable and, above all, effective way to improve physical fitness.
- Douglas B. The Complete Idiot's Guide to Tai Chi and Qi Gong. New York: Alpha Books, 1999.
- Reid D. A Complete Guide to Chi Gung: Harnessing the Power of the Universe. Boston: Shambala, 2000.
- Lan C, Lai JS, Wong MK, Yu ML. Cardiorespiratory function, flexibility, and body composition among geriatric tai chi chuan practitioners. Arch Phys Med Rehabil 1996;77(6):612-6.
- Taylor-Pillae RE, Haskell WL, Froelicher ES. Hemodynamic responses to a community based tai chi exercise intervention in ethnic Chinese adults with cardiovascular disease risk factors. Eur J Cardiovasc Nurs 2006;5(2):165-74.
- Wu G, Liu W, Hitt J, Millon D. Spatial, temporal and muscle action patterns of tai chi gait. Journal of Electromyography and Kinesiology 2004;14(3):343-54.
- Lui PPY, Qin L, Chan KM. Tai chi chuan exercises in enhancing bone mineral density in active seniors. Clin Sports Med 2008;27(1):75-86.
- Low S, Ang LW, Goh KS, Chew SK. A systematic review of the effectiveness of tai chi on fall reduction among the elderly. Arch Gerontol Geriatr, April 16, 2008.
- Irwin M, Olmstead R, Oxman MN. Augmenting immune responses to varicella zoster virus in older adults: a randomized controlled trial of tai chi. J Am Geriatr Soc 2007;55(4):511-7.
- Song LE, Lam P, Bae S. Effects of tai chi exercise on pain, balance, muscle strength, and physical functioning in older women with osteoarthritis: a randomized clinical trial. J Rheumatol 2003;30:2039-44.
- Fransen M, Naim L, Winstanley J, et al. A randomized control trial of 200 subjects comparing tai chi, hydrotherapy and control to measure pain, physical function, muscular strength and walking capacity. Arthr Care Res 2007;3:407-14.
- Voukelatos A, Cumming RG, Lord SR, Rissel C. A randomized controlled trial of tai chi for prevention of falls: The central Sydney tai chi trail. J Am Geriatr Soc 2007;55(8):1185-91.
- Lam P Dennis SM, Diamond TH, Zwar N. Improving glycaemic and BP control in type 2 diabetes. The effectiveness of tai chi. Austr Fam Physician 2008;37:884-7.
- Jones AY, Dean E, Scudds RJ. Effectiveness of a community-based tai chi program and implications for public health initiatives. Arch Phys Med Rehabil 2005;86(4):619-25.
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