Wu Style Medical Research: The Evidence for Tai Chi

A complete compilation of the 25 medical research articles published in the Medical Articles section of wustyle.com — 24,652 words of evidence on balance, cardiovascular health, diabetes, arthritis, falls, bone density, neuropathy and more.

About this collection

The International Wu Style Tai Chi Chuan Federation maintains a Medical Articles section on its website (wustyle.com) as a public evidence library on the health effects of Tai Chi. The collection gathers peer-reviewed study summaries, clinical reviews and press reports covering balance and falls, cardiovascular and circulatory health, respiratory disease, diabetes, arthritis and osteoporosis, neuropathy, mental health and healthy ageing.

These 25 articles are reproduced here in full, in their original wording, so that the Vietnamese Tai Chi community can read the evidence base behind the art in one place. Each article keeps its own title, source link and topic tags. Nothing has been rewritten or paraphrased — only the site's navigation chrome has been removed.

Please note: most of the pieces are summaries of published research written for a general audience, and some date from the early 2000s. They are presented for educational purposes and are not medical advice. Always consult a qualified clinician before starting an exercise programme, particularly if you have an existing health condition.

1. A Randomized Controlled Trial of Tai Chi for Tension Headaches (3,774 words)
2. A randomized, prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women (354 words)
3. Are there any health benefits from tai chi exercises? (384 words)
4. Change in perceived psychosocial status following a 12-week Tai Chi exercise programme. (381 words)
5. Comparison of muscle torque, balance, and confidence in older tai chi and healthy adults. (313 words)
6. Complementary and Alternative Medicine: Tai Chi (75 words)
7. DIABETES AND TAI CHI THERAPY (1,091 words)
8. Effects of exercise on joint sense and balance in elderly men: Tai Chi versus golf. (303 words)
9. Falls In Older People (655 words)
10. Health Benefits, Tai Chi Linked (330 words)
11. Improvement in balance, strength, and flexibility after 12 weeks of Tai chi exercise in ethnic Chinese adults with cardiovascular disease risk factors (296 words)
12. Shingles Immunity and Health Functioning in the Elderly: Tai Chi Chih as a Behavioral Treatment (7,590 words)
13. Tai Chi and Cardiovascular Health (420 words)
14. Tai Chi and fall reductions in older adults: a randomized controlled trial. (344 words)
15. Tai Chi and medical research - peer reviewed published papers (1,244 words)
16. Tai Chi Chuan: Mind-Body Practice or Exercise Intervention? Studying the Benefit for Cancer Survivors (230 words)
17. Tai Chi for posture and back pain (73 words)
18. Tai Chi 'helps improve diabetes' (505 words)
19. Tai Chi 'improves body and mind' (363 words)
20. Tai Chi may aid in arthritis treatment (253 words)
21. Tai chi: physiological characteristics and beneficial effects on health (326 words)
22. The Effect of Tai Chi on Chronic Obstructive Disease (250 words)
23. The role of Tai Chi Chuan in reducing state anxiety and enhancing mood of children with special needs (212 words)
24. The Role of Tai Chi Exercise in Promoting Health Benefits for Older Persons (4,818 words)
25. Using tai chi to fight degenerative nerve disease (68 words)

1. A Randomized Controlled Trial of Tai Chi for Tension Headaches

Source: wustyle.com — A Randomized Controlled Trial of Tai Chi for Tension Headaches · Topics: headaches · Nervous System

Ryan B. Abbott,1 Ka-Kit Hui,1 Ron D. Hays,2 Ming-Dong Li,1 and Timothy Pan1

1Center for East West Medicine, Department of Medicine and 2Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California at Los Angeles Los Angeles, CA 90095, USA and RAND Corporation, Santa Monica, CA 90407, USA

For reprints and all correspondence: Ka-Kit Hui, UCLA, 2428 Santa Monica Boulevard, Suite 208, Santa Monica, CA 90404, USA. Tel: +1-310-828-9358; Fax: +1-310-829-9318; E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.Received November 15, 2005; Accepted June 19, 2006.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

AbstractThis study examined whether a traditional low-impact mind–body exercise, Tai Chi, affects health-related quality-of-life (HRQOL) and headache impact in an adult population suffering from tension-type headaches. Forty-seven participants were randomly assigned to either a 15 week intervention program of Tai Chi instruction or a wait-list control group. HRQOL (SF-36v2) and headache status (HIT-6™) were obtained at baseline and at 5, 10 and 15 weeks post-baseline during the intervention period. Statistically significant (P < 0.05) improvements in favor of the intervention were present for the HIT score and the SF-36 pain, energy/fatigue, social functioning, emotional well-being and mental health summary scores. A 15 week intervention of Tai Chi practice was effective in reducing headache impact and also effective in improving perceptions of some aspects of physical and mental health.IntroductionA Clinical and Epidemiological Description of Tension-Type HeadachesAccording to the National Headache Foundation, more than 45 million Americans suffer from chronic headaches, with losses of $50 billion a year to absenteeism and medical expenses and an excess of $4 billion spent on over-the-counter medications (1). Tension-type headaches (TTH), which represent approximately 78% of all headaches (1), occur either in single episodes or chronically, and are often the result of temporary stress, anxiety, fatigue or anger. Symptoms include soreness and pain, a tightening band-like sensation around the head, pressure sensations, and contracted head and neck muscles. Symptoms are bilateral and are not aggravated by physical activity. Standard care for TTH includes relaxation routines, massage, biofeedback, pharmacological interventions (such as over-the-counter pain killers and muscle relaxants) and stress reduction (2). The Usage of Complementary and Alternative Medicine in the US is Substantially Increasing

In the US, complementary and alternative medicine (CAM) use has increased substantially in recent years [CAM is a group of diverse medical and health care systems, therapies and products that are not presently considered to be a part of conventional medicine (examples include chiropractics, ayurveda, homeopathy, naturopathy, etc.) (3)]. In 2002, 62% of the US adults polled said that they had used some form of CAM within the past year (3). In 1997, it was estimated that the US public had spent between $36 billion and $47 billion on CAM therapies, with between $12.2 billion and $19.6 billion spent out-of-pocket for professional CAM services (more than the out-of-pocket fees for all hospitalizations in that year, and about half that paid for all out-of-pocket physician services) (3).

Traditional Chinese medicine (TCM) is a complete system of medicine representative of CAM practices. TCM dates before the common era in written form, and its techniques include acupuncture, herbal medicine and practices such as Tai Chi.

Tai Chi is a Traditional Mind–Body Exercise and an Evidence-Based Treatment for a Variety of ConditionsTai Chi is a form of traditional Chinese exercise that purports to improve health by changes in mental focus, breathing, coordination and relaxation. The goal of Tai Chi is to ‘rebalance’ the body's own healing capacity. Tai Chi has been practiced in China for hundreds of years and is now widely practiced throughout the world. It has been estimated that over 100 million people regularly practice Tai Chi in China alone (4).

As examined in two recent review articles (5,6), studies have shown that Tai Chi can help to improve balance and prevent falls in the elderly (7,8), improve musculoskeletal conditions (9,10), lower hypertension (11), enhance cardiovascular and respiratory function (12), improve mental health (13,14), and enhance endocrine and immune functioning (15–17).

This study sought to examine whether Tai Chi would prove to be effective in the treatment of TTH. As early as 1990, relaxation therapy and biofeedback had been shown to be effective in the treatment of TTH (18), and Tai Chi may have an effect similar to both of these interventions. Also, it has been demonstrated that acupuncture is effective in the treatment of TTH (19,20), and it is believed in TCM theory that acupuncture and Tai Chi operate along the same principles (21).

Methods Study Approval, Participant Criteria and Recruitment

The protocol and informed consent forms were reviewed and approved by the Institutional Review Board (IRB approval#: 03-12-063-01) at the University of California at Los Angeles (UCLA).

Inclusion criteria were as follows: adults between 20 and 65 years of age at time of trial with the ability to undertake 30 min of mild exercise a day, who were diagnosed with TTH [using International Headache Society (IHS) criteria (10)] by a physician at the UCLA Center for East West Medicine (CEWM). Exclusion criteria were as follows: having any headache condition other than, or in addition to, TTH (e.g. migraine, cluster headaches, etc.); having previous practice of Tai Chi or Qi Gong (Qi Gong refers to all traditional Asian health practices involving what is thought to be the circulation of energy in pathways throughout the body, whereas Tai Chi is a martial art developed from Qi Gong practices and is considered a form of Qi Gong); significant comorbid illness that would be expected to prevent completion of the study; any additional conditions (e.g. severe hearing loss, respiratory, cardiovascular or neurological problems) that might interfere with the required intervention and evaluations; any acute intercurrent illness that might interfere with the interpretation of the study (e.g. influenza); and self-reported inability to commit to the intervention schedule.

Participants were volunteers recruited from the Los Angeles area who responded to advertisements circulated by the UCLA Department of Medicine and posted in local newspapers seeking adults with tension headaches wishing to receive free treatment. Interested participants were asked to telephone and were screened to determine eligibility. Informed consent was obtained during the first visit to the CEWM, where participants were then independently screened for recruitment criteria.

Out of 122 Potential Participants 47 Met All Recruitment Criteria and Were Randomized into Either the Control or Intervention Group

A total of 122 phone calls were received from potential participants (see Fig. 1). Of these, 29 (24%) did not respond to follow-up contact, 4 (3%) were unwilling to provide eligibility information, 29 (24%) were deemed ineligible from phone interview and 9 (7%) potential participants were no longer interested in participation after hearing details of the study. After screening, 4 (3%) additional potential participants were deemed ineligible. It was determined that 47 (39%) participants met all recruitment criteria and were randomized into either the control group (n = 23) or intervention group (n = 24).

Figure 1. Study design and flow of subjects.

Thirty of the Forty-Seven Randomized Participants Completed the Study

After randomization, five participants declined to participate as a result of a time delay between recruitment and randomization, or due to conflicts with the intervention schedule. Hence, a total of 42 participants were randomized to the treatment (n = 21) or the control group (n = 21). During the course of intervention, an additional 8 participants dropped out of the treatment group and 4 participants dropped out of the control group, leaving 30 participants who completed the study (13 in the treatment group; 17 in the control group).

The Intervention Consisted of 15 Weeks of Bi-Weekly Instruction in the Yang Style Short Form of Tai Chi

Participants in the intervention group received bi-weekly sessions an hour in duration for 15 weeks. There were two cohorts for the intervention group to provide more flexibility to participants. Classes were taught at a local park distinct from the location of study assessment.

Subjects were taught the classical Yang style of Tai Chi short form. This 24 standardized movement form is the most widely practiced style of Tai Chi (4). An instructor with over 20 years of experience in Tai Chi instruction and practice administered sessions.

Handouts were provided summarizing the Tai Chi movements, and a video of the form was provided to assist participants.

Improvement was Assessed with the Health-Related Quality-of-Life

Measure SF-36v2 and the Headache Impact Measure HIT-6™

Health-related quality-of-life (HRQOL) was assessed with the SF-36v2, a generic measure that has been extensively used in both clinical and research settings (22). The SF-36v2 measures eight domains of health as follows: general health perceptions (5 items); physical functioning (10 items); role limitations due to physical problems (4 items, role-physical); bodily pain (2 items); energy/fatigue (4 items); social functioning (2 items); role limitations due to emotional problems (3 items, role-emotional); and emotional well-being (5 items).

The HIT-6™ is a 6-item fixed-length, short-form version of the DYNHA® Headache Impact Test designed to capture the effect of headache and its treatment on an individual's functional status and well-being. The items in HIT-6™ cover the content areas found in widely used measures of headache impact, including pain, ability to carry out usual activities, social functioning, energy/fatigue, cognitive functioning and psychological distress. HIT-6™ is useful both for screening and for monitoring change in disease impact (23).

Assessment Methods

Assessment was performed before the first treatment session (post-randomization), at Weeks 5, 10 and 15 during the 15 week intervention period. Each participant received a mailing on the first day (Monday) of each assessment week containing all self-report measures with instructions, and was asked to return the assessments in an enclosed self-addressed stamped envelope by the end of the week. Participants were called on the second day (Tuesday) of each assessment week to verify that the mailing had been received. Participants were called on the fourth day (Thursday) and fifth day (Friday) of the week as a reminder. All outcome measures were held in a secure location at the CEWM in sealed envelopes until the completion of the intervention period.

Statistical Analysis

An administrative assistant (in no other way connected with the study) was the only person given access to the data, and was responsible for entering all raw data into Microsoft excel for analysis. We evaluated the extent to which randomization was successful by comparing the age and gender of the treatment and control groups (Table 1). We computed t-tests to assess the statistical significance of the difference in changes in SF-36 scores and the HIT score between the treatment and control groups (Table 2). The 15 week follow-up data was used if available. If not available, the 10 week data was used. If still not available, the 5 week data was used. This approach allowed us to maximize the sample size for the analysis. There was too few observations at the individual follow-up intervals to justify a trend analysis.

Table 1. Demographic characteristics of participants

Table 2. Differences in changes in HRQOL and headache impact between treatment and control groups

Results There were no Differences in Gender or Age Between Groups

There were no significant differences in gender or age between the treatment and control groups (Table 1). The proportion of people randomized to the intervention and control groups that had data and were included in the analysis did not differ significantly (54 versus 74%, χ2 = 1.98, df = 1, P = 0.159).

The Intervention Improved HRQOL and Reduced Headache Impact

There were five significant differences in which the control group scored higher at baseline than the intervention group (see Fig. 2): physical functioning (t = 2.98, P = 0.0083, df = 17), role limitations due to physical health (t = 4.21, P = 0.002, df = 28), vitality (t = 2.57, P = 0.0157, df = 28), social functioning (t = 2.59, P = 0.0151, df = 28) and the PCS (t = 3.24, P = 0.0031, df = 28). Because of baseline differences, we regressed follow-up scores on an indicator of group assignment, controlling for age, gender and baseline score on the outcome measure. This analysis revealed six statistically significant effects of the intervention on the outcome variables (differences in adjusted change in parentheses) as follows: pain (6), energy/fatigue (8), social functioning (6), emotional well-being (8), the mental health summary score (7) and the HIT score (7) [the HIT score has been inverted for ease of interpretation (a lower score indicates reduced headache impact)]. Each of these differences favored the treatment group.

Figure 2. SF-36 and HIT scores at baseline and follow-up for the treatment and control groups.

Discussion

The results of the study reveal significant positive effects of Tai Chi on generic health outcomes for people with TTH. The magnitude of the effects was noteworthy ranging from 0.64 to 0.82 of a standard deviation for the significant differences observed.

Rationale for Study Design

This study was designed based on IHS guidelines for pharmaceutical trials (2) and the designs of other Tai Chi research studies. A notable departure from IHS guidelines was the lack of double-blind design and placebo control. Unfortunately, the nature of the intervention precludes blinding participants to their group assignment. A recent review article of Tai Chi studies (5) notes that of the 47 studies judged to be of sufficient academic rigor (9 RCTs, 23 NRSs and 15 observational studies), none were double-blind.

The control group was placed on a wait list for Tai Chi instruction instead of receiving a placebo intervention. This wait list control design was also used in a recent study of Tai Chi for varicella-zoster virus specific immunity and health function by Irwin et al. (15,16).

There are different styles of Tai Chi, and the studies that have examined Tai Chi to date have not examined a standardized style. However, it should be noted that all forms of Tai Chi studied share a low-impact nature, and involve the practice of changes in mental focus, breathing, coordination and relaxation. The differences between various forms of Tai Chi may be negligible in terms of their efficacy. Even so, instruction was given in the most popular form of Tai Chi, the Yang style short form.

The most significant difficulty encountered during the study was a relatively high dropout rate. No participant reported an adverse effect from the intervention. Of the eight dropouts in the intervention group, five (62%) participants who dropped out stated that the time commitment and travel required by them was too much to attend and three (38%) participants dropped out of the study due to personal reasons. Of the five dropouts in the control group, three (60%) participants stated that the time commitment for the evaluations was too much, one (20%) participant declined to give a reason for dropout, and one (20%) participant could not be contacted. In future trials, additional participant compensation may reduce the dropout rate.

This study has provided evidence of the efficacy of Tai Chi in treating TTH and improving HRQOL. Given these results, a larger study is warranted with increased sample size. In future research, the population may be expanded to include other types of headache conditions.

Benefits of Tai Chi Compared with Pharmaceutical Intervention

As an intervention for headache, Tai Chi offers several benefits over conventional treatment. Virtually all pharmaceutical-based interventions include some risk to the patient of side-effects or complications, particularly over a long-term course of use. Of the most widely utilized drugs for TTH, acetaminophen (the active ingredient in Tylenol and other pain medications) can cause liver toxicity, and NSAIDS (such as ibuprofen and aspirin) can cause gastrointestinal symptoms and bleeding. To the extent that treatment can be refocused to exercise-based therapies, this will provide significant benefit to the patient.

Furthermore, not all patients respond favorably to pain medications. Patients may find only partial relief for their symptoms, or may be completely unable to tolerate pharmaceutical intervention. To the extent that Tai Chi represents a viable alternative to medication, it provides a major addition to the arsenal of potential treatments.

Tai Chi may also help to control the cost of treatment because it requires only an initial period during which the patient receives training. This cost is low compared to newer (on-patent) pharmaceutical treatments (if required) which may include repeated physician visits to ensure proper progress, and also low compared with the long-term cost of over-the-counter medications (and their potential complications).

Finally, Tai Chi does more than alleviate pain or provide symptomatic relief; it benefits HRQOL. This may be because Tai Chi addresses an underlying cause of the pain associated with TTH, namely stress. The pain associated with TTH may be caused by, or exacerbated by, muscle contractions caused by stress. [The exact cause of TTH is not clear. Muscle tension or spasms of the head or scalp, neck, face or jaw have been thought to play a role. TTH pain may also be the result of the same biochemical changes in the brain and impaired blood flow in the scalp and neck that lead to migraine headaches (24,25).] Analgesics will only target the symptoms of stress. When medication stops, the pain may return because the underlying problem has not been adequately managed. With its emphasis on relaxation, breathing, focus and coordination, Tai Chi seems to directly affect stress and tension that contribute to the pain associated with TTH (16). In addition to affecting this pain, Tai Chi may affect other symptoms that arise from stress such as tachycardia, fatigue, anxiety, insomnia, etc., thus affecting HRQOL.

Conclusions

As a TCM/CAM therapy, Tai Chi offers a holistic approach to patient care that differs from the approach of conventional treatment. Tai Chi offers a range of benefits, and can be integrated with other modalities of TCM, CAM and conventional medicine. To integrate CAM and conventional medicine into a new model that is safer, accessible, affordable and effective will require additional research. Future well-designed clinical studies are needed.

Acknowledgments

The authors gratefully acknowledge financial support for this project from the Gerald Oppenheimer Family Foundation; the Annenberg Foundation; the David Chu Bequest; the Sirpuhe & John Conte Foundation; the Stephen Philibosian Foundation; the Stanley Dashew Trust; Mr Dean Ambrose (the California Community Foundation); Mr Beryl Weiner and Mrs Judith Weiner; and Mr Richard Orgell. Ron D. Hays was supported in part by the UCLA/DREW Project EXPORT, National Institutes of Health, National Center on Minority Health & Health Disparities (P20-MD00148-01) and the UCLA Center for Health Improvement in Minority Elders/Resource Centers for Minority Aging Research, National Institutes of Health, National Institute of Aging (AG-02-004). The authors would also like to gratefully acknowledge the assistance of others who have helped to make this project possible: Ms Karen Spritzer; Mrs Cathy Abbott and Mr Frederick Abbott; the physicians, researchers and staff of the UCLA Center for East West Medicine, particularly Mr Michael Johnson, Dr Marc Brodsky, Dr Bill Tu, Dr Sue Yi, Dr Ed Hui and Dr Malcolm Taw.

References

1. National Headache Foundation: Fact Sheet. 1 January 2003. National Headache Foundation, 2005. Available at:http://www.headaches.org/consumer/presskit/factsheet.pdf.

2. Schoenen, J.;Boureau, F.;Kunkel, R.;Pfaffenrath, V.;Steiner, TJ.;Tfelt-Hansen, P., et al. Oxford, UK: International Headache Society; 1998. Guidelines for trials of drug treatments in tension-type headache. The IHS' Members Handbook 1997/1998.

3. Barnes P, Powell-Griner E, McFann K, Nahin R. Complementary and Alternative Medicine Use Among Adults: United States. 2002 Adv Data. 2004.

4. Jahnke, R. The Healing Promise of Qi: Creating Extraordinary Wellness Through Qigong and Tai Chi. New York: McGraw Hill; 2002.

5. Wang C, Collet JP, Lau J. The effect of Tai Chi on health outcomes in patients with chronic conditions: a systematic review. Arch Intern Med. 2004;164:493–501. [PubMed]

6. Klein PJ, Adams WD. Comprehensive therapeutic benefits of Taiji: a critical review. Am J Phys Med Rehabil. 2004;83:735–45. [PubMed]

7. Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T. Reducing frailty and falls in older persons. J Am Geriatr Soc. 1996;44:489–97. [PubMed]

8. Tse SK, Bailey DM. Tai Chi and postural control in the well elderly. Am J Occup Ther. 1992;46:295–300. [PubMed]

9. Hong Y, Li JX, Robinson PD. Balance control, flexibility, and cardiorespiratory fitness among older Tai Chi practitioners. Br J Sports Med. 2000;34:29–34. [PubMed]

10. Lan C, Lai JS, Chen SY, Wong MK. Tai Chi Chuan to improve muscular strength and endurance in elderly individual: a pilot study. Arch Phys Med Rehabil. 2000;81:604–7. [PubMed]

11. Young DR, Appel LJ, Jee S, Miller ER. The effects of aerobic exercise and Tai Chi on blood pressure in older people: results of a randomized trial. J Am Geriatr Soc. 1999;47:277–84. [PubMed]

12. Lai JS, Lan C, Wong MK, Teng SH. Two-year trends in cardiorespiratory function among older Tai Chi practitioners and sedentary subjects. J Am Geriatr Soc. 1995;43:1222–7. [PubMed]

13. Li F, Duncan TE, Duncan SC, McAuley E, Chaumeton NR, Harmer P. Enhancing the psychological well-being of elderly individuals through Tai Chi exercise: a latent growth curve analysis. Struct Equation Modeling. 2001;8:53–83.

14. Baron LJ. Tai Chi practice in the elementary classroom. Can J Res Early Childhood Educ. 1998;6:341–52.

15. Irwin MR, Pike JL, Cole JC, Oxman MN. Effects of a behavioral intervention, tai chi chih, on varicella-zoster virus specific immunity and health functioning in older adults. Psychosom Med. 2003;65:824–30. [PubMed]

16. Irwin M, Pike J, Oxman M. Shingles Immunity and Health Functioning in the Elderly: Tai Chi Chih as a Behavioral Treatment. Evid Based Complement Alternat Med. 2004;1:223–32. [PubMed]

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19. Karst M, Reinhard M, Thum P, Wiese B, Rollnik J, Fink M. Needle acupuncture in tension type headache: a randomized, placebo-controlled study. Cephalalgia. 2001;21:637–42. [PubMed]

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2. A randomized, prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women

Source: wustyle.com — A randomized, prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women · Topics: bone density · Gerontology · Muscular System · Orthopedics · osteoporosis

Chan K, Qin L, Lau M, Woo J, Au S, Choy W, Lee K, Lee S.

Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong.

OBJECTIVE: To evaluate the potential benefits of programmed Tai Chi Chun (TCC) exercise on the weight-bearing bones of early postmenopausal women. DESIGN: Age-matched and randomized prospective intervention. SETTING: University medical school. PARTICIPANTS: One hundred thirty-two healthy postmenopausal women (mean age, 54.0+/-3.5y) within 10 years of menopause onset were recruited and randomized into the TCC exercise group (n=67) or the sedentary control group (n=65). INTERVENTION: Supervised TCC exercise was performed by the TCC group for 45 minutes a day, 5 days a week, for 12 months; control subjects retained a sedentary life style. Main outcome measures Bone mineral density (BMD) was measured in the lumbar spine and proximal femur by using dual-energy x-ray absorptiometry and in the distal tibia by using multislice peripheral quantitative computed tomography (pQCT). All BMD measurements were repeated after 12 months in both groups. Fracture rate was also documented. RESULTS: Baseline measurements showed homogeneity in age, anthropometric variables, and menstruation status between the TCC and control groups. Exactly 81.6% of the subjects in the TCC group and 83.1% of subjects in the control group completed the 12-month follow-up study. BMD measurements revealed a general bone loss in both TCC and sedentary control subjects at all measured skeletal sites, but with a reportedly slower rate in the TCC group. A significant 2.6- to 3.6-fold retardation of bone loss (P<.01) was found in both trabecular and cortical compartments of the distal tibia in the TCC group as compared with the controls, as measured by pQCT. A total of 4 fracture cases were documented during follow-up, including 3 subjects in the control group and 1 in the TCC group. CONCLUSIONS: This is the first prospective and randomized study to show that a programmed TCC exercise intervention is beneficial for retarding bone loss in weight-bearing bones in early postmenopausal women. Long-term follow-up is needed to substantiate the role of TCC exercise in the prevention of osteoporosis and its related fracture.

PMID: 15129394 [PubMed - indexed for MEDLINE]

3. Are there any health benefits from tai chi exercises?

Source: wustyle.com — Are there any health benefits from tai chi exercises? · Topics: blood pressure · chicken pox · immune system

Tai chi, the slow, graceful Chinese exercise program that is sometimes called a "moving meditation," was originally created centuries ago as a martial art. It does appear to have some health benefits, though rigorous studies are hard to come by.

The National Center for Complementary and Alternative Medicine, an arm of the National Institutes of Health (nccam.nih.gov) notes, "It is not fully known what changes occur in the body during tai chi, whether they influence health, and if so, how." But so many Americans now practice the slow-moving exercise - 1.3 percent, according to a 2002 survey - that the government is now funding a number of studies to see what health benefits tai chi may hold.

Among the best-documented health effects for tai chi is its ability to improve balance, said biologist Peter Wayne, director of Tai Chi Research Programs from Harvard Medical School's Division for Research and Education in Complementary and Integrative Medical Therapies. In a systematic review of the published literature, Wayne and his colleagues found that 20 of 24 studies support the hypothesis that tai chi improves balance.

A recent study in the Journal of the American Geriatric Society found that tai chi can also boost immunity and protect older adults against shingles, a painful disease caused by reactivation of the chicken pox virus, which can linger in the body for decades. In this study, 112 adults age 59 to 86 were randomly assigned to tai chi or health education classes for 16 weeks.

Those who got tai chi had nearly twice as much immunity against the chicken pox virus (all participants had had chicken pox) measured by a blood test, as well as a stronger immune response to the chicken pox vaccine.

Tai chi has also been shown in a number of studies to lower blood pressure in people with hypertension.

But whether tai chi is any better for health than some other mind-body practices such as yoga and meditation remains to be seen, said Wayne. Tai chi teachers are not licensed by state boards, so a word of caution: If you are new to tai chi, check out several teachers and pick one with the most experience.

JUDY FOREMAN

E-mail health questions to This email address is being protected from spambots. You need JavaScript enabled to view it..

4. Change in perceived psychosocial status following a 12-week Tai Chi exercise programme.

Source: wustyle.com — Change in perceived psychosocial status following a 12-week Tai Chi exercise programme. · Topics: cardiovascular disease · Circulatory System · psychological health

Taylor-Piliae RE, Haskell WL, Waters CM, Froelicher ES.

Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, California 94305-5705, USA. This email address is being protected from spambots. You need JavaScript enabled to view it.

AIM: This paper reports a study to examine change in psychosocial status following a 12-week Tai Chi exercise intervention among ethnic Chinese people with cardiovascular disease risk factors living in the United States of America. BACKGROUND: Regular participation in physical activity is associated with protection against cardioavascular disease, and improvements in physical and psychological health. Increasing amounts of scientific evidence suggests that mind-body exercise, such as Tai Chi, are related to improvements in mental health, emotional well-being, and stress reduction. No prior study has examined the effect of a Tai Chi exercise intervention on psychosocial status among people with cardiovascular disease risk factors. METHODS: This was a quasi-experimental study. Participants attended a 60-minute Tai Chi exercise class three times per week for 12 weeks. Data were collected at baseline, 6 and 12 weeks following the intervention. Psychosocial status was assessed using Chinese versions of Cohen's Perceived Stress Scale, Profile of Mood States, Multidimensional Scale of Perceived Social Support, and Tai Chi exercise self-efficacy. RESULTS: A total of 39 participants, on average 66-year-old (+/-8.3), married (85%), Cantonese-speaking (97%), immigrants participated. The majority were women (69%), with < or =12 years education (87%). Statistically significant improvements in all measures of psychosocial status were found (P < or = 0.05) following the intervention. Improvement in mood state (eta2 = 0.12), and reduction in perceived stress (eta2 = 0.13) were found. In addition, Tai Chi exercise statistically significantly increased self-efficacy to overcome barriers to Tai Chi (eta2 = 0.19), confidence to perform Tai Chi (eta2 = 0.27), and perceived social support (eta2 = 0.12). CONCLUSIONS: Tai Chi was a culturally appropriate mind-body exercise for these older adults, with statistically significant psychosocial benefits observed over 12-weeks. Further research examining Tai Chi exercise using a randomized clinical trial design with an attention-control group may reduce potential confounding effects, while exploring potential mechanisms underlying the relaxation response associated with mind-body exercise. In addition, future studies with people with other chronic illnesses in all ethnic groups are recommended to determine if similar benefits can be achieved.

PMID: 16629916 [PubMed - indexed for MEDLINE]

5. Comparison of muscle torque, balance, and confidence in older tai chi and healthy adults.

Source: wustyle.com — Comparison of muscle torque, balance, and confidence in older tai chi and healthy adults. · Topics: balance · Gerontology · knee strength · Muscular System · Nervous System

Tsang WW, Hui-Chan CW.

Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (SAR), China.

PURPOSE: The objectives of this cross-sectional study were to examine whether older Tai Chi practitioners had better knee muscle strength, less body sway in perturbed single-leg stance, and greater balance confidence than healthy older adults. METHODS: Tai Chi and control subjects (N = 24 each, aged 69.3 +/- 5.0 and 71.6 +/- 6.1 yr, respectively) were matched with respect to age, gender, height, weight, and physical activity level. Concentric and eccentric isokinetic tests of the subjects" dominant knee extensors and flexors were conducted at an angular velocity of 30 degrees.s(-1). Control of body sway was assessed in static double-leg stance and in single-leg stance perturbed by forward or backward platform perturbations. The Activities-specific Balance Confidence (ABC) scale was used to investigate subjects" balance confidence in daily activities. RESULTS: Tai Chi practitioners had higher peak torque-to-body weight ratios in concentric and eccentric isokinetic contractions of their knee extensors and flexors (P = 0.044). They manifested less anteroposterior body sway angles in perturbed single-leg but not static double-leg stance than did control subjects (P < 0.001). Tai Chi practitioners also reported significantly higher balance confidence score ratios (P = 0.001). Older adults" knee muscle strengths showed negative correlations with body sway angles in perturbed single-leg stance and positive correlations with ABC score ratios. Moreover, their body sway angles in perturbed single-leg stance were negatively correlated with their ABC score ratios (all P < 0.05). CONCLUSION: Our results demonstrate that long-term Tai Chi practitioners had better knee muscle strength, less body sway in perturbed single-leg stance, and greater balance confidence. Significant correlations among these three measures uncover the importance of knee muscle strength and balance control during perturbed single-leg stance in older adults" balance confidence in their daily activities.

PMID: 15692325 [PubMed - indexed for MEDLINE]

6. Complementary and Alternative Medicine: Tai Chi

Source: wustyle.com — Complementary and Alternative Medicine: Tai Chi · Topics: anxiety · arthritis · Cardiology · cardiovascular disease · Circulatory System

Tai chi aims to address the body and mind as an interconnected system and to improve mental and physical health while benefiting posture, balance, flexibility and strength. Tai chi includes sequences of slow movements coordinated with deep breathing and mental focus. Tai chi can be practiced alone or with a group of people in a class. Practitioners guide pupils through movements, encouraging them to keep their bodies stable and upright while shifting weight. Read more...

7. DIABETES AND TAI CHI THERAPY

Source: wustyle.com — DIABETES AND TAI CHI THERAPY · Topics: diabetes · Endocrinology

I was quite surprised when I began searching for research on Tai Chi’s benefits for diabetes . . . it was very difficult to come by. Because on its face, Tai Chi seems to possibly offer many benefits to someone with diabetes. Tai Chi is known to stimulate microcirculation in practitioners, and is a highly effective stress management technique, and very gently burns a significant amount of calories. In fact, Tai Chi may actually help the body find homeostatic chemical levels. For example, in a study on sex hormones Tai Chi was found to have a “balancing effect” on the hormonal chemistry of participants, lowering the abnormally high estrogen levels in older men, while raising the abnormally low estrogen levels in older women.

These findings in other research led me to believe that there had probably been substantial research done on Tai Chi & Qigong’s benefits for those with diabetes, given that these findings in other studies at least initially suggest Tai Chi & Qigong may offer much to the diabetes patient. But, as I said, it doesn’t appear there is much out there in terms of “tai chi & qigong as an adjunct diabetes therapy,” at least from Western institutions.

However, a couple of Chinese medical institutions studies had very exciting results. A Beijing University of Chinese Medicine and Pharmacology study found that blood sugar could be lowered successfully by doing QiGong exercises. 42.9 percent of patients in the study were able to take less medicine while having more staple foods. Also, a Nanjing University study found that Tai Chi exercise helped to regulate metabolic disorder of type 2 diabetes mellitus with geriatric obesity by regulating the nervous-endocrine system in the body. So, why isn’t there more Western medical research on this?

Unfortunately, less than one half of one percent of NIH funding goes to research all alternative or “complimentary” health techniques. Meaning that yoga, meditation, herbology, homeopathy, etc. etc. all share that tiny, tiny slice of the NIH funding pie. Until the NIH provides adequate attention / funding for Tai Chi & Qigong (Chi Kung) research, many of the benefits people with various maladies have enjoyed from Tai Chi & Qigong will not be enjoyed by the millions of others with such conditions. Because physicians will lack the knowledge necessary to inform their patients of Tai Chi & Qigong as a possible viable therapeutic option, until adequate research is done.

Never the less, you might ask your doctor to do some research on this for you. But, for now, let’s look at current recommendations for diabetes therapy, and then compare Tai Chi benefits systematically to see if it might be a good therapeutic match for diabetes. As always, I remind everyone not to self-treat. These articles are meant to stimulate a dialogue between you and your physician, and your physician and medical research institutions to lobby on your behalf to get powerful natural health therapies like Tai Chi fully researched so that you have the maximum possible options for your health protocol.

In an article posted on Post Graduate Medicine Online, Dr.s Adam B. Mayerson, MD; Silvio E. Inzucchi, MD, state that “Diet, exercise, and the attainment of ideal body weight are the central components of any therapeutic [type 2 diabetes] regimen . . .”. Tai Chi is proven to be an effective exercise that not only provides cardiovascular benefit (roughly equal to moderate impact aerobics), but surprisingly given Tai Chi’s gentle low impact nature, burns a significant number of calories, in fact more than surfing, and nearly as much as downhill skiing. To achieve such caloric burning benefits, and cardiovascular benefits, with such a gentle exercise as Tai Chi may be important to those with diabetes.

The health site Top5plus5.com’s information on diabetes explained that the type of exercise a patient practices is crucial to their well being, stating “Patients with active diabetic retinopathy should not participate in exercises involving straining or heavy lifting since these activities can provoke eye damage. Patients should also be aware that nerve damage caused by high blood sugar levels can lead to a loss of sensation in the feet, with a subsequent increased risk of blistering and ulceration. Patients with progressive heart damage from high blood sugar should be warned about the risk of sudden heart failure and death.”

Tai Chi may offer promise regarding heart health so important to diabetes sufferers. On the 9th of October, 2004, BBC News - Saturday, reported “Tai Chi 'can treat heart failure.” The British Heart Foundation said the study was "excellent news" and Tai Chi could be adopted into treatment programmes in the UK in the future.”http://news.bbc.co.uk/1/hi/health/3728174.stm

Again, one should never self-treat, and should always approach all possible therapies in conjunction with their physician. Our articles at World Tai Chi & Qigong Day are meant to stimulate discussion between you and your physician, and hopefully between your physician and health institutions. Our hope is that this will lead to a more realistic apportionment of medical research funding towards Tai Chi & Qigong (Chi Kung), and other natural health therapies. One caution is, we hope that researchers will approach Tai Chi & Qigong with a desire to find out “why it helps many people” rather than with an agenda to prove that it doesn’t work. The way that studies are done is just as important as if studies are done.

Our vision for the future is that physicians too, will begin to discover for themselves what Tai Chi and Qigong health technologies have to offer on a personal level as Tai Chi is increasingly offered through medical universities to aspiring nurses and physicians. The future of healthcare should not be a war between alternative therapies and standard therapies, but an expansion of standard therapies to include whatever works best for the patients. Many in the medical field are great advocates of such a vision, and World Tai Chi & Qigong Day celebrates their efforts.

ABOUT THE AUTHOR:

Bill Douglas is the Tai Chi Expert at DrWeil.com, Founder of World T'ai Chi & Qigong Day (held in 60 nations each year), and has authored and co-authored several books including a #1 best selling Tai Chi book The Complete Idiot’s Guide to T’ai Chi & Qigong. Bill’s been a Tai Chi source for The Wall Street Journal, New York Times, etc. Bill is the author of the ebook, How to be a Successful Tai Chi Teacher(Namasta University Publishing). You can learn more about Tai Chi & Qigong, search a worldwide teachers directory, and also contact Bill Douglas athttp://www.worldtaichiday.org

8. Effects of exercise on joint sense and balance in elderly men: Tai Chi versus golf.

Source: wustyle.com — Effects of exercise on joint sense and balance in elderly men: Tai Chi versus golf. · Topics: balance · Gerontology · Muscular System · Nervous System · proprioception

Tsang WW, Hui-Chan CW.

Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong (SAR), China.

PURPOSE: Our previous studies showed that experienced Tai Chi practitioners had better joint proprioception and balance control during weight shifting. The objective of the present study was to examine whether experienced golfers had attained similar improvement when compared with the Tai Chi practitioners, as well as healthy elderly subjects and young university students. METHODS: We compared 12 experienced elderly Tai Chi practitioners, with 11 experienced elderly golfers, 12 healthy elderly subjects, and 12 young university students, who were all males, using: 1) passive knee joint repositioning test to assess their joint proprioceptive acuity and 2) limits of stability test to assess their ability to voluntarily weight shift within their base of support. RESULTS: Both Tai Chi practitioners and golfers had better knee joint proprioceptive acuity than did the elderly control subjects (P < 0.05). Of special interest is that their performance was similar to that of the young subjects. In the limits of stability test, Tai Chi practitioners and golfers had faster reaction time, leaned further without losing stability, and showed better control of leaning trajectory than did elderly control subjects (all P < 0.05). The latter two outcome measures were also comparable to those of the young subjects. CONCLUSION: These results demonstrate that both experienced Tai Chi practitioners and golfers had improved knee joint proprioception and limits of stability, when compared with those of elderly control subjects similar in age, gender (male), and physical activity level. Such improved outcome measures were comparable to those of young male subjects. These findings suggest that experienced Tai Chi practitioners and golfers had improved joint proprioceptive acuity and dynamic standing balance control, despite the known aging effects in these specific sensorimotor functions.

PMID: 15064594 [PubMed - indexed for MEDLINE]

9. Falls In Older People

Source: wustyle.com — Falls In Older People · Topics: fall prevention · Gerontology · Muscular System · Skeletal System

R Soc Med. 2001 April; 94(4): 202.

PMCID: PMC1281399

Graham Mulley

Elderly Services, St James's University Hospital, Leeds, UK

`Simple fall' is a forbidden expression on my ward rounds. Falls are common causes of admission of old patients; they are usually complex. The possible causes are legion and important contributory factors are often overlooked.

A new work, Falls in Older People by Lord, Sherrington and Menz1, corrects many misconceptions. Falls are not a non-specific accompaniment of ageing. They are poorly correlated with `dizziness'. Patients may be convinced that they did not lose consciousness when falling, but people with syncope may have retrograde amnesia. The presence of loose rugs in the home is not a predictor of falls: the homes of fallers are no more hazardous than those of non-fallers. Well-meaning therapists may tack down carpets, remove loose mats and relocate furniture. These alterations can annoy the older person (who later may reorder her furnishings in the way she prefers them). The finding that making such apparently sensible modifications to the house causes a reduction in falls outside the house is counterintuitive. Another surprise: there is no direct link between drinking alcohol and falls in old age. Current drinkers have fewer falls than abstainers.

Falls do not occur at random—there is no Poisson distribution. One-third of people over 65 will fall at least once a year. Most falls occur on the flat; falls on the stairs or in the bathroom are relatively rare. Old women tend to fall in the house, old men in the garden. In `care homes', many falls occur on the way to or from the toilet. Only one in a hundred falls results in a hip fracture, but one-fifth cause serious injury. Of those who fall and lie on the floor for hours, half will be dead within six months. Lord and his co-authors carefully analyse the published work on risk factors and prevention. The risk of falls is doubled in dementia. There is also an increased risk with depression; we do not know why. The more drugs an elderly person takes, the greater the risk of falls: the principle of minimal medication is often contravened. Visual impairment is an important risk factor: patients who use eye-drops for glaucoma have a three-fold increased risk of falling; those with cataract are more at risk of breaking a hip. The importance of footwear in the genesis of falls is emphasized: high heels (favoured by many old ladies) reduce stride length, alter toe propulsion and increase lumbar lordosis. Loose slippers can also be a factor in the genesis of falls.

I have nothing but praise for this monograph. The Australian authors—a physiologist, a physiotherapist and a lecturer in foot mechanics and gerontology—recognized that textbooks have dealt with falls superficially and that no-one had methodically analysed and interpreted the published work. They write elegantly and apply academic rigour to the data, highlighting the gaps and uncertainties in our knowledge and generously providing many research ideas for readers to pursue. Each chapter has a succinct summary.

There are over 1000 references, helpful illustrations and very useful tables. We learn about large-scale studies of the effectiveness of multifaceted approaches to falls. There is some evidence for the benefits of specific approaches: after a fifteen-month Tai Chi programme there was a 50% reduction in the risk of falls. The authors make a plea for clarity in the words we use: dizziness can mean many things; drop attacks are not necessarily synonymous with syncope. The list of which risk factors can be modified and which intervention strategies work should be in every geriatric ward and accident and emergency department. Who knows, it might inhibit clinicians from mentioning `simple' falls.

References

1. Falls in Older People: Risk Factors and Strategies for Prevention. Stephen R Lord, Catherine Sherrington, Hylton B Menz. Cambridge: Cambridge University Press, 2000 [249 pp; ISBN 0-521-58964-9 (p/b); £29.95 (US $49.95)].

10. Health Benefits, Tai Chi Linked

Source: wustyle.com — Health Benefits, Tai Chi Linked · Topics: general health

New research from Tufts finds the ancient practice of tai chi may actually help improve health.

Boston [04-28-04] The two thousand year old practice of tai chi – a combination of martial arts movements and deep breathing – has been used for generations in China to release energy and negative feelings. But an effort by Tufts to review the body of research on tai chi finds that the ancient practice may also be linked with a variety of other health benefits – from flexibility to cardiovascular health.

Using 47 studies on tai chi in English and Chinese medical journals, Tufts’ Dr. Chenchen Wang – a physician at Tufts-New England Medical Center – analyzed the effect of the practice on healthy people as well as those with assorted health conditions.

“Overall, these studies reported that long-term tai chi had favorable effects on the promotion of balance control, flexibility and cardiovascular fitness and reduced the risk of falls in the elderly,” said Wang, an assistant professor of medicine at Tufts. “Benefit was also found for balance, strength and flexibility in older subjects; and pain, stress and anxiety in healthy subjects.”

Wang and colleagues concluded that tai chi is generally a safe exercise, and one that may be most beneficial for older adults, including those who suffer from arthritis, high blood pressure, multiple sclerosis and other conditions.

“The sickly elderly who participated in the program also showed improved balance, strength, and flexibility and fewer falls,” reported the Jerusalem Post.

While the study – funded in part by the National Institutes of Health – provided insight into links between tai chi and improved health, it left some unanswered questions, including which mechanisms were responsible for tai chi’s apparent health benefits.

“Despite its popularity, the biological mechanisms and clinical effects of tai chi are not well understood,” Wang and colleagues wrote. “The long-term effects of tai chi practice are still unknown, and there is insufficient information to recommend tai chi to patients with chronic conditions.”

11. Improvement in balance, strength, and flexibility after 12 weeks of Tai chi exercise in ethnic Chinese adults with cardiovascular disease risk factors

Source: wustyle.com — Improvement in balance, strength, and flexibility after 12 weeks of Tai chi exercise in ethnic Chinese adults with cardiovascular disease risk factors · Topics: cardiovascular disease · Circulatory System · diabetes · fall prevention · hypertension

Taylor-Piliae RE, Haskell WL, Stotts NA, Froelicher ES.

Stanford Prevention Research Center, Stanford University School of Medicine, Stanford University, Calif, USA.

CONTEXT: Declines in physical performance are associated with aging and chronic health conditions. Appropriate physical activity interventions can reverse functional limitations and help maintain independent living. Tai chi is a popular form of exercise in China among older adults. OBJECTIVE: To determine whether tai chi improves balance, muscular strength and endurance, and flexibility over time. DESIGN: Repeated measures intervention; data collected at baseline, 6 weeks, and 12 weeks. SETTING: Community center in the San Francisco Bay Area. PARTICIPANTS: Thirty-nine Chinese adults with at least 1 cardiovascular disease (CVD) risk factor. INTERVENTIONS: A 60-minute tai chi exercise class 3 times per week for 12 weeks. MAIN OUTCOME MEASURES: A battery of physical fitness measures specifically developed for older adults assessed balance, muscular strength and endurance, and flexibility. RESULTS: Subjects were 65.7 (+/- 8.3) years old, Cantonese-speaking (97%) immigrants, with 12 years or less of formal education (87%) and very low income (67%). Reported CVD risk factors were hypertension (92%), hypercholesteremia (49%), diabetes (21%), and 1 current smoker. Subjects were below the 50th percentile of fitness at baseline compared to age- and gender-specific normative US data. Statistically significant improvements were observed in all balance, muscular strength and endurance, and flexibility measures after 6 weeks, and they increased further after 12 weeks. CONCLUSIONS: Tai chi is a potent intervention that improved balance, upper- and lower-body muscular strength and endurance, and upper- and lower-body flexibility in these older Chinese adults. These findings provide important information for future community-based tai chi exercise programs and support current public health initiatives to reduce disability from chronic health conditions and enhance physical function in older adults.

PMID: 16541997 [PubMed - indexed for MEDLINE]

12. Shingles Immunity and Health Functioning in the Elderly: Tai Chi Chih as a Behavioral Treatment

Source: wustyle.com — Shingles Immunity and Health Functioning in the Elderly: Tai Chi Chih as a Behavioral Treatment · Topics: Gerontology · Immune System · shingles

Evid Based Complement Alternat Med. 2004 December; 1(3): 223–232.

Published online 2004 December 1. doi: 10.1093/ecam/neh048.

PMCID: PMC538519

Copyright © 2004, the authors Evidenced-based Complementary and Alternative Medicine, Vol. 1, Issue 3 © Oxford University Press 2004; all rights reserved. The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated.

Michael Irwin,1* Jennifer Pike,1 and Michael Oxman2

1Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Neuropsychiatric Institute, Los Angeles, CA, USA

2Department of Medicine and Pathology, University of California, San Diego, and the San Diego Veterans Affairs Medical Center, San Diego, CA, USA, .

*For reprints and all correspondence: Michael Irwin, MD, Norman Cousins Professor, Cousins Center for Psychoneuroimmunology, UCLA Neuropsychiatric Institute, 300 Medical Plaza, Suite 3-109, Los Angeles, CA 90095-7057, USA. Tel: +1-310-825-8281. Fax: +1-310-794-9247. Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Received June 10, 2004; Accepted September 30, 2004.

Abstract

Both the incidence and severity of herpes zoster (HZ) or shingles increase markedly with increasing age in association with a decline in varicella zoster virus (VZV)-specific immunity. Considerable evidence shows that behavioral stressors, prevalent in older adults, correlate with impairments of cellular immunity. Moreover, the presence of depressive symptoms in older adults is associated with declines in VZV-responder cell frequency (VZV-RCF), an immunological marker of shingles risk. In this review, we discuss recent findings that administration of a relaxation response-based intervention, tai chi chih (TCC), results in improvements in health functioning and immunity to VZV in older adults as compared with a control group. TCC is a slow moving meditation consisting of 20 separate standardized movements which can be readily used in elderly and medically compromised individuals. TCC offers standardized training and practice schedules, lending an important advantage over prior relaxation response-based therapies. Focus on older adults at increased risk for HZ and assay of VZV-specific immunity have implications for understanding the impact of behavioral factors and a behavioral intervention on a clinically relevant end-point and on the response of the immune system to infectious pathogens.

Introduction

Behavioral factors are hypothesized to influence the immune system, with implications for infectious disease risk (1–3). Other studies have found that older adult populations show a substantial decline in immune function and are at increased risk for a number of infectious diseases (4,5). Taken together, the untoward effects of age and behavioral symptoms (e.g. depressed mood or insomnia) raise the question of whether behavioral interventions might augment immune responses in older adults who may be risk for a decline of viral-specific immunity. In this review, we focus on an infectious disease model related to reactivation of a latent herpes virus, varicella zoster virus (VZV); examine the risk factors associated with the increased incidence of herpes zoster (HZ) in older adults; discuss the psychosocial influences that may modulate VZV-specific immunity in older adults; and report on the use of a mind–body, behavioral intervention to ameliorate these risk factors.

Herpes Zoster

HZ or shingles is caused by reactivation of an endogenous VZV infection that has persisted in a latent form within sensory ganglia following an earlier attack of varicella (chickenpox) (6). Both the incidence and severity of HZ increase markedly with increasing age, and the majority of episodes occur in persons over the age of 60 years (7,8). At age 50, the annual incidence of HZ is 2.5–4.0 cases per 1000; this rate nearly doubles by the age of 60 years, HZ afflicts more than 500 000 persons per year in the USA (8).

HZ and VZV-specific Immunity

The factors associated with increased risk of HZ in the older adult and the mechanisms responsible for maintaining VZV in the latent state are not fully understood. Nevertheless, there is much circumstantial evidence that cell-mediated immunity plays a critical role in limiting the occurrence of HZ and its complications (6,9,10) (Fig. 1). Age-related decline in VZV-responder cell frequency (RCF; frequency of lymphocytes that proliferate in response to VZV antigen) is temporally related to an increase in the incidence and severity of HZ and its complications in older rats (7,8,11–14). Further, iatrogenic immunosuppression with diminished VZV-specific T-lymphocyte proliferation is associated with greater susceptibility to VZV reactivation and HZ (15–17). In contrast to the age related decline of cellular immunity, levels of antibodies to VZV do not appear to be significantly diminished in the elderly, nor is there any increased frequency of HZ in individuals who lack VZV antibodies (i.e. patients with congenital or acquired γ-globulin deficiencies) (6,18). Moreover, in elderly subjects, there is no decline in the number of memory CD45RO+ T cells, a finding that argues against the selective loss of this subset as the cause of decline in VZV-RCF with age (19). The proliferative response to VZV is confined to CD4+ CD45RO+ T cells in the assay of VZV-RCF; the number of antigen-presenting cells is not limiting (11).

Figure 1

Varicella zoster virus specific cellular immunity and age. The relationship between human age, level of lymphocyte proliferative response to varicella zoster virus antigen and phytohemagglutinin (PHA), and delayed-type hypersensitivity response to varicella(more ...)

Individual Variability in VZV-specific Immunity and the risk of HZ

It has been hypothesized that HZ does not occur at random in older adults, but rather selectively strikes individuals whose cell-mediated immunity to VZV is reduced (14) (Fig. 2). Older adult populations are very heterogeneous with respect to baseline VZV-specific in immunity as well as other aspects of cellular immunity (20). Moreover, we have found that the immunological response to varicella zoster vaccine is variable and not universal. The factors that account for this variability, selective response to immunization and altered risk for HZ in older adults are not well understood, but within-population differences in physical and psychological functioning have been implicated.

Figure 2

Pathogenesis of herpes zoster. Reprinted with permission from Oxman (111).

Depressive Symptoms, Health Behaviors and VZV-specific Immunity in the Older Adult

In view of recent evidence that the immune system is integrated with other homeostatic processes ultimately regulated by the brain (1,2) (Fig. 3), the influence of biobehavioral factors on the incidence of HZ and on VZV-specific immune responses deserves attention. Thus, we have examined the effects of major depression on VZV-specific immunity by comparing VZV-RCF levels in middle-aged depressed patients versus controls who were matched on the basis of age and gender (21). All subjects were in good physical health and none were receiving psychotropic medications or other treatments that are known to alter immune responses. VZV-RCF was significantly lower in the subjects with major depression than in matched normal controls, indicating that depression and possibly other behavioral factors such as disordered sleep (22) are associated with a marked decline in VZV-specific cellular immunity, as measured by the frequency of peripheral blood mononuclear cells capable of proliferating in response to VZV antigen.

Figure 3

Relationship between depression, life stress, sleep and the autonomic, neuroendocrine and immune systems. The evidence for the relationship between life stress and depression and varicella zoster-specific immunity and herpes zoster risk is the subject(more ...)

In the older adult, other factors such as the presence of chronic disease, increased risk of exposure to stressful life events and personal losses, diminished social supports and declines of self-concepts of efficacy and mastery might also impinge on immune defences and increase the risk of HZ and possibly other infectious diseases (3,23). However, there are few clinical data that have addressed the confluence of behavioral, immunological and health outcome variables in the same individuals at the same time, despite the promise of animal studies showing a link between behavioral stressors and viral infectious disease susceptability (24,25). In humans, psychosocial stress (e.g. caregiving for an ill relative or marital distress) is reported to correlate with reduced immunological control of latent herpes viruses [Epstein–Barr virus (EBV), herpes simplex virus (HSV) and cytomegalovirus (CMV)], as evidenced by elevated antibody titers and reduced memory T-cell responses (26–28). In addition, beyond the effects of chronic stress on latent herpes viral models, perceived life stress correlates with increased rates of respiratory infection after experimental inoculation with common cold viruses (29,30) and with decreased immunological responses following vaccination against hepatitis B (31). However, no studies have examined the relationship between behavioral factors and HZ other than the retrospective and prospective analyses of Schmader et al. (32–34). In the first study, 101 individuals with recent HZ reported a significantly higher number of stressful, and particularly ‘negative’ life events, in the 6 months before rash onset compared with 101 age-matched controls (34). The second study involving 2568 persons found that negatively perceived events were modestly associated with an increased risk of zoster over 8 years of follow-up (33). Another recent study reported that space flight was associated with increases of viral reactivation and shedding into saliva (35). In older adults, who are on average at increased risk for infectious disease due to age-related declines of immune function, the link between psychosocial factors, immunity and infectious disease outcomes is relatively unexplored apart from the observations of Kiecolt-Glaser et al. and Vedhara et al., who found that Alzheimer caregiver stress depresses cellular immune responses to influenza vaccination (36,37). If the decline of immunity to VZV and the increased risk of HZ in older adults were shown to be related psychosocial factors alone or in combination with the effects of age and chronic disease, this could provide invaluable insight into the biobehavioral mechanisms of immune changes in older adults and these insights could refine behavioral strategies for amelioration of these immune effects.

Biological and Behavioral Changes in the Older Adult: Implications for Declining Immune Responses

Older adults are at increased risk for infectious and inflammatory disorders (38), which is thought to be due at least in part to autonomic and behavioral abnormalities associated with aging (39) (Fig. 3). In addition, stress may compound these abnormalities in older adults (40,41). Aged organisms show an exaggerated autonomic and neuroendocrine responsivity to stress in which responses are delayed in shutting off, with attendant suppressive effects on natural and cellular immunity (42). Likewise, depressed and/or psychologically stressed persons show elevations of sympathoadrenal activity at rest and in response to acute challenge; such cardiovascular and sympathetic abnormalities correlate with many of the immunological changes found in these populations (43,44). Other studies on behavioral mechanisms suggest that sleep disturbance uniquely contributes to the multi-system physiological effects of aging, stress and affective disorders (22,45). Sleep disturbance, prominent in older adults, results in sympathoadrenal activation (46) and is associated with declines in immune function (47–49) (Fig. 3).

Successful Adaptation: Role of Psychological and Behavioral Interventions

Psychobiological models posit an inter-relationship between aging, stressor, cognitive appraisal of stress, affective integration and translation of the cognitive and affective processes into changes in immunity and HZ risk. However, feedback systems are also operative to VZV. Not only can one's appraisal of stressors elicit affective and physiological arousal but, conversely, physiology can influence one's thinking (23). Consequently, several strategies for intervention can be deduced from consideration of a reciprocal interaction between mind–brain–body. One approach involves modifying cognitive appraisal and ameliorating emotional distress (e.g. cognitive–behavioral therapy), whereas another focuses on reducing psychophysiological arousal through the use of relaxation response-based training. In a model that is reciprocal, the causal priority of the intervention is less of a concern than the view that effective stress management is related to its impact on the interaction of cognitions, affective responses, physiological activity and behavior (50).

As reviewed by Miller and Cohen (51), few studies have reported on the effects of behavioral interventions on cellular immunity. As an example, four studies have evaluated the immune effects of hypnosis and relaxation (5,52–54). In two of these studies, medical students were assigned randomly to a hypnotic/relaxation group prior to examination stress (52,53). Both studies found that the frequency of relaxation correlated with an amelioration of stress-induced changes in lymphocyte proliferation, natural killer (NK) cell activity and T-cell subset enumeration, although neither study found significant effects for the intervention due in part to variability in the practice of relaxation. In older adults, progressive muscle relaxation training was also found to produce significant increases in NK cell activity and decreases in HSV antibody titers (5). Other behavioral intervention studies have focused on development of supportive social relationships, education and cognitive re-appraisal of events. In patients with malignant melanoma, supportive group psychotherapy was associated with increases in NK cell activity that correlated with lower rates of recurrence in a 6 year follow-up (55). In homosexual men and women undergoing human immunodeficiency virus (HIV) antibody tesing, omnibus cognitive–behavioral interventions were reported to show increases of CD4 T lymphocytes and NK cells and decreases in EBV and human herpesvirus type 6 antibody titers (56). Finally, one study showed that simple emotional disclosure enhanced the immune response to hepatitis B vaccination (57).

Limitations of Prior Behavioral Intervention Strategies in Psychoneuroimmunology

Taken together, these data suggest that behavioral interventions impact immune system functioning. However, there are several limitations. Much more is known about the role of behavioral factors in the suppression of immunity than about what behavioral strategies may be important in boosting immune function, especially in those at-risk populations who are aged, undergoing stress or suffering from chronic disease. Secondly, in many of the studies, standardization of techniques and/or participant adherence (i.e. frequency of relaxation practice) was variable or incompletely assessed. Thirdly, immunological outcomes (e.g. non-specific lymphocyte proliferation) typically relied on measures that were non-specific and for which clinically relevant disease end-points had not been determined (58).

Tai Chi: Effects on Health Outcomes and HZ Immunity

Increasing interest has focused on the use of tai chi for promoting health in persons with chronic disease (59–61), and a recent review suggested the promise of tai chias a means of improving a number of health outcomes (59). However, the majority of studies did not use randomized control trial methodologies, and the efficacy of tai chi on physiology and health outcomes remains poorly characterized (59). Nevertheless, some trials suggest that tai chi can improve health functioning, have effects on both physical and emotional health (62), reduce the risk of falls (63–65) and possibly enhance cardiovascular functioning in sedentary and older adults (62,66–69). Randomized, controlled trials are needed to test the effects of this novel behavioral intervention on specific immunity and infectious disease risk in vulnerable older adult populations.

Tai chi offers special promise as a mind–body intervention that might enhance immune and health outcomes in older adults, because it incorporates elements of meditation and physical activity, both of which have been found to have salutary effects on immune responses (40). Our laboratory has proposed recently that tai chi chih (TCC), a westernized version of tai chi, might be particularly suitable for evaluation in randomized controlled trials (70), as TCC is a standardized series of 20 simple, repetitive non-strenuous movements. TCC, a form of ‘meditation through movement', involves a series of fluid, continuous forms of movement which are integrated by mind concentration, balance and shifting of body weight, muscle relaxation and breathing control. Because of its moderate intensity, steady rhythm and low physical and mental tension, TCC has been suggested as an appropriate intervention for elderly patients (64) who are not otherwise able to adhere to physical exercise. TCC incorporates physical activity, the maintenance of which predicts better physical performance, lower frequency of health conditions and lower risk of functional declines and mortality in older adults (71–73), possibly by on reducing autonomic and inflammatory responses to challenge (74–77). In this review, we discuss our recent findings that this ‘meditation through movement’ has immunological effects. In a controlled trial, we assessed the effects of TCC on clinically relevant immunity to VZV in older adults who were randomized to either TCC or a waiting list control group (70).

The study sample included 36 adults older than 60 years of age, all of whom were in good health; 18 persons were randomly allocated to the TCC group and 18 persons were allocated to the waiting list control group. Randomization procedures were successful in delineating two groups of subjects who were similar in age, gender, ethnicity, marital status, current employment status and educational level. Inclusion criteria were as follows: 60 years of age or older at time of entry, geographically accessible, history of varicella (chickenpox) and long-term (>30 years) residence in the continental USA. The latter two inclusion criteria are indicative of the prior occurrence of varicella and the potential for a specific immunological memory response to VZV as measured by VZV-RCF (78,79). Exclusion criteria were as follows: immunosuppression resulting from neoplastic disease, corticosteroids or other therapy; significant underlying illness that would be expected to prevent completion of the study; any other condition (e.g. extensive psoriasis, chronic pain syndrome, cognitive impairment or severe hearing loss) that in the opinion of the investigator might interfere with the required evaluations; not ambulatory; prior HZ; receipt of immunizations (e.g. hepatitis B vaccine or influenza vaccine) within 1 month of study entry; current depression, suicidal risk, use of mood-altering medications or a combination of these depressive factors; any acute intercurrent illness that might interfere with interpretation of the study (such as an acute viral illness within the last 2 weeks); and unable to commit to the intervention schedule. Women were post-menopausal.

Subjects in the TCC group learned to perform 20 standardized movements during a 15 week intervention period under the guidance of an expert TCC teacher who had 20 years of experience in teaching this mind–body intervention. TCC is performed as slow, relaxed, continuous movements incorporating elements of balance, postural alignment and concentration. It also requires a considerable amount of work by the leg muscles and thus is thought to have an aerobic component of moderate intensity (67). Thus, each TCC session was restricted to 45min with a 10min warm-up, a 30min TCC practice and a 5min cool-down period. Sessions were given three times per week (45 sessions over 15 weeks). The level of participation in the TCC was high, with median compliance at 39 of 45 possible sessions with a range of 29–42 sessions attended. Participants assigned to the waiting list control group were instructed to maintain their routine activities and not to begin any new meditation, mind–body (e.g. yoga) or exercise programs; adherence was confirmed by self-report. The control participants were promised a TCC program and given a voucher for instruction at the end of the study.

The results of this randomized controlled trial showed that shingles immunity, as measured by VZV-RCF, increased from baseline to 1 week post-intervention in the TCC intervention group whereas the wait list control group did not change significantly (Fig. 4). This effect of TCC was tested statistically using a conservative intent-to-treat approach. To provide a further indication of the effects of the intervention on VZV-RCF, percentage change from baseline to post-intervention was examined in individual subjects. Within the TCC intervention group, VZV-RCF increased in nine subjects, was unchanged in seven (including four who were analyzed as intent-to-treat cases) and decreased in one subject; whereas in the control group, three subjects increased, eight were unchanged (one intent-to-treat case) and five decreased (likelihood ratio = 6.1, P < 0.05). Importantly, the TCC group showed a robust increase of VZV-RCF, and on average had a nearly 50% increase of VZV-RCF from baseline to 1 week post-intervention using this intra-subject approach. In response to vaccination with live attenuated Oka/Merck varicella vaccine, Levin et al. have demonstrated an ~75% increase above baseline in >200 seropositive elderly adults (mean age 67 years) (80,81), an increase that is similar to that induced by an episode of HZ (82). Response to vaccination is sustained for months to years (82), but further research is needed to evaluate the durability of the effects of TCC on VZV-RCF levels. Increases of VZV-RCF are driven primarily by the response of CD4+ CD45RO+ T cells or memory T cells (83), and we speculate that TCC might have comparable effects on these cell types across the full spectrum of antigenic challenge, with potential implications for multiple infectious diseases for which no vaccine is yet available (e.g. HIV infection; respiratory infection). Moreover, the increase of VZV-RCF in this sample is even more striking because the older adults were in good health, not depressed and had higher baseline levels of VZV-RCF than had been reported previously in this at-risk population (84). Future studies could extend these findings and examine the effects of TCC on other memory T-cell responses (e.g. to influenza virus) and/or test whether this mind–body treatment alters response to a primary immunological response. Smith et al. have found that psychological stress impairs development of a delayed-type hypersensitivity response to a novel protein antigen, keyhole limpet hemocyanin, in humans (85), whereas older adults who are more physically active show higher antibody and delayed-type hypersensitivity responses to this antigen as compared with sedentary older adults (86). These data showing an increase of VZV immunity following TCC contrast with those of Locke et al. who found that hypnosis had no effect on varicella antigen-induced delayed-type hypersensitivity responses in humans (87).

Figure 4

VZV-specific CMI (VZV-RCF) at baseline and at 1 week post-intervention in the intent-to-treat sample. VZV-RCF increased from baseline to 1 week post-intervention in the TCC group [F(1,31) = 4.4, P < 0.05] but not in the control group. Data are(more ...)

It is thought that an increase in VZV-RCF may be associated with better control of latent VZV virus, an assumption that has led to the development of a varicella vaccine that induces increases of VZV-RCF in older rats (82). In an ongoing Veterans Affairs Cooperative Trial (n = 38 546), this investigational varicella zoster vaccine is currently being tested to determine its efficacy in the prevention of onset and severity of HZ and postherapetic neuralgia. The present TCC study does not have an adequate sample size to address whether TCC can alter the incidence of shingles, given its annual incidence at <8 cases per 1000 persons. Alternatively, it is possible that the increase of VZV-RCF associated with TCC might be secondary to viral reactivation. Mehta et al. recently reported that non-surgical stress induces subclinical reactivation of VZV as evidence by the detection of VZV DNA by polymerase chain reaction in saliva samples, although no change in the levels of anti-VZV IgG was found before and after the stress. Others indicate that viral reactivation and shedding of VZV occur HZ clinical outbreak (88) and/or zoster sine herpete (pain without rash) (89,90), in contrast to mucosal shedding of other herpes viruses that continues for decades after primary infection (91). Importantly, none of our subjects evidenced HZ or reported symptoms of pain or distress during the course of the trial. Nevertheless, even if the intervention acts to induce subclinical reactivation, increases of VZV-RCF, induced by contained reversions may help to maintain immunity to VZV in older adults and prevent future occurrences of HZ in older adults, as suggested by Hope-Simpson (see Fig. 2) (14).

This study also found that TCC was associated with improvements in physical functioning and physical role limitations, especially in those older adults who had impairments in physical status at entry. In the sample who completed the intervention, the TCC group had significantly higher scores on the Medical Outcomes Scale, SF-36 role-physical scores (Fig. 5) and physical functioning scores at 1 week post-intervention as compared with controls. Moreover, in those older adults whose baseline scores were at or below the population norm for men and women aged 60 years and older (92), these observations were particularly striking. After completion of the intervention, TCC participants showed increases of health functioning scores to levels that were at or above the population norms. Moreover, those participants who had low health functioning at baseline showed more marked improvements over time with significantly greater increases of SF-36 role-physical and physical functioning as compared with changes in the TCC group who had minimal impairments of physical status at baseline. The magnitude of change from baseline to post-intervention was large for these measures of health functioning and was comparable with that reported for certain medical procedures. For example, in the instance of SF-36 role-physical scores, the average change in the low TCC group was comparable with or exceeded that reported for hip replacement surgery (93) or for heart valve replacement in older adults (94), although it is not known whether the effects of TCC persist in the long term.

Figure 5

SF-36 scale score role-physical at baseline, during the itnervention at weeks 5, 10 and 15, and 1 week post-intervention in the completer sample, TCC (n = 14) and control group (n = 17). SF-36 role-physical scores were higher in the TCC group compared(more ...)

Several pathways may mediate the effects of TCC on immunity and health functioning. Although none has yet been established, we have hypothesized that two components, relaxation and exercise, may mediate the observed changes in immunity and health outcome (Fig. 6). In a meta-analyses on the effects of relaxation training, Hyman et al. (95) found that various relaxation response-based interventions led to a reduction of clinical somatic symptoms with additional effects on symptoms of anxiety and depression (96), blood pressure (97) and recovery from immune-mediated diseases such as psoriasis (98). Decreases of autonomic arousal that follow relaxation-based interventions, and possibly TCC, may modulate immunity. Substantial evidence suggests that sympathetic activation has inhibitory effects on cellular immune responses in the elderly (99–102), whereas decreases of sympathetic outflow, adrenergic receptor antagonism, or both abrogate stress-induced immune suppression (99,101,103,104). In contrast, TCC might increase parasympathetic, vagally mediated tone which has been found to inhibit proinflammatory cytokine mechanisms (105,106). Importantly, the effects of TCC were not mediated by social functioning, mental health functioning or changes in physical health status, as the intervention did not alter SF-36 measures of social functioning or role-emotional, and SF-36 scores of physical functioning were not correlated with changes in VZV-RCF.

Figure 6

Hypothesized mediators of the effects of tai chi chih on varicella zoster virus memory T-cell responses. The evidence for the pathway components of exercise and relaxation or meditation with changes of sympathovagal balance are considered.

The benefits of exercise and exercise training on immunity in the elderly have been reported previously (107,108) and, as noted above, physically active older adults have more robust primary humoral and delayed-type hypersensitivity responses to a novel antigenic challenge (86). In addition, moderate exercise training for 8 weeks has been found to promote increases of herpes viral-specific immunity in mice (109) and this effect is mediated by adrenergic receptor mechanisms (110). Indeed, TCC is a multifaceted intervention that includes not only relaxation, but also components of aerobic exercise (61,66). During the acute practice of TCC, for example, increases of heart rate, oxygen consumption and lactate accumulation are reported, indicating that TCC serves as an aerobic exercise of moderate intensity (66). Further data show that TCC training over 12 months enhances cardiorespiratory function as measured by increases of VO2 MAX and decreases of blood pressure (68).

TCC Boosts Immunity to VZV and Health Status in Older Adults: Need for Further Trials

Our research shows that an alternative medicine, mind–body intervention, namely TCC, results in improvements in measures of immunity to VZV in an older adult population at risk for HZ. TCC is a standardized and manualized series of exercises that can be readily administered in a group setting to older adults with cost-effectiveness, supporting the exportability of this intervention for community-dwelling older adults. In addition, this study indicates that TCC has value for improving functional limitations in physical domains. Other forms of tai chi are purported to have physiological and psychological benefits and to promote balance control and cardiovascular fitness in older adults. Further high quality, randomized controlled trials are needed to further delineate the effects of these mind–body practices on health risk factors and on chronic medical outcomes, especially in vulnerable older adult populations.

Conflict of InterestMichael Oxman is currently the National Study Chairman of VA Cooperative Study #403: The Shingles Prevention Study which is supported in part by a grant from Merck and Co., Inc, the producer of the investigational shingles vaccine to the VA congerative studies program.

Acknowledgments

This work was supported in part by grants AA13239, DA16541, MH55253, AT 00255, AG18367, T32-MH19925, AR/AG41867, 1 R01 AR 49840-01, M01-RR00865, General Clinical Research Centers Program and the Cousins Center for Psychoneuroimmunology.

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13. Tai Chi and Cardiovascular Health

Source: wustyle.com — Tai Chi and Cardiovascular Health · Topics: Cardiology · cardiovascular disease · Circulatory System

There is evidence, though sometimes controversial, that exercise improves many aspects of cardiovascular health including reduced incidence of coronary heart disease, stroke, and hypertension. [1], [2], [3] The majority of this research has focused on the impact of vigorous or moderate exercise. Less is known about the cardiovascular benefits of lower intensity exercise, such as Tai Chi.

A growing body of evidence suggests Tai Chi practice, even over short periods of time, may improve cardiovascular health. Depending on how it is practiced, Tai Chi has been characterized as a low to moderate intensity exercise. Three studies are briefly discussed to illustrate the types of evidence available to evaluate the impact that Tai Chi may have on components of cardiovascular health. Young et al. [4]conducted a well designed, randomized controlled trial with 62 subjects that compared the effects of aerobic exercise versus Tai Chi on blood pressure in mildly hypertensive older adults. Over the 12-week study period, Tai Chi was observed to be equally effective as aerobic exercise in reducing both systolic and diastolic blood pressure. Lai et al. [5] conducted a longitudinal, prospective study comparing two-year trends in cardiorespiratory function of a group of elderly Tai Chi practitioners (n=45) with an age-matched, sedentary control group (n=39). Their results suggest that Tai Chi may delay the decrease in aerobic capacity usually found with aging. Lan et. al. [6] conducted a cross-sectional, case-controlled study to evaluate the health benefits of long-term, geriatric Tai Chi practitioners. Cycle ergometry revealed that peak oxygen uptake was greater for Tai Chi practitioners (n=41) compared to age-matched sedentary subjects (n=35). No adverse effects related to the short- or long-term practice of Tai Chi were reported in any of these studies. These and other studies are summarized in reviews by Li et al. [7] and Lan et al.[8].

In summary, these and related studies suggest that Tai Chi is a safe exercise, even for frail elders, and may be beneficial to various aspects of cardiovascular health. It requires no specialized equipment, is relatively inexpensive and can be taught/learned in a group setting. Tai Chi appears to elicit a cardiovascular response equivalent to that associated with moderate intensity exercise, and as such meets the American College of Sports Medicine, American Heart Association, and Centers for Disease Control recommendations for daily performance of low- to moderate-intensity activities [9]. However, studies have yet to investigate whether the physiological mechanisms by which Tai Chi impacts cardiovascular health are the same as those believed to relate to more typical endurance and aerobic training[10].

14. Tai Chi and fall reductions in older adults: a randomized controlled trial.

Source: wustyle.com — Tai Chi and fall reductions in older adults: a randomized controlled trial. · Topics: balance · falling · Gerontology · Muscular System · physical performance

Li F, Harmer P, Fisher KJ, McAuley E, Chaumeton N, Eckstrom E, Wilson NL.

Oregon Research Institute, 1715 Franklin Boulevard, Eugene, OR 97403, USA.This email address is being protected from spambots. You need JavaScript enabled to view it.

BACKGROUND: The authors' objective was to evaluate the efficacy of a 6-month Tai Chi intervention for decreasing the number of falls and the risk for falling in older persons. METHODS: This randomized controlled trial involved a sample of 256 physically inactive, community-dwelling adults aged 70 to 92 (mean age, 77.48 years; standard deviation, 4.95 years) who were recruited through a patient database in Portland, Oregon. Participants were randomized to participate in a three-times-per-week Tai Chi group or to a stretching control group for 6 months. The primary outcome measure was the number of falls; the secondary outcome measures included functional balance (Berg Balance Scale, Dynamic Gait Index, Functional Reach, and single-leg standing), physical performance (50-foot speed walk, Up&Go), and fear of falling, assessed at baseline, 3 months, 6 months (intervention termination), and at a 6-month postintervention follow-up. RESULTS: At the end of the 6-month intervention, significantly fewer falls (n=38 vs 73; p=.007), lower proportions of fallers (28% vs 46%; p=.01), and fewer injurious falls (7% vs 18%; p=.03) were observed in the Tai Chi group compared with the stretching control group. After adjusting for baseline covariates, the risk for multiple falls in the Tai Chi group was 55% lower than that of the stretching control group (risk ratio,.45; 95% confidence interval, 0.30 to 0.70). Compared with the stretching control participants, the Tai Chi participants showed significant improvements (p<.001) in all measures of functional balance, physical performance, and reduced fear of falling. Intervention gains in these measures were maintained at a 6-month postintervention follow-up in the Tai Chi group. CONCLUSIONS: A three-times-per-week, 6-month Tai Chi program is effective in decreasing the number of falls, the risk for falling, and the fear of falling, and it improves functional balance and physical performance in physically inactive persons aged 70 years or older.

PMID: 15814861 [PubMed - indexed for MEDLINE]

15. Tai Chi and medical research - peer reviewed published papers

Source: wustyle.com — Tai Chi and medical research - peer reviewed published papers

Jimenez-Martin PJ, Melendez-Ortega A, Albers A and Schofield D. A Review of Tai Chi Chuan and parameters related to balance. European Journal of Integrative Medicine 2013; 5(6):469-475.

Background: Previous systematic reviews of the literature on tai chi and balance have focussed on one of two topics, either examining the quality of the research design, which has had great variance, or offering a general description of the studies included in the review. The current review is an analysis of the factors that affect balance.

Methodology: The authors searched seven data bases for publications relating to tai chi and balance between 1996 and 2012. The inclusion criteria were randomised trials written in English.

Results: A total of 397 articles were identified. Once the inclusion filter was added a total of 27 random controlled studies were eligible of analysis.

Conclusion: Analysis of the eligible papers confirmed that tai chi chuan practice improves both static and dynamic balance and has a positive effect on those factors that influence balance. No studies were found examining whether there was an improvement in balance in those individuals suffering from deterioration of brain function. One study examined the effects of tai chi chuan on people with vestibular problems.

Comment: The paper by Jimenez-Martin et al is one of the on-going looking at the effects of tai chi chuan on balance. Falls remain a significant healthcare problem around the world. Being able to elucidate the types of therapies that can help relieve this will have a dramatic effect not only on the individuals who are suffering from problems with balance, but, with the addition of tai chi chuan, also with the cost of treatment and care. This work should be better known throughout the healthcare community.

Cheon S-M, Chae B-K, Sung H-R, et al. The Efficacy of Exercise Programs for Parkinson’s Disease: Tai Chi versus Combined Exercise. Journal of Clinical Neurology. 2013; 9:237-243.

Background: Exercise if recommended for every patient suffering from Parkinson’s Disease. The effectiveness of different exercise regimes has not been clearly elucidated. The paper compares the effectiveness of tai chi chuan compared to combined stretching-strengthening exercise.

Methodology: Patients with mild to moderate Parkinson’s Disease were recruited to join either a combined stretching-strengthening group, the tai chi group or the non-interventional control group. The two activity groups met three times each week for 8 weeks. The tai chi group was led by a certified instructor based on the Tai-Chi-for-arthritis program. The combined exercise group did a mix of folk dancing, stepping and elastic band exercises. The functional fitness, Parkinson symptoms, Quality of Life and depression were evaluated.

Results: Both exercise groups showed better overall functional fitness following the 8 week intervention. However, the Parkinson group did not reveal any improvement in symptoms. Reviewing the Quality of Life aspects, the stretching-strengthening group did batter with regard to the domain while the tai chi group fared better in the emotional domain. The control group showed continued decline for Quality of Life and depression. Post-intervention assessment revealed that the Tai Chi group improved compared to the control group.

Conclusion: Exercise shows improved functional fitness and Quality of Life in Parkinson’s Disease patients, with Tai Ch giving better results in the Quality of Life and functional fitness overall.

Comment: It is obvious from this study that exercise, in general, is beneficial for Parkinson’s patients. In particular, it was noted that the improvements between the two exercise groups differed, indicating that for these patients it may be most useful to combine both tai chi with some other form of exercise if there is to be a full range of improvements.

Ng L, Chiang LK, Tang R, et al. Effectiveness of incorporating Tai Chi in a pulmonary rehabilitation program for Chronic Obstructive Pulmonary Disease (COPD) in primary care- A pilot randomized controlled trial. European Journal of Integrative Medicine. 2014; 6:248-258.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a major public health concern throughout the industrialized world. Studies have shown that pulmonary rehabilitation and tai chi chuan are beneficial for those patients suffering from this disease. This study was aimed at determining whether the self-efficacy and quality of life of CIPD patients who were active in a pulmonary rehabilitation program either with or without tai chi would improve.

Methodology: 192 COPD patients were recruited from primary care clinics. They were randomly assigned to wither the tai chi group or the pulmonary rehabilitation group. Both groups received 2 sessions/week for 6 weeks. Data collection was performed at baseline, 2 and 6 months post intervention.

Results: An intention to treat analysis was preformed revealing the groups were matched. Improvements were seen in exercise capacity, health status and self-efficacy within both groups at

6 months post-intervention. Though more favourable improvements were noted with the tai chi group, only the functional exercise capacity revealed a statistical improvement.

Conclusion: The effect of incorporating Tai Chi into pulmonary rehabilitation programs showed a modest benefit.

Comment: In the case of this research we see a modest improvement in exercise capacity of the tai chi participants. Given the very short time frame that this research project used it is quite conceivable that a longer study would reveal greater effects of tai chi chuan.

Nery RM, Zanini M, Ferrari JN et al. Tai Chi Chuan for Cardiac Rehabilitation in Patients with Coronary Arterial Disease. Arquivos Brasileiros de Cardiologia. 2014; 102(6).

Background: Studies have shown that the practice of tai chi chuan can improve cardiac function in patients with heart disease. This paper is a systematic review of the literature assessing the effectiveness of tai chi chuan on patients suffering from coronary artery disease.

Methodology: The following databases were searched for papers in English, Portuguese and Spanish looking at the effects of tai chi chuan on patients with coronary artery disease; MEDLINE, ENBASE, LILACS and the Cochrane Register of Controlled Trials. Three independent investigators extracted and assessed the data for methodology and quality.

Results: The initial search found 201 papers dealing with tai chi and coronary artery disease. Following the critical review and analysis, 12 studies were considered for inclusion. After a full analysis, an additional 9 were excluded leaving three papers meeting the full criteria for inclusion. These studies included patients who had a confirmed diagnosis of coronary artery disease and were considered stable and able to exercise. Each study had a control group that either practiced a structured exercise or were given counselling for exercise. Follow-up ranged from 2 to 12 months.

Conclusion: The preliminary evidence based on the three studies used in this review suggests that tai chi chuan can be utilized as a form of cardiac rehabilitation for patients with stable coronary artery disease. The methodological problems and small sample sizes in each study indicate that further research into this area is needed.

Comment: Non-pharmacological approaches to many of the diseases we see are becoming an important consideration for care, especially self-care. This paper, while expressing reservations due to methodology and small sample size gives us an entrance into further, future research that most practitioner s can easily incorporate into their practices.

Dr. Mark J. Langweiler is a long time practitioner of Wu style Tai Chi Chuan and is a disciple of Sifu Wu Kwong Yu. He is currently a Senior Lecturer in Anatomy at the University of South Wales and chief instructor at the South Wales Wu Style Tai Chi Chuan Teaching Centre. He can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it..

16. Tai Chi Chuan: Mind-Body Practice or Exercise Intervention? Studying the Benefit for Cancer Survivors

Source: wustyle.com — Tai Chi Chuan: Mind-Body Practice or Exercise Intervention? Studying the Benefit for Cancer Survivors · Topics: cancer · Oncology

Tai chi chuan (TCC) has been used as a mind-body practice in Asian culture for centuries to improve wellness and reduce stress and has recently received attention by researchers as an exercise intervention. A review of the English literature on research in TCC published from 1989 to 2006 identified 20 prospective, randomized, controlled clinical trials in a number of populations, including elderly participants (7 studies), patients with cardiovascular complications (3 studies), patients with chronic disease (6 studies), and patients who might gain psychological benefitfrom TCC practice (2 studies). However, only the studies of TCC in the elderly and 2 studies of TCC for cardiovascular disease had adequate designs and size to allow conclusions about the efficacy of TCC. Most (11 studies) were small and provided limited information on the benefit of TCC in the settings tested. There is growing awareness that cancer survivors represent a population with multiple needs related to physical deconditioning, cardiovascular disease risk, and psychological stress. TCC as an intervention may provide benefit to cancer survivors in these multiple areas of need based on its characteristics of combining aspects ofmeditation and aerobic exercise. However, little research has been conducted to date to determine the benefit of TCC in this population. We propose a model to study the unique characteristics of TCC compared to physical exercise that may highlight characteristic features of this mind-body intervention in cancer survivors.

17. Tai Chi for posture and back pain

Source: wustyle.com — Tai Chi for posture and back pain · Topics: back pain · Nervous System · Orthopedics · posture · Skeletal System

Tai Chi is a form of exercise that has recently been gaining popularity as a way to relieve and/or manage back pain and neck pain. It is often easy to associate Tai Chi with groups of people in parks or gyms moving slowly and deliberately in synchronization. These people are using the same Tai Chi principles and movements created in ancient China and still practiced all around the world as a healing exercise.

18. Tai Chi 'helps improve diabetes'

Source: wustyle.com — Tai Chi 'helps improve diabetes' · Topics: Circulatory System · diabetes · Digestive System · Endocrine System · Endocrinology

Tai Chi exercises can help people with type 2 diabetes control their condition, research suggests.

Two separate studies found a 12-week programme of exercise was enough to boost the immune system, and to cut blood sugar levels.

The traditional Chinese martial art combines deep breathing and gentle movement to boost relaxation levels.

Both studies, by researchers in Taiwan and Australia, appear in the British Journal of Sports Medicine.

Around 1.8 million people in the UK have type 2 diabetes and another 750,000 are thought to be undiagnosed.

The first study, by a team in Taiwan, compared 30 people with diabetes with 30 healthy people acting as controls.

Over 12 weeks the participants learned 37 Tai Chi movements under the guidance of an expert, and took home a video to study the correct poses.

They took part in three hour-long sessions a week.

At the end of the programme, tests on the group with type 2 diabetes showed a drop in their blood sugar levels, and a boost in the level of cells and chemicals key to a healthy immune response.

Strenuous physical activity is known to depress the immune system, but the latest study suggests that more moderate exercise may have the opposite effect.

Other effects

Previous research has suggested Tai Chi boosts cardiovascular and respiratory function, as well as improving flexibility and relieving stress.

The researchers said that if Tai Chi improves the way the body breaks down sugar, it could have a beneficial impact on the immune system, which is sparked into excessive activity by the presence of high levels of sugar in the blood.

Alternatively, the exercise may simply boost the immune system by raising fitness levels, and engendering a feeling of wellbeing.

The second study by the University of Queensland, based on just 11 participants, produced similar results.

In this study the participants - who all had raised blood sugar levels - attended sessions of Tai Chi, and another similar martial art, Qigong, for 60 to 90 minutes three times a week.

As well as a drop in blood sugar levels, the participants lost weight, and recorded significant falls in blood pressure. Insulin resistance was also improved.

Participants also said they slept better, had more energy, felt less pain and had fewer food cravings while on the programme.

Cathy Moulton, of the charity Diabetes UK, said moderate exercise had been shown to have a beneficial impact on type 2 diabetes.

Diabetes UK recommends that people with diabetes do a minimum of 30 minutes of moderate physical activity on at least five days of the week.

Ms Moulton said: "Any activity that leaves you feeling warm and slightly breathless but still able to hold a conversation counts as moderate exercise - including vigorously cleaning the house, briskly walking the dog and of course Tai Chi.

"In addition to the importance of moderate physical activity, the relaxation element of Tai Chi may help to reduce stress levels, preventing the release of adrenalin which can lead to insulin resistance and high blood glucose levels."

19. Tai Chi 'improves body and mind'

Source: wustyle.com — Tai Chi 'improves body and mind' · Topics: Cardiology · cardiovascular disease · Circulatory System · fall prevention · Gerontology

The ancient Chinese martial art of Tai Chi can help to improve people's health, research suggests.

Doctors in the United States analysed 47 studies looking at the impact Tai Chi had on people with chronic health problems, like heart disease or MS.

They found that it could improve balance control, flexibility and even the health of their heart.

Writing in The Archives of Internal Medicine, they said it also reduced stress, falls, pain and anxiety.

Deep breathing

Tai Chi originated in China where it has been used for hundreds of years.

It combines deep breathing with relaxation and postures that flow from one to another through slow movements.

Practitioners say it can have a positive effect on people's health, improving memory, concentration, digestion, balance and flexibility.They say it is also helpful for people with psychological problems, such as depression, anxiety or stress.This latest study by doctors at Tufts-New England Medical Center in Boston suggests there is medical evidence to back up those claims.Their findings are based on a review of studies published in English and Chinese."Overall, these studies reported that long-term Tai Chi practice had favourable effects on the promotion of balance control, flexibility and cardiovascular fitness and reduced the risk of falls in elders," the researchers said.They said the martial art helped to reduce "pain, stress and anxiety in healthy subjects".But it also had benefits for people with serious conditions, such as heart disease and high blood pressure."Benefits were reported by the authors of these studies in cardiovascular and respiratory function in healthy subjects and in patients who had undergone coronary artery bypass surgery as well as in patients with heart failure, hypertension, acute myocardial infarction, arthritis and multiple sclerosis."'Well documented'Bob Weatherall, secretary of the British Council of Chinese Martial Arts, welcomed the findings."The health aspects of Tai Chi are well documented," he told BBC News Online."It is used extensively in hospitals in China to improve the health of patients. Hospitals in England have started using it too."Tai Chi is all about breathing and posture. It's about getting the mind and body to work together. Some people call it moving meditation."Most people practice it for its health benefits and for stress relief."

20. Tai Chi may aid in arthritis treatment

Source: wustyle.com — Tai Chi may aid in arthritis treatment · Topics: arthritis · Skeletal System

By Pat Carney

CNN Headline News

(CNN) -- When it comes to working out, no exercise regimen is "one size fits all," but one particular martial art form comes pretty close.

According to a review article in the Archives of Internal Medicine, the ancient martial art of Tai Chi not only improves strength, balance and flexibility in older people, but it also has positive effects on chronic health conditions like multiple sclerosis and joint problems.

In fact, the Arthritis Foundation has looked to Tai Chi as treatment for arthritis.

The Arthritis Foundation's program is based on Dr. Paul Lam's "Tai Chi for Arthritis" program.

Lam, who is now 53, developed osteoarthritis in his 20s and used Tai Chi as a way to control the disease.

While there are no published studies proving whether Tai Chi can reduce pain and inflammation associated with arthritis, participants report benefits ranging from pain relief to lower blood pressure.

Wang urges patients with chronic health problems take precautions before beginning a Tai Chi practice, because for some people Tai Chi could worsen joint problems and other symptoms of arthritis.

So as the saying goes, be sure to check with your doctor before starting any exercise program.

21. Tai chi: physiological characteristics and beneficial effects on health

Source: wustyle.com — Tai chi: physiological characteristics and beneficial effects on health · Topics: cardiovascular disease · Circulatory System · Gerontology · Muscular System · Skeletal System

Tai chi: physiological characteristics and beneficial effects on health

J X Li1, Y Hong1, K M Chan2

1 Department of Sports Science and Physical Education, The Chinese University of Hong Kong

2 Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong

Correspondence to:

Correspondence to: Dr Li, Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, NT, Hong Kong This email address is being protected from spambots. You need JavaScript enabled to view it.

Objectives—To assess the characteristic effects of Tai Chi Chuan (TCC) exercise on metabolism and cardiorespiratory response, and to measure its effect on cardiorespiratory function, mental control, immune capacity, and the prevention of falls in elderly people.

Design—A review of controlled experimental studies and clinical trials designed with one of two aims: either to assess physiological responses during the performance of TCC or to assess the impact of this exercise on general health and fitness.

Main outcome measures—Metabolic rate, heart rate, blood pressure, ventilation, maximal oxygen uptake (O2MAX), immune capacity, falls, and fall related factors.

Subjects—A total of 2216 men and women.

Results—Under review were 31 original studies, published in Chinese or English journals, that met the criteria for inclusion. Most of the papers written in Chinese had not been introduced into the Western literature. Nine of these studies showed that TCC can be classified as moderate exercise, as its does not demand more than 55% of maximal oxygen intake. When this form of exercise and others conducted at equal intensity were compared, TCC showed a significantly lower ventilatory equivalent (E/O2MAX). Evidence provided by cross sectional and longitudinal studies suggests that TCC exercise has beneficial effects on cardiorespiratory and musculoskeletal function, posture control capacity, and the reduction of falls experienced by the elderly.

Conclusions—TCC is a moderate intensity exercise that is beneficial to cardiorespiratory function, immune capacity, mental control, flexibility, and balance control; it improves muscle strength and reduces the risk of falls in the elderly.

22. The Effect of Tai Chi on Chronic Obstructive Disease

Source: wustyle.com — The Effect of Tai Chi on Chronic Obstructive Disease

Ruichao Niu, Ruoxi He, Bai-ling Luo, Chengping Hu

Heart, Lung and Circulation (2014) 23, 347-352

The current study, unlike many of its predecessors, evaluated the effects of tai chi quan on chronic obstructive pulmonary disease (COPD) looking specifically at three components, lung function, exercise capacity and diaphragm strength. The study was designed as a single blinded randomised trial. Forty-six CPOD sufferers were randomly placed in two groups, a control group that was offered a non-specific form of low-impact exercise (walking and associated medical care) and the tai chi group. The trial lasted six months. The tai chi cohort participated in four supervised sessions each week and was provided with a booklet and DVD for home use. At the end of the trial outcome measurements were assessed by two physicians who had no knowledge of the study design or the group (control or test) in which the participants were enrolled.

Outcomes of lung function, exercise capacity and diaphragm were all improved in both groups; however, the tai chi group saw a greater improvement in each category. Previous studies investigating tai chi quan use in patients with COPD have shown similar results but used flawed research designs making the observations inconsistent. This study provides preliminary data to support the use of tai chi in respiratory rehabilitation for patients with COPD. The authors stressed that this is a pilot and a larger trial is needed for detailed results and to clarify the significance of tai chi quan as a means of pulmonary rehabilitation.

23. The role of Tai Chi Chuan in reducing state anxiety and enhancing mood of children with special needs

Source: wustyle.com — The role of Tai Chi Chuan in reducing state anxiety and enhancing mood of children with special needs · Topics: mental health · Pediatrics · special needs · stress management

Lois J. Baron, , a and Christine Faubertb

a Department of Education, Concordia University, 1455 de Maisonneuve West, Montreal, Quebec, Canada H3G 1M8

b School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada

Received 4 March 2004; Revised 22 March 2004; accepted 25 March 2004. Available online 24 June 2004.

Abstract

This paper reports the findings of a single-case research design which examined the effects of 1-h, twice-weekly Tai Chi Chuan sessions on state anxiety and mood of children with severe learning disabilities. The participants were three upper elementary children (mean AGE=13.3 years). The intervention lasted 10 weeks. The State-Trait Anxiety Inventory for Children (STAIC) A-State Scale, a 28-item mood inventory, and Conners’ Teacher Rating Scales-39 (CTRS-39), a scale used to assess whether a child has attention deficits and/or hyperactivity, were given at intervals during the pre-treatment baseline (A1), treatment (B), and post-treatment baseline (A2). Individual scores were the unit of analysis in this exploratory piece of work. Mean state anxiety and mood scores and the split-middle technique were used to analyze the data. Results suggest that the intervention had the strongest effect on the participant who presented with hyperactivity and heightened anxiety. The findings support the benefits of using a single-case research design with this population.

24. The Role of Tai Chi Exercise in Promoting Health Benefits for Older Persons

Source: wustyle.com — The Role of Tai Chi Exercise in Promoting Health Benefits for Older Persons · Topics: Circulatory System · fall prevention · Gerontology · Gerontology · Muscular System

Fuzhong Li, Ph.D., Oregon Research Institute

Tai Chi, or Taijiquan to be exact, originated in China about 300 hundreds years ago (China Sports, 1980) and began as a form of martial arts like boxing. It has continued to evolve from being originally used as a combative and self-defense form to a health-enhancing exercise, practiced by individuals of all ages to maintain health and prevent disease. As an alternative exercise, Tai Chi has drawn increasing research interest, with accumulating evidence showing the therapeutic value of Tai Chi to overall health and well-being. The goal of this paper is to summarize current research findings with a particular focus on geriatric populations, discuss findings with respect to their practical implications, and highlight future research directions.

Overview of Research Findings

A number of excellent review articles exist showing evidence that Tai Chi generates various health benefits for individuals of varying age groups and patient populations (Fasko & Grueninger, 2001; Lan, Lai, & Chen, 2002; Li, Hong, & Chan, 2001; Verhagen, Immink, va der Meulen et al., 2004; Wang, Collet, & Lau, 2004; Wayne, Krebs, Wolf, et al., 2004; Wu, 2002).

Without overdue redundancy, the following provides a summary review of research studies that involve randomized controlled trials (RCTs) although results from non-RCTs are reported in the absence of RCTs. With aging processes, declines in physical and mental status in older adults often result in balance control impairments, functional limitations in locomotor activities,

disability in particular activities, and decreased quality of life. Therefore, this review also focuses on health outcomes that have been shown to be clinically most relevant to this population. These include balance and falls, musculoskeletal conditions, sleep quality, cardiovascular and respiratory function, and psychosocial wellbeing.

Balance Control, Falls, and Fear of Falling

Falls are significant public health problem among older adults (Murphy, 2000; Stevens, 2005), making it a major threat to the independence and quality of life of older adults, as well as imposing significant burden to individuals, society, and national health systems (National Action Plan, 2005). As a stand-alone exercise intervention, Tai Chi has been shown to reduce the risk for falls.

Wolf and his colleagues (1996) conducted the very first randomized controlled trial comparing the efficacy of two methods of exercise on falls. Community living healthy adults were randomized to one of three groups: Tai Chi training; computerized balance training; and an attention control. Results of this 15-week trial showed that Tai Chi participants experienced significant reductions (by about 47%) in falls compared to the exercise control participants. In a follow-up 48-week RCT, Wolf et al (2003) evaluated Tai Chi with older adults who were less robust (that is, transitioning to frailty). No significant between-experimental group reductions in falls were observed. However, by analyzing fall data from month four through month twelve, the

study showed a significantly reduced risk of falls in the Tai chi group compared with the exercise control group.

In an independent study, Li et al. (2005) confirmed the general findings of those reported by Wolf and his colleagues. These researchers reported that, at the end of a 6-month Tai Chi intervention, significantly fewer falls (38 versus 73), lower proportions of fallers (28% versus 246%), and injurious falls (7% versus 18%) were observed in the Tai Chi condition, compared to a low-impact stretching control condition. Overall, the risk of multiple falls in the Tai Chi group as 55% lower than that of the stretching controls. In addition, compared to stretching control participants, Tai Chi participants showed significant improvements in measures of functional balance, physical performance, and reduced fear of falling. Of equal importance, intervention gains in these measures were maintained at a 6-month postintervention follow-up in the Tai Chi group (Li et al., 2004).

Musculoskeletal Conditions

Evidence to date indicates that Tai Chi training preserves or even increases lower-extremity muscle strength. Wolfson et al. (1996) showed that 6 months of Tai Chi training (following their primary interventions) did not improve lower-extremity muscle strength, compared to an exercise control group. However, their data did indicate that Tai Chi training preserved lower-extremity strength gains developed by the intervention. In a 20-week pilot study, Christou et al. (2003) showed that, compared to those in the control condition, Tai Chi participants significantly improved knee extensor strength and force control among older adults. Tai Chi also appears to be safe and beneficial for patients with rheumatoid arthritis. In a randomized trial among older women with osteoarthritis, Song et al (2003) showed a 12-week Tai Chi program resulted in significant improvements in pain and stiffness in joints, balance, and abdominal strength, and fewer reported perceived difficulties in physical functioning, compared to those of control subjects. Another randomized trial, Hartman et al (2000) showed that a 12-week program significantly improved osteoarthritis symptoms such as fatigue, arthritis self-efficacy, feelings of tension, and satisfaction with general health status.More recent evidence points to the potential of Tai Chi as a weight-bearing exercise for retarding bone loss in older women. In a 12-month randomized trial, Chan et al (2004) tested the hypothesis that Tai Chi may retard bone loss in early postmenopausal women. At the end of the trial, bone mineral density (BMD) measurements revealed a general bone loss in both Tai Chi and control subjects at all measured skeletal sites, but with a slower rate in the Tai Chi group. Although the BMD findings were equivocal, the findings lend some support for the potential of Tai Chi to retard bone loss.

Cardiovascular and Respiratory Function

Although numerous studies have evaluated the effects of Tai Chi on cardiovascular and respiratory function, no RCTs have been reported that involve older adults. A number of Taiwan-based observational studies have shown improvements in cardiorespiratory function resulting from Tai Chi. For example, among long-term older adults practicing Tai Chi, significantly better

cardiorespiratory function has been reported (Lai, Lan, Wong, & Teng, 1995; Lan, Lai, Chen, & Wong, 1998), and improvements were also observed among coronary artery bypass surgery patients deemed to be at low risk during their participation in a Tai Chi exercise program (Lan, Chen, Lai, & Wong, 1999).

Hypertension

Tai Chi is a low-impact activity with self-paced and fluid movements, making it appropriate as a means to reduce blood pressure in people with hypertension. Two intervention trials compared the effects of Tai Chi and aerobic exercise on blood pressure – a surrogate for hypertension. An earlier study by Channer et al (1996) showed that over 11 sessions of exercise, both Tai Chi and aerobic exercise were associated with reductions in systolic blood pressure; Tai Chi was also ssociated with reductions in diastolic blood pressure in a sample of patients recovering from acute myocardial infraction. In a different study by Young et al. (1999), physically inactive older women with systolic blood pressure 130-159 mmHg and diastolic blood pressure > 95 mmHg were randomized to a 12-week moderate-intensity aerobic exercise program or a Tai Chi program of light activity. At the end of the intervention, the Tai Chi group decreased 7.0 mmHg of systolic and 2.4 mmHg of diastolic blood pressure. No significant differences were observed between the two exercise activities. The authored concluded that programs of moderate intensity aerobic exercise and light exercise may have similar effects on blood pressure in previously sedentary older individuals.

Quality of Sleep

Self-reported sleep complaints are common among older adults (Neubauer, 1999) and it is estimated that up to 50% of elderly persons complain about their sleep (Alessi, 2000). Li et al. (2003) conducted a six-month intervention trial to examine the impact of a simpler Tai Chi program on improving quality of sleep and reducing daytime sleepiness among older adults reporting moderate sleep complaints. Participants were randomly assigned to a Tai Chi group or an exercise control group. At the end of the study, Tai Chi participants reported significant improvements in several sleep-quality related measures in comparison to the control participants; with reduced sleep latency (by about 18 minutes per night) and daytime sleepiness, and improved sleep duration (by about 48 minutes per night). The study provided preliminary evidence linking the benefits of Tai Chi exercise to improved quality of sleep and reduced

daytime sleepiness in older adults.

Psychosocial Wellbeing and Confidence

Li and his colleagues (2001a,b,c,d, 2002a, 2002b) provided a series of reports examining the extent to which Tai Chi enhanced older adults’ multidimensional psychological well-being and health-related quality of life indicators. In a 6-month randomized controlled trial, healthy older adults were randomly assigned to either a control condition or Tai Chi. Results indicated that Tai

Chi participants reported higher levels of health perceptions, life satisfaction, positive affect, and well-being, and lower levels of depression, negative affect, and psychological distress (Li et al., 2001a). Participants also showed higher levels of both domain-specific physical self-esteem (Li et al., 2002b) and exercise self-efficacy relevant to movement confidence (Li et al., 2001c).

Change in the level of movement self-efficacy was found to be significantly related to change in physical functioning (Li et al., 2001b). Similar profiles have been reported by other researchers (Kutner, Barnhart, Wolf, McNeely, & Xu 1997) in that Tai Chi practice resulted in improved well-being, increased alertness, relaxation, better mental outlook, achievement, and greater confidence.

Practical Implications

The previous summary and review makes it clear that Tai Chi provides multiple health and therapeutic benefits for older adults. Thus, some discussion of practical implications appears to be in order.

Fall Prevention

Falls can result in devastating consequences for older adults. Accumulating evidence to date suggest that Tai Chi may be an effective means of improving deficits in balance and functional limitations, and therefore, may serve as a therapeutic exercise for balance and strength, and consequently, reduce the risk of falling and the rate of falls in older adults. Tai Chi may also be considered as an exercise modality that generates confidence building to counteract fear of falling, a common psychological symptom of falls among community adults.

However, Tai Chi does not provide a quick fix for the fall problem. Most research in this area has focused on short-term results. Findings from current RCTs show that, however, a minimum of three months training is required before clinically meaningful reductions in risks of falling can be achieved, suggesting the need for long-term, sustained, and frequent practice,

perhaps on a day-to-day basis, to obtain the full benefit.

Tai Chi as an Alternative, Therapeutic Exercise

Tai Chi has been recommended for treating many chronic conditions. For example, as a low-impact, low-intensity alternative exercise therapy, Tai Chi has also been proposed as a potential option for the management of osteoarthritis (Lumsden, Baccala & Aartire, 1998). As a fall prevention activity, Tai Chi has emerged as an appropriate stand-alone balance training program

for older adults to improve balance and prevent falls (JAGS, 2001).

But even though Tai Chi appears to have numerous benefits to participants, it is still too early for physicians to begin prescribing Tai Chi as a remedy for chronic health problems because many of the studies have design limitations (Wang et al., 2004), making it difficult to generalize results to broader patient populations. In this regard, patients with chronic health problems need to take precautions before beginning a Tai Chi program, because for some people Tai Chi could worsen medical conditions or problems/ symptoms. In some cases, appropriate modifications may be needed to better accommodate patients’ special needs or physical limitations.

Program Costs, Logistics, and Protocols

One of the most desirable aspects of Tai Chi is its absence of a need for high technology in promoting health. Tai Chi is easily distinguished from highly technical computerized balance training protocols, and may be just as successful in achieving fall reduction or balance improvement objectives; certainly, Tai Chi is more practical. Tai Chi is a low-cost exercise regimen because special equipment or facilities are not needed (Lan et al., 2002; Li et al., 2003). Li et al (2001b) reported that, in a 6-month RCT, the total direct cost was approximately $9000 (an average of $3.50 per person per session). Others (Wilson & Datta, 2001) have reported that a twice weekly Tai Chi program was cost-saving whether direct benefits alone (hip fracture costs

averted) or direct plus indirect benefits were considered, with a total net cost savings of $1274.43 per person per year. When considering direct cots only, the net cost savings were $8.04 per participant per year. Lower costs ensure that more community-dwelling older adults have sufficient access to programs, and abundant opportunities to participate, which is likely to have profound public health implications.

While costs of learning Tai Chi are potentially low, one should not underestimate the fact that Tai Chi is a complex system of movements that, when performed, requires body awareness, motor coordination, and agility; features that could make Tai Chi less immediately deliverable to community adults (Li et al., 2003). Therefore, even though the benefits of regular Tai Chi

exercise are quite clear, the challenge of maximizing the opportunity for older persons remains because certain movements may be beyond the capabilities of some elderly individuals or others with disabilities. Thus, there is a need to modify existing Tai Chi protocols to develop forms that are simple, easy to perform, and enjoyable (Chen, 2002; Li et al., 2003; Wolf et al., 1997), and

that do not require years of sustained practice to master.

Tai Chi Styles

There are several styles of Tai Chi, some of which are historic/traditional and some of which are of more recent origin. The earliest known form can be traced to the Chen style and evolved and progressed into multiple styles or schools. Currently, there are five main schools of Tai Chi (People’s Sports, 1996), each named after the style’s founding family: (a) Chen, (b) Yang, (c)

Sun, (d) Wu (Jian Qian), and (e) Wu (He Qin). Each style has a characteristic protocol that differs from other styles in the postures or forms included, the order in which they appear, the pace at which movements are executed, and the level of difficulty. For example, one significant difference between Chen and Yang styles is that Yang style movements are relaxed and evenly paced. By comparison, the Chen style is characterized by alternating slow movements with quick and vigorous movements, including restrained and controlled actions/motions, reflecting its martial origin.

Yang Style Tai Chi, which evolved from the Chen school, is probably the most popular Tai Chi style being practiced today (e.g., Swaim, 1999; Yu & Johnson, 1999). Yang style movements are performed in a relaxed and flowing manner, with the trunk erect as the axis of all movements, making it immediately suitable for elderly, frail, or disabled populations. To date, the Yang style, with its variations, has been used as an therapeutic exercise modality in most medical and behavioral research. Although there are multiple versions of the Yang style (both short and long, covering 24-, 48-, 88-, and 108-Forms) (China National Sports Commission, 1983), the 24-Form, based on the most popular sequences of the Yang Chengfu school (China Sports, 1980; People Sports, 1996), is the most readily adaptable to the lifestyles and living situations of older adult populations. It is also the most accommodating, requiring minimal demands of personal strength, speed, endurance, flexibility, and motor skills for participation.

Is Tai Chi Ready for Dissemination?

In a 2001 joint communiqué on the prevention of falls among the elderly, the American Geriatrics Society, the British Geriatrics Society, and the American Academy of Orthopedic Surgeons suggested that Tai Chi “...is a promising type of exercise, although it requires further evaluation before it can be recommended as the preferred balance training” (JAGS, 2001). Since the publication of this joint communiqué, one large successful RCTs has been published (Li et al., 2005) providing supporting evidence documented by Wolf et al.’s earlier work (1996). As a result of these studies, we should be asking questions about how we can most effectively translate and disseminate the Tai Chi program. With this accumulated evidence, the time is near for Tai Chi to be recommended as a preferred exercise for balance training and be routinely prescribed for older patients at risk for falling following appropriate screening.

Future Research Directions

Despite the increasing interest in studying the effectiveness of Tai Chi training and the resulting evidence of health benefits, there remain areas that require further research. We highlight a few of these.

A Need to Understand the Mechanisms of the Benefits Shown

Although findings from Tai Chi intervention studies are important from a public health perspective, they provide little information relative to the underlying mechanisms that may produce such effects. In this regard, little attention has been given considering intervention/treatment mediators or moderators that help identify causal pathways between treatment and outcome, and possible mechanisms through which a treatment might achieve its effects. For example, although Tai Chi has repeatedly been shown to improve balance, possible mechanisms by which Tai Chi improves this outcome, and prevent subsequent falls, remains to be determined. Future studies should target specifically older adults with balance impairments, and consider integrated laboratory and/or clinical measures that may help identify specific mechanisms whereby Tai Chi can remedy balance disorders.

A Need to Better Understand Effects to Patients with Chronic Conditions

A review by Wang et al. (2004) concluded that there is insufficient information to recommend Tai Chi to patients with chronic conditions. For example, the impact of Tai Chi on several important geriatric syndromes such as frailty, dementia, and sarcopenia are worthy of study or further research. Large clinical trials, involving populations with specific medical conditions are needed before health professionals can recommend Tai Chi exercise as an alternative to the more conventional exercise forms that have been shown to produce health benefits. The potential application of Tai Chi to important geriatric issues yet to be studied include: obesity, osteoporosis, diabetes, neurological disorders (e.g., Parkinson’s disease; peripheral neuropathy).

A Need to Study Long-Term Effects

Tai Chi intervention studies are typically conducted with a short-duration (e.g., 3 months, 6 months). Long-term effects of Tai Chi training (e.g., 12 months up to 2 or 3 years) are largely undetermined. Therefore, questions such as how long the established effects on clinical endpoints will sustain over a longer period of time remains to be determined. Certain outcomes may take a longer time to show an effect. Reductions in falls are a good example. Other outcomes such as BMD, may require up to one year to demonstrate clinically meaningful change because Tai Chi is a low-impact activity. Also, research from the general exercise literature indicates that people who participate in an exercise program often fall back into their older inactive lifestyle after a program ends (van der Bij, Laurant, & Wensing, 2002). Although anecdotal evidence suggest that participants remained active upon program termination (Li et al., 2001b; Wolf et al., 1996), critical issues such as getting people to initiate and maintain the Tai Chi activity over a long-term need to be addressed.

A Need to Evaluate Programs That Can Be Disseminated in Broader Community Settings

Ultimately, for the results of the research-based evidence to have greater public health impact they must be diffused and made accessible to the community. However, it remains unclear whether the general community can readily implement or adopt these Tai Chi training protocols despite evidence of their tested efficacy. To date, there is no widespread, nationally available Tai

Chi-based falls prevention program that is based on the effectiveness of scientifically controlled studies. In this regard, program evaluation research is needed to translate effective interventions into a program that is implementable in community settings.

The Oregon Research Institute is currently conducting a project to move effective interventions into community practice. The project has identified randomized controlled studies of scientifically-based effective Tai Chi fall interventions and focuses on issues related to “reach” (i.e., proportion of older adults who are willing to participate in a given Tai Chi program initiative), “uptake” (adoption; i.e., the proportion of settings and service agencies who are willing to initiate a program), and “implementation” (i.e., the intervention agents' fidelity to the various elements of a Tai Chi training protocol, including consistency of delivery as intended and the time and cost of the intervention). The intended results of this translation and dissemination project will provide an effective, evidence-based falls prevention package that can be implemented in community settings to improve functional ability and reduce fall prevalence

among community-dwelling older adults.

Summary

The extant research evidence provides strong support for what was originally considered “anecdotal evidence” about the health benefits of Tai Chi for older adults. Overall, Tai Chi has been shown to have physiologic and psychosocial benefits and appears to be safe and effective in promoting balance control and muscular strength, and cardiovascular fitness for older adults. More research is needed, with rigorous scientific methodologies, to fully understand the mechanisms whereby Tai Chi produces these health benefits. From a public health perspective, immediate efforts are needed to translate programs that can be disseminated in local settings that target community healthy older adults.

Fuzhong Li, Ph.D., is a Senior Research Scientist at the Oregon Research Institute, Eugene, OR.

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Li, F., Fisher, K. J., Harmer, P., Irbe, D., Tearse, R. G., & Weimer, C. (2004). Tai Chi and self-rated quality of sleep and daytime sleepiness in older adults: A randomized controlled trial. Journal of American Geriatrics Society, 52, 892-900.

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25. Using tai chi to fight degenerative nerve disease

Source: wustyle.com — Using tai chi to fight degenerative nerve disease · Topics: degenerative nerve disease · Nervous System · Neurology · Peripheral neuropathy

Tai Chi Treatment for Peripheral Neuropathy

Peripheral neuropathy is a degenerative nerve disease with no cure and few effective treatment options until now. Li Li, professor of kinesiology at LSU, is conducting a study into the benefits of tai chi for elderly peripheral neuropathy patients. So far, those practicing tai chi show far greater levels of improvement that those pursuing more traditional methods of treatment.

Read More: http://www.emaxhealth.com/6/9096.html

Attribution & usage

All 25 articles above were scraped and compiled from the Medical Articles section of wustyle.com, operated by the International Wu Style Tai Chi Chuan Federation (Copyright © 2017 International Wu Style Tai Chi Chuan Federation). Where an article cites an underlying journal paper, that paper's authors and journal are credited inside the article text itself. Study summaries in this collection were compiled by Dr. Mark J. Langweiler, Senior Lecturer in Anatomy, University of South Wales. The compilation, translation into Vietnamese and page layout are the work of TaichiNOW; the original material and all copyrights remain with the Federation and the individual authors.

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Wu Style Medical Research: The Evidence for Tai Chi

About this collection

Contents

1. A Randomized Controlled Trial of Tai Chi for Tension Headaches

2. A randomized, prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women

3. Are there any health benefits from tai chi exercises?

4. Change in perceived psychosocial status following a 12-week Tai Chi exercise programme.

5. Comparison of muscle torque, balance, and confidence in older tai chi and healthy adults.

6. Complementary and Alternative Medicine: Tai Chi

7. DIABETES AND TAI CHI THERAPY

8. Effects of exercise on joint sense and balance in elderly men: Tai Chi versus golf.

9. Falls In Older People

10. Health Benefits, Tai Chi Linked

11. Improvement in balance, strength, and flexibility after 12 weeks of Tai chi exercise in ethnic Chinese adults with cardiovascular disease risk factors

12. Shingles Immunity and Health Functioning in the Elderly: Tai Chi Chih as a Behavioral Treatment

13. Tai Chi and Cardiovascular Health

14. Tai Chi and fall reductions in older adults: a randomized controlled trial.

15. Tai Chi and medical research - peer reviewed published papers

16. Tai Chi Chuan: Mind-Body Practice or Exercise Intervention? Studying the Benefit for Cancer Survivors

17. Tai Chi for posture and back pain

18. Tai Chi 'helps improve diabetes'

19. Tai Chi 'improves body and mind'

20. Tai Chi may aid in arthritis treatment

21. Tai chi: physiological characteristics and beneficial effects on health

22. The Effect of Tai Chi on Chronic Obstructive Disease

23. The role of Tai Chi Chuan in reducing state anxiety and enhancing mood of children with special needs

24. The Role of Tai Chi Exercise in Promoting Health Benefits for Older Persons

25. Using tai chi to fight degenerative nerve disease

Attribution & usage