Health Care Professional Information

Common Name

Tai Chi Chuan, Taiji, Tai Ji, Tai Chi Quan

Clinical Summary

Tai Chi is an exercise program that uses a sequence of precise body movements, meditation, and synchronized breathing to improve health and well-being. Practitioners believe that disease results when the flow of Qi (internal energy) is blocked and when there is disharmony between the yin and yang forces. Based on traditional Chinese medicine theory, Tai chi exercises are thought to result in balancing these forces and promoting the flow of Qi to improve health. Like most moderate physical activities, tai chi can improve stamina, muscle tone, agility, and flexibility. The coordinated practice of breathing with the exercises may serve a meditative function to reduce stress.

Reviews of clinical trials show that tai chi practice has many benefits including alleviation of pain, and improved flexibility and strength (1) (2). Clinical studies in women showed that tai chi is effective in slowing bone loss (3), reduces multiple fracture-related risks (4), and improves physical functioning (5). Tai chi may improve range of motion in patients with rheumatoid arthritis (6), but more evidence is needed (7). Tai chi improves aerobic capacity in sedentary adults (2), respiratory function in patients with COPD (8) and quality-of-life (QoL) in patients with chronic heart failure (9) (10), reduces hypertension and lipid profile in hypertensive individuals (11), and improves sleep (12) and physical function (13) in elderly individuals. Patients with fibromyalgia reported significant improvements in symptom management and QoL following a tai chi exercise program (14) (15). In patients with Parkinson's disease (16) and multiple sclerosis (17), tai chi can improve balance and reduce risk of falls. A combination intervention of tai chi, resistance training and diet intervention found significant improvements in measures of mobility in obese older women (18).

Preliminary data suggest that tai chi improves QoL (19) (20) and neuropsychological functioning (21) in cancer survivors. Combination qigong/tai chi exercise programs improved fatigue, depression and sleep dysfunction in breast cancer survivors (22), and a condensed tai chi program was found to be a feasible and acceptable modality for senior cancer survivors (23).

Tai chi can be practiced by people of all age groups and has been found to have a good adherence rate (10) (13) as the movements are gentle and there is a low risk for injury.

Purported Uses
  • Balance
  • Fatigue
  • Pain
  • Physical functioning
Mechanism of Action

Improved postural control and walking ability are due to specific features that characterize the tai chi protocol, in which weight shifting and ankle sway move one’s center of gravity toward the limits of stability (16). Alternating narrow and wide stances continually change the base of support, increase support-leg standing and trailing-leg swing time, and encourage rotation of the torso with an upright posture. Forward heel-to-toe and backward toe-to-heel steps strengthen dorsiflexion and plantar flexion, respectively. Changes in measures of mobility are attributed to the improved flexibility and balance produced with regular tai chi practice (18), and are also the mechanisms by which tai chi helps to prevent falls (24). Tai chi particularly appears to alleviate bradykinetic movements associated with Parkinson’s disease by improving gait characteristics such as maximum excursion while reducing deviation in movement (eg, reaching forward to take objects from a cabinet; transitioning from a seated-to-standing and standing-to-seated positions), and markedly increasing gait velocity and stride length (16).

Several studies evaluating biomarker changes with tai chi indicate that the physical aspects of this exercise mediate reductions in both decreased fat mass and IL-2 levels along with increased fat-free mass and IL-6, while the meditative component may also contribute to antiinflammatory effects (25). Declining proinflammatory cytokine IL-2 levels further result in increasing bone formation and metabolism levels (26). Other anti-inflammatory effects include increased superoxide dismutase activity with reduced IL-1β (27). Tai chi may also improve health-related QoL by regulating other inflammatory responses and biomarkers (20).

Contraindications

Patients who suffer from musculoskeletal injuries should consult a physician before starting tai chi.

Literature Summary and Critique

Larkey LK, et al. Randomized controlled trial of qigong/tai chi easy on cancer-related fatigue in breast cancer survivors. Ann Behav Med. 2014.
This double-blind, randomized controlled trial compared a combination of tai chi and qigong with sham qigong to evaluate their effects on fatigue, mood, and sleep disturbances. At total of 87 postmenopausal fatigued breast cancer survivors were randomized to either intervention, but participants and staff were blinded to these assignments by labeling both classes “rejuvenating movement.” Real and sham 60-minute sessions were conducted twice weekly for the first 2 weeks to increase learning retention, followed by weekly sessions for the remaining 10 weeks, and taught by staff experienced in leading exercise with cancer patients. Methods of evaluation included the Pittsburgh Sleep Quality Index, Fatigue Symptom Inventory, and the Beck Depression Inventory. A significant decrease was noted with the real/combined intervention for fatigue compared with the sham control both post-intervention (P = .005) and at 3 months follow-up (P = .024). There were also improvements with both interventions over time for depression and sleep quality.

Campo RA, et al. Feasibility and acceptability of a Tai Chi Chih randomized controlled trial in senior female cancer survivors. Integr Cancer Ther. 2013;12:464-474.  
A condensed form of tai chi (tai chi chih; TCC) was evaluated in cancer survivors with physical functioning limitations for its effects on health-related QoL (QOL). A total of 63 senior female cancer survivors were randomized to 60-minute sessions three times weekly for 12 weeks of either TCC or a health education control (HEC). Primary outcomes were feasibility and acceptability, with secondary outcomes including patient feedback on the intervention and health-related QOL using the SF-36 Health Survey. Retention was highest with TCC vs HEC (91% vs 81%, respectively), although class attendance was lower in the TCC group (79% vs 83%), and there were no between-group differences for satisfaction levels (both high). Within-group analyses showed significant improvements in the mental component summary score of the SF-36 survey for TCC (P = .01) but not HEC. However, with only baseline and 1 week post-intervention assessments, too few timepoints may not have adequately captured the benefits of TCC on QoL. An additional difference was noted in the type of perceived benefit received: TCC participants felt they received mental and physical benefits, while HEC participants reported benefits of social support and the information supplied. Larger trials are needed to confirm dosage and QoL effects for cancer survivors.

Sprod LK, et al. Health-related quality of life and biomarkers in breast cancer survivors participating in tai chi chuan. J Cancer Surviv. 2012;6:146-154.
This study compared changes in health-related QoL (HRQOL) and biomarkers between tai chi chuan (TCC) and standard support therapy (SST). Twenty-one breast cancer patients were randomized to either TCC or SST for 12 weeks of 3 times weekly 60-minute sessions. Pre- and postintervention measures included interleukin (IL)-6, IL-8, insulin-like growth factor-1 (IGF-1), IGF-binding protein (IBFBP)-1, IGFBP-3, glucose, insulin, and cortisol. TCC participants experienced significant improvements in total HRQOL, physical functioning, physical role limitations, social functioning, and general mental health, while the SST group improved in social functioning and vitality only. IGF-1 changes were associated with overall HRQOL, physical role limitation, and social functioning; IGFBP-1 changes with physical role limitations changes; and IGFBP-3 changes with physical functioning changes. Cortisol changes were associated with physical role limitation changes and health perceptions; and glucose and IL-8 changes with emotional role limitation changes. This work should be replicated in larger RCTs in patients with various types of cancer to confirm results and increase generalizability.

Li F, et al. Tai chi and postural stability in patients with Parkinson's disease. N Engl J Med. 2012;366:511-519.
In this triple-arm RCT, a tailored tai chi program was evaluated for its effects on postural control in patients with idiopathic Parkinson's disease. A total of 195 patients with stage 1– 4 disease were randomly assigned to either tai chi, resistance training, or stretching. All exercise sessions were conducted for 60 minutes twice weekly for 24 weeks. The primary outcome was limits-of-stability test changes from baseline (maximum excursion and directional control). Secondary outcomes included gait and strength measures, functional-reach and timed up-and-go scores, Unified Parkinson's Disease Rating Scale motor scores, and number of falls. Tai chi participants consistently performed better than resistance-training and stretching groups for both maximum excursion and directional control. Tai chi also outperformed resistance-training for stride length and functional reach, and was better than stretching for all secondary outcomes and to lower the incidence of falls. Further, benefits with tai chi were maintained 3 months post-intervention with no serious adverse events in patients with mild-to-moderate Parkinson's disease.

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References
  1. Klein PJ, Adams WD. Comprehensive therapeutic benefits of Taiji: a critical review. Am J Phys Med Rehabil. Sep 2004;83(9):735-745.
  2. Taylor-Piliae RE, Froelicher ES. Effectiveness of Tai Chi exercise in improving aerobic capacity: a meta-analysis. J Cardiovasc Nurs. Jan-Feb 2004;19(1):48-57.
  3. Chan K, Qin L, Lau M, et al. A randomized, prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women. Arch Phys Med Rehabil. May 2004;85(5):717-722.
  4. Wayne PM, Kiel DP, Buring JE, et al. Impact of Tai Chi exercise on multiple fracture-related risk factors in post-menopausal osteopenic women: a pilot pragmatic, randomized trial. BMC Complement Altern Med. 2012;12:7. doi: 10.1186/1472-6882-12-7
  5. Song R, Lee EO, Lam P, et al. Effects of tai chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with osteoarthritis: a randomized clinical trial. J Rheumatol. Sep 2003;30(9):2039-2044.
  6. Han A, Robinson V, Judd M, et al. Tai chi for treating rheumatoid arthritis. Cochrane Database Syst Rev. 2004(3):CD004849. doi: 10.1002/14651858.CD004849
  7. Lee MS, Pittler MH, Ernst E. Tai chi for rheumatoid arthritis: systematic review. Rheumatology (Oxford). Nov 2007;46(11):1648-1651. doi: 10.1093/rheumatology/kem151
  8. Chan AW, Lee A, Lee DT, et al. The sustaining effects of Tai chi Qigong on physiological health for COPD patients: a randomized controlled trial. Complement Ther Med. Dec 2013;21(6):585-594. doi: 10.1016/j.ctim.2013.09.008
  9. Yeh GY, Wood MJ, Lorell BH, et al. Effects of tai chi mind-body movement therapy on functional status and exercise capacity in patients with chronic heart failure: a randomized controlled trial. Am J Med. Oct 15 2004;117(8):541-548. doi: 10.1016/j.amjmed.2004.04.016
  10. Yeh GY, McCarthy EP, Wayne PM, et al. Tai chi exercise in patients with chronic heart failure: a randomized clinical trial. Arch Intern Med. Apr 25 2011;171(8):750-757. doi: 10.1001/archinternmed.2011.150
  11. Tsai JC, Wang WH, Chan P, et al. The beneficial effects of Tai Chi Chuan on blood pressure and lipid profile and anxiety status in a randomized controlled trial. J Altern Complement Med. Oct 2003;9(5):747-754. doi: 10.1089/107555303322524599
  12. Li F, Fisher KJ, Harmer P, et al. Tai chi and self-rated quality of sleep and daytime sleepiness in older adults: a randomized controlled trial. J Am Geriatr Soc. Jun 2004;52(6):892-900. doi: 10.1111/j.1532-5415.2004.52255.x
  13. Manor B, Lough M, Gagnon MM, et al. Functional benefits of tai chi training in senior housing facilities. J Am Geriatr Soc. Aug 2014;62(8):1484-1489. doi: 10.1111/jgs.12946
  14. Taggart HM, Arslanian CL, Bae S, et al. Effects of T'ai Chi exercise on fibromyalgia symptoms and health-related quality of life. Orthop Nurs. Sep-Oct 2003;22(5):353-360.
  15. Wang C, Schmid CH, Rones R, et al. A randomized trial of tai chi for fibromyalgia. N Engl J Med. Aug 19 2010;363(8):743-754. doi: 10.1056/NEJMoa0912611
  16. Li F, Harmer P, Fitzgerald K, et al. Tai chi and postural stability in patients with Parkinson's disease. N Engl J Med. Feb 9 2012;366(6):511-519. doi: 10.1056/NEJMoa1107911
  17. Azimzadeh E, Hosseini MA, Nourozi K, et al. Effect of Tai Chi Chuan on balance in women with multiple sclerosis. Complement Ther Clin Pract. Nov 27 2014. doi: 10.1016/j.ctcp.2014.09.002
  18. Maris SA, Quintanilla D, Taetzsch A, et al. The combined effects of tai chi, resistance training, and diet on physical function and body composition in obese older women. J Aging Res. 2014;2014:657851. doi: 10.1155/2014/657851
  19. Mustian KM, Katula JA, Gill DL, et al. Tai Chi Chuan, health-related quality of life and self-esteem: a randomized trial with breast cancer survivors. Support Care Cancer. Dec 2004;12(12):871-876. doi: 10.1007/s00520-004-0682-6
  20. Sprod LK, Janelsins MC, Palesh OG, et al. Health-related quality of life and biomarkers in breast cancer survivors participating in tai chi chuan. J Cancer Surviv. Jun 2012;6(2):146-154. doi: 10.1007/s11764-011-0205-7
  21. Reid-Arndt SA, Matsuda S, Cox CR. Tai Chi effects on neuropsychological, emotional, and physical functioning following cancer treatment: a pilot study. Complement Ther Clin Pract. Feb 2012;18(1):26-30. doi: 10.1016/j.ctcp.2011.02.005
  22. Larkey LK, Roe DJ, Weihs KL, et al. Randomized Controlled Trial of Qigong/Tai Chi Easy on Cancer-Related Fatigue in Breast Cancer Survivors. Ann Behav Med. Aug 15 2014. doi: 10.1007/s12160-014-9645-4
  23. Campo RA, O'Connor K, Light KC, et al. Feasibility and acceptability of a Tai Chi Chih randomized controlled trial in senior female cancer survivors. Integr Cancer Ther. Nov 2013;12(6):464-474. doi: 10.1177/1534735413485418
  24. Winters-Stone K. Tai Ji Quan for the aging cancer survivor: Mitigating the accelerated development of disability, falls, and cardiovascular disease from cancer treatment. J Sport Health Sci. Mar 1 2014;3(1):52-57. doi: 10.1016/j.jshs.2013.11.003
  25. Janelsins MC, Davis PG, Wideman L, et al. Effects of Tai Chi Chuan on insulin and cytokine levels in a randomized controlled pilot study on breast cancer survivors. Clin Breast Cancer. Jun 2011;11(3):161-170. doi: 10.1016/j.clbc.2011.03.013
  26. Peppone LJ, Mustian KM, Janelsins MC, et al. Effects of a structured weight-bearing exercise program on bone metabolism among breast cancer survivors: a feasibility trial. Clin Breast Cancer. Jun 2010;10(3):224-229. doi: 10.3816/CBC.2010.n.030
  27. Mendoza-Nunez VM, Hernandez-Monjaraz B, Santiago-Osorio E, et al. Tai Chi exercise increases SOD activity and total antioxidant status in saliva and is linked to an improvement of periodontal disease in the elderly. Oxid Med Cell Longev. 2014;2014:603853. doi: 10.1155/2014/603853

Consumer Information

How It Works

Bottom Line: Tai Chi exercises are effective in relieving pain, improving flexibility, strength, and sleep quality, and reducing fatigue, stress, and the risk of falls in some patients.

Tai Chi combines body movements, meditation and breathing exercises to improve health and well-being. The movements are designed to express the yin and yang components, the basic elements of Chinese medicine in a balanced form. Practitioners believe that disease results when the flow of Qi (internal energy) is blocked and when there is disharmony between the yin and yang forces. Based on traditional Chinese medicine theory, tai chi exercises are thought to result in balancing these forces and promoting the flow of Qi to improve health.

Tai chi practice improves physical functioning in many ways, including improved strength, stamina, muscle tone, agility, flexibility, and sleep quality. Tai chi can also help to reduce stress, pain, and risk of falls, slow bone loss and reduce high blood pressure. The coordinated breathing used in tai chi also helps to improve respiratory function. In turn, all of these benefits improve quality of life, and many of these benefits extend or overlap across various populations such as the frail and elderly, postmenopausal women, and patients with heart disease, fibromyalgia,  Parkinson’s disease, or cancer. Tai chi can be practiced by people of all age groups as the movements are gentle with minimal stress on the body.

Purported Uses
  • Balance
    Several studies show that tai chi improves balance which may also help to reduce the risk of falls.
  • Fatigue
    A clinical trial found that a combination tai chi/qigong program reduced fatigue in breast cancer patients.
  • Pain
    This use is supported by clinical trials.
  • Physical Functioning
    Several studies show that tai chi can improve muscle strength, flexibility, stamina, and stable posture. 
Research Evidence

Fatigue in breast cancer survivors
In this study, 87 postmenopausal breast cancer survivors with persistent fatigue were randomly divided into two groups: a tailored tai chi/qigong program or an imitation qigong program. Both participants and staff did not know which exercise program they were receiving because both classes were labeled “rejuvenating movement.” Exercise sessions were for 60 minutes twice weekly for the first 2 weeks in order to learn the exercises. After that, classes met once weekly for another 10 weeks. There was a significant decrease in fatigue for those in the real exercise group, even at 3 months follow-up. Interestingly, both groups saw improvements for depression and sleep quality.

Quality-of-life (QoL) in senior cancer survivors
A shortened tai chi format was compared with a health education series among 63 senior cancer survivors with physical limitations. All sessions were for 60 minutes three times weekly over 12 weeks. Both groups reported high satisfaction levels with their programs. The tai chi group showed a significant improvement in overall mental health, but because surveys were only conducted at two timepoints, the full benefits on QoL may not have been accurately captured.

Posture stability and improved movement in patients with Parkinson's disease
A tailored tai chi program was compared with 2 other modalities (resistance-training and stretching) for its effects on posture control in patients with Parkinson's disease. A total of 195 patients were randomly assigned among the three groups. All exercise sessions were conducted for 60 minutes twice weekly for 24 weeks. Tai chi participants consistently performed better than resistance-training and stretching groups in stability tests. Tai chi also outperformed resistance-training for walking and reaching movements, and was better than stretching for all measures including reducing the number of falls. These benefits were maintained 3 months after the study and with no serious side effects.

Biomarkers related to QoL changes in breast cancer patients
The potential for biomarkers as another way to measure effects objectively is an appealing area of integrative medicine research. This study examined whether chemical changes such as inflammatory markers were associated with QoL changes in breast cancer patients receiving either standard support therapy or tai chi instruction. Both groups met 3 times weekly for 60-minute sessions over 12 weeks. Tai chi participants improved in overall QoL, physical functioning, social functioning, and mental health, while the support group improved in social functioning and vitality only. Researchers were also able to link changes in specific biomarkers to the various qualitative measures, but larger studies are needed to see whether these corresponding relationships can be made with any consistency.

Special Point
  • Consult your doctor before starting tai chi if you are suffering from musculoskeletal injuries.
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