- Tai Chi Chuan
For Patients & Caregivers
Based on Chinese philosophy and traditional medicine theory, tai chi is a movement therapy that seeks to harmonize the Yin and Yang vital forces and promote the flow of energy in the body known as Qi to improve health. It coordinates a series of prescribed movements with meditation and breathing exercises. Clinical trials of tai chi have been conducted in elderly, frail, and disabled patients, and those with chronic conditions such as fibromyalgia, arthritis, Parkinson’s disease, heart disease, and cancer. These studies show that tai chi can improve sleep, strength, stamina, flexibility, balance, blood pressure, physical functioning, mental outlook, and awareness. It can also reduce stress, risk of falls, and bone loss. Tai chi can be practiced by people of all age groups as the movements are gentle with little stress on the body. Like other mind-body approaches, benefits obtained from this modality increase with regular practice.
Tai chi practice can improve posture, movement control, and ability to walk, in part due to the gradual weight shift that occurs with the lower and upper limbs. Slow foot movements such as forward heel-to-toe and backward toe-to-heel motions also improve flexibility, stamina, and muscle tone. The practice of moving from wide to narrow stances as well as turning in the movements expands the number of situations under which the body experiences support. The coordinated breathing used along with the exercises helps to improve lung function. Taken together, these details within the exercises are the mechanisms that serve to improve balance while reducing risk of falls. Tai chi has also been shown to reduce inflammation that is linked with many chronic diseases, including heart disease and cancer.
Several studies show that tai chi improves balance which may also help to reduce the risk of falls.
A clinical trial found that a combination tai chi/qi gong program reduced fatigue in breast cancer patients.
A randomized trial showed that tai chi was as good or even better than aerobic exercise to reduce fibromyalgia symptoms.
This use is supported by clinical trials.
Several studies show that tai chi can improve muscle strength, flexibility, stamina, and stable posture in a variety of populations including cancer patients.
For Healthcare Professionals
Tai chi is an exercise program that uses a sequence of precise body movements, meditation, and synchronized breathing to improve health and well-being. Based on Chinese philosophy and traditional medicine theory, tai chi exercises are thought to harmonize the Yin and Yang vital forces and promote the flow of Qi, or internal energy, to improve health. Like most moderate physical activities, tai chi can improve stamina, muscle tone, agility, and flexibility. The coordinated practice of breathing along with the exercises may serve a meditative function to increase awareness and reduce stress.
Reviews of clinical trials show that tai chi practice has many benefits including reduced pain and improved flexibility and strength (1) (2). Clinical studies in women showed that tai chi is effective in slowing bone loss (3), reducing multiple fracture-related risks (4), and improving physical function (5). Along with resistance training and diet intervention, tai chi significantly improved mobility measures in obese older women (6).
In a comparative effectiveness trial, tai chi compared with aerobic exercise had similar to significantly greater benefits for patients with fibromyalgia (52). In studies of potential benefits for joint diseases, tai chi improved range of motion in patients with rheumatoid arthritis (7) (8), reduced knee osteoarthritic pain (9), and improved functional fitness and physical and mental health among ethnically diverse participants (10). In patients with end-stage hip osteoarthritis, a combined tai chi/strength training program improved balance and aerobic capacity, but not pain or side hip motion (11). For older adults with previous fall-related emergency department visits, those who were given a tai chi intervention were less likely to experience subsequent falls than those given a lower-extremity training (12). Another study among disabled elderly did not find a group-based tai chi program to be effective, perhaps due to insufficient intervention or low attendance (13).
Tai chi can also provide benefits in patients with other chronic conditions. It improved aerobic capacity in sedentary adults (2) and respiratory function in patients with COPD (14), although a systematic analysis did not show superiority with tai chi over other interventions for this condition (15). Tai chi improved quality-of-life (QoL) for those with chronic heart failure (16) (17), and reduced hypertension and associated risk factors (9) (18) (19), reversed markers of inflammation (20), and improved sleep (21) and physical function (22) in elderly individuals. Another study suggests that sleep improvements occur after long-term rather than short-term practice in patients with chronic insomnia (23). At a molecular level, tai chi was reported to reduce cellular inflammatory responses and to decrease expression of genes encoding pro-inflammatory mediators, both associated with sleep disturbance, in older adults with insomnia (49). In a small study of chronic stroke patients, tai chi improved balance, gait, and QoL (24). In patients with recent myocardial infarction, tai chi was associated with increased peak oxygen consumption, suggesting its application in cardiac rehabilitation (25). Patients with fibromyalgia reported significant symptom improvements following a tai chi exercise program (26) (27), and in patients with Parkinson’s disease (28) (29) and multiple sclerosis (30), tai chi improved balance and reduced risk of falls. It was also found to be more cost-effective for patients with mild-to-moderate Parkinson’s disease than resistance training or stretching, with better fall reduction outcomes (31). Tai chi produced benefits in pain reduction and QoL similar to conventional neck exercises for participants with chronic neck pain (32).
Studies in younger populations are few. Tai chi programs improved self-concept in adolescents (33) as well as flexibility and balance among college students (34). It is also among the complementary health approaches use in children aged 4–17 years, with higher usage among girls than boys, although overall usage among this age group is still small (35).
Preliminary data suggest that tai chi improves QoL (36) (37) and neuropsychological functioning in cancer patients (38). It was shown to be a feasible and acceptable modality among senior cancer survivors as well (39), and may help to reduce their risk factors for other chronic diseases (19). In a study of breast cancer survivors, tai chi practice resulted in clinically relevant, sustained improvements in insomnia, and was equally effective as cognitive behavioral therapy for insomnia (CBT-I) (50). A combination qi gong/tai chi exercise program was also found to improve fatigue, depression, and sleep dysfunction in breast cancer survivors (40). A meta-analysis also found significant improvements in cancer-related fatigue, sleep difficulty, depression, and overall quality of life (53).
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 (28). 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. Improvements in mobility are attributed to the increased flexibility and balance that may occur with regular tai chi practice (6), and are also the mechanisms by which this modality helps to prevent falls (41). 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 seated-to-standing / standing-to-seated positions) and markedly increasing gait velocity and stride length (28).
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 anti-inflammatory effects (42). Declining pro-inflammatory cytokine IL-2 levels further result in increased bone formation and metabolism levels (43). Other anti-inflammatory effects include increased superoxide dismutase activity with reduced IL-1β (44). Tai chi may also improve health-related QoL by regulating other inflammatory responses and biomarkers (37).
- Tai chi is generally considered to be safe (19). Adverse events have not yet been reported in studies of tai chi for patients with COPD (15), Parkinson’s disease (29), or cancer (39) (45). Additional studies are further evaluating safety in patients with cardiovascular (46) (47) and Parkinson’s disease (48).
- It is advisable that patients with musculoskeletal injuries consult their physicians before starting a tai chi program.