Tai Chi (Tai Ji)

Tai ji 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 ji 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 ji 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 ji practice has many benefits including reduced pain and improved flexibility and strength ^(1) (2). Clinical studies in women showed that tai ji 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 ji significantly improved mobility measures in obese older women ⁽⁶⁾.

In studies of potential benefits for joint diseases, tai ji 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 ji/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 ji 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-ji program to be effective, perhaps due to insufficient intervention or low attendance ⁽¹³⁾.

Tai ji 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 ji over other interventions for this condition ⁽¹⁵⁾. Tai ji 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 ji 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 ji improved balance, gait, and QoL ⁽²⁴⁾. In patients with recent myocardial infarction, tai ji was associated with increased peak oxygen consumption, suggesting its application in cardiac rehabilitation ⁽²⁵⁾. Patients with fibromyalgia reported significant symptom improvements following a tai ji exercise program ^(26) (27), and in patients with Parkinson’s disease ^(28) (29) and multiple sclerosis ⁽³⁰⁾, tai ji 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 ji 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 ji 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 ji 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 ji practice resulted in clinically relevant, sustained improvements in insomnia, and was equally effective as cognitive behavioral therapy for insomnia (CBT-I) ⁽⁵⁰⁾. A combination qigong/tai ji exercise program was also found to improve fatigue, depression, and sleep dysfunction in breast cancer survivors ⁽⁴⁰⁾.

Tai ji can be practiced by people of all age groups and has been found to have a good adherence rate ^(17) (22) as the movements are gentle and there is a low risk for injury.