- Tai Chi Chuan
For Patients & Caregivers
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What Is It
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, limb function, blood pressure, mental outlook, and awareness. It can also help reduce stress, fall risk, 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.
How It Works
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.
Clinical trials suggest that tai chi can help reduce 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.
Is It Safe
Where Can I Get Treatment
Many hospitals, cancer centers, and community and senior centers offer tai chi classes. The Integrative Medicine Service at MSK offers tai chi and other exercise and mind-body modalities in a new online program, Integrative Medicine at Home, to help support the recovery and well-being of cancer patients everywhere.
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) (53). Clinical studies in women showed that tai chi may help reduce bone loss (3) and fracture-related risks (4), and improve physical function (5). Along with resistance training and diet intervention, tai chi significantly improved mobility 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 visits, those who were given a tai chi intervention were less likely to experience subsequent falls than those given a lower-extremity training (12). Tai chi in both community and home practice settings also appear to reduce fall risk and improve physical and executive function among older adults (54) (55), although a study among disabled elderly did not find a group program 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). Tai chi also reduced cellular inflammatory responses and proinflammatory gene expression 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).
In cancer patients, preliminary data suggest that tai chi improves QoL (36) (37) and neuropsychological functioning (38). It was feasible and acceptable among senior cancer survivors as well (39), and may help reduce 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 as effective as cognitive behavioral therapy for insomnia (CBT-I) (50). A combination qi gong/tai chi exercise program also improved fatigue, depression, and sleep dysfunction (40). In addition, meta-analyses found significant improvements in cancer-related fatigue, sleep difficulty, depression, and QoL (53) as well as cortisol levels and limb function (56).
Tai chi 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. In a meta-analysis of RCTs to assess safety, tai chi was found to be generally safe, with significantly fewer adverse events than with controls among patients with heart failure (57).
The Integrative Medicine Service at MSK offers tai chi and other exercise and mind-body modalities in a new online program, Integrative Medicine at Home, to help support the recovery and well-being of cancer patients everywhere.
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 (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.
Practitioners and Treatments
Tai chi classes are offered in many hospitals, cancer centers, and community and senior centers, generally by experienced instructors. The Integrative Medicine Service at MSK offers tai chi and other exercise and mind-body modalities in a new online program, Integrative Medicine at Home, to help support the recovery and well-being of cancer patients everywhere.