Health Benefits of Tai Chi
By Yoon Hang Kim, MD MPH, and Jeanne Bowers. Dr. Kim is the Director, Georgia Integrative Medicine, Atlanta, and Ms. Bowers is completing a master's degree in Psychology, University of West Georgia; they both report no financial relationships relevant to this field of study.
Tai chi is an internal chinese martial art that combines deep breathing and relaxation with slow, gentle, and graceful movements.1 Tai Chi is designed to develop Qi or biofield energy. In Chinese medicine, activities cultivating Qi (biofield energy) are collectively known as Qi Gong. Qi Gong is the fourth branch of Chinese medicine, along with acupuncture, herbs, and Tui na (Chinese medical massage). Therefore, within the Chinese medical paradigm, the health benefits are implicit and have wide social validity. In China, it is a common sight to witness vast numbers of people practicing Tai Chi and other forms of Qi Gong in the parks.
The physical techniques of Tai Chi are described in the Tai Chi Classics (a set of writings written by the founder of Tai Chi, Chang San Fang, in the 12th century) as being characterized by the use of leverage through the joints based on coordination and relaxation, rather than muscular tension, in order to neutralize or initiate attacks.2 The traditional study of Tai Chi primarily involves three subjects, including health, meditation, and martial arts. Tai Chi is taught as a form consisting of varying amounts of postures, depending of the style of Tai Chi.
In the West, Tai Chi has been advocated for the development of the mind-body connection, breathing regulation with body movement, and meditation.3 Despite the lack of rigorous evidence regarding its benefits, Tai Chi is widely practiced in many countries as a form of exercise for health and fitness. Tai Chi is practiced as an exercise to promote good health, memory, concentration, digestion, balance, and flexibility, and is also thought to improve psychological conditions such as anxiety, depression, and declines associated with aging and inactivity.4 It is also practiced to improve quality of life.5
The purpose of this review is to summarize the studies that have examined the effect of Tai Chi on patients with a variety of chronic conditions.
Fall Prevention
Tai Chi movements are unique in that slow weight-shifting and turning of the hips allows the practitioner to develop kinesthetic awareness. The movements are slow and continuous, allowing the individuals to learn to move most effectively throughout the form. By performing slow, continuous, and fluid patterns, the individual becomes aware of optimally safe postures. It is postulated that such awareness could decrease the incidence of falls.6
In 2000, Chan and Bartlett published a meta-analysis of current studies to determine the effectiveness of Tai Chi as a therapeutic intervention to improve balance. The study revealed that Tai Chi appeared to benefit balance. In 2003, Komagata and Newton published a comprehensive review on the effectiveness of Tai Chi on improving balance in older adults.7 In this review, more than 30 potential articles were reviewed and scored on the quality of the studies; 11 studies met the inclusion criteria. Authors concluded that the majority of the studies supported the effectiveness of Tai Chi to improve balance. In 2004, Verhagen and colleagues. published the results of a systematic review on the effectiveness of Tai Chi for fall prevention.8
There were two trials that displayed high quality in the design of the study.
The trial of Li and colleagues was designed to determine whether a six-month Tai Chi exercise program could improve self-reported physical functioning limitations among healthy, physically inactive older individuals.9 In this study, people over 65 years were randomly divided into two groups. People in the intervention group received Tai Chi exercises with one-hour instruction twice a week. The control group was placed on a waiting list and was promised a four-week program at the end of the study. Primary outcome was physical functioning, using the SF-20, and measurements were performed at baseline, and 12 and 24 weeks after randomization. During the study, the mean improvement of physical functions improved in the Tai Chi group by 19.8%, while the control showed 8.2% improvement.
Wolf and colleagues conducted the Atlanta FICSIT trial where a total of 200 healthy people of 70 years or older participated.10 They were randomly divided into three groups. The first group was a Tai Chi group taught one hour twice a week; the second group was computerized balance training for one hour once a week; and the third group was education control group one hour once a week. The outcome measures were recorded at baseline, 15 weeks after randomization, and at four months follow-up. In the Tai Chi group, a significant reduction of fall risk of 47.5% was observed.
In 2005, Li et al conducted a follow-up study to evaluate the efficacy of a six-month Tai Chi intervention for decreasing the number of falls and the risk for falling in older persons.11 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). Participants were randomized to participate in a three-times-per-week Tai Chi group or to a stretching control group for six months. The primary outcome measure was the number of falls. At the end of the six-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. Authors concluded that a three-times-per-week, six-month Tai Chi program is effective in decreasing the number of falls, the risk for falling, and the fear of falling, as well as improving functional balance and physical performance in physically inactive persons aged 70 years or older.
In 2006, Zeeuwee and colleagues published the designs of the randomized, controlled trial demonstrating the effect of Tai Chi Chuan in reducing falls among elderly people.12 In that trial, 270 people ³ 70 years old, living at home, will be identified in the files of the participating general practitioners. People will be asked to participate when meeting the following inclusion criteria: 1) have experienced a fall in the preceding year; or 2) suffer from two of the following risk factors: disturbed balance, mobility problems, dizziness, or the use of benzodiazepines or diuretics. People will be randomly allocated to either the Tai Chi Chuan group (13 weeks, twice a week) or the no treatment control group. The results are pending from this study.
In 2007, Voukelatos and colleagues published findings of a randomized, controlled trial to determine the effectiveness of a 16-week Tai Chi training to reduce falls in people aged 60 and older.13 Seven hundred two participants were randomly divided into Tai Chi group and wait list control group. The Tai Chi group received one hour of instruction once a week for 16 weeks. The measurements were recorded at 16 weeks and 24 weeks (residual effect). Results showed that falls were less frequent in the Tai Chi group than the control group (P = 0.02).
The significance of these studies is that they all showed Tai Chi to reduce the fall risks. Fall injury is significant because more than one-third of adults 65 and older fall each year.14 Of those who fall, 20%-30% suffer moderate-to-severe injuries that make it hard to get around or live alone, as well as increase the chance of early death.15 Older adults are hospitalized for fall-related injuries five times more often than they are for injuries from other causes.16 The total direct cost of all fall injuries for people 65 and older in 2000 was slightly more than $19 billion: $0.2 billion ($179 million) for fatal falls and $19 billion for nonfatal falls.17 Women suffer a more complicated course for falls.18 In 2000, the costs of both fatal and nonfatal falls were higher for women than for men. Medical costs for women, who made up 58% of older adults in 2000, were two to three times higher than for men.19
In conclusion, there is a mounting evidence for the use of Tai Chi to prevent falls. The frequency of Tai Chi interventions was one hour once a week from for one to three days. All trials showed benefit.
Recent Review Papers
Recently, Lee et al published several review papers examining the evidence of Tai Chi for a number of conditions, including those listed below:
- Diabetes20
- Osteoporosis21
- Osteoarthritis22
- Cardiovascular Diseases23
- Rheumatoid Arthritis24
- Supportive Treatment for Cancer25
Diabetes
Regular exercise should be a cornerstone of effective diabetes management. It has been shown that regular practice of Tai Chi is equivalent to the amount of aerobic exercise intensity normally recommended for Type 2 diabetics.26 Tai Chi also has been shown to decrease insulin resistance.27
This systematic review by Lee et al concluded that the evidence supporting the practice of Tai Chi for treating Type 2 diabetes is scarce and not convincing. Lee et al's review was limited to studies conducted up to 2006.
In 2007, Tsang and colleagues published the results of a randomized, controlled trial studying the effects of Tai Chi on glucose homeostasis and insulin sensitivity.28 Tsang et al used 24 simplified Yang style one hour twice a week for 16 weeks, which is similar to the fall prevention Tai Chi protocol. Tsang et al found no effect of Tai Chi on improvement of insulin sensitivity. They concluded that the simplified 24 Yang style may not be sufficient. In 2008, Tsang et al published results of another randomized, controlled trial exploring the health benefits of Tai Chi for older people with type 2 diabetes.29 In this study, Tai Chi for Diabetes, which was developed to address health related problems in diabetes, was used. Again, the Tai Chi instructions were taught one hour twice a week for 16 weeks. The results were again negative. Tsang et al concluded that the frequency of Tai Chi instructions and the intensity of Tai Chi for diabetes may exceed what was required for the fall prevention trials.
Osteoporosis
Lee et al published the findings of the effect of Tai Chi for osteoporosis in 2008.30 The review included five randomized clinical trials and two controlled clinical trials. Overall, Lee et al concluded that the evidence for Tai Chi in the prevention or treatment is not convincing.
However, three randomized, controlled studies documented the benefits of Tai Chi to include deceleration of bone loss in early postmenopausal women and, in fact, a possible increase in bone density. Of interest, is the fact that for the trials showing positive results, women were required to participate in Tai Chi five times a week. Again, the prevention or the treatment of osteoporosis may require more intensity and frequency of Tai Chi instructions than for the fall prevention.
Osteoarthritis
Lee et al published the findings of the effect of Tai Chi for osteoarthritis in 2007.31 A review analyzed the findings of five randomized clinical trials and seven controlled clinical trials. Although two of the randomized, controlled trials concluded that there was significant pain reduction on the visual analog scale, Lee et al concluded that there is evidence suggesting that Tai Chi may be effective for pain control in patients with knee osteoarthritis. However, the evidence was not convincing for improvement of physical function.
Since the publication, there were two more randomized, controlled trials supporting the usefulness of Tai Chi for management of osteoarthritis. Fransen and colleagues published the results of a randomized, controlled clinical trial comparing hydrotherapy vs Tai Chi.32 A total of 152 participants were randomly divided into hydrotherapy classes, Tai Chi classes, and wait list control group. Outcomes were measured at 12 weeks and 24 weeks after the randomization, and included pain and physical function. Both Tai Chi and hydrotherapy groups displayed statistically significant improvements compared to the wait list control group.
Another randomized, controlled trial was published in 2007 by Song and colleagues exploring the effects of Tai Chi on arthritis symptoms in women with osteoarthritis. The result showed that, at the end of 12 weeks of Tai Chi exercise, the Tai Chi group perceived significantly less joint pain (P = 0.03) and stiffness (P = 0.03).
Cardiovascular Disease
In 1999, Young and colleagues published a study to compare the effects of Tai Chi, compared with aerobic exercises, on blood pressure in 62 subjects aged 60 and older suffering from high blood pressure.33 The Tai Chi group received a low intensity Tai Chi instruction. In the control group, aerobic exercises were performed at 40-60% of heart rate reserve. All exercises were performed during 12 weeks, twice a week for one hour. In both groups, significant reductions in blood pressure were recorded; there were no differences between the two groups. The findings that Tai Chi was comparable to aerobic exercise was a surprise at first.
Since then, there have been more than 160 studies to date exploring the cardiovascular benefits of Tai Chi. Lee et al published the findings of a systematic review in 2007 evaluating nine randomized, controlled trials.34 They concluded that there is evidence suggesting blood pressure reduction in patients with hypertension. For other cardiovascular diseases, such as stroke and chronic heart failure, there is also some evidence that Tai Chi may be helpful.
Rheumatoid Arthritis
Lee et al published the findings of a systematic review in 2007 evaluating two randomized, controlled trials and three controlled clinical trials. They concluded that the evidence is not convincing for the health benefits of Tai Chi for rheumatoid arthritis. These findings are similar with the Cochrane Database, which states that results suggest Tai Chi does not exacerbate symptoms of rheumatoid arthritis.35 Either way, Tai Chi has shown to have statistically significant benefits on lower extremity range of motion, particularly the ankle's range of motion for people with rheumatoid arthritis.
Supportive Treatment for Cancer
Lee et al published the results of a systematic review evaluating three randomized clinical trials and one controlled clinical trial. All of the studies were for patients with breast cancer. Two randomized, controlled trials reported significant differences in psychological and physiological symptoms compared to psychosocial support control.
Conclusion
Given the safety and wide range of benefits, Tai Chi should be considered in women for fall prevention, osteoporosis, and breast cancer supportive therapy. There appears to be definite benefits, such as blood pressure reduction, and suggested benefits in both osteoarthritis and rheumatoid arthritis.
References
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Kim YH. Health benefits of Tai Chi. Altern Ther Women’s Health. 2008;10:25-29.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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