Health Benefits of Tai Chi
By Yoon Hang Kim, MD, MPH, and Jeanne Bowers. Dr. Kim is 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 and balance Qi or biofield energy. In Chinese medicine, activities cultivating Qi 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 parks.
The physical techniques of Tai Chi are described in the Tai Chi Classics (a set of writings 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 in relaxation, rather than muscular tension, in order to neutralize or initiate attacks.2 The traditional study of Tai Chi focuses primarily on three subjects: health, meditation, and martial arts. Tai Chi is taught as a form consisting of a varying amount of postures depending on the style of Tai Chi, of which many exist.
In the west, Tai Chi has been advocated for development of the mind-body connection, breathing regulation combined with body movement, and meditation.3 Despite the relative 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 frequently practiced as a means to improve quality of life.5
The purpose of this review is to summarize studies that have examined the effect of Tai Chi on 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 individuals to learn to move most effectively throughout the form. By performing these 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 to determine the effectiveness of Tai Chi as a therapeutic intervention to improve balance. The study concluded that Tai Chi appeared to be of benefit. In 2003, Komagata and Newton published a comprehensive review on the effectiveness of Tai Chi on improving balance in older adults.7 In this article, more than 30 articles were reviewed and scored on methodological quality, with 11 studies meeting inclusion criteria. The authors concluded that the majority of the studies supported the effectiveness of Tai Chi with respect to improving balance. In 2004, Verhagen and colleagues published the results of a systematic review on the effectiveness of Tai Chi for fall prevention.8
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 otherwise healthy, physically inactive older individuals.9 In this study, people over 65 years were randomly divided into two groups. Those in the intervention group practiced Tai Chi exercises with instruction twice a week for one hour at a time. The control group was placed on a waiting list and was promised a four-week program at the end of the study. Primary outcome of interest was physical functioning using the SF-20, with measurements performed at baseline, 12 weeks, and 24 weeks after randomization. During the study, in physical functioning improved in the Tai Chi group by a mean of 19.8%, while the control showed 8.2% improvement.
Wolf and colleagues conducted the 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 for one hour twice a week; the second group was a computerized balance training for one hour once a week; and the third group was an education control group held for one hour once a week. Outcome measures were recorded at baseline, 15 weeks after randomization, and at four months follow-up. In the Tai Chi group, a significant and marked 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 of 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). 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. Li et al concluded that a three-times-per-week, six-month Tai Chi program is effective in decreasing number of falls, the risk of falling, and the fear of falling, and that it improves functional balance and physical performance in physically inactive persons aged 70 years or older.
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.12 In this study, 702 participants were randomly divided into a Tai Chi group and a wait list control group. The Tai Chi group received one hour of instruction once a week for 16 weeks. Measurements were recorded at 16 weeks and 24 weeks (to examine potential residual effect). Results showed that falls were less frequent in the Tai Chi group than in the control group (P = 0.02).
The significance of these studies is that they all showed Tai Chi to reduce the risk of falling. This is significant because more than one-third of adults 65 and older fall each year.13 Of those who fall, 20%-30% suffer moderate-to-severe injuries that make it hard to get around or live alone, and increase the chance of early death.14 Older adults are hospitalized for fall-related injuries five times more often than they are for injuries from other causes.15 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.16 Women suffer a more complicated course for falls.17 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.18
In conclusion, there is mounting evidence for the use of Tai Chi to prevent falls. The frequency of Tai Chi intervention typically recommended is one hour anywhere from 1-3 times per week from.
Clinical Studies
Recently, Lee and colleagues published several review papers examining the evidence of Tai Chi for a number of conditions including below conditions:
- Diabetes
- Osteoporosis
- Osteoarthritis
- Cardiovascular Diseases
- Rheumatoid Arthritis
- Supportive Treatment for Cancer
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 diabetes.19 Tai Chi also has been shown to decrease insulin resistance.20
The systematic review by Lee et al concluded, however, that the evidence supporting the practice of Tai Chi for treating Type 2 is scarce and not convincing.21 Lee et al's review was limited to studies conducted up to 2006.
In 2007, Tsang et al published the results of a randomized, controlled trial studying the effects of Tai Chi on glucose homeostasis and insulin sensitivity.22 They used 24 simplified Yang Style movements one hour twice a week for 16 weeks, which is similar to the frequently recommended fall prevention Tai Chi protocol. The authors found no effect of Tai Chi on improvement of insulin sensitivity. In 2008, Tsang et al published the results of another randomized, controlled trial exploring the health benefits of Tai Chi for older people with type 2 diabetes.23 Again, Tai Chi instructions were offered one hour twice a week for 16 weeks. The results were again negative. The authors 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 2008.24 The review included five randomized clinical trials and two controlled clinical trials. Overall, the authors concluded that the evidence for Tai Chi in the prevention or treatment of osteoporosis 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, an increase in bone density. Of interest is the fact that the trials suggest that positive results required the women 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 noted for fall prevention.
Osteoarthritis
Lee et al published an analysis of the effect of Tai Chi for osteoarthritis in 2007.25 The review analyzed the findings of five randomized clinical trials and seven controlled clinical trials. Although only two of the randomized, controlled trials concluded that there was significant pain reduction as determined on 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 publication of Lee's review, there have been 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.26 A total of 152 participants were randomly divided into hydrotherapy classes, Tai Chi classes, and a wait list control group. Outcomes were measured at 12 weeks and 24 weeks after 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 symptoms in women with osteoarthritis. The results showed that, at the end of 12 weeks, the Tai Chi group perceived significantly less joint pain (P = 0.03) and stiffness (P = 0.03).
Cardiovascular Disease
In 1999, Young et al published a study comparing the effects of Tai Chi with aerobic exercises on blood pressure in 62 hypertensive subjects 60 years of age.27 The Tai Chi group received low-intensity Tai Chi instruction. In the exercise group, aerobic exercises were performed at 40%-60% of heart rate reserve. All exercises were performed over 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 conclusion that Tai Chi was comparable to aerobic exercises was a surprise to many.
Since then, there have been more than 160 additional 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.28 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.29 The authors concluded that the evidence is not convincing for the health benefits of Tai Chi for rheumatoid arthritis. This finding can be taken together with a Cochrane Database review, which stated that results suggest Tai Chi does not exacerbate symptoms of rheumatoid arthritis. Tai Chi does, however, appear to offer statistically significant differences on lower extremity range of motion, in particular ankle 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.30 All of the studies were for patients with breast cancer. Two randomized, controlled trials reported significant improvements in psychological and physiological symptoms compared to psychosocial support control.
Conclusion
Given its safety and wide range of benefits, Tai Chi can be considered as adjunctive therapy in the settings of osteoporosis and breast cancer supportive therapy. There also appear to be therapeutic benefits with respect to lowering of blood pressure, and suggested benefits in osteoarthritis and, to a lesser extent, rheumatoid arthritis. Healthcare practitioners can refer patients to classes, or even for one-on-one instruction.
References
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Kim YH. Health benefits of Tai Chi. 2008;11:53-56.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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