Clinical Trials Show How|
Tai Chi Chuan Helps Heart, Arthritis, Motor Function
by Bill Gallagher PT, MS, CMT, CYT
Director, East West Rehabilitation Institute
Tai Chi Chuan (Taijiquan, T’ai Ch’i) is commonly categorized by rehab practitioners as a complementary or alternative therapy. To some, the labels alternative and complementary mean that it is not proven effective. Furthermore, Tai Chi Chuan is an exercise developed and perpetuated by Taoist physician/martial artists who speak in terms of vital energy or "Qi" flow, scientifically ambiguous terms, difficult for some to accept. However, the use of Tai Chi Chuan for wellness and rehabilitation is well supported by scientific research. The following is just a small sampling of clinical trials published in scientific journals that demonstrate the benefits of Tai Chi Chuan.
Tai Chi Chuan is an excellent way to train the cardiovascular system. Lan from National Taiwan University published a series of studies in this area. In one study, he completed a cross-sectional survey demonstrating a significant difference in VO2 max (maximum oxygen uptake- a key measure of cardiovascular fitness) between long-time practitioners of Tai Chi Chuan and a control group of non-exercisers.1 Lan re-measured VO2 max two years later in a follow-up study. In this prospective study he found that Tai Chi Chuan practitioners had less of a decrease in VO2 max over time.2 These two studies suggest that Tai Chi Chuan can slow down the deterioration of the cardiovascular system. The same group designed a prospective study of 38 elderly non-exercisers.3 Half were taught Tai Chi Chuan and the other half served as controls. They found that VO2 max increased for those that learned the Tai Chi Chuan form. This data supports the conclusion that practicing Tai Chi Chuan benefits the cardiovascular system.
Tai Chi can be both a preventive and restorative therapy for the cardiovascular system. In a prospective study of 126 patients, Channer compared Tai Chi Chuan, aerobics and no treatment after heart attack. He found that diastolic blood pressure went down in the Tai Chi Chuan group but not in the other groups.4
A recent study by Lan also examined subjects after coronary artery bypass surgery during cardiac rehab.5 This prospective study compared cardiovascular health in nine patients who participated in Tai Chi Chuan versus 11 control patients who completed an orthodox home exercise program. They found higher adherence to the exercise program, and significant improvements in VO2 peak, and peak work rate in the Tai Chi Chuan group. In contrast, the control group subjects declined in all measures, and were less adherent to the orthodox cardiac exercise program.
One of the strengths of Tai Chi Chuan is that it can deliver an excellent cardiovascular challenge without exposing the joints to the possibility of injury inherent to high impact activities. This is especially important for elders. Past studies have demonstrated that elderly people can reach 50 percent to 70 percent of their target heart rate during practice of Tai Chi Chuan.3 Moreover, it has been shown to give a moderate cardiovascular workout.6 For the younger population, Tai Chi Chuan can easily be adapted to be more taxing on the cardiovascular system by taking deeper stances, holding challenging positions longer and playing "push hands," a two-person exercise that helps develop sensitivity and power.
It seems obvious that Tai Chi Chuan would be an excellent exercise for people with arthritis. Other exercise regimens, like swimming or biking, prescribed for people with arthritis avoid or minimize impact. The advantage of Tai Chi Chuan is that it is very low-impact exercise and performed in functional, weight bearing positions. It appears to strengthen bones and connective tissue and, as already discussed, also seems to benefit the cardiovascular system without exacerbating arthritic symptoms. Two papers have demonstrated that people with rheumatoid arthritis can safely practice Tai Chi Chuan without exacerbating symptoms. Kirsteins divided 40 patients in two groups: 20 controls and 20 who participated in Tai Chi Chuan. He found that Tai Chi caused no significant exacerbation of joint symptoms. He concluded that Tai Chi Chuan could serve as an integral part of their rehabilitation program.7 In a second randomized prospective study, 16 patients who participated in a Tai Chi Chuan program were found to have greater upper extremity range of motion than the control group who did not participate in any exercise program.8
Motor Control Research
One area just beginning to be explored is Tai Chi Chuan’s effect on motor control. Jin Yan at the University of Houston examined the effect of Tai Chi on the task of force output while performing arm movements. In this study, he compared linear and curvilinear manual aiming movements between participants of Tai Chi Chuan as an exercise (n=12) and a group who walked or jogged (n=8), and found the Tai Chi Chuan group moved with significantly less pressure variability than the control group.9
Yan hypothesized that Tai Chi Chuan is a whole body activity that improves integration of the sensory and motor systems, thereby training the student to optimize motor control. Since the movements are slow and smooth and require remembering a set sequence, the participants have time to process sensorimotor information into a full body movement. Although this is the only paper known to the authors examining motor control, it is clearly an area that holds promise.
Falls and Balance
A review of Tai Chi Chuan and research would not be complete without discussion of the FICSIT study (Frailty and Injuries: Cooperative Studies of Intervention Techniques). There were more than 2,000 participants in the study sites from eight cities. This study compared the effect of interventions like strength training, endurance training and orthodox balance training to Tai Chi Chuan. The key finding was that the Tai Chi Chuan group reduced their risk of falling by 47.5 percent. In addition to reducing falls, psychological benefits were also seen. The Tai Chi Chuan group reported less fear of falling and more self-confidence.
Tai Chi Chuan is a physically and mentally challenging exercise. This article has reviewed only ten of the hundreds articles evaluating Tai Chi in the scientific literature. Evidence of benefits achieved using Tai Chi Chuan as therapeutic exercise is clear. It is strengthened by a collection of research that broadens and deepens each year. Tai Chi has demonstrated usefulness in treating cardiac conditions, arthritis and balance disorders. Beyond that, it appears to be very useful for wellness, fall prevention and motor control. Lastly, in almost all of the research, compliance results are higher in the group that practiced Tai Chi Chuan. Beyond being a healthy, restorative exercise, it is also more likely to be practiced at home than conventional therapeutic exercise. When a skeptic asks, "Why learn Tai Chi Chuan to?" you can now cite scientific literature demonstrating that Tai Chi Chuan is as beneficial as your intuition suggests it is.
1. Lan, C., Lai, J., & Wong, M. (1996). Cardiorespiratory function, flexibility, and body composition among geriatric Tai Chi Chuan practitioners. Archives of Physical and Medical Rehabilitation, 77, 612-616.
2. Lai, J., Lan, C., Wong, M., & Teng, J. (1995). Two-year trends in cardiorespiratory function among older Tai Chi Chuan practitioners and sedentary subjects. Journal of the American Geriatric Society, 43, 1222-1227.
3. Lan, C., Lai, J., Chen, S., & Wong, M. (1998). Twelve-month Tai Chi training in the elderly: Its effect on health fitness. Medical Science and Sports Exercise, 30(3), 345-351.
4. Channer, K.S., Barrow, D., Barrow, R., Osborne, M., & Ives, G. (1996). Changes in hemodynamic parameters following Tai Chi Chuan and aerobic exercise in patients recovering from acute myocardial infarction. Postgraduate Medical Journal, 72(848), 349-351.
5. Lan, C., Chen, S., & Wong, M. (1999). The effect of Tai Chi on cardiorespiratory function in patients with coronary artery bypass surgery. Medical Science and Sports Exercise, 31(5), 634-638.
6. Zhuo, D., Shephard, R., Plyley, M., & Davis, G. (1984). Cardiorespiratory and metabolic responses during Tai Chi Chuan exercise. Canadian Journal of Applied Sport Science, 9(1), 7-10.
7. Kirsteins, A., Dietz, F., & Hwang, S. (1991). Evaluating the safety and potential use of a weight-bearing exercise Tai Chi Chuan for rheumatoid arthritis patients. American Journal of Physical and Medical Rehabilitation, 70(3), 136-141.
8. Deusen, J., . (1987). The efficacy of the ROM dance program for adults with rheumatoid arthritis. American Journal of Occupational Therapy, 41(2), 90-95.
9. Yan, J. (1999). Tai Chi practice reduces movement force variability for seniors. Journal of Gerontology, 54(12), M629-M634.
10. Province, M., & Hornbrook, M., . (1995). The effects of exercise on falls in elderly patients: A preplanned meta-analysis of the FICSIT trials. JAMA, 273(17), 1341-1347.
Bill Gallagher PT, CMT, CYT, is Director of the East West Rehabilitation Institute in New York City. He has developed a uniquely integrative approach to help people suffering from pain and disability. By integrating the Physical Therapy traditions of the East (Yoga, Qigong, Taijiquan, Tuina) with cutting edge therapies of the West (Osteopathy, Biofeedback, Myofascial Release), Bill helps his clients maximize function & minimize pain. Through meditation instruction, guided imagery, biofeedback & other disciplines that work with the Mind-Body-Spirit, clients are further empowered to optimize function & comfort while reducing suffering. Bill is recognized as an authority on Integrative/Mind Body/Complementary rehabilitation & teaches his visionary synthesis to both practicing rehab specialists & at several Physical Therapy schools including Columbia University. Visit his website at www.EastWestRehab.com, email BillGPT@bellatlantic.net or call (212) 781-2626.