By Shirley Vanderbilt
Originally published in Massage & Bodywork magazine, April/May 2003.
Associated Bodywork and Massage Professionals. All rights reserved.
The body movements of tai chi, so graceful and fluid, have long been practiced by both young and old in Eastern cultures. This ancient conditioning exercise, also referred to as tai chi chuan (T’ai Chi Ch’uan or TCC), is rooted in martial arts folk tradition, with “chuan” meaning “boxing,” sometimes referred to as shadow boxing. An exercise in mind and consciousness, the movements are representative of the circular, encompassing state of the universe, bringing “serenity in action and action in serenity.1
More recently, tai chi has enjoyed great popularity by followers here in the United States. Over the years, results of studies on the benefits of tai chi have trickled in, many from China, primarily touting its success in promoting balance and agility for the older population. Now researchers are finding tai chi may be doing more than keeping our elders balanced and free from falls. It also increases microcirculatory function and may retard bone loss in postmenopausal women. It has even been found to provide heart transplant recipients a sense of “empowered” new hearts.
In what has sometimes been referred to as the “graying” of America, our society is experiencing a steady increase in the aging population. For many in this group, advancing age brings a concomitant decline in health, especially in the form of brittle bones, loss of agility and vascular problems. Falls are a common risk and the accompanying injuries can mean long periods of immobility leading to other serious health problems and even depression. We all know that moderate exercise is a wellness preservative, but the more rigorous forms we choose in our early years may not serve us well when we grow older. As a gentle form of exercise, tai chi is especially appropriate for aging bodies because of its low velocity and physical impact.
In 2001, researchers at The Chinese University of Hong Kong published a review of controlled experimental studies and clinical trials on tai chi, with the purpose of assessing benefits in several areas. Many of the Chinese language reports had not been introduced into Western literature. The 31 original studies involved a total of 2,216 subjects of both genders. In addition to general benefits to cardio-respiratory function, immune capacity, mental control, flexibility and balance function, researchers noted evidence that tai chi improved muscle strength and reduced the risk of falls in the elderly.2
However, in a review published in Journal of the American Geriatrics Society the following year, Ge Wu, Ph.D., of the physical therapy department at the University of Vermont, stated results of studies of tai chi for balance and fall prevention conducted over the past decade were scattered and inconsistent. Examining 16 studies, of which 11 were longitudinal, he noted wide variations in subject populations, measurements and tai chi protocol. These discrepancies are important in evaluating current results as well as establishing goals for future research. Among the variations in measurements, Wu found stability and balance testing ranged from self-report to functional measures (such as single-leg stance, Romberg stance or walking) to laboratory-based measures. While studies included both genders, they were loaded toward female subjects. Wu noted, “Studies have shown that women have worse balance than men and that their balance is less likely to improve with exercise interventions.” In addition, there was variation in style of tai chi — yang, wu or tai chi chih, each of which requires a different stance which may, in turn, affect the degree of influence on balance and strength.3 With this information in mind, we examine several more recent studies published after completion of these reviews.
A group of Taiwanese physicians at Chang Gung University in Taipei included 14 healthy, active older subjects as their control group in assessing the effects of tai chi on postural stability in the elderly. Using a biomechanical laboratory setting, the team evaluated both a simple postural condition, and then a more challenging condition with simultaneous disturbance of vision and proprioception. The experimental group of 25, TCC practitioners with more than two years daily (30 to 60 minutes) practice of high intensity, showed better postural stability than controls in the more challenging conditions. Researchers in this 2001 study concluded, “TCC as a coordination exercise may reduce the risk of falling by maintaining the ability of posture control.” But, as Wu noted in other studies, the subjects were disproportionately women.4
Older women in retirement communities in southeast Georgia were the subjects of a study by nursing professor Helen Taggart published in 2002. Using a single factor, within-subjects design, Taggart evaluated the effects of tai chi on balance, functional mobility and fear of falling in a group of 45 women over age 65. The exercise, led by a tai chi instructor, was performed in twice-weekly, 30-minute sessions over a period of three months. Statistically significant improvements were reported in all measures with Taggart concluding, “Tai chi is economically and practically appropriate for this population of older adults.”5
Following his review, Wu published a report in late 2002 on the effects of long-term tai chi practice for the improvement of knee extensor strength and reduction of postural sway in the elderly. Using retired faculty members from Beijing, China, universities, he compared a physically active control group of 19 subjects with tai chi practitioners. The experimental group of 20 had practiced regularly over a period of three years (hour-long sessions, three times weekly). Wu sought to clarify underlying mechanisms in the positive effect of tai chi on postural stability and reducing falls. Measurements were taken for stability and isokinetic muscle strength in knee extensors and knee flexors. His results showed that tai chi practice does, in fact, improve or maintain strength of postural muscles in the lower extremities, which influences good postural stability.6
Expanding the Reach of Tai Chi
The effect of tai chi on one aspect of aging — the decline in peripheral circulatory function — was examined by physical therapy researchers in Taiwan (2002). The study team gathered lab results on 10 older men (mean age 69.5) who had been practicing tang TCC for at least three years, three times weekly. Measurements included minute ventilation and oxygen consumption during bicycle exercise, venous function, hyperemic arterial blood flow and cutaneous vascular responsiveness to an agonist (a drug that mimics the body’s own regulatory function7). These same measurements were also conducted on a group of 10 sedentary men in the same age range, and 12 sedentary younger men averaging age 23.5 The TCC men were found to exhibit “greater endothelium-dependent dilation in skin vasculature than older sedentary men” and displayed measurements similar to the younger group in venous and arterial hemodynamic variables.8 Authors concluded: “TCC training in older individuals is associated with improved peripheral circulatory function and may prove to be a suitable exercise for helping older people to prevent peripheral vascular diseases.”9
In another interesting approach from Taiwan, nursing researchers took a look at the experiences of exercise among eight heart transplant patients, ages 40 to 64 (mean=55.9). Training in tai chi was one of several traditional Chinese exercises offered to patients over the 10-week, three-times-a-week program. According to the study team, “The patients continuously felt their hearts being strengthened after taking exercise training while, at the same time, they felt their physical and mental conditions were improving. The patients did experience how exercise helped them instill ‘power’ into their new heart and body.” Although limited by sample size and other methodological considerations, this study opens an intriguing avenue for continued research.10
Building on evidence that exercise positively impacts bone mineral density (BMD), a study team at Chinese University of Hong Kong recently assessed tai chi’s impact in retarding bone loss in postmenopausal women. Comparing a group of regular TCC exercisers (3.5 hours/weekly for at least the past four years) with an equal number of non-TCC practitioners (physically inactive or engaged in minor, irregular exercise weekly), the team conducted baseline measurements of BMD in the lumbar spine, proximal femur and distal tibia, with repeat measurements one year later. During the study period, the TCC group continued their regular practice while the control group refrained from physical exercise. Although both groups showed generalized bone loss at follow-up, the 17 TCC participants exhibited higher BMD at baseline and a decelerated rate of loss on follow-up, with a significantly reduced rate of loss in the tibia area. Methodological limitations included small sample size, lack of tai chi protocol control and possible inequity in lifestyle activity between the two groups.11
As with everything in life, individuals can differ in their beneficial response to a particular tai chi protocol. A study group at Oregon Research Institute in Eugene, Ore., conducted a reanalysis of a tai chi intervention data set to determine if any subgroups of their study sample could be separated from the overall mean beneficial result. Their findings (published 2002) indicated “participants with initial low levels of physical function, who reported low levels of health perceptions and high levels of depression at baseline, tended to benefit more in terms of changes in physical function than those with higher perceptions of health and lower depression.”12 This is not to say participants with a pre-existing higher physical functioning cannot show the same benefits; but perhaps it could indicate a need to test this group for benefit within a more vigorous or higher intensity practice. These differences are significant in examining end results. Within a heterogeneous group of elderly participants, although there may be a significant mean effect, that averaged mean can mask the wide variance of individual subject response.13
Overall, regular practice of tai chi appears to positively impact the health and physical functioning of the elderly. But, according to research from the Fooyin Institute of Technology in Kaohsiung, Taiwan (2001), facilitating its acceptance in the senior population may require an examination of potential barriers in elders’ attitudes and misconceptions. A team of nursing professors surveyed 80 community-dwelling elders (mean age 74.3 years), of whom 40 were tai chi practitioners, regarding their views on initiating and continuing tai chi practice. The results closely resemble research findings for elders’ exercise in general and offer valuable information for initiating increased involvement of elders in tai chi exercise.
Encouragement from friends and family, as well as positive health outcomes, played a significant part in elders’ desire to begin and continue the practice. For non-participants, barriers included fear of being too weak, negative body image (too old or fat), lack of knowledge, and time or situational constraints. Authors emphasized the importance for healthcare practitioners to become instrumental in overcoming these barriers and promoting tai chi as a health practice for elders.14 Massage therapists and bodyworkers can help educate and encourage clients to investigate this alternative approach for growing old gracefully.