October 2012 Issue

Tai Chi — A Centuries-Old Practice That Heals Body, Mind, and Spirit
By Jennifer Van Pelt, MA
Today’s Dietitian
Vol. 14 No. 10 P. 76

Tai chi, a shortened form of the phrase t’ai chi ch’uan, which is loosely translated as “boundless fist,” originated centuries ago in China. It’s practiced as a sport, as a martial art with or without weapons, and/or for its health benefits.

Tai chi involves slow, continuous whole-body movements linked together in “forms” and integrated with controlled breathing and mental focus. According to traditional Chinese medicine, movements and breathing are designed to stimulate the flow of qi (pronounced “chee”), or life energy, thereby improving health and vitality. (The word “qi” is different from “chi” in the word tai chi.)

Practicing tai chi promotes the balance and harmony of the universal yin and yang. One doesn’t have to believe in this philosophy, however, to practice tai chi and derive its physical health benefits. Tai chi is considered to be a type of qigong, translated as “energy work,” that involves coordinated breathing, slow movement, and awareness. The two types of practices are closely related and may be performed separately or together. Elements of qigong are included in tai chi training. Qigong, when practiced separately, focuses more on meditation and healing and includes seated or lying exercises. Tai chi movements are all taught from a standing position.

The tai chi style practiced today for its health and fitness benefits is based on the Sun style, which was developed in the late 19th century and involves gentler movements practiced in a more upright stance. However, there are several tai chi styles, including some with faster and more powerful movements.

According to the National Center for Complementary and Alternative Medicine, more than 2.3 million Americans practice tai chi for mind-body benefits, such as improved balance and coordination, better physical condition, and relaxation and stress relief.

“Tai chi is often described as ‘meditation in motion,’ but it might well be called ‘medication in motion,’” according to a Harvard Medical School report.1 According to several published studies from researchers worldwide, there are many medical benefits associated with tai chi. Established benefits include improved balance, which helps prevent falls in the elderly, and better functioning and pain relief in those with arthritis. Emerging evidence suggests tai chi also may provide benefits for patients recovering from breast cancer and those with heart failure, hypertension, osteoporosis, Parkinson’s disease, sleep problems, stroke, anxiety, and depression.

This article will review how tai chi may benefit those with arthritis and depression.

Arthritis Relief
Osteoarthritis is the most common joint disorder, affecting about 27 million Americans. Rheumatoid arthritis affects approximately 2 million more. Symptoms include difficulty walking and grasping, balance problems, muscle weakness, joint stiffness, and pain.

Tai chi is the most studied mind-body exercise for managing arthritis. Systematic reviews have concluded that tai chi has better outcomes than water exercise and mixed exercise (aerobic, strength, and flexibility training) for improving daily living activities and quality of life for individuals with arthritis.2,3 Recent randomized trials reported that tai chi enhanced knee muscle endurance, increased bone mineral density, reduced pain, increased physical functioning and quality of life, and reduced fear of falling in older adults with osteoarthritis.3-5

Although earlier research reviews didn’t find a substantial benefit for patients with rheumatoid arthritis, a small 2010 study reported improvements in leg muscle function, overall physical condition, confidence in moving, balance, and pain during exercise and daily life in female patients.6

The smooth, flowing upper and lower body movements are easy on the joints while simultaneously strengthening muscles. Because body weight is constantly shifted from leg to leg with both knees flexed during tai chi, leg strength and balance are increased. Hand movements and positioning may help alleviate wrist and hand arthritis pain.
The Tai Chi for Arthritis program (www.taichiforarthritis.com), developed by an Australian family physician who has arthritis himself, eliminates higher-risk tai chi movements and focuses specifically on movements that benefit people with the condition.

Lifting the Spirits
Tai chi’s benefits for depression are less studied, but recent research indicates that, like yoga, tai chi’s mind-body emphasis can aid mental health. A large review of almost 4,000 participants concluded that one year of tai chi significantly improved psychological well-being and reduced stress, anxiety, and depression in both healthy individuals and patients with various chronic conditions.7

Tai chi headlined in The New York Times in March 2011 after researchers reported that it markedly improved depression symptoms in elderly patients who didn’t respond to antidepressant treatment. Because depressed older adults often are prescribed an additional antidepressant when they don’t respond to initial antidepressant treatment, medication side effects are common. Researchers suggested that adding tai chi could reduce the need for prescribed medications.8,9

Tai chi’s positive effect on depressed individuals is likely a combination of physical exercise, socialization with other class participants, and breathing exercises. Participants in tai chi research studies reported that their sleep quality improved and overall stress level was reduced.1,2,7

Advice for Clients
The best class for those with arthritis to attend is the specially designed Tai Chi for Arthritis program endorsed by the Arthritis Foundation. Clients can find class locations at www.arthritis.org/tai-chi.php. Or they can check local community centers, senior centers, and gyms for gentle tai chi classes. If there are no programs offered in a client’s area, he or she can purchase a DVD for home use from the same website. Tai chi classes that emphasize balance and mobility or the DVD Discover Tai Chi for Balance & Mobility also are appropriate for arthritic clients. 

Tai chi classes generally aren’t advertised specifically for depression. Gentle and arthritis tai chi classes will provide mental health as well as fitness benefits for older clients with depression. For younger clients who are more active and don’t have physical limitations, more vigorous tai chi classes offered at martial arts facilities, yoga studios, and gyms may be more appealing.

Clients in wheelchairs or with other movement limitations should look for facilities and instructors who are experienced in accommodating seated participants. Tai chi hand movements and breathing exercises performed while seated can provide benefits for these clients.

Military veterans with combat-related depression and/or posttraumatic stress disorder may find tai chi programs offered at local VA hospitals and veterans organizations. Tai chi and other mind-body exercises are being researched and employed by the military to aid veterans with physical injuries and mental health issues.

Research on tai chi for other medical conditions is ongoing. The Tai Chi for Health Institute recently expanded its offerings to include specialized class formats for patients with diabetes and back pain, and it’s expected that interest in tai chi’s mind-body benefits will continue to increase among clients.

— Jennifer Van Pelt, MA, is a certified group fitness instructor and healthcare research analyst/consultant in the Reading, Pennsylvania, area.

1. The health benefits of tai chi. Harvard Health Publications website. http://www.health.harvard.edu/newsletters/Harvard_Womens_Health_Watch/2009/May/The-health-benefits-of-tai-chi. May 2009. Accessed August 13, 2012. 

2. Chyu M-C, von Bergen V, Brismée J-M, Zhang Y, Yeh JK, Shen C-L. Complementary and alternative exercises for management of osteoarthritis. Arthritis. 2011;2011:364319.

3. Lee HJ, Park HJ, Chae Y, et al. Tai Chi Qigong for the quality of life of patients with knee osteoarthritis: a pilot, randomized, waiting list controlled trial. Clin Rehabil. 2009;23(6):504-511.

4. Wang C, Schmid CH, Hibberd PL, et al. Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial. Arthritis Rheum. 2009;61(11):1545-1553.

5. Song R, Roberts BL, Lee EO, Lam P, Bae SC. A randomized study of the effects of t’ai chi on muscle strength, bone mineral density, and fear of falling in women with osteoarthritis. J Altern Complement Med. 2010;16(3):227-233.

6. Uhlig T, Fongen C, Steen E, Christie A, Ødegård S. Exploring Tai Chi in rheumatoid arthritis: a quantitative and qualitative study. BMC Musculoskelet Disord. 2010;11:43.

7. Wang C, Bannuru R, Ramel J, Kupelnick B, Scott T, Schmid CH. Tai Chi on psychological well-being: systematic review and meta-analysis. BMC Complement Altern Med. 2010;10:23.

8. Lavretsky H, Alstein LL, Olmstead RE, et al. Complementary use of tai chi chih augments escitalopram treatment of geriatric depression: a randomized controlled trial. Am J Geriatr Psychiatry. 2011;19(10):839-850.

9. Parker-Pope T. Tai chi eases depression in elderly. The New York Times website. http://well.blogs.nytimes.com/2011/03/18/tai-chi-eases-depression-in-elderly. March 18, 2011. Accessed August 13, 2012.