December 2009 Issue

Good Move — Consider Tai Chi for Better Diabetes Control
By Lindsey Getz
Today’s Dietitian
Vol. 11 No. 12 P. 12

Science recently uncovered a good reason to recommend meditative physical exercise to your patients with diabetes. According to a University of Florida study, a regular tai chi exercise program may help lower blood glucose levels, allowing people with diabetes to better control their disease.

Looking at adults with type 2 diabetes, the study found that participants who were involved with a supervised tai chi exercise program two days per week with three days of home practice for six months lowered their fasting blood glucose levels, better managed their disease, and improved their overall quality of life compared with those who participated at a much lower level of intervention.

Tai chi is an ancient Chinese form of meditation that combines breathing and relaxation techniques with slow, deliberate movements. Study author Beverly Roberts, PhD, RN, FAAN, FGSA, the Annabel Davis Jenks endowed professor for teaching and research in clinical nursing excellence at the University of Florida College of Nursing, says studies such as hers have demonstrated the practice’s vast health benefits. Along with Rhayun Song, PhD, RN, of Chungnam National University, Roberts studied tai chi’s effects on older Korean adults with type 2 diabetes. The results were featured in the June issue of The Journal of Alternative and Complementary Medicine.

Roberts says tai chi is a great recommendation for patients who don’t like to exercise. “The style and movements of tai chi are very slow—circular and fluid is a good way to think of them,” she says. “That makes it easier for people who have trouble moving quickly. It doesn’t require sweating and the huffing and puffing that are associated with other exercises. And people really like the idea of it being low impact. It’s easy on the joints and muscles.”

Diane S. Graves, MPH, RD, LD, CLT, owner of No Nonsense Nutrition in Austin, Tex., says that’s one of the primary reasons she recommends tai chi to her patients. “Many people who come to see me don’t like to exercise and don’t really move very much,” she says. “But tai chi is low impact. It emphasizes natural movement and helps people learn how to use their bodies efficiently, effectively, and safely.”

And though it doesn’t require the same strenuous output, tai chi has similar effects to other aerobic exercises when it comes to diabetic control, says Roberts. “It’s been found that tai chi improves aerobic capacity, which is what traditional exercises like walking or jogging improve,” she explains. “So it definitely has similar effects.”

Because it’s low impact, it’s also appropriate to recommend to clients of any age or fitness level, adds Emily Gedney, RD, of EVOLUTION Bodywork & Nutrition in Rhode Island. “One of the best things about tai chi is that anyone can do it,” she says.

Bonus Benefits
In addition to its potential effect on blood glucose levels, tai chi is associated with other benefits. Graves says she began taking tai chi classes in 2001 after dealing with some health issues. Today, she’s involved in multiple classes and regularly encourages her clients to consider the exercise. “It is invigorating and relaxing at the same time, as well as socially, intellectually, and physically challenging,” she says. “It helps my focus and concentration and leaves me feeling better and more energetic afterwards.”

Tai chi’s ability to reduce stress is well documented, says Roberts. “One reason is that after learning the slow movements of the form, people become so familiar with them that they can do the movements without thinking,” she says. “That helps clear the mind; it almost becomes meditative. The other reason it can reduce stress is because tai chi teaches people to listen to their bodies. It’s not only paying attention to how the body is moving but what parts of it are tense.”

The focus required along with the slow movements, coordinated breathing, and incorporation of some of the tai chi principles turns off the cascade of stress hormones and leads to a sense of calm energy, says Graves. “Stress is at the root of many diseases in our society,” she continues. “Effectively combating stress can create an environment in the body for healing and optimal health. People who never thought it possible actually begin to enjoy being in their bodies.”

“You’d use it for the same reason you might go in for acupuncture,” adds Patti Kim, a naturopathic doctor and licensed acupuncturist at the Amrit Davaa Wellness Center in Los Angeles, who has recommended tai chi to many of her patients. “Chinese medicine and practices are based on the idea that disease or pain comes from stagnation. Our bodies have channels of energy flow. Since I’m based in L.A., I tell my patients to think of these channels as freeways. If there’s a traffic jam, there’s going to be pain or disease. We need to find avenues that allow our bodies to remain moving, alive, and nourished.”

Practicing tai chi can even help promote better eating habits, adds Gedney. “Tai chi helps you slow down and have a better understanding of your mind/body connection, giving you better control over both,” she explains. “That can actually help control mindless eating by helping you become more aware of it.”

And tai chi may also be advantageous for other patients, not only those with diabetes. As a stress-reducing exercise, it can benefit any patient, including those with ailments such as arthritis, says Roberts. “Arthritis is characterized by pain and stiffness and often limits what that person can do,” she explains. “But what’s unique about tai chi is that the movements can be done without stressing the joints. When practicing over time, people can actually gain more flexibility in their joints and even become stronger.”

People with disabilities and those suffering from balance issues have also practiced tai chi as a means of increasing strength and mobility and reducing the risk of falls. Roberts adds that future studies could investigate the effect of tai chi on conditions such as osteoporosis and heart disease, as well as the aging process. There are likely many more benefits that clients and patients can derive from practicing this ancient art.

Of course, tai chi is not ideal for everyone. Patients who need exercise to leave them sweaty and exerted may find tai chi unfulfilling. “Some say they don’t feel like they’ve really had a workout after performing tai chi,” says Graves. “If they are looking for an exercise that will exhaust them, tai chi is not for them. It is something that increases energy. When you are finished practicing, you should have more energy rather than less.”

Some individuals may initially resist trying it. In the end, many of these people find that they love it, so encourage your patients to at least give it a shot. “I wouldn’t say everyone runs to it with open arms,” says Gedney. “There are a lot of stereotypes that tend to go along with it, such as the belief that it’s going to be all chanting or something completely outrageous, which is not the case at all. People who have kept an open mind often end up really enjoying it.”

Research Before Recommending
While you may want to consider recommending tai chi to your clients, it’s important to become familiar with it first. “Before you refer a client to any class—whether it be yoga, tai chi, or something else—as a professional, it’s your responsibility to become more familiar with that class,” says Gedney, whose mother is a tai chi instructor.

Gedney has taken many classes before recommending them to her clients. “Take the class yourself so you understand what’s involved and who it’s appropriate for. I wouldn’t recommend a food or supplement that I wasn’t willing to try myself, and it’s the same with an exercise class.”

If the concept of tai chi is mostly new to you and you’re unaware of local places that teach it, do your homework. Roberts recommends borrowing tai chi DVDs or books from the library and checking with local community centers about classes. She also suggests visiting for information and to search for local classes with trustworthy instructors. Finding an experienced teacher is important. “The instructor does matter,” stresses Kim. “There are a lot of instructors out there who have only taken a few weekend seminars and don’t really have the techniques mastered themselves.”

After you find the right class and an instructor whom you can feel confident recommending to your patients, you may find that many of them report improvement. “There’s simply no way to maintain a healthy body and mind without movement,” says Graves. “Tai chi, compared with other types of exercise, creates a natural flow of energy throughout the body that is invigorating yet relaxing. It has so many benefits: reducing stress, supporting the immune system, and improving balance, agility, coordination, focus, and muscle tone. And it may even help with blood glucose control. What’s not to like?”

— Lindsey Getz is a freelance writer based in Royersford, Pa.