Tai Chi Exercise Reduces Knee Osteoarthritis Pain In The Elderly, Research Shows
ScienceDaily (Nov. 1, 2009) — Researchers from Tufts University School of Medicine have determined that patients over 65 years of age with knee osteoarthritis (OA) who engage in regular Tai Chi exercise improve physical function and experience less pain. Tai Chi (Chuan) is a traditional style of Chinese martial arts that features slow, rhythmic movements to induce mental relaxation and enhance balance, strength, flexibility, and self-efficacy.
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Full findings of the study are published in the November issue of Arthritis Care & Research, a journal of the American College of Rheumatology.
The elderly population is at most risk for developing knee OA, which results in pain, functional limitations or disabilities and a reduced quality of life. According to the Centers for Disease Control and Prevention (CDC) there are 4.3 million U.S. adults over age 60 diagnosed with knee OA, a common form of arthritis that causes wearing of joint cartilage. A recent CDC report further explains that half of American adults may develop symptoms of OA in at least one knee by age 85.
For this study, Chenchen Wang, M.D., M.Sc., and colleagues recruited 40 patients from the greater Boston area with confirmed knee OA who were in otherwise good health. The mean age of participants was 65 years with a mean body mass index of 30.0 kg/m2. Patients were randomly selected and 20 were asked to participate in 60-minute Yang style Tai Chi sessions twice weekly for 12 weeks. Each session included: a 10-minute self-massage and a review of Tai Chi principles; 30 minutes of Tai Chi movement; 10 minutes of breathing technique; and 10 minutes of relaxation.
"Tai Chi is a mind-body approach that appears to be an applicable treatment for older adults with knee OA," said Dr. Wang. Physical components of Tai Chi are consistent with current exercise recommendations for OA, which include range of motion, flexibility, muscle conditioning, and aerobic work out. Researchers believe the mental feature of Tai Chi addresses negative effects of chronic pain by promoting psychological wellbeing, life satisfaction, and perceptions of health.
The remaining 20 participants assigned to the control group attended two 60-minute class sessions per week for 12 weeks. Each control session included 40 minutes of instruction covering OA as a disease, diet and nutrition, therapies to treat OA, or physical and mental health education. The final 20 minutes consisted of stretching exercises involving the upper body, trunk, and lower body, with each stretch being held for 10-15 seconds.
At the end of the 12-week period, patients practicing Tai Chi exhibited a significant decrease in knee pain compared with those in the control group. Using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale, researchers noted a -118.80 reduction in pain from baseline between the Tai Chi and control group. Researchers also observed improved physical function, self-efficacy, depression, and health status for knee OA in subjects in the Tai Chi group. "Our observations emphasize a need to further evaluate the biologic mechanisms and approaches of Tai Chi to extend its benefits to a broader population," concluded Dr. Wang.
Monday, August 30, 2010
Tai Chi for Fibromyalgia
Laurie Barclay, MD
Freelance writer and reviewer, Medscape, LLC
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
From Medscape Medical News
Tai Chi May Be Useful to Treat Fibromyalgia
Laurie Barclay, MD
August 18, 2010 — Tai chi may be a helpful intervention for patients with fibromyalgia, according to the results of a single-blind, randomized trial reported in the August 19 issue of the New England Journal of Medicine.
"Previous research has suggested that tai chi offers a therapeutic benefit in patients with fibromyalgia," write Chenchen Wang, MD, MPH, from Tufts Medical Center, Tufts University School of Medicine in Boston, Massachusetts, and colleagues. "...[Tai chi] combines meditation with slow, gentle, graceful movements, as well as deep breathing and relaxation, to move vital energy (or qi) throughout the body. It is considered a complex, multicomponent intervention that integrates physical, psychosocial, emotional, spiritual, and behavioral elements."
Fibromyalgia was defined by American College of Rheumatology 1990 criteria. Participants (n = 66) were randomly assigned 1:1 to receive classic Yang-style tai chi or a control intervention consisting of wellness education and stretching. In both groups, participants received 60-minute sessions twice weekly for 12 weeks.
Fibromyalgia Impact Questionnaire (FIQ) score (ranging from 0 - 100) at the end of 12 weeks was the main study outcome, with higher scores indicating more severe symptoms. Secondary outcomes were summary scores on the physical and mental components of the Medical Outcomes Study 36-Item Short-Form Health Survey. To assess durability of the response, these tests were performed again at 24 weeks.
Improvements in the FIQ total score and quality of life in the tai chi group were clinically important. For this group, mean baseline and 12-week FIQ scores were 62.9 ± 15.5 and 35.1 ± 18.8, respectively, vs 68.0 ± 11 and 58.6 ± 17.6, respectively, in the control group. The mean between-group difference from baseline in the tai chi group vs the control group was −18.4 points (P < .001).
The tai chi group also fared better than the wellness intervention group in physical component scores of the Short-Form Health Survey (28.5 ± 8.4 and 37.0 ± 10.5 for the tai chi group vs 28.0 ± 7.8 and 29.4 ± 7.4 for the control group; between-group difference, 7.1 points; P = .001) and mental component scores (42.6 ± 12.2 and 50.3 ± 10.2 vs 37.8 ± 10.5 and 39.4 ± 11.9, respectively; between-group difference, 6.1 points; P = .03).
These improvements were still present at 24 weeks (FIQ score between-group difference, −18.3 points; P < .001), with no reported adverse events.
Limitations of this study include lack of double blinding, lack of generalizability because treatment was delivered by a single tai chi master at a single center, and follow-up limited to 24 weeks.
"In conclusion, our preliminary findings indicate that tai chi may be a useful treatment in the multidisciplinary management of fibromyalgia," the study authors write. "Longer-term studies involving larger clinical samples are warranted to assess the generalizability of our findings and to deepen our understanding of this promising therapeutic approach."
The National Center for Complementary and Alternative Medicine, the American College of Rheumatology Research and Education Foundation Health Professional Investigator Award, and the Boston Claude D. Pepper Older Americans Independence Center Research Career Development Award supported this study. The contents of the journal article are solely the responsibility of the study authors and do not necessarily represent the official views of the National Center for Complementary and Alternative Medicine or the National Institutes of Health. Disclosure forms provided by the study authors are available with the full text of the original article here .
N Engl J Med. 2010;363:743-754.
Medscape Medical News © WebMD, LLC
Send press releases and comments to news@medscape.net.
Freelance writer and reviewer, Medscape, LLC
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
From Medscape Medical News
Tai Chi May Be Useful to Treat Fibromyalgia
Laurie Barclay, MD
August 18, 2010 — Tai chi may be a helpful intervention for patients with fibromyalgia, according to the results of a single-blind, randomized trial reported in the August 19 issue of the New England Journal of Medicine.
"Previous research has suggested that tai chi offers a therapeutic benefit in patients with fibromyalgia," write Chenchen Wang, MD, MPH, from Tufts Medical Center, Tufts University School of Medicine in Boston, Massachusetts, and colleagues. "...[Tai chi] combines meditation with slow, gentle, graceful movements, as well as deep breathing and relaxation, to move vital energy (or qi) throughout the body. It is considered a complex, multicomponent intervention that integrates physical, psychosocial, emotional, spiritual, and behavioral elements."
Fibromyalgia was defined by American College of Rheumatology 1990 criteria. Participants (n = 66) were randomly assigned 1:1 to receive classic Yang-style tai chi or a control intervention consisting of wellness education and stretching. In both groups, participants received 60-minute sessions twice weekly for 12 weeks.
Fibromyalgia Impact Questionnaire (FIQ) score (ranging from 0 - 100) at the end of 12 weeks was the main study outcome, with higher scores indicating more severe symptoms. Secondary outcomes were summary scores on the physical and mental components of the Medical Outcomes Study 36-Item Short-Form Health Survey. To assess durability of the response, these tests were performed again at 24 weeks.
Improvements in the FIQ total score and quality of life in the tai chi group were clinically important. For this group, mean baseline and 12-week FIQ scores were 62.9 ± 15.5 and 35.1 ± 18.8, respectively, vs 68.0 ± 11 and 58.6 ± 17.6, respectively, in the control group. The mean between-group difference from baseline in the tai chi group vs the control group was −18.4 points (P < .001).
The tai chi group also fared better than the wellness intervention group in physical component scores of the Short-Form Health Survey (28.5 ± 8.4 and 37.0 ± 10.5 for the tai chi group vs 28.0 ± 7.8 and 29.4 ± 7.4 for the control group; between-group difference, 7.1 points; P = .001) and mental component scores (42.6 ± 12.2 and 50.3 ± 10.2 vs 37.8 ± 10.5 and 39.4 ± 11.9, respectively; between-group difference, 6.1 points; P = .03).
These improvements were still present at 24 weeks (FIQ score between-group difference, −18.3 points; P < .001), with no reported adverse events.
Limitations of this study include lack of double blinding, lack of generalizability because treatment was delivered by a single tai chi master at a single center, and follow-up limited to 24 weeks.
"In conclusion, our preliminary findings indicate that tai chi may be a useful treatment in the multidisciplinary management of fibromyalgia," the study authors write. "Longer-term studies involving larger clinical samples are warranted to assess the generalizability of our findings and to deepen our understanding of this promising therapeutic approach."
The National Center for Complementary and Alternative Medicine, the American College of Rheumatology Research and Education Foundation Health Professional Investigator Award, and the Boston Claude D. Pepper Older Americans Independence Center Research Career Development Award supported this study. The contents of the journal article are solely the responsibility of the study authors and do not necessarily represent the official views of the National Center for Complementary and Alternative Medicine or the National Institutes of Health. Disclosure forms provided by the study authors are available with the full text of the original article here .
N Engl J Med. 2010;363:743-754.
Medscape Medical News © WebMD, LLC
Send press releases and comments to news@medscape.net.
Tai chi for Arthritis Relief
Tai Chi for Arthritis Relief
Gentle movements of the ancient Chinese exercise tai chi are one of many alternatives to help elderly people find pain relief.
By Jeanie Lerche Davis
WebMD Feature
Reviewed by Charlotte E. Grayson Mathis, MD
The movements of tai chi are gentle, graceful, mystical -- and, for elderly people, a very safe way to relieve arthritis pain and gain balance, strength, and flexibility. Tai chi is one of many alternative therapies that can provide relief from pain, possibly letting you cut back on pain medications.
Early mornings in large and small cities in China - and increasingly in America's parks, hospitals, and community centers - people are practicing tai chi. It is an ancient tradition said to have developed in medieval China, to help restore health of monks in poor physical condition from too much meditation and too little exercise.
Chi (pronounced chee) is the Chinese word for energy. In the healing arts, tai chi is used to promote the movement of energy through the body -- similar to blood being pumped through the body, explains Cate Morrill, a certified tai chi instructor in Atlanta. Morrill spends much of her time in teaching classes for seniors, many of whom are unfamiliar with this practice. "But after five, 10, 15 minutes of tai chi, they report having pain relief," she tells WebMD.
Virtually all major health organizations - including the Arthritis Foundation -- recommend tai chi as an activity for seniors because it provides balance of body and mind.
"The movements of tai chi keep the body fresh and allow the person to find a freer range of motion in the joints, greater flexibility, better balance," Morrill explains. Tai chi is often called "moving meditation," because it is relaxing, because the focus is on breathing and creating inner stillness -- quieting the mind, relaxing the body. When people focus on breathing and on the movements, they aren't focused on their worldly worries.
Older adults who try tai chi find the benefits flow into their everyday lives in surprising ways, Morrill tells WebMD. "Everyday stuff like gardening and cleaning the house -- even basic moves like getting in and out of a bathtub - are easier when muscles are strong and flexible, when there is proper balance and body alignment."
What Happens in Tai Chi Class
Tai chi movements are full of natural symbolism - "Wind Rolls with Lotus Leaves," "Brush Dust Against the Wind," and "White Crane Spreads Wings."
Yet the application of these moves is very practical: "Folks with arthritis in the knees tend to not bend their knees very much when they walk, so they tend to have a stiffer gait. Some tai chi exercise work to increase the knee flexibility," says Morrill.
For example, in the movement "Wave Hands Like Clouds," the focus is on the hands, which seem to drift like clouds in the air. But as the hands wave, the rest of the body is in continual slow motion, Morrill explains. The hips are driving the body motion -- as one leg bends, the other stretches, then the motion switches to the other side of the body. The arms rotate at the shoulder to strengthen shoulder muscles, which encourages the arms to stretch out fully. As weight is shifted, the body is slightly turned to produce flexibility in the waist and strength and flexibility in side muscles.
This movement may last only two minutes or so; during the hour-long class, seniors will complete at least 20 different sets of movements, says Morrill.
Seniors should not try learning tai chi from a video or DVD, she adds. A class setting, with qualified instructor who has worked with seniors, is essential. "Elderly students need an instructor who can correct their posture. If someone has severe arthritis in the left knee, they may not be able to do moves like someone who has a light case of arthritis. It's the instructor's job to modify movement to make it as safe and painless as possible for each student ... to select moves that are most appropriate."
Also, there's the camaraderie that comes from a class, Morrill tells WebMD. "People with arthritis tend to not get out much, but tai chi classes let them realize there are others in the same situation, so friendships develop, people support each other, they find other people they can share skills with. One might do the grocery shopping because the arthritis in her legs isn't too bad - and her friend does the cooking."
Gain Back 8 Years of Youth
According to legend, "if you meditate and do tai chi 100 days in a row, you gain back eight years of youth," says Morrill.
While many of today's tai chi movements have roots in martial arts, the goal is indeed therapeutic. Progress is measured in terms of coordination, strength, balance, flexibility, breathing, digestion, emotional balance, and a general sense of well-being.
Tai chi and other types of mindfulness-based practices "are intended to maintain muscle tone, strength, and flexibility, and perhaps even spiritual aspects like mindfulness - focusing in the moment, focusing away from the pain," says Raymond Gaeta, MD, director of pain management services at Stanford Hospital & Clinics.
Parag Sheth, MD, assistant professor of rehabilitation medicine at Mt. Sinai Medical Center in New York, saw the popularity of tai chi on a visit to China 15 years ago. "We saw it every morning - thousands of people in the park doing tai chi, all of them elderly," he tells WebMD.
"There's logic in how tai chi works," Sheth says. "Tai chi emphasizes rotary movements -- turning the body from side to side, working muscles that they don't use when walking, building muscle groups they are not used to using. If they have some strength in those support muscles - the rotators in the hip -- that can help prevent a fall."
The slow, controlled movements help older people feel secure doing tai chi, he adds. "Also, they learn to bend on one leg -- to control that movement - which is something you don't get to practice very often," says Sheth. "That's important because, as we get older and more insecure, we tend to limit our movements and that limits certain muscles from getting used. When people strengthen those muscles slowly, when they find their balance, they learn to trust themselves more."
A study published in 1997 found that seniors who took 15 tai chi lessons and practiced for 15 minutes twice daily were able to significantly reduce their risk of falls. Since then, several more studies have pointed to the physical benefits of tai chi for the elderly.
• One six-month study, a group of elderly people who took part in tai chi were about twice as likely to report that they were not limited in their ability to perform moderate-to-vigorous daily activities - things like walking, climbing, bending, lifting. The seniors in that study also reported better overall quality of life - in terms of bodily pain, mental health, and perceptions of health and independence.
• Another study of seniors with arthritis showed that those who took a 12-week tai chi course got around better and had less pain in their legs. Yet another study found that people with arthritis who took a 12-week tai chi class had stronger abdominal muscles and better balance afterward.
• A review of four studies on tai chi found that it does not appear to significantly reduce pain or lessen the severity of rheumatoid arthritis. However, it does significantly improve range of motion in the joints of the legs and ankles. Those who got the most benefit reported participating more in their tai chi classes and enjoying them more compared with those who were in a traditional exercise program.
"I'm an absolute huge fan of tai chi," says Jason Theodoskais, MD, MS, MPH, FACPM, author of The Arthritis Cure and a preventive and sports medicine specialist at the University of Arizona Medical Center.
Any type of motion helps lubricate the joints by moving joint fluid, which is helpful in relieving pain, he says. "Tai chi is not a cure-all, but it's one piece of the puzzle. What's good about tai chi is that it's a gentle motion, so even people who are severely affected with arthritis can do it. Also, tai chi helps strengthen the joints in a functional manner... you strengthen muscles in the way your body normally uses the joints."
Gentle movements of the ancient Chinese exercise tai chi are one of many alternatives to help elderly people find pain relief.
By Jeanie Lerche Davis
WebMD Feature
Reviewed by Charlotte E. Grayson Mathis, MD
The movements of tai chi are gentle, graceful, mystical -- and, for elderly people, a very safe way to relieve arthritis pain and gain balance, strength, and flexibility. Tai chi is one of many alternative therapies that can provide relief from pain, possibly letting you cut back on pain medications.
Early mornings in large and small cities in China - and increasingly in America's parks, hospitals, and community centers - people are practicing tai chi. It is an ancient tradition said to have developed in medieval China, to help restore health of monks in poor physical condition from too much meditation and too little exercise.
Chi (pronounced chee) is the Chinese word for energy. In the healing arts, tai chi is used to promote the movement of energy through the body -- similar to blood being pumped through the body, explains Cate Morrill, a certified tai chi instructor in Atlanta. Morrill spends much of her time in teaching classes for seniors, many of whom are unfamiliar with this practice. "But after five, 10, 15 minutes of tai chi, they report having pain relief," she tells WebMD.
Virtually all major health organizations - including the Arthritis Foundation -- recommend tai chi as an activity for seniors because it provides balance of body and mind.
"The movements of tai chi keep the body fresh and allow the person to find a freer range of motion in the joints, greater flexibility, better balance," Morrill explains. Tai chi is often called "moving meditation," because it is relaxing, because the focus is on breathing and creating inner stillness -- quieting the mind, relaxing the body. When people focus on breathing and on the movements, they aren't focused on their worldly worries.
Older adults who try tai chi find the benefits flow into their everyday lives in surprising ways, Morrill tells WebMD. "Everyday stuff like gardening and cleaning the house -- even basic moves like getting in and out of a bathtub - are easier when muscles are strong and flexible, when there is proper balance and body alignment."
What Happens in Tai Chi Class
Tai chi movements are full of natural symbolism - "Wind Rolls with Lotus Leaves," "Brush Dust Against the Wind," and "White Crane Spreads Wings."
Yet the application of these moves is very practical: "Folks with arthritis in the knees tend to not bend their knees very much when they walk, so they tend to have a stiffer gait. Some tai chi exercise work to increase the knee flexibility," says Morrill.
For example, in the movement "Wave Hands Like Clouds," the focus is on the hands, which seem to drift like clouds in the air. But as the hands wave, the rest of the body is in continual slow motion, Morrill explains. The hips are driving the body motion -- as one leg bends, the other stretches, then the motion switches to the other side of the body. The arms rotate at the shoulder to strengthen shoulder muscles, which encourages the arms to stretch out fully. As weight is shifted, the body is slightly turned to produce flexibility in the waist and strength and flexibility in side muscles.
This movement may last only two minutes or so; during the hour-long class, seniors will complete at least 20 different sets of movements, says Morrill.
Seniors should not try learning tai chi from a video or DVD, she adds. A class setting, with qualified instructor who has worked with seniors, is essential. "Elderly students need an instructor who can correct their posture. If someone has severe arthritis in the left knee, they may not be able to do moves like someone who has a light case of arthritis. It's the instructor's job to modify movement to make it as safe and painless as possible for each student ... to select moves that are most appropriate."
Also, there's the camaraderie that comes from a class, Morrill tells WebMD. "People with arthritis tend to not get out much, but tai chi classes let them realize there are others in the same situation, so friendships develop, people support each other, they find other people they can share skills with. One might do the grocery shopping because the arthritis in her legs isn't too bad - and her friend does the cooking."
Gain Back 8 Years of Youth
According to legend, "if you meditate and do tai chi 100 days in a row, you gain back eight years of youth," says Morrill.
While many of today's tai chi movements have roots in martial arts, the goal is indeed therapeutic. Progress is measured in terms of coordination, strength, balance, flexibility, breathing, digestion, emotional balance, and a general sense of well-being.
Tai chi and other types of mindfulness-based practices "are intended to maintain muscle tone, strength, and flexibility, and perhaps even spiritual aspects like mindfulness - focusing in the moment, focusing away from the pain," says Raymond Gaeta, MD, director of pain management services at Stanford Hospital & Clinics.
Parag Sheth, MD, assistant professor of rehabilitation medicine at Mt. Sinai Medical Center in New York, saw the popularity of tai chi on a visit to China 15 years ago. "We saw it every morning - thousands of people in the park doing tai chi, all of them elderly," he tells WebMD.
"There's logic in how tai chi works," Sheth says. "Tai chi emphasizes rotary movements -- turning the body from side to side, working muscles that they don't use when walking, building muscle groups they are not used to using. If they have some strength in those support muscles - the rotators in the hip -- that can help prevent a fall."
The slow, controlled movements help older people feel secure doing tai chi, he adds. "Also, they learn to bend on one leg -- to control that movement - which is something you don't get to practice very often," says Sheth. "That's important because, as we get older and more insecure, we tend to limit our movements and that limits certain muscles from getting used. When people strengthen those muscles slowly, when they find their balance, they learn to trust themselves more."
A study published in 1997 found that seniors who took 15 tai chi lessons and practiced for 15 minutes twice daily were able to significantly reduce their risk of falls. Since then, several more studies have pointed to the physical benefits of tai chi for the elderly.
• One six-month study, a group of elderly people who took part in tai chi were about twice as likely to report that they were not limited in their ability to perform moderate-to-vigorous daily activities - things like walking, climbing, bending, lifting. The seniors in that study also reported better overall quality of life - in terms of bodily pain, mental health, and perceptions of health and independence.
• Another study of seniors with arthritis showed that those who took a 12-week tai chi course got around better and had less pain in their legs. Yet another study found that people with arthritis who took a 12-week tai chi class had stronger abdominal muscles and better balance afterward.
• A review of four studies on tai chi found that it does not appear to significantly reduce pain or lessen the severity of rheumatoid arthritis. However, it does significantly improve range of motion in the joints of the legs and ankles. Those who got the most benefit reported participating more in their tai chi classes and enjoying them more compared with those who were in a traditional exercise program.
"I'm an absolute huge fan of tai chi," says Jason Theodoskais, MD, MS, MPH, FACPM, author of The Arthritis Cure and a preventive and sports medicine specialist at the University of Arizona Medical Center.
Any type of motion helps lubricate the joints by moving joint fluid, which is helpful in relieving pain, he says. "Tai chi is not a cure-all, but it's one piece of the puzzle. What's good about tai chi is that it's a gentle motion, so even people who are severely affected with arthritis can do it. Also, tai chi helps strengthen the joints in a functional manner... you strengthen muscles in the way your body normally uses the joints."
Tai Chi helps reduce blood pressure
REDUCE BLOOD PRESSURE WITH TAI CHI
Page: 1 2 (of 2)
By Suzanne C. Weltman
This gentle workout-a modern-day form of an ancient Chinese martial art-reduces stress, lowers blood pressure, and improves cardiovascular fitness.
RELATED STORIES
• Lower Blood Pressure with Music
• Reduce Your Blood Pressure
• Video: Cardiac Yoga
When Marilyn McCord’s blood pressure edged toward an unhealthy high, she knew she needed to take action. With the support of her physician, she decided to try Tai Chi instead of drugs to lower her numbers.
Modern Tai Chi (pronounced tie-chee) is a mind-body exercise based on an ancient Chinese form of self-defense. It combines slow, graceful physical movements with focused breathing and inner concentration. It is a gentle, self-paced exercise in which each movement or posture flows effortlessly into the next. Studies have shown that Tai Chi quiets the mind and reduces stress, resulting in a more relaxed state of well-being. One study showed that Tai Chi was nearly as effective at lowering blood pressure as moderate aerobic exercise.
The philosophy of Tai Chi centers on aligning what is called “Chi,” or the energetic life force that flows through your body. A typical hour-long Tai Chi session begins with exercises that are designed to awaken the Chi within the body, followed by a special sequence of movements or postures. Depending on the Tai Chi form—short or long—there may be as few as 13 movements or more than 100. The movement sequences have poetic names, such as “White Crane Spreads Its Wings” and “Waving Hands in Clouds.”
Tai Chi—sometimes referred to as meditation in motion—focuses on deep breathing and gentle movements that work all the muscles in the body, says Beth Rose, a Philadelphia-area instructor. “Tai Chi helps you feel calmer,” she says. “You reach a state of relaxed awareness, and it becomes a tool for dealing with stress. I’ve had students tell me it’s easier for them to go up the stairs now. They also breathe better because their circulation has improved and they get more oxygen into their system. To me, there’s no question that Tai Chi helps heart health.”
Marilyn agrees with Rose that the exercise provides health benefits. Marilyn, 66, of Durango, Colorado, watched her blood pressure gradually drop from 150/90 mmHg to 135/82 after regularly practicing Tai Chi for several months. “Every time I do Tai Chi, I feel so much better,” she says.
She says that the deep breathing she learned has an immediate effect on her stress and blood pressure levels. “When I begin to feel stressed, I can practice Tai Chi’s open-close breathing, and it lowers my blood pressure almost immediately.”
Continued on Page 2: The Science of Tai Chi
BLOOD PRESSURE > LOWER BLOOD PRESSURE >
REDUCE BLOOD PRESSURE WITH TAI CHI
Page: 1 2 (of 2)
Previous
THE SCIENCE OF TAI CHI
RELATED STORIES
• Lower Blood Pressure with Music
• Reduce Your Blood Pressure
• Video: Cardiac Yoga
Researchers at the National Center for Complementary and Alternative Medicine suggest that further study will clarify what happens in the body during Tai Chi and will reveal exactly how the practice influences health.
A pilot study conducted several years ago by the Johns Hopkins School of Medicine showed that practicing Tai Chi lowered blood pressure nearly as much as moderate-intensity aerobics, such as brisk walking. In that study, systolic blood pressure (the higher number) was reduced by about 7 millimeters of mercury (mmHg) after six weeks of Tai Chi exercise.
In another study, published in the journal Medicine & Science in Sports & Exercise, low-risk coronary artery bypass patients who completed a year-long Tai Chi program after conventional rehabilitation showed improved results in their cardiorespiratory system. At Harvard’s Division for Research and Education in Complementary and Integrative Medical Therapies, scientists are studying the health effects of Tai Chi when added to a traditional therapy program for patients with chronic heart failure.
So where do you begin? It’s best to find a trained Tai Chi instructor and learn the basic moves in a class. Sandra Pruzansky, a Tai Chi instructor certified by the Arthritis Foundation, says most classes will let people observe one session.
“It is important that the teacher discusses how to move safely and take care of body parts like your knees,” Pruzansky says. “Be sure to ask yourself if you feel you can learn from the teacher.” Pruzansky finishes each of her classes by asking students “to give back some Chi energy and send it out to anyone who may need it.” It leaves them “fully relaxed and energized,” she says.
Basic Tai Chi Principles
1. Balance: For a strong foundation, it is important that you feel a solid connection with the ground.
2. Structure: Realigning and keeping your body upright involves letting go of old posture habits.
3. Tension Release: Where do you hold tension in your body? Tai Chi helps you identify and let go of tension.
4. Breathing: Uniform breathing, especially long, slow exhalations, helps release tension and increase concentration.
5. Energy Development: Practicing Tai Chi makes many people feel more energetic and rejuvenated
Talk with your doctor before starting any new exercise regimen.
How to Begin
• Ask Tai Chi instructors about their training, credentials, and experience with cardiovascular fitness and rehabilitation to determine if they’re right for you.
• Visit a Tai Chi class in action before signing up. To find a Tai Chi instructor in your area, visit the Web site of the American Tai Chi Association, www.americantaichi.org.
• Take it easy while you learn: Don’t push or overexert yourself. Tai Chi is a gradual process that takes time to learn.
Page: 1 2 (of 2)
By Suzanne C. Weltman
This gentle workout-a modern-day form of an ancient Chinese martial art-reduces stress, lowers blood pressure, and improves cardiovascular fitness.
RELATED STORIES
• Lower Blood Pressure with Music
• Reduce Your Blood Pressure
• Video: Cardiac Yoga
When Marilyn McCord’s blood pressure edged toward an unhealthy high, she knew she needed to take action. With the support of her physician, she decided to try Tai Chi instead of drugs to lower her numbers.
Modern Tai Chi (pronounced tie-chee) is a mind-body exercise based on an ancient Chinese form of self-defense. It combines slow, graceful physical movements with focused breathing and inner concentration. It is a gentle, self-paced exercise in which each movement or posture flows effortlessly into the next. Studies have shown that Tai Chi quiets the mind and reduces stress, resulting in a more relaxed state of well-being. One study showed that Tai Chi was nearly as effective at lowering blood pressure as moderate aerobic exercise.
The philosophy of Tai Chi centers on aligning what is called “Chi,” or the energetic life force that flows through your body. A typical hour-long Tai Chi session begins with exercises that are designed to awaken the Chi within the body, followed by a special sequence of movements or postures. Depending on the Tai Chi form—short or long—there may be as few as 13 movements or more than 100. The movement sequences have poetic names, such as “White Crane Spreads Its Wings” and “Waving Hands in Clouds.”
Tai Chi—sometimes referred to as meditation in motion—focuses on deep breathing and gentle movements that work all the muscles in the body, says Beth Rose, a Philadelphia-area instructor. “Tai Chi helps you feel calmer,” she says. “You reach a state of relaxed awareness, and it becomes a tool for dealing with stress. I’ve had students tell me it’s easier for them to go up the stairs now. They also breathe better because their circulation has improved and they get more oxygen into their system. To me, there’s no question that Tai Chi helps heart health.”
Marilyn agrees with Rose that the exercise provides health benefits. Marilyn, 66, of Durango, Colorado, watched her blood pressure gradually drop from 150/90 mmHg to 135/82 after regularly practicing Tai Chi for several months. “Every time I do Tai Chi, I feel so much better,” she says.
She says that the deep breathing she learned has an immediate effect on her stress and blood pressure levels. “When I begin to feel stressed, I can practice Tai Chi’s open-close breathing, and it lowers my blood pressure almost immediately.”
Continued on Page 2: The Science of Tai Chi
BLOOD PRESSURE > LOWER BLOOD PRESSURE >
REDUCE BLOOD PRESSURE WITH TAI CHI
Page: 1 2 (of 2)
Previous
THE SCIENCE OF TAI CHI
RELATED STORIES
• Lower Blood Pressure with Music
• Reduce Your Blood Pressure
• Video: Cardiac Yoga
Researchers at the National Center for Complementary and Alternative Medicine suggest that further study will clarify what happens in the body during Tai Chi and will reveal exactly how the practice influences health.
A pilot study conducted several years ago by the Johns Hopkins School of Medicine showed that practicing Tai Chi lowered blood pressure nearly as much as moderate-intensity aerobics, such as brisk walking. In that study, systolic blood pressure (the higher number) was reduced by about 7 millimeters of mercury (mmHg) after six weeks of Tai Chi exercise.
In another study, published in the journal Medicine & Science in Sports & Exercise, low-risk coronary artery bypass patients who completed a year-long Tai Chi program after conventional rehabilitation showed improved results in their cardiorespiratory system. At Harvard’s Division for Research and Education in Complementary and Integrative Medical Therapies, scientists are studying the health effects of Tai Chi when added to a traditional therapy program for patients with chronic heart failure.
So where do you begin? It’s best to find a trained Tai Chi instructor and learn the basic moves in a class. Sandra Pruzansky, a Tai Chi instructor certified by the Arthritis Foundation, says most classes will let people observe one session.
“It is important that the teacher discusses how to move safely and take care of body parts like your knees,” Pruzansky says. “Be sure to ask yourself if you feel you can learn from the teacher.” Pruzansky finishes each of her classes by asking students “to give back some Chi energy and send it out to anyone who may need it.” It leaves them “fully relaxed and energized,” she says.
Basic Tai Chi Principles
1. Balance: For a strong foundation, it is important that you feel a solid connection with the ground.
2. Structure: Realigning and keeping your body upright involves letting go of old posture habits.
3. Tension Release: Where do you hold tension in your body? Tai Chi helps you identify and let go of tension.
4. Breathing: Uniform breathing, especially long, slow exhalations, helps release tension and increase concentration.
5. Energy Development: Practicing Tai Chi makes many people feel more energetic and rejuvenated
Talk with your doctor before starting any new exercise regimen.
How to Begin
• Ask Tai Chi instructors about their training, credentials, and experience with cardiovascular fitness and rehabilitation to determine if they’re right for you.
• Visit a Tai Chi class in action before signing up. To find a Tai Chi instructor in your area, visit the Web site of the American Tai Chi Association, www.americantaichi.org.
• Take it easy while you learn: Don’t push or overexert yourself. Tai Chi is a gradual process that takes time to learn.
Tai Chi for Diabetes
Tai Chi for Diabetes
According to two small studies published in the British Journal of Sports Medicine in April 2008, Tai Chi exercises can improve blood glucose levels and improve the control of type 2 diabetes and immune system response.
Tai Chi is a Chinese martial art that combines diaphragmatic breathing and relaxation with soft, gentle movements. It is considered moderate exercise, which has previously been shown to improve immune system response, in contrast to strenuous physical activity, which depresses it. Previous studies have shown that it improves respiratory and cardiovascular function, while improving flexibility and relieving stress.
Type 2 diabetes is a form of diabetes that usually sets in later in life. It is associated with chronic inflammation cause by increase glucose levels in the blood, known as hyperglycemia. When there is excess blood sugar, it can combine with hemogloben, the oxygen transporter in the red blood cell, it can become glycated hemogloben. This can be used to indicate the levels of excess sugars.
In the immune system, helper T cells prompt stimulus of other immune system cells, altering the immune response. They respond to specific antigens, producing interleukins and other important signaling chemicals. As a result, they are essential for the cell mediated immune response .
In a first study, the investigators sought to analyze the impact of a 12 week Tai Chi Chuan exercise program on helper T cell activity in 30 patients with type 2 diabetes, and contrast this with 30 healthy people of the same age.
After 12 weeks in the exercise program, the levels of glycated hemoglobin levels fell significantly, from 7.59% to 7.16% in diabetic patients, a significant difference. Interleukin-12, which boosts the immune response, increased in level; interleukin-4, which lessens the immune response, declined. In conjunction, T cell activity also significantly increased.
According to these responses, it is possible that Tai Chi can prompt a declination in blood glucose levels, perhaps by improving blood glucose metabolism, prompting a decrease in the inflammatory response. In an alternative explanation also suggested by the authors, the exercise may boost levels of fitness along with a feeling of well being -- this in turn may boost the health of the immune system.
A second study in the same issue, investigators focused on adults with metabolic syndrome. This is a group of symptoms including hypertension and high blood glucose which are associated with increased risk of cardiovascular disease and diabetes.
A 12 week program of Tai Chi and Qigong was administered to 13 patients with metabolic syndrome for up to 1.5 hours up to 3 times a week, while being encouraged to perform the exercises outside of the classes.
At the end of 12 weeks, they had lost an average of 3 kg in weight and had dropped waist size by almost 3 cm. Additionally, the blood pressures of the subjects fell significantly more than exercise alone can account for, according to the authors. Insulin resistance also fell, indicating a decreased predisposition for type 2 diabetes. Participants additionally claimed to sleep better, have more energy, feel less pain, and have fewer cravings for food while participating in the program.
Notably, three patients no longer met the criteria for metabolic syndrome after this test.
Regular Tai Chi Chuan exercise improves T cell helper function of patients with type 2 diabetes mellitus with an increase in T-bet transcription factor and IL-12 production
S-H Yeh, H Chuang, L-W Lin, C-Y Hsiao, P-W Wang, R-T Liu, K D Yang
Online First Br J Sports Med 2008
Preliminary study of the effect of Tai Chi and Qigong medical exercise on indicators of metabolic syndrome and glycaemic control in adults with raised blood glucose levels
X Liu, Y D Miller, N W Burton, W J Brown
Online First Br J Sports Med 2008;
doi 10.1136/bjsm.2007.043562
According to two small studies published in the British Journal of Sports Medicine in April 2008, Tai Chi exercises can improve blood glucose levels and improve the control of type 2 diabetes and immune system response.
Tai Chi is a Chinese martial art that combines diaphragmatic breathing and relaxation with soft, gentle movements. It is considered moderate exercise, which has previously been shown to improve immune system response, in contrast to strenuous physical activity, which depresses it. Previous studies have shown that it improves respiratory and cardiovascular function, while improving flexibility and relieving stress.
Type 2 diabetes is a form of diabetes that usually sets in later in life. It is associated with chronic inflammation cause by increase glucose levels in the blood, known as hyperglycemia. When there is excess blood sugar, it can combine with hemogloben, the oxygen transporter in the red blood cell, it can become glycated hemogloben. This can be used to indicate the levels of excess sugars.
In the immune system, helper T cells prompt stimulus of other immune system cells, altering the immune response. They respond to specific antigens, producing interleukins and other important signaling chemicals. As a result, they are essential for the cell mediated immune response .
In a first study, the investigators sought to analyze the impact of a 12 week Tai Chi Chuan exercise program on helper T cell activity in 30 patients with type 2 diabetes, and contrast this with 30 healthy people of the same age.
After 12 weeks in the exercise program, the levels of glycated hemoglobin levels fell significantly, from 7.59% to 7.16% in diabetic patients, a significant difference. Interleukin-12, which boosts the immune response, increased in level; interleukin-4, which lessens the immune response, declined. In conjunction, T cell activity also significantly increased.
According to these responses, it is possible that Tai Chi can prompt a declination in blood glucose levels, perhaps by improving blood glucose metabolism, prompting a decrease in the inflammatory response. In an alternative explanation also suggested by the authors, the exercise may boost levels of fitness along with a feeling of well being -- this in turn may boost the health of the immune system.
A second study in the same issue, investigators focused on adults with metabolic syndrome. This is a group of symptoms including hypertension and high blood glucose which are associated with increased risk of cardiovascular disease and diabetes.
A 12 week program of Tai Chi and Qigong was administered to 13 patients with metabolic syndrome for up to 1.5 hours up to 3 times a week, while being encouraged to perform the exercises outside of the classes.
At the end of 12 weeks, they had lost an average of 3 kg in weight and had dropped waist size by almost 3 cm. Additionally, the blood pressures of the subjects fell significantly more than exercise alone can account for, according to the authors. Insulin resistance also fell, indicating a decreased predisposition for type 2 diabetes. Participants additionally claimed to sleep better, have more energy, feel less pain, and have fewer cravings for food while participating in the program.
Notably, three patients no longer met the criteria for metabolic syndrome after this test.
Regular Tai Chi Chuan exercise improves T cell helper function of patients with type 2 diabetes mellitus with an increase in T-bet transcription factor and IL-12 production
S-H Yeh, H Chuang, L-W Lin, C-Y Hsiao, P-W Wang, R-T Liu, K D Yang
Online First Br J Sports Med 2008
Preliminary study of the effect of Tai Chi and Qigong medical exercise on indicators of metabolic syndrome and glycaemic control in adults with raised blood glucose levels
X Liu, Y D Miller, N W Burton, W J Brown
Online First Br J Sports Med 2008;
doi 10.1136/bjsm.2007.043562
Tai chi and Psychological Well Being
Tai Chi Linked to Improvements in Psychological Well-Being CME/CE
News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd
Authors and Disclosures
CME/CE Released: 05/27/2010; Valid for credit through 05/27/2011
Target Audience
This article is intended for primary care clinicians, psychiatrists, and other specialists who care for patients with psychological stress or for those at risk for cardiovascular disease.
May 27, 2010 — Tai Chi appears to be associated with improvements in psychological well-being, although well-controlled, longer randomized trials are needed, according to the results of a systematic review and meta-analysis reported in the May 21 issue of BMC Complementary and Alternative Medicine.
"Tai Chi, the Chinese low impact mind-body exercise, has been practiced for centuries for health and fitness in the East and is currently gaining popularity in the West," said lead author Chenchen Wang, from Tufts Medical Center, Tufts University School of Medicine in Boston, Massachusetts, in a news release. "It is believed to improve mood and enhance overall psychological well being, but convincing evidence has so far been lacking."
The reviewers searched 8 English-language and 3 Chinese-language databases through March 2009 for randomized controlled trials, nonrandomized controlled studies, and observational studies reporting at least 1 psychological health outcome. Two reviewers extracted and verified data, and a random-effects model allowed meta-analysis of randomized trials in each subcategory of health outcomes.
Methodologic quality of each study was also evaluated.
The reviewers identified 40 studies enrolling a total of 3817 participants and reporting on a total of 29 psychological measurements. Of 33 randomized and nonrandomized trials, 21 reported significant improvements in psychological well-being with 1 hour to 1 year of regular Tai Chi. Specific effects in community-dwelling healthy participants and in patients with chronic conditions were decreased stress (effect size [ES], 0.66; 95% confidence interval [CI], 0.23 - 1.09), anxiety (ES, 0.66; 95% CI, 0.29 - 1.03), and depression (ES, 0.56; 95% CI, 0.31 - 0.80), and improved mood (ES, 0.45; 95% CI, 0.20 - 0.69).
"More detailed knowledge about the physiological and psychological effects of Tai Chi exercise may lead to new approaches to promote health, treat chronic medical conditions, better inform clinical decisions and further explicate the mechanisms of successful mind-body medicine," Dr. Wang said.
The beneficial association between Tai Chi practice and psychological health was supported by 7 observational studies with relatively large sample sizes.
"Tai Chi appears to be associated with improvements in psychological well-being including reduced stress, anxiety, depression and mood disturbance, and increased self-esteem. Definitive conclusions were limited due to variation in designs, comparisons, heterogeneous outcomes and inadequate controls. High-quality, well-controlled, longer randomized trials are needed to better inform clinical decisions."
The study authors have disclosed no relevant financial relationships.
BMC Complement Altern Med. 2010;10:23. Abstract
More information about the health effects of Tai Chi is available from the National Center for Complementary and Alternative Medicine
Clinical Context
Tai Chi is a form of low-impact mind-body exercise using balance, flexibility, and strength. Its use has spread worldwide for the past 2 decades, and it has been reported to have beneficial psychological effects in both healthy subjects and in those with medical conditions such as cardiovascular disease.
This is a systematic review and meta-analysis of studies on Tai Chi to determine its impact on psychological well-being.
Study Highlights
• The reviewers conducted an electronic search of the medical literature using 8 English-language and 3 Chinese-language databases through March 2009.
• They also searched reference lists of selected articles for studies.
• Included were original studies of randomized trials, nonrandomized comparison studies, and observational studies.
• Reviews, conference proceedings, and case reports were excluded.
• Studies were assessed for quality, and data were extracted for the meta-analysis by 2 reviewers.
• The reviewers determined ES for each outcome by pooling the ES of each study.
• An ES of 0 to 0.19 was considered negligible; 0.20 to 0.49, small; 0.50 to 0.79, moderate; and 0.80 and above, high.
• 2579 English-language and Chinese-language articles were reviewed and 40 identified for data abstraction.
• Studies had to include at least 10 human subjects and evaluate at least 1 outcome of psychological health including stress, anxiety, depression, mood, and self-esteem.
• Stress:
o For stress, there were 5 randomized trials, 5 nonrandomized trials, and 1 observational study from 4 countries (United States, Australia, Germany, and China) reporting effects on 870 participants aged 16 to 85 years.
o Subjective measures were used, such as the Perceived Mental Stress Score, the Impact of Event Scale, and the Chinese Psychological Stress Scores.
o There was a significant improvement in stress management and psychological distress (ES, 0.66 [moderate]).
o Tai Chi was associated with a benefit for stress in healthy adults, those with HIV-related distress, and elderly Chinese persons with cardiovascular disorders.
o The overall quality of the studies was modest to inadequate, with no controls in most studies.
• Anxiety:
o For anxiety, there were 5 randomized trials, 9 nonrandomized trials, and 5 observational studies examined in 1869 people from 4 countries (United States, United Kingdom, Australia, and China).
o Scales used included the Profile of Mood States Anxiety subscale; the Depression, Anxiety, Stress Subscale; and the Taylor Manifest Anxiety Scale.
o Tai Chi practiced 2 to 4 times a week (30 - 60 minutes at a time) for 5 to 24 weeks was associated with a significant reduction in anxiety (ES, 0.66 [moderate]).
o Overall study quality was modest.
• Depression:
o For depression, 10 randomized trials, 6 nonrandomized trials, and 4 observational studies examined effects on 2008 patients, with Tai Chi ranging from 1 hour to 14 years.
o Studies used the Center for Epidemiology Studies Depression Scale, Profile of Mood States Depression subscale, and the Beck Depression Inventory.
o Tai Chi for 6 to 48 weeks (40 minutes to 2 hours each, 1 - 4 times a week) resulted in reduced depression symptoms (ES, 0.56 [moderate]).
o However, most studies were on healthy populations, with only 2 studies on clinically depressed patients.
• Mood:
o For mood, 4 randomized trials, 8 nonrandomized trials, and 3 observational studies with 1613 patients examined Tai Chi offered from 1 hour to 14 years (1 - 7 times a week).
o The studies used various scales including the Profile of Mood States Scale, Functional Assessment of HIV Infection, and Symptom Checklist-90.
o Tai Chi significantly improved mood, with an overall ES of 0.45 (small).
o Tai Chi was of benefit for mood in healthy adults, elderly with cardiovascular disease risk factors, obese women, and adolescents with attention-deficit disorder.
o Study quality was poor overall, with inadequate controls.
• Self-esteem:
o Self-esteem was studied in 3 randomized trials and 1 nonrandomized trial in 425 subjects.
o Tai Chi practiced for 12 to 26 weeks (45 - 60 minutes, 2 - 3 times weekly) improved self-esteem, as assessed by scales such as Rosenberg's 10-item Global Self-Esteem Scale and the Body Cathexis Score.
o There was a positive association between Tai Chi and self-esteem, but an ES could not be calculated because quantitative results were limited.
• The authors concluded that the evidence supported a positive effect of Tai Chi on reducing stress, anxiety and depression symptoms, and enhancing mood and self-esteem, but study quality was limited and dose-response could not be assessed.
Clinical Implications
• Tai Chi is associated with reducing stress, anxiety, and depression symptoms and improving self-esteem and mood in a variety of patients.
The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.
Authors and Disclosures
As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.
Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.
Laurie Barclay, MD
Freelance writer and reviewer, Medscape, LLC
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
Brande Nicole Martin
CME Clinical Editor, Medscape, LLC
Disclosure: Brande Nicole Martin has disclosed no relevant financial relationships.
Désirée Lie, MD, MSEd
Clinical Professor, Family Medicine, University of California, Irvine, Orange, California; Director of Research and Patient Development, Family Medicine, University of California, Irvine, Medical Center, Rossmoor, California
Disclosure: Désirée Lie, MD, MSEd, has disclosed the following relevant financial relationship:
Served as a nonproduct speaker for: "Topics in Health" for Merck Speaker Services
Laurie E. Scudder, DNP, NP
Accreditation Coordinator, Continuing Professional Education Department, Medscape, LLC; Clinical Assistant Professor, School of Nursing and Allied Health, George Washington University, Washington, DC; Nurse Practitioner, School-Based Health Centers, Baltimore City Public Schools, Baltimore, Maryland
Disclosure: Laurie E. Scudder, DNP, NP, has disclosed no relevant financial relationships.
Learning Objectives
Upon completion of this activity, participants will be able to:
1. Describe the effect of Tai Chi on stress, mood, anxiety, depressive symptoms, and self-esteem.
2. Describe the quality of studies examining the effect of Tai Chi on psychological well-being and the effect of Tai Chi dose on outcomes.
Credits Available
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
Family Physicians - maximum of 0.25 AAFP Prescribed credit(s)
Nurses - 0.50 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)
All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation.
Physicians should only claim credit commensurate with the extent of their participation in the activity.
Accreditation Statements
For Physicians
MEDSCAPE
Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Medscape, LLC designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity. Medscape News CME has been reviewed and is acceptable for up to 300 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins September 1, 2009. Term of approval is for 1 year from this date. Each issue is approved for .25 Prescribed credits. Credit may be claimed for 1 year from the date of this issue.
Note: Total credit is subject to change based on topic selection and article length.
Medscape, LLC staff have disclosed that they have no relevant financial relationships.
AAFP Accreditation Questions
Contact This Provider
For Nurses
MEDSCAPE
Medscape, LLC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
Awarded 0.5 contact hour(s) of continuing nursing education for RNs and APNs; none of these credits is in the area of pharmacology.
Accreditation of this program does not imply endorsement by either Medscape, LLC or ANCC.
Contact This Provider
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact CME@medscape.net
CME/CE Released: 05/27/2010; Valid for credit through 05/27/2011
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This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.
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News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd
Authors and Disclosures
CME/CE Released: 05/27/2010; Valid for credit through 05/27/2011
Target Audience
This article is intended for primary care clinicians, psychiatrists, and other specialists who care for patients with psychological stress or for those at risk for cardiovascular disease.
May 27, 2010 — Tai Chi appears to be associated with improvements in psychological well-being, although well-controlled, longer randomized trials are needed, according to the results of a systematic review and meta-analysis reported in the May 21 issue of BMC Complementary and Alternative Medicine.
"Tai Chi, the Chinese low impact mind-body exercise, has been practiced for centuries for health and fitness in the East and is currently gaining popularity in the West," said lead author Chenchen Wang, from Tufts Medical Center, Tufts University School of Medicine in Boston, Massachusetts, in a news release. "It is believed to improve mood and enhance overall psychological well being, but convincing evidence has so far been lacking."
The reviewers searched 8 English-language and 3 Chinese-language databases through March 2009 for randomized controlled trials, nonrandomized controlled studies, and observational studies reporting at least 1 psychological health outcome. Two reviewers extracted and verified data, and a random-effects model allowed meta-analysis of randomized trials in each subcategory of health outcomes.
Methodologic quality of each study was also evaluated.
The reviewers identified 40 studies enrolling a total of 3817 participants and reporting on a total of 29 psychological measurements. Of 33 randomized and nonrandomized trials, 21 reported significant improvements in psychological well-being with 1 hour to 1 year of regular Tai Chi. Specific effects in community-dwelling healthy participants and in patients with chronic conditions were decreased stress (effect size [ES], 0.66; 95% confidence interval [CI], 0.23 - 1.09), anxiety (ES, 0.66; 95% CI, 0.29 - 1.03), and depression (ES, 0.56; 95% CI, 0.31 - 0.80), and improved mood (ES, 0.45; 95% CI, 0.20 - 0.69).
"More detailed knowledge about the physiological and psychological effects of Tai Chi exercise may lead to new approaches to promote health, treat chronic medical conditions, better inform clinical decisions and further explicate the mechanisms of successful mind-body medicine," Dr. Wang said.
The beneficial association between Tai Chi practice and psychological health was supported by 7 observational studies with relatively large sample sizes.
"Tai Chi appears to be associated with improvements in psychological well-being including reduced stress, anxiety, depression and mood disturbance, and increased self-esteem. Definitive conclusions were limited due to variation in designs, comparisons, heterogeneous outcomes and inadequate controls. High-quality, well-controlled, longer randomized trials are needed to better inform clinical decisions."
The study authors have disclosed no relevant financial relationships.
BMC Complement Altern Med. 2010;10:23. Abstract
More information about the health effects of Tai Chi is available from the National Center for Complementary and Alternative Medicine
Clinical Context
Tai Chi is a form of low-impact mind-body exercise using balance, flexibility, and strength. Its use has spread worldwide for the past 2 decades, and it has been reported to have beneficial psychological effects in both healthy subjects and in those with medical conditions such as cardiovascular disease.
This is a systematic review and meta-analysis of studies on Tai Chi to determine its impact on psychological well-being.
Study Highlights
• The reviewers conducted an electronic search of the medical literature using 8 English-language and 3 Chinese-language databases through March 2009.
• They also searched reference lists of selected articles for studies.
• Included were original studies of randomized trials, nonrandomized comparison studies, and observational studies.
• Reviews, conference proceedings, and case reports were excluded.
• Studies were assessed for quality, and data were extracted for the meta-analysis by 2 reviewers.
• The reviewers determined ES for each outcome by pooling the ES of each study.
• An ES of 0 to 0.19 was considered negligible; 0.20 to 0.49, small; 0.50 to 0.79, moderate; and 0.80 and above, high.
• 2579 English-language and Chinese-language articles were reviewed and 40 identified for data abstraction.
• Studies had to include at least 10 human subjects and evaluate at least 1 outcome of psychological health including stress, anxiety, depression, mood, and self-esteem.
• Stress:
o For stress, there were 5 randomized trials, 5 nonrandomized trials, and 1 observational study from 4 countries (United States, Australia, Germany, and China) reporting effects on 870 participants aged 16 to 85 years.
o Subjective measures were used, such as the Perceived Mental Stress Score, the Impact of Event Scale, and the Chinese Psychological Stress Scores.
o There was a significant improvement in stress management and psychological distress (ES, 0.66 [moderate]).
o Tai Chi was associated with a benefit for stress in healthy adults, those with HIV-related distress, and elderly Chinese persons with cardiovascular disorders.
o The overall quality of the studies was modest to inadequate, with no controls in most studies.
• Anxiety:
o For anxiety, there were 5 randomized trials, 9 nonrandomized trials, and 5 observational studies examined in 1869 people from 4 countries (United States, United Kingdom, Australia, and China).
o Scales used included the Profile of Mood States Anxiety subscale; the Depression, Anxiety, Stress Subscale; and the Taylor Manifest Anxiety Scale.
o Tai Chi practiced 2 to 4 times a week (30 - 60 minutes at a time) for 5 to 24 weeks was associated with a significant reduction in anxiety (ES, 0.66 [moderate]).
o Overall study quality was modest.
• Depression:
o For depression, 10 randomized trials, 6 nonrandomized trials, and 4 observational studies examined effects on 2008 patients, with Tai Chi ranging from 1 hour to 14 years.
o Studies used the Center for Epidemiology Studies Depression Scale, Profile of Mood States Depression subscale, and the Beck Depression Inventory.
o Tai Chi for 6 to 48 weeks (40 minutes to 2 hours each, 1 - 4 times a week) resulted in reduced depression symptoms (ES, 0.56 [moderate]).
o However, most studies were on healthy populations, with only 2 studies on clinically depressed patients.
• Mood:
o For mood, 4 randomized trials, 8 nonrandomized trials, and 3 observational studies with 1613 patients examined Tai Chi offered from 1 hour to 14 years (1 - 7 times a week).
o The studies used various scales including the Profile of Mood States Scale, Functional Assessment of HIV Infection, and Symptom Checklist-90.
o Tai Chi significantly improved mood, with an overall ES of 0.45 (small).
o Tai Chi was of benefit for mood in healthy adults, elderly with cardiovascular disease risk factors, obese women, and adolescents with attention-deficit disorder.
o Study quality was poor overall, with inadequate controls.
• Self-esteem:
o Self-esteem was studied in 3 randomized trials and 1 nonrandomized trial in 425 subjects.
o Tai Chi practiced for 12 to 26 weeks (45 - 60 minutes, 2 - 3 times weekly) improved self-esteem, as assessed by scales such as Rosenberg's 10-item Global Self-Esteem Scale and the Body Cathexis Score.
o There was a positive association between Tai Chi and self-esteem, but an ES could not be calculated because quantitative results were limited.
• The authors concluded that the evidence supported a positive effect of Tai Chi on reducing stress, anxiety and depression symptoms, and enhancing mood and self-esteem, but study quality was limited and dose-response could not be assessed.
Clinical Implications
• Tai Chi is associated with reducing stress, anxiety, and depression symptoms and improving self-esteem and mood in a variety of patients.
The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.
Authors and Disclosures
As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.
Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.
Laurie Barclay, MD
Freelance writer and reviewer, Medscape, LLC
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
Brande Nicole Martin
CME Clinical Editor, Medscape, LLC
Disclosure: Brande Nicole Martin has disclosed no relevant financial relationships.
Désirée Lie, MD, MSEd
Clinical Professor, Family Medicine, University of California, Irvine, Orange, California; Director of Research and Patient Development, Family Medicine, University of California, Irvine, Medical Center, Rossmoor, California
Disclosure: Désirée Lie, MD, MSEd, has disclosed the following relevant financial relationship:
Served as a nonproduct speaker for: "Topics in Health" for Merck Speaker Services
Laurie E. Scudder, DNP, NP
Accreditation Coordinator, Continuing Professional Education Department, Medscape, LLC; Clinical Assistant Professor, School of Nursing and Allied Health, George Washington University, Washington, DC; Nurse Practitioner, School-Based Health Centers, Baltimore City Public Schools, Baltimore, Maryland
Disclosure: Laurie E. Scudder, DNP, NP, has disclosed no relevant financial relationships.
Learning Objectives
Upon completion of this activity, participants will be able to:
1. Describe the effect of Tai Chi on stress, mood, anxiety, depressive symptoms, and self-esteem.
2. Describe the quality of studies examining the effect of Tai Chi on psychological well-being and the effect of Tai Chi dose on outcomes.
Credits Available
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
Family Physicians - maximum of 0.25 AAFP Prescribed credit(s)
Nurses - 0.50 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)
All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation.
Physicians should only claim credit commensurate with the extent of their participation in the activity.
Accreditation Statements
For Physicians
MEDSCAPE
Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Medscape, LLC designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity. Medscape News CME has been reviewed and is acceptable for up to 300 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins September 1, 2009. Term of approval is for 1 year from this date. Each issue is approved for .25 Prescribed credits. Credit may be claimed for 1 year from the date of this issue.
Note: Total credit is subject to change based on topic selection and article length.
Medscape, LLC staff have disclosed that they have no relevant financial relationships.
AAFP Accreditation Questions
Contact This Provider
For Nurses
MEDSCAPE
Medscape, LLC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
Awarded 0.5 contact hour(s) of continuing nursing education for RNs and APNs; none of these credits is in the area of pharmacology.
Accreditation of this program does not imply endorsement by either Medscape, LLC or ANCC.
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Monday, August 16, 2010
Sayings from the Tao
Manifesting Qi:
Speaking of the vital essence of beings,
This is what gives them vitality.
It generates the five grains below.
It becomes the arrayed stars above.
When flowing between the Heavens and the Earth,
We refer to it as ghostly and spiritual.
When stored within the human chest/heart,
We call such beings sages.
The Tranquility of Qigong Practice
The Hole (Dantian) functions as a container,
It follows only the Dao.
Everything comes from the Dao.
It is elusive, evasive.
Evasive, elusive,
Yet latent within it are patterns.
Elusive, evasive,
Yet latent within it are objects.
Dark and dim,
Yet latent within it is the Jing (life force).
The Jing being very true,
Latent within it is Xin (trust, integrity, evidence).
Greed
Chapter 46 of the Tao te Ching
Is the seed of apocalypse
It is the rocket-fuel of selfishness:
Me, me, me!
If people could only be glad with all they have,
If they only knew it, they’d be happy.
Chapter 45 of the Tao te Ching :
A great thing done is never perfect
But that doesn’t mean it fails: it does what it is.
Real richness means to act as if you had nothing,
Because then you will never be drained of it.
The greatest straightness seems bent,
The greatest ability seems awkward,
And the greatest speech, like a stammering.
Act calmly, not coldly.
Peace is greater than anger.
Tranquility and harmony
are the true order of things.
Speaking of the vital essence of beings,
This is what gives them vitality.
It generates the five grains below.
It becomes the arrayed stars above.
When flowing between the Heavens and the Earth,
We refer to it as ghostly and spiritual.
When stored within the human chest/heart,
We call such beings sages.
The Tranquility of Qigong Practice
The Hole (Dantian) functions as a container,
It follows only the Dao.
Everything comes from the Dao.
It is elusive, evasive.
Evasive, elusive,
Yet latent within it are patterns.
Elusive, evasive,
Yet latent within it are objects.
Dark and dim,
Yet latent within it is the Jing (life force).
The Jing being very true,
Latent within it is Xin (trust, integrity, evidence).
Greed
Chapter 46 of the Tao te Ching
Is the seed of apocalypse
It is the rocket-fuel of selfishness:
Me, me, me!
If people could only be glad with all they have,
If they only knew it, they’d be happy.
The Tao
Chapter 42 of the Tao te Ching
Gives birth to the One:
The One
Gives birth to the two;
The Two
Give birth to the three –
The Three give birth to every living thing.
All things are held in yin, and carry yang:
And they are held together in the chi of teeming energy.
Chapter 45 of the Tao te Ching :
A great thing done is never perfect
But that doesn’t mean it fails: it does what it is.
Real richness means to act as if you had nothing,
Because then you will never be drained of it.
The greatest straightness seems bent,
The greatest ability seems awkward,
And the greatest speech, like a stammering.
Act calmly, not coldly.
Peace is greater than anger.
Tranquility and harmony
are the true order of things.
Shamanic Tiger Qigong
Shaking: Up and down, heaven and earth. Right, then left. Think of body parts, starting from top of head. Freestyle.
1. Sleeping Tiger.
2. Sleeping Tiger wakes up.
3. Tiger wags its tail. (R then L)
4. Tiger emerges from cave, looks to horizon. L
5. Tiger displays martial power. Rotating arms towards and away from you, feet in Tai chi stance. R
6. Spiritual sword kills the demon. L
7. Qi transforms the three layers (energy ball, sweep sky, (heaven), horizon (earth), humanity.
8. Connect with heaven and penetrate earth. Rotate spine and qi, first top down, then bottom up.
9. Embrace the sun and moon.
10. Tiger climbs the mountain. R
11. Ride the wind down the mountain. Both hands facing to right, claws, jab towards face. R
12. Qi transforms into rainbow.
13. Moving clouds make rain, end up with palms facing down.
14. Double dragons play with the pearl. If the dragon loses its pearl it will be unable to make rain and loses its power.
15. Heavenly dew purifies the body. (settle the breath)
16. Golden turtle plunges into the ocean. Lean forward, fist to kidneys.
17. Colorful wave cleanses the spirit. Like settle breath, but put arms out, like swimming breast stroke.
18. Red phoenix visits the sun. Now bring arms up, palms facing outward, look up.
19. Lift the moon from the water. Arms come down facing down, reach down to hold moon in arms, palms facing up, knees bent.
20. Dragon and tiger leap into heaven. Leap up from crouching position, put hands on shoulders, then lift hands above your head, palm facing out. Reach up right, then left.
21. Harmonizing wind unites the cosmos. Arms come down, rotating wrists, back to shoulders, slide back down torso, palms facing out, end up palms down, arms bent, ready for:
22. Maintain peace in the eight directions. Look to side you are lifting leg.
23. Sacrifice everything to the heavenly cave. Palms rotate back, come up into sleeping tiger.
24. Close. Remain in the heavenly qi.
1. Sleeping Tiger.
2. Sleeping Tiger wakes up.
3. Tiger wags its tail. (R then L)
4. Tiger emerges from cave, looks to horizon. L
5. Tiger displays martial power. Rotating arms towards and away from you, feet in Tai chi stance. R
6. Spiritual sword kills the demon. L
7. Qi transforms the three layers (energy ball, sweep sky, (heaven), horizon (earth), humanity.
8. Connect with heaven and penetrate earth. Rotate spine and qi, first top down, then bottom up.
9. Embrace the sun and moon.
10. Tiger climbs the mountain. R
11. Ride the wind down the mountain. Both hands facing to right, claws, jab towards face. R
12. Qi transforms into rainbow.
13. Moving clouds make rain, end up with palms facing down.
14. Double dragons play with the pearl. If the dragon loses its pearl it will be unable to make rain and loses its power.
15. Heavenly dew purifies the body. (settle the breath)
16. Golden turtle plunges into the ocean. Lean forward, fist to kidneys.
17. Colorful wave cleanses the spirit. Like settle breath, but put arms out, like swimming breast stroke.
18. Red phoenix visits the sun. Now bring arms up, palms facing outward, look up.
19. Lift the moon from the water. Arms come down facing down, reach down to hold moon in arms, palms facing up, knees bent.
20. Dragon and tiger leap into heaven. Leap up from crouching position, put hands on shoulders, then lift hands above your head, palm facing out. Reach up right, then left.
21. Harmonizing wind unites the cosmos. Arms come down, rotating wrists, back to shoulders, slide back down torso, palms facing out, end up palms down, arms bent, ready for:
22. Maintain peace in the eight directions. Look to side you are lifting leg.
23. Sacrifice everything to the heavenly cave. Palms rotate back, come up into sleeping tiger.
24. Close. Remain in the heavenly qi.
Tai Chi 24 Movement Routine Yang Style
Tai Chi 24 Movement Routine Yang Style
1. Beginning
2. Parting wild horse’s mane 3X
3. White Crane Cools its Wings
4. Brush knee 3X
5. Play the lute
6. Repulse the Monkey
7. Grasping Sparrow’s Tail – Left
8. Grasping Sparrow’s Tail – Right
9. Single Whip
10. Waving hands like clouds 3X
11. Single Whip
12. High Pat Horse
13. Kick with Right Heel
14. Double Strike the Ears
15. Kick with Left Heel
16. Snake creeps down/Golden Rooster – Right
17. Snake creeps down/Golden Rooster – Left
18. Jade Lady Weaves the shuttles – Left and Right
19. Searching for the Neele at the Bottom of the Sea
20. Fan penetrates the Back
21. Turn and Chop
22. Deflect downward Parry and Punch
23. Crossing Hands
24. Close
1. Beginning
2. Parting wild horse’s mane 3X
3. White Crane Cools its Wings
4. Brush knee 3X
5. Play the lute
6. Repulse the Monkey
7. Grasping Sparrow’s Tail – Left
8. Grasping Sparrow’s Tail – Right
9. Single Whip
10. Waving hands like clouds 3X
11. Single Whip
12. High Pat Horse
13. Kick with Right Heel
14. Double Strike the Ears
15. Kick with Left Heel
16. Snake creeps down/Golden Rooster – Right
17. Snake creeps down/Golden Rooster – Left
18. Jade Lady Weaves the shuttles – Left and Right
19. Searching for the Neele at the Bottom of the Sea
20. Fan penetrates the Back
21. Turn and Chop
22. Deflect downward Parry and Punch
23. Crossing Hands
24. Close
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