Tai chi – Indications, Contraindications

Tai chi is a gentle exercise program that is a part of Traditional Chinese Medicine (TCM). Derived from the martial arts, tai chi is composed of slow, deliberate movements, meditation, and deep breathing, which enhance physical health and emotional well-being.

Tai chi (pronounced tie chee) is an ancient Chinese martial art that combines slow, focused body movements, meditation, and deep breathing. Originally used for self-defense, it is now practiced as a gentle form of exercise, which has been used as part of traditional Chinese medicine (TCM).

The relaxed and deliberate movements of tai chi help develop balance, coordination and flexibility. You move from one position to the next without stopping, so that your body is in constant motion during the tai chi session. Because you must focus on breathing and movements, tai chi helps focus your mind in a form of meditation.

Tai chi is based on spiritual and philosophical ideas that advocate a need for balance in the body, mind, and spirit. Central to tai chi is the idea that qi (pronounced “chee”), or life energy, flows throughout the body. Qi must be able to move freely for good health. The principle of yin/yang is important, too. Yin and yang are opposite and complementary forces in the universe, in the same way as light and dark are. Tai chi is meant to harmonize these pairs of opposites. Finally, tai chi imitates motion found in nature, such as the movements of animals, thereby uniting human beings with the natural world.

Types

There are five different styles of tai chi, dating from different periods in history. Each has a unique set of methods and principles, lineage, and date of origin.

They are:

• Chen style, which began sometime between 1528 and 1587
• Yang style, which began sometime between 1799 and 1872
• Wu or Wu Hao style, which began sometime between 1812 and 1880
• Wu style, which began sometime between 1870 and 1942
• Sun style, which began sometime between 1861 and 1932

Some of these forms of tai chi lean towards health, while others stress competition or self-defense.

People considering a tai chi course should speak to an experienced instructor about which style they practice and whether it will offer the expected benefits.

Tai Chi Theory

Tai Chi emphasizes breathing and movement that are both flowing and graceful. Though its primary action is in the movement and breathing, this must all be carried out with particular mental focus during Tai Chi. This is why Tai Chi has often been referred to as “meditation in motion.”

In theory, Tai Chi directly affects qi – the “vital energy” or “life force” of the body – where the proper flow of qi is said to be necessary to maintain health. During Tai Chi, this energy flows through the body through a network of 20 pathways (meridians from acupuncture). When these pathways are blocked, qi does not flow properly, and in theory, illness ensues. Tai Chi is thought to stimulate this flow of qi through the body and organs through its movements and breathing. Tai Chi can be seen as acupuncture from the inside.

From a more scientific standpoint, Tai Chi is not unlike other forms of low-impact exercises; however, Tai Chi focuses more specifically on posture and alignment.

• Body alignment and posture in Tai Chi – Training the body to avoid slouching and rounding the shoulders through better posture and spinal alignment reduces stress on the components of the spine. Like other martial arts and exercises, correct form is emphasized through consistent training. Practicing Tai Chi may therefore reduce the practitioner’s back pain through the application.
• Balance and coordination in Tai Chi – Transferring of weight from one leg to the other, while extending and retracting limbs, and flexing joints, plays a critical role in improving the balance of the practitioner. Tai Chi aids in enhancing the coordination of the practitioner by increasing proprioception – the body’s automatic perception of movement and spatial orientation through interpreting signals from the muscles, joints, and connective tissues; “position sense.”

  A heightened position sense acquired through Tai Chi is helpful for preventing an accident that may lead to back pain. It also helps reduce the aggravation of existing back pain by reducing awkward movements. There has been considerable evidence showing that Tai Chi practiced by the elderly greatly reduces the chances of falls.

The practice of Tai Chi entails three key components:

• Movement – slow and fluid movements improve the body’s alignment, posture, strength, flexibility, coordination, balance, and stamina. Many of these benefits of Tai Chi are consistent with many other forms of low-impact exercise, with the added benefit of focusing on improved posture, balance, and alignment.
• Breathing – focused and rhythmical breathing emphasizes a relaxed body and encourages strong circulation. Oxygenated blood flows to the muscles and brain during Tai Chi.
• Meditation/state of mind – a meditative state of mind during Tai Chi, coupled with these movements and breathing is said to dissipate stress and anxiety, which helps relieve pain caused by psychological and emotional factors.

Indications

Various research suggests tai chi offers a range of benefits for people with and without chronic conditions. These benefits include:

• improved balance
• pain management
• and brain function
• improved sleepquality
• enhanced immune system

Fall reduction

Tai chi showed some potential benefits for helping prevent trips and falls in older adults across a range of studies.

A 2012 review looked at 159 randomized controlled trials of various types of practices to prevent falls in older adults.

The studies involved more than 79,193 people, with the authors concluding that tai chi could reduce the risk of falling.

A 2015 systematic review of seven trials involving 544 tai chi chuan practitioners concluded it helped improve balance control and flexibility.

Meanwhile, a 2014 reviewTrusted Source found that exercises, including tai chi, might have reduced the fear of falling among older adults in a retirement community immediately after a workout. However, the review did not reach any conclusions about tai chi reducing the frequency of falls.

One 2012 trial of 195 older adults with Parkinson’s disease showed that tai chi helped treat balance issues with more success than resistance training or regular stretching.

Another article notes that the activity is a successful exercise intervention for factors related to falls in older people.

The evidence from these studies suggests that tai chi might help support many aspects of balance and posture.

Chronic pain

Several small studies suggest that tai chi can significantly impact the chronic pain that people experience with specific conditions, such as osteoarthritis of the knee and fibromyalgia.

A 2013 meta-analysis of seven different trials seemed to demonstrate that a 12-week course of tai chi could improve the stiffness and pain symptoms of knee osteoarthritis and improve physical function.

However, the review authors recommended further, larger-scale trials to support their conclusions, as the studies they examined had flaws and potential biases.

A 2015 review of 54 studies involving 3,913 participants provided moderate-quality evidence that tai chi could help improve physical function in those with knee osteoarthritis. While tai chi only formed the basis of five of the studies, the evidence that exercise helped provide short-term relief for knee osteoarthritis was strong.

Tai chi also seems to have some evidence supporting its use to help manage fibromyalgia.

A 2010 trial showed tai chi to be better than wellness education and stretching for regularizing sleep patterns and treating symptoms of pain and fatigue in people with fibromyalgia.

A 2012 study of 101 people suggested that combining tai chi with mindfulness training could improve fibromyalgia symptoms and functional difficulties.

Chronic heart failure

Some practitioners of tai chi praise it as an effective management tool for people with chronic heart failure. However, current evidence does not support this conclusion. Any studies showing an improvement indicate that the findings were insignificant.

A 2015 systematic review of 20 studies showed tai chi as beneficial for multiple areas of cardiovascular health, such as blood pressure and heart rate. However, the quality of the studies was low, and the researchers drew no definitive conclusions.

A 2014 review of 13 small trials also showed inconclusive evidence to support the activity as a preventative measure against cardiovascular disease.

However, the results of one trial, which followed people after a recent heart attack, demonstrated that tai chi significantly improved maximum oxygen capacity.

Mental health and cognitive function

Tai chi is a tranquil, fluid martial art that has associations with mindfulness and psychological well-being.

However, the evidence is thin on the ground for the mental health benefits of the activity. Some studies suggest a link, but a large 2010 meta-analysisTrusted Source of 40 studies failed to provide definitive conclusions.

Research looking at the effect of tai chi on cognitive function yielded more promising results.

A systematic review and meta-analysis from 2014 involved 2,553 adults aged 60 years and over with and without cognitive impairments. The results were significant in showing beneficial effects on cognitive function. The studies also demonstrated small but significant benefits for people who were cognitively impaired.

A 2015 review of nine studies involving 632 healthy adults showed the potential benefits of tai chi for cognitive ability. It advocated further large-scale studies to confirm the potential benefits of tai chi.

While tai chi is a gentle, low-impact activity, people should seek medical advice before starting any form of exercise. This especially applies to those who are:

• older
• pregnant
• experiencing back pain or osteoporosis

It Decreases Blood Pressure

Tai chi may be just as effective as popular methods for lowering blood pressure, such as weight loss and lowered sodium intake. According to the American Heart Association’s publication Heart Insight Magazine, tai chi may positively affect blood cholesterol, related lipids and inflammation. This means that enjoying tai chi regularly may lower your chance of heart disease.

It Reinvigorates Your Body and Mind

Thinking of pouring yourself that third cup of coffee? A major goal of tai chi is the flow of qi around the body. This is done through slow, deep breathing, which leaves you with a burst of energy. And not the jittery, “I’ve had way too much coffee” kind, either. You’ll be left with the calm, natural alertness you feel after a good night’s rest. Sorry, Starbucks.

Look for quiet parks and other serene spaces away from highways to really reap the full mindfulness benefits.

It Makes You Stronger

Make no mistake, “gentle” does not mean “non-toning.” You can definitely build muscle doing tai chi. Harvard Medical School compares the effects of its deliberate movements to those of resistance training or brisk walking. Flowing between movements, you must engage your core, back, and arm and leg muscles, making tai chi a great low-impact exercise option.

It Builds Community

Group activity that’s good for the soul and counts as exercise? Yes, please! Some of Abbott’s global experts share their reasons for why it’s important to stay active with others. For one, it keeps you accountable and makes you more likely to stick with an activity. Plus, it allows you to work up a sweat while making positive memories. Tai chi also involves silence (it’s a no cellphone zone!), so you and a new pal can bond over a shared experience without agonizing over awkward silences.

It Encourages Serenity

Deep breathing in tai chi may decrease anxiety, stress, and depression. A recent article in Stanford Medicine reported that researchers have discovered 175 neurons in the brain that can differentiate types of breathing, such as from crying or laughing. During an activity like tai chi, these neurons may pick up on your controlled breathing, signaling the body to enter a state of tranquility. Better mood, coming right up!

It Leads to Better Balance (Literally)

Research has found that balance may falter with age. Frontiers in Neurology reports that after age 40, the body’s vestibular system — which controls balance — starts to decline. One of the health benefits of tai chi is it may counteract this natural process. During tai chi, the body moves fluidly as if it is opposing energy forces to create harmony. This involves shifting your weight back and forth from leg to leg, which helps improve balance. Who says you can’t turn back the clock?

What’s great about tai chi is there is room to find what works for you. While some like to focus more on breath work, others reap more benefits from focusing on the martial arts aspect or learning tai chi sequences. Explore the practice and find what works for your wellness needs.

Muscle strength. Tai chi can improve both lower-body strength and upper-body strength. When practiced regularly, tai chi can be comparable to resistance training and brisk walking.

Although you aren’t working with weights or resistance bands, the unsupported arm exercise involved in tai chi strengthens your upper body. Tai chi strengthens both the lower and upper extremities and also the core muscles of the back and abdomen.

Flexibility. Tai chi can boost upper- and lower-body flexibility as well as strength.

Balance. Tai chi improves balance and, according to some studies, reduces falls. Proprioception — the ability to sense the position of one’s body in space — declines with age. Tai chi helps train this sense, which is a function of sensory neurons in the inner ear and stretch receptors in the muscles and ligaments. Tai chi also improves muscle strength and flexibility, which makes it easier to recover from a stumble. Fear of falling can make you more likely to fall; some studies have found that tai chi training helps reduce that fear.

Aerobic conditioning. Depending on the speed and size of the movements, tai chi can provide some aerobic benefits. If your clinician advises a more intense cardio workout with a higher heart rate than tai chi can offer, you may need something more aerobic as well.

Warm-up. Easy motions, such as shoulder circles, turning the head from side to side, or rocking back and forth, help you to loosen your muscles and joints and focus on your breath and body.

Instruction and practice of tai chi forms. Short forms — forms are sets of movements — may include a dozen or fewer movements; long forms may include hundreds. Different styles require smaller or larger movements. A short form with smaller, slower movements is usually recommended at the beginning, especially if you’re older or not in good condition.

Qigong (or chi kung). Translated as “breath work” or “energy work,” this consists of a few minutes of gentle breathing sometimes combined with movement. The idea is to help relax the mind and mobilize the body’s energy. Qigong may be practiced standing, sitting, or lying down.

What is the history of tai chi?

Zhang Sanfeng, a martial artist who lived in China in the late 16th century, created the practice of tai chi. According to legend, Sanfeng had a dream about a snake and a crane engaged in battle. Their graceful movements inspired his noncombative style of martial arts. This ancient form of movement has been practiced in China for centuries and is still a daily routine for tens of thousands of people there, especially the elderly. It was first introduced to the United States in the early 1970s and has since grown in popularity.

How does tai chi work?

There are various perspectives on how tai chi works. Eastern philosophy holds that tai chi unblocks the flow of qi . When qi flows properly, the body, mind, and spirit are in balance and health is maintained. Others believe that tai chi works in the same way as other mind-body therapies, and there is ample evidence that paying attention to the connection between the mind and the body can relieve stress, combat disease, and enhance physical well-being.

Tai chi has three major components, movement, meditation, and deep breathing.

• Movement. All of the major muscle groups and joints are needed for the slow, gentle movements in tai chi. Tai chi improves balance, agility, strength, flexibility, stamina, muscle tone, and coordination. This low-impact, weight-bearing exercise strengthens bones and can slow bone loss, thus preventing the development of osteoporosis.
• Meditation. Research shows that meditation soothes the mind, enhances concentration, reduces anxiety, and lowers blood pressure and heart rate.
• Deep breathing. Exhaling stale air and toxins from the lungs while inhaling a plentitude of fresh air increases lung capacity, stretches the muscles involved in breathing, and releases tension. It also enhances blood circulation to the brain, which boosts mental alertness. At the same time, the practice supplies the entire body with fresh oxygen and nutrients.

What does a tai chi session entail?

Tai chi sessions are usually group classes that last about an hour. Each session begins with a warm-up exercise. Then the instructor guides the class through a series of 20 to 100 tai chi movements that together comprise a “form.” A form can take up to 20 minutes to complete. Each form has a nature-based name that describes its overall action, such as “wave hands like clouds” or “grasp the bird’s tail.” At the same time, students are asked to focus on the point just below their navels, believed to be the center from which qi flows. The teacher encourages the class to perform all movements in a slow, meditative manner, and to focus on deep breathing. At the end of the class, there is usually a wind-down exercise, relaxation, and meditation.

How many sessions will I need?

Classes are usually taught on a weekly basis. Many practitioners recommend practicing tai chi for about 15 to 20 minutes twice daily at home, since regular practice is essential for mastering the forms and achieving lasting results. Before beginning a tai chi program, you should check with your doctor and discuss your health needs with the tai chi instructor. Exercises can be modified depending on your mobility, history of injuries, chronic pain, joint swelling (if present), and medication that may affect balance.

What conditions respond well to tai chi?

Tai chi improves overall fitness, coordination, balance, and agility. People who practice tai chi on a regular basis tend to have good posture, flexibility, and range of motion, are more mentally alert, and sleep more soundly at night.

Tai chi is both a preventive and complementary therapy for a wide range of conditions. Specifically, it is beneficial for chronic pain, gout, heart disease, high blood pressure, arthritis, osteoporosis, diabetes, headaches, fibromyalgia, rheumatoid arthritis, osteoarthritis, and sleep disorders. Tai chi is also beneficial for the immune system and the central nervous system, which makes it especially good for people with a chronic illness, anxiety, viral infections, depression, or any stress-related conditions. The deep breathing of tai chi regulates the respiratory system, helping to treat respiratory ailments, such as asthma, bronchitis, and emphysema. It also stimulates the abdomen, which aids digestion and helps relieve constipation and gastrointestinal conditions. Many clinical studies indicate that elderly people who practice tai chi have better hand-eye coordination and are less prone to falls, both serious health risks to people in that age group.

Are there conditions that should not be treated with tai chi?

Tai chi is typically safe for everyone, regardless of age or athletic ability, and can be modified for most health problems. People with limited mobility, even those in wheelchairs, can learn and successfully use tai chi. In one study of 256 sedentary adults 70 to 92 years of age, tai chi decreased the number of falls and the fear of falling compared to stretching. Those who practiced tai chi also had improved functional balance and physical performance after 6 months. However, tai chi is not meant to replace medical care for a serious condition. Talk to your doctor and your instructor about any health problems or recent injuries you may have, or if you are pregnant.

Is there anything I should look out for?

Tai chi exercises muscles in areas of your body that may have been neglected. Therefore, you may feel sore in the beginning. It takes time to develop the posture, flexibility, and agility needed for tai chi, so do not get discouraged. As with any exercise program, safety is affected by proper stretching and warm up exercises, as well as correct alignment. If you experience dizziness, shortness of breath, headaches, or severe pain, stop practicing and talk to your instructor right away, and consult your doctor. People with severe psychiatric disturbances should use tai chi under the care of their physicians to see how they respond to the relaxation.