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It’s dawn. The mists rise from the wet grass. The park is silent. Near the lake, ghostly figures bend and sway, their bodies flowing in a slow-motion dance. On closer examination, most of the dancers are elderly. The expressions of serenity on their faces and the fluidity of their movements belie their age.
They are practitioners of tai chi, an ancient Chinese art of classical conditioning used for centuries to promote long life and self-defense. We’re seeing them more often in parks across the country. It’s an art still widely used today for its broad health benefits for all ages, especially for elderly people with one of the most common complaints of aging found among Americans: osteoarthritis.
The joint instability, stiffness, muscle atrophy, decreased range of motion, and secondary inflammation attributed to osteoarthritis adds up to considerable pain and decreased quality of life for sufferers.
While treatment usually includes anti-inflammatory medications and exercise as tolerated, Massachusetts researchers have found that tai chi offers arthritis sufferers a no-impact weight-bearing exercise that gives relief from pain and may even reverse the functional disability usually associated with advancing cases of the disease.
A group of 33 arthritis patients ages 49 to 81 were given two one-hour tai chi classes a week for 12 weeks. A control group was given physician advice to exercise but was offered no special intervention other than a telephone call every two weeks.
The Springfield (MA) College research team found "older adults with osteoarthritis can realize meaningful improvements in their mental and physical health through regular tai chi practice," says lead author Catherine Hartman, MS, CHFI, who conducted the study as part of her masters’ work and now is a health project director at Dana-Farber Cancer Institute in Boston.1
Further, Hartman says, "Tai chi may be especially suitable for the geriatric population because it improves the health-related fitness outcomes necessary for functional mobility and independent living."
Although tai chi is performed as slow, fluid movements, Hartman says the physical act of performing tai chi is equivalent to walking at a speed of 6 km (3.6 miles) per hour, while the cognitive aspect equates to quiet meditation. "Tai chi involves cognitive, cardiovascular, and musculoskeletal responses that evoke physiological and psychological changes," says Hartman.
Among the benefits other studies have shown for elderly practitioners of tai chi are improved fitness outcomes, including VO2 max, muscular strength, flexibility, reduced percentage of body fat, and reduced risk of falls. Plus, tai chi requires no large amount of space or particular equipment, and "anybody can do it," says Hartman.
Subjects in Hartman’s study had widely varying disabilities — some caused severe limitations in mobility including obesity, use of a walker, and the use of an oxygen tank. At the outset, the tai chi group had osteoarthritis for significantly more years and reported less participation in physical activity and more pain than the control group.
After just 12 weeks, Hartman’s team found that tai chi practitioners benefited significantly from the following:
• decreased pain;
• improvement in one-leg balance;
• improvement in 50-foot walking speed;
• improvement in time to rise from a chair;
• decreased levels of tension;
• increased feelings of well-being and calm;
• increased satisfaction with overall health, including controlling fatigue and regulating pain during physical activities.
Hartman’s study did not show increased mobility in lower extremities, although she says she is confident such a benefit would present itself with longer practice. Other studies have attributed a host of benefits to elderly tai chi practitioners, says Janelle White, MD, geriatric staff physician at the Canyon Ranch Health Resort in Tucson, AZ. A Chinese study of 38 people ages 58 to 70 who practiced tai chi for 11 months with 4.6 practice sessions per week found the following:2
• Men practicing tai chi:
— increased their VO2 max by 16.1%;
— increased thoracic/lumbar flexibility by 11%;
— increased muscle strength in knee extensor by 18.1%;
— increased muscle strength in knee flexor by 15.4%.
• Women practicing tai chi:
— increased VO2 max by 21.3%;
— increased thoracic/lumbar flexibility by 8.8%;
— increased muscle strength in knee extensor by 20.3%;
— increased muscle strength in knee flexor by 15.9%.
The control group showed no changes in those parameters.
A large multicenter study called Frailty and Injuries: Cooperative Studies of Intervention Techniques included a tai chi component that showed a 47.5% reduction in multiple falls.3 Furthermore, a large study of most myocardial infarction patients in England, which randomized patients to a nonexercise support group, an aerobic exercise group, and a tai chi exercise group showed improvements in systolic and diastolic blood pressure only in the tai chi group.4
Among the benefits White noticed in patients with arthritis who visit the Canyon Ranch clinics and study tai chi with the ranch’s octogenarian instructor are:
• improved balance and fewer falls;
• increased strength;
• improved circulation;
• lower blood pressure;
• lower cholesterol;
• improved flexibility;
• reduced anxiety and depression;
• improved mental functioning;
• improved bone mass;
• improved breathing patterns.
"We have concentrated programs for people with different chronic disease conditions, including two one-week programs every year for patients with arthritis," says White. "Tai chi is a very popular option for them, although they obviously can’t learn the entire form in that short period of time, yet we still see good results."
Even in the one-week programs, patients get a good idea of how to perform the movements. The results patients see in a short time may motivate them to continue with classes and practice after they leave the ranch, says White.
Tai chi is characterized by stillness and lightness and slowness with a focus on relaxation of muscles of the whole body and the use of mind — not force. The physiological responses are raised from passivity, inside the body, according to Canyon Ranch’s patient literature. That is exactly the opposite of dynamic exercise, which involves strenuous activity of the muscles, causing increased oxygen demand and resulting in temporary increases in heart rate and blood pressure.
White says the exact mechanism at work in tai chi is not known to Western medicine, but she notes that more energy is needed to move slowly and that slow movement is essential for brain control and endurance. "The stillness that comes from this slow practice aids in developing awareness, relaxing nerves and abolishing anxiety and tension. Tai chi promotes flexibility of the nervous system and harmony of the mind and body," she says.
White also notes that tai chi instructors vary widely. Practitioners considering referring patients to tai chi should look for instructors willing to be flexible in their teaching to accommodate disabilities. "Look for instructors willing to teach modified and simplified forms (some classical forms may take a year or more to learn correctly) and instructors who are not perfectionists, insisting on every movement being done in an absolutely precise manner," she says.
White explains that her experience shows that it’s the movement and the breathing associated with the movement that help, although Chinese medicine attributes many of the benefits of tai chi to precise stimulation of meridians that increase energy flows to the areas affected by arthritis. "That may be true, but we see benefits even when people perform the movements in the most imprecise ways," she says.
Clinicians know that very few arthritis patients participate in exercise programs, despite their potential benefit. Hartman suggests that they may find tai chi appealing as an enjoyable alternative to traditional exercise programs.
1. Hartman CA, Manos TM, Winter C, et al. Effects of Tai Chi training on function and quality of life indicators in older adults with osteoarthritis. J Am Geriatr Soc 2000; 48:1,553-1,559.
2. Ching Lan, Jin-Shan Lai, Ssu-Yuan Chen, et al. 12-month Tai Chi training in the elderly: Its effect on health fitness. Med Sci Sports Exerc 1998; 30:345-351.
3. Kutner NG, Barnhart H, Wolf SL et al. Self-report benefits of Tai Chi practice by older adults. J Gerontol 1997; 52:242-246.
4. Channer KS, Barrow D, Barrow R, et al. Postgraduate Med J 1996; 72:349-351.