By Dónal P. O’Mathúna, PhD
Dr. O’Mathúna is a lecturer in Health Care Ethics at the School of Nursing, Dublin City University, Ireland.
The slow graceful movements of tai chi now regularly show up in the backdrop of movies and TV shows. More and more tai chi classes are being offered as a way to gently exercise the body and relax the mind. In addition, tai chi is said to have many general health benefits, primarily coming from the prevention of illness rather than cure or relief of symptoms. Some claim it can reduce blood pressure, cholesterol levels, tension, depression, fatigue, and anxiety. Others claim it improves circulation, digestion, and appetite. It is also said to bring mental and spiritual clarity.
Before recommending the practice, however, a closer examination of the growing number of clinical studies is warranted. Although much of the focus on tai chi has been on its potential to reduce falls among the elderly, the focus here will be on its psychological effects in this same population, and specifically its impact on depression and anxiety.1
Tai chi, or tai chi chuan, literally means "supreme ultimate power" and is part of traditional Chinese medicine (TCM). It originally was developed to provide general physical fitness for the martial arts.2 However, the slow and smooth movements of tai chi now differ significantly from the vigorous movements of judo, karate, or tae kwon do. Five major styles of tai chi developed over the centuries, with the Yang form being the most popular.1 A "combined" style developed from a meeting in China in 1956 and was designed to make the movements easy to learn and practice in shorter periods of time.2 The Chinese government promoted this form widely and made it compulsory in most colleges and universities. As a result, millions of Chinese people practice tai chi today. Since the 1980s, it has also been growing in popularity in the West.
All forms of tai chi involve meditation, breathing exercises, and slow, graceful movements. Each session is composed of a series of specific postures combined into one long exercise. The movements are all considered circular with each session being viewed as one continuous, integrated circle.2 Within each session, however, there are many variations and changes. Sessions come in short and long versions, lasting either 10 or 30 minutes.
Mechanism of Action
As with all aspects of TCM, the traditional purpose of tai chi is to restore a balanced flow of qi (or chi) and thereby promote health. Qi is a nonphysical "life energy" that is believed to pervade and animate the universe. Illness is held to be a manifestation of imbalances or poor flow of qi. Tai chi movements are viewed as part of a healthy lifestyle that promotes a more balanced flow of qi. Practicing tai chi outdoors is said to be better because it allows universal qi in the earth to rise up through one’s feet to replenish the person’s own qi. More biological or scientific mechanisms of action have not been established for tai chi, other than viewing it as a gentle form of exercise and "meditation in motion."
One of the earliest studies of tai chi in the West found reduced tension, depression, anger, fatigue, confusion, and state-anxiety when comparing pre- and post-study scores among 33 beginners and 33 experienced tai chi practitioners.3 This study was neither controlled nor blinded. The same researcher did a similarly uncontrolled study to compare the psychological benefits of tai chi to those of brisk walking, meditation, and reading.4 After 3-4 years, all four regimens were equivalent in reducing mood disturbances, and the stress-reduction effects of tai chi and brisk walking were comparable. Another nonrandomized controlled trial involved 90 subjects using tai chi for 30 minutes daily, six days a week, for one month.5 At the end of the trial, those practicing tai chi had reduced stress and anxiety, and improved overall psychological symptoms.
The first randomized controlled trial examining psychological effects involved 135 subjects (average age 51 years).6 These were randomly assigned to one of five groups: tai chi, control, moderate-intensity walking, low-intensity walking, or low-intensity walking plus relaxation response. Each was practiced for 45 minutes, three times per week for 16 weeks. No significant differences were found among the five groups on measures of mood, self-esteem, personality, or life satisfaction. However, sub-group analysis did find that women in the tai chi group experienced significant reductions in mood disturbance (P < 0.006) and improvements in general mood (P < 0.04).
Another controlled trial involved 98 healthy subjects (average age 73 years) who were not involved in any structured exercise program in the previous month.7 They were randomly assigned to either the control group or to practice tai chi for one hour, twice a week, for six months. At that point, the tai chi group showed significantly greater reductions in depression, negative affect, and psychological distress and greater increases in positive affect and well-being, life satisfaction, and health perception compared to the control group (P < 0.05).
The third randomized controlled trial of tai chi in this area was conducted with 14 patients (average age 73 years) diagnosed with depression of a non-organic nature.8 None of the participants had been involved in regular exercise for the previous six months, and none had a medical contraindication to exercise. The subjects were randomly assigned to either a group that participated in three tai chi sessions per week for three months, or to a waiting group. According to their scores on the Chinese version of the Center for Epidemiology Studies Depression Scale, the tai chi group showed statistically significant improvements compared to the control group (P < 0.05). A multivariate analysis of subcategories of depressive symptoms (somatic, negative affect, interpersonal, and well-being) showed significant improvements in all four categories (P < 0.05).
No adverse effects of tai chi were reported in the literature examined. Although Western medicine questions the existence of qi, tai chi can be practiced without any reference to, or in support of, any particular belief system.
Few rigorously controlled trials examine the impact of tai chi on depression or anxiety. Some of the trials have not been randomized and sometimes the outcomes reported were not clearly defined. All but the last trial examined above involved healthy subjects rather than those diagnosed with depression or anxiety. In spite of these limitations, the results have generally been supportive of tai chi’s ability to improve mood and reduce anxiety among the elderly. Whether this is the result of a generalized benefit from moderate exercise, or specifically related to the combination of exercise, meditation, and breathing aspects of tai chi, cannot be clearly determined from the currently available trials. However, what evidence is available suggests that tai chi, as a result of its meditative and breathing dimensions, may provide benefits that go beyond those of exercise. The gentle nature of tai chi makes it particularly suited for elderly adults.
Those interested in becoming more active could consider tai chi as one option that may bring accompanying psychological and well-being benefits. All adults, especially the elderly, who are considering starting an exercise program should seek out medical advice to ensure they are physically ready to do so. Doctors and others examining such people should seek details on the precise nature of the tai chi program as the duration and rigor can vary considerably. Patients should be made aware of what symptoms to watch out for that would indicate overexertion. Keeping such cautions in mind, people can be advised that tai chi may bring the psychological benefits established for exercise along with possible benefits from "meditation in motion."
1. Wang C, et al. The effect of Tai Chi on health outcomes in patients with chronic conditions: A systematic review. Arch Intern Med 2004;164:493-501.
2. Li JX, et al. Tai chi: Physiological characteristics and beneficial effects on health. Br J Sports Med 2001;35: 148-156.
3. Jin P. Changes in heart rate, noradrenaline, cortisol and mood during Tai Chi. J Psychosom Res 1989;33: 197-206.
4. Jin P. Efficacy of Tai Chi, brisk walking, meditation, and reading in reducing mental and emotional stress. J Psychosom Res 1992;36:361-370.
5. Fu CY, et al. The effects of Tai Chi on psychological balance. J Chin Rehabil 1996;11:88-89.
6. Brown DR, et al. Chronic psychological effects of exercise and exercise plus cognitive strategies. Med Sci Sports Exerc 1995;27:765-775.
7. Li F, et al. Enhancing the psychological well-being of elderly individuals through Tai Chi exercise: A latent growth curve analysis. Struct Equation Modeling 2001;8:53-83.
8. Chou KL, et al. Effect of Tai Chi on depressive symptoms amongst Chinese older patients with depressive disorders: A randomized clinical trial. Int J Geriatr Psychiatry 2004;19:1105-1107.