Tai Chi

  • Author:
    Richard Weil, MEd, CDE

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Introduction to tai chi

When the Western world thinks of "martial arts," it inevitably thinks of kicking, punching, fighting, and body contact. Not slow, rhythmic, and meditative body movements designed to enhance relaxation, inner calm, and peace. But that's what the martial art of tai chi is all about: slow, rhythmic, meditative movements designed to help you find peace and calm. In this article, we will cover the history, philosophy, and benefits of tai chi, as well as how and where to get started, and more.

What is tai chi, and where does it come from?

Tai chi history

Tai chi is a centuries-old Chinese martial art that descends from qigong, an ancient Chinese discipline that has its roots in traditional Chinese medicine. (The people that you see moving gracefully with flowing motions in parks throughout China, and increasingly throughout much of the modern world, are practicing tai chi.) According to some records, tai chi dates back as far as 2,500 years! It involves a series of slow, meditative body movements that were originally designed for self-defense and to promote inner peace and calm. According to the tai chi historian Marvin Smalheiser, some tai chi masters are famous for being able to throw an attacker effortlessly to the floor with the attacker and spectators unable to clearly see how it was done. Their movements use internal energy and movements too subtle for most people to observe, reflected in the notion that "four ounces can deflect a thousand pounds." At this high level of skill, a defender can use a small amount of energy to neutralize the far greater external force of an attacker.

Qi

In traditional Chinese medicine, human beings are considered miniature versions of the universe, and like the universe, they are thought to be made up of the constant interaction of five elements (metal, water, fire, wood, and earth). It is believed that these five elements flow in an interrelated manner throughout all the organs of the body as the five phases of universal qi (pronounced "chee"), with qi defined as the life force - the intrinsic energy in the body that travels along pathways in the body called meridians. A state of good health is achieved when the interactions between these elements cause the flow of your qi to occur in a smooth and balanced manner. You could say that one reason you study tai chi is to help your qi flow smoothly.

Qigong

Qigong, from which tai chi (qi) originates, is a discipline that involves the mind, breath, and movement to create a calm, natural balance of energy that can be used in work, recreation or self-defense. Like yoga, where many varieties have evolved over the centuries, there are more than 3,000 varieties of qigong and five major traditions: Taoist, Buddhist, Confucian, martial arts, and medical, and two major types: "soft" and "hard." Soft qigong is called inner qigong, of which tai chi is an example.

Types of tai chi

Yang, wu, and tai chi chih are three of the most popular styles of tai chi. The yang style, which includes 24 movements in its simple form (108 movements in the traditional form), is demanding because you must keep your stance wide and your knees bent most of the time. The wu style, which includes 24 to 36 movements in its shorter form (100 movements in the traditional), is gentler than the yang style because it uses a narrower, but higher stance where the knees are not quite as bent. The tai chi chih style, which has 20 movements, also uses a higher stance, but with much less transfer of weight from one leg to the other than the other two. Because the wu style uses a high, narrow stance, it may be easier for beginners and ideal for improving balance. No matter which style you practice, they all are conducted slowly, deliberately, and gracefully, with each movement flowing seamlessly into the next without hesitation.

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What are the benefits of tai chi?

In China, it is believed that tai chi can delay aging and prolong life, increase flexibility, strengthen muscles and tendons, and aid in the treatment of heart disease, high blood pressure, arthritis, digestive disorders, skin diseases, depression, cancer, and many other illnesses. Unfortunately, there hasn't been a good deal of scientific evidence to support these claims. In a special study of tai chi called a meta-analysis, where many studies on one subject are reviewed, the author concludes that although there is some evidence to support the positive effects of tai chi on health, fitness, and balance, many of the studies are limited by small numbers of subjects and wide variation in the type and duration of tai chi used. Bearing these limitations in mind, here are some of the documented benefits.

Balance and fall prevention

Most of the research on tai chi has been done in older individuals in the area of balance and fall prevention. This area of research is important because fall-related injuries are the leading cause of death from injury and disability among older adults. One of the most serious fall injuries is hip fracture; one-half of all older adults hospitalized for hip fracture never regain their former level of function. Because tai chi movements are slow and deliberate with shifts of body weight from one leg to the other in coordination with upper body movements (sometimes with one leg in the air), it challenges balance and many have long assumed it helps improve balance and reduce fall frequency. This assumption has been credited and strongly supported by some research.

One study compared men age 65 and older who had more than 10 years of experience practicing tai chi and no involvement in any other regular sports and physical activity, with similar-aged men who had not practiced tai chi or any other physical activities (they were sedentary). It was found that the men who studied tai chi performed better on tests of balance, flexibility, and cardiovascular function. In another study involving 22 men and women aged 22 to 76 years with mild balance disorders, it was found that eight weeks of tai chi training significantly improved function on a standard balance test (called the Romberg test).

Fear of falling and improvement in self-confidence

In an interesting twist on studies of falling, researchers found that the frequency of fear of falling was reduced from 56% to 31% in a large group of adults 70 years and older who practiced tai chi regularly. Confidence about not falling, and self-confidence in general, may be an unintended benefit of tai chi but one that is certainly worth pursuing. In a similar tai chi study of older adults, 54% of the subjects who practiced tai chi attributed their improved sense of confidence to improved balance. The authors concluded that "when mental as well as physical control is perceived to be enhanced, with a generalized sense of improvement in overall well-being, older persons' motivation to continue exercising also increases."

Strength and endurance

One study looked at adults in their 60s and 70s who practiced tai chi three times a week for 12 weeks (60-minute classes). These adults were given a battery of physical-fitness tests to measure balance, muscular strength and endurance, and flexibility before and after the 12 weeks. After just six weeks, statistically significant improvements were observed in balance, muscular strength, endurance, and flexibility measures. Improvements in each of these areas increased further after 12 weeks. The authors of the study concluded that tai chi is a potent intervention that improved balance, upper- and lower-body muscular strength and endurance, and upper- and lower-body flexibility in older adults.

Aerobic capacity

Aerobic capacity diminishes as we age, but research on traditional forms of aerobic exercise show that it can improve with regular training. In another meta-analysis study, researchers looked at seven studies focusing on the effects of tai chi on aerobic capacity in adults (average age 55 years). The investigators found that individuals who practiced tai chi for one year (classical yang style with 108 postures) had higher aerobic capacity than sedentary individuals around the same age. The authors state that tai chi may be a form of aerobic exercise.

Walking

Walking speed decreases with age and research suggests that it may be associated with an increased risk of falling. In one study, however, it was found that individuals who practiced tai chi walked significantly more steps than individuals who did not. Walking has clearly been associated with a decreased risk of cardiovascular disease, diabetes, and other chronic illness, and so if tai chi can improve walking, then it's certainly worth giving it a try.

Fibromyalgia

Fibromyalgia (FM) is one of the most common musculoskeletal disorders and is associated with high levels of impaired health and painful symptoms that frequently flair up without relief. The cause of FM is unknown, and there is no known cure. In a study of 39 subjects with FM who practiced tai chi twice weekly for six weeks (one-hour classes), it was found that FM symptoms and health-related quality of life improved after the study. This could be good news for many other individuals who suffer from this disorder.

Stress

The demands of living are stressful for adults of all ages. Although one cannot directly point to studies showing a reduction in stress from practicing tai chi (though in one study subjects who practiced tai chi reported that mental control was one of the benefits), the breathing, movement, and mental concentration required of individuals who practice tai chi may be just the distraction you need from your hectic lifestyle. The mind-body connection is one that deserves special attention, as it has been reported that breathing coordinated with body movement and eye-hand coordination promote calmness. I know that when I practice yoga or tai chi, the inner sense of peace and calm is indisputable, and so I suggest that you give tai chi a chance if you're looking for a creative and physically active way to improve how you mentally and physically respond to stress.

Some more reasons to practice tai chi:

  • Movements are low-impact and gentle and put minimal stress on your muscles and joints.
  • The risk of injury is very low.
  • You can do it anywhere, anytime.
  • It requires very little space (no excuses apartment dwellers!) and no special clothing or equipment.
  • You do it at your own pace.
  • It's noncompetitive.
  • It can be done in groups or by yourself (find a tai chi instructor to come to your workplace at lunch hour!).
  • There are lots of movements to keep you interested, and as you become more accomplished you can add those to your routine.

How much tai chi should I do?

There's not enough research to suggest what the optimal dose of tai chi is to accrue benefits. Studies have shown effects with as little participation as one hour of training per week, although, as in any new activity (such as dancing) there is a sharp learning curve in the beginning, and many individuals might find participating two to three times per week, at least in the beginning, is probably a more effective dose. It is the conventional wisdom in tai chi circles that a person needs at least one year of tai chi before one becomes proficient.

How do I get started with tai chi?

Tai chi is becoming more popular in the United States as Americans look for new and different ways to exercise. Video tapes are one way to get started with tai chi. Check http://www.taichihealth.net/ and http://www.collagevideo.com for a selection of tai chi tapes; everything from tai chi for seniors to urban tai chi. Although I frequently recommend video tapes, you may be better served learning tai chi hands on...that is, with an instructor. The movements should be done properly, and a watchful instructor might be better at helping you than a video tape if you have difficulty with movement. Check your local community recreation center, health club, martial arts studio, Y, or senior center for tai chi classes. Of course, if there are no classes in your area, then a video tape is the next best thing. As I mentioned, there are several styles of tai chi. The wu style seems best for balance and fall prevention, but your choices may be limited, and so I suggest that you practice whatever is available to you. As tai chi gains in popularity, your local options may increase as well. However, since all styles of tai chi involve slow, flowing movements with attention to breathing, you'll benefit from whatever style you can find.

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What clothing should I wear for tai chi?

Comfortable and loose-fitting clothing that won't restrict your movements are best. Sweatpants, tights, or leotards, and a T-shirt will do. Although it doesn't look like very arduous work (because the movements are so slow), you may work up a sweat, and so overdressing is not recommended.

What precautions should I take before practicing tai chi?

Tai chi is gentle enough for almost everyone. However, if you have arthritis that affects your joints (the Arthritis Foundation recommends tai chi), orthopedic conditions that limit your mobility (back pain, sprains, fractures, and severe osteoporosis), if you're pregnant, if you have a hernia, or if you have any other medical condition that might be affected by exercise, then it's a good idea to speak with your doctor before you try tai chi. If you're concerned about the class that you're considering, then watch the class or speak with the instructor before you start. You want to feel comfortable with the activity, so speak up!

What have you got to lose?

That's tai chi. Practicing it regularly can improve your aerobic capacity, muscular strength, flexibility, and balance; and it can improve your well-being and decrease your stress. It's a martial art that has been practiced for centuries by millions of Chinese. Could all of them be wrong? My suggestion is to give it a try. You've got a lifetime of fitness ahead of you, and so adding something new and different to your fitness skills that has this much potential is worth a try, and certainly worth the effort!

Medically reviewed by a Board Certified Family Practice Physician

REFERENCES:

Hain, TC, et al. Effects of T'ai Chi on balance. Arch Otolaryngol Head Neck Surg. 1999 Nov;125(11):1191-5.

Hong, Y, et al. Balance control, flexibility, and cardiorespiratory fitness among older Tai Chi practitioners. Br J Sports Med. 2000 Feb;34(1):29-34.

http://taoist-arts.com/articles/2000163_qigong_and_taoism.html

http://www.tai-chi.com/info_detail.php?id=8, July 10, 2007

http://www.tai-chi.com/info_detail.php?id=16

Kutner, NG, et al. Self-report benefits of Tai Chi practice by older adults. J Gerontol B Psychol Sci Soc Sci. 1997 Sep;52(5):P242-6.

Stevens, JA, et al. Reducing falls and resulting hip fractures among older women. MMWR Recomm Rep. 2000 Mar 31;49(RR-2):3-12.

Taggart, HM, et al. Effects of T'ai Chi exercise on fibromyalgia symptoms and health-related quality of life. Orthop Nurs. 2003 Sep-Oct;22(5):353-60.

Taylor-Piliae, RE, et al. Improvement in balance, strength, and flexibility after 12 weeks of Tai chi exercise in ethnic Chinese adults with cardiovascular disease risk factors. Altern Ther Health Med. 2006 Mar-Apr;12(2):50-8.

Taylor-Piliae, RE, et al. Effectiveness of Tai Chi exercise in improving aerobic capacity: a meta-analysis. J Cardiovasc Nurs. 2004 Jan-Feb;19(1):48-57.

Tinetti, ME, et al. Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. JAMA. 1995 May 3;273(17):1348-53.

Tse, SK, et al. T'ai chi and postural control in the well elderly. Am J Occup Ther. 1992 Apr;46(4):295-300.

Wolf, SL, et al. The Atlanta FICSIT study: two exercise interventions to reduce frailty in elders. J Am Geriatr Soc. 1993;41:329-32.

Wolf, SL. The effect of Tai Chi Quan and computerized balance training on postural stability in older subjects. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies on Intervention Techniques. Phys Ther. 1997 Apr;77(4):371-81.

Wu, G. Evaluation of the effectiveness of Tai Chi for improving balance and preventing falls in the older population--a review. J Am Geriatr Soc. 2002 Apr;50(4):746-54.

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Reviewed on 6/3/2015
References
Medically reviewed by a Board Certified Family Practice Physician

REFERENCES:

Hain, TC, et al. Effects of T'ai Chi on balance. Arch Otolaryngol Head Neck Surg. 1999 Nov;125(11):1191-5.

Hong, Y, et al. Balance control, flexibility, and cardiorespiratory fitness among older Tai Chi practitioners. Br J Sports Med. 2000 Feb;34(1):29-34.

http://taoist-arts.com/articles/2000163_qigong_and_taoism.html

http://www.tai-chi.com/info_detail.php?id=8, July 10, 2007

http://www.tai-chi.com/info_detail.php?id=16

Kutner, NG, et al. Self-report benefits of Tai Chi practice by older adults. J Gerontol B Psychol Sci Soc Sci. 1997 Sep;52(5):P242-6.

Stevens, JA, et al. Reducing falls and resulting hip fractures among older women. MMWR Recomm Rep. 2000 Mar 31;49(RR-2):3-12.

Taggart, HM, et al. Effects of T'ai Chi exercise on fibromyalgia symptoms and health-related quality of life. Orthop Nurs. 2003 Sep-Oct;22(5):353-60.

Taylor-Piliae, RE, et al. Improvement in balance, strength, and flexibility after 12 weeks of Tai chi exercise in ethnic Chinese adults with cardiovascular disease risk factors. Altern Ther Health Med. 2006 Mar-Apr;12(2):50-8.

Taylor-Piliae, RE, et al. Effectiveness of Tai Chi exercise in improving aerobic capacity: a meta-analysis. J Cardiovasc Nurs. 2004 Jan-Feb;19(1):48-57.

Tinetti, ME, et al. Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. JAMA. 1995 May 3;273(17):1348-53.

Tse, SK, et al. T'ai chi and postural control in the well elderly. Am J Occup Ther. 1992 Apr;46(4):295-300.

Wolf, SL, et al. The Atlanta FICSIT study: two exercise interventions to reduce frailty in elders. J Am Geriatr Soc. 1993;41:329-32.

Wolf, SL. The effect of Tai Chi Quan and computerized balance training on postural stability in older subjects. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies on Intervention Techniques. Phys Ther. 1997 Apr;77(4):371-81.

Wu, G. Evaluation of the effectiveness of Tai Chi for improving balance and preventing falls in the older population--a review. J Am Geriatr Soc. 2002 Apr;50(4):746-54.

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