Bagua Eight Palms
Bagua Eight Palms
Tai Chi Health
This gentle form of exercise can prevent or ease many ills of aging and could be the perfect activity for the rest of your life.
Tai chi is often described as "meditation in motion," but it might well be called "medication in motion." There is growing evidence that this mind-body practice, which originated in China as a martial art, has value in treating or preventing many health problems. And you can get started even if you aren't in top shape or the best of health.
In this low-impact, slow-motion exercise, you go without pausing through a series of motions named for animal actions — for example, "white crane spreads its wings" — or martial arts moves, such as "box both ears." As you move, you breathe deeply and naturally, focusing your attention — as in some kinds of meditation — on your bodily sensations. Tai chi differs from other types of exercise in several respects. The movements are usually circular and never forced, the muscles are relaxed rather than tensed, the joints are not fully extended or bent, and connective tissues are not stretched. Tai chi can be easily adapted for anyone, from the most fit to people confined to wheelchairs or recovering from surgery.
"A growing body of carefully conducted research is building a compelling case for tai chi as an adjunct to standard medical treatment for the prevention and rehabilitation of many conditions commonly associated with age," says Peter M. Wayne, assistant professor of medicine at Harvard Medical School and director of the Tai Chi and Mind-Body Research Program at Harvard Medical School's Osher Research Center. An adjunct therapy is one that's used together with primary medical treatments, either to address a disease itself or its primary symptoms, or, more generally, to improve a patient's functioning and quality of life.
Tai chi in motion
A tai chi class might include these parts:
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.
Getting started
The benefits of tai chi are generally greatest if you begin before you develop a chronic illness or functional limitations. Tai chi is very safe, and no fancy equipment is needed, so it's easy to get started. Here's some advice for doing so:
Don't be intimidated by the language. Names like Yang, Wu, and Cheng are given to various branches of tai chi, in honor of people who devised the sets of movements called forms. Certain programs emphasize the martial arts aspect of tai chi rather than its potential for healing and stress reduction. In some forms, you learn long sequences of movements, while others involve shorter series and more focus on breathing and meditation. The name is less important than finding an approach that matches your interests and needs.
Check with your doctor . If you have a limiting musculoskeletal problem or medical condition — or if you take medications that can make you dizzy or lightheaded — check with your doctor before starting tai chi. Given its excellent safety record, chances are that you'll be encouraged to try it.
Consider observing and taking a class. Taking a class may be the best way to learn tai chi. Seeing a teacher in action, getting feedback, and experiencing the camaraderie of a group are all pluses. Most teachers will let you observe the class first to see if you feel comfortable with the approach and atmosphere. Instruction can be individualized. Ask about classes at your local Y, senior center, or community education center. The Arthritis Foundation (www.arthritis.org; 800-283-7800, toll-free) can tell you whether its tai chi program, a 12-movement, easy-to-learn sequence, is offered in your area.
If you'd rather learn at home, you can buy or rent videos geared to your interests and fitness needs (see "Selected resources"). Although there are some excellent tai chi books, it can be difficult to appreciate the flow of movements from still photos or illustrations.
Talk to the instructor. There's no standard training or licensing for tai chi instructors, so you'll need to rely on recommendations from friends or clinicians and, of course, your own judgment. Look for an experienced teacher who will accommodate individual health concerns or levels of coordination and fitness.
Dress comfortably. Choose loose-fitting clothes that don't restrict your range of motion. You can practice barefoot or in lightweight, comfortable, and flexible shoes. Tai chi shoes are available, but ones you find in your closet will probably work fine. You'll need shoes that won't slip and can provide enough support to help you balance, but have soles thin enough to allow you to feel the ground. Running shoes, designed to propel you forward, are usually unsuitable.
Gauge your progress. Most beginning programs and tai chi interventions tested in medical research last at least 12 weeks, with instruction once or twice a week and practice at home. By the end of that time, you should know whether you enjoy tai chi, and you may already notice positive physical and psychological changes.
No pain, big gains
Although tai chi is slow and gentle and doesn't leave you breathless, it addresses the key components of fitness — muscle strength, flexibility, balance, and, to a lesser degree, aerobic conditioning. Here's some of the evidence:
Muscle strength. In a 2006 study published in Alternative Therapies in Health and Medicine, Stanford University researchers reported benefits of tai chi in 39 women and men, average age 66, with below-average fitness and at least one cardiovascular risk factor. After taking 36 tai chi classes in 12 weeks, they showed improvement in both lower-body strength (measured by the number of times they could rise from a chair in 30 seconds) and upper-body strength (measured by their ability to do arm curls).
In a Japanese study using the same strength measures, 113 older adults were assigned to different 12-week exercise programs, including tai chi, brisk walking, and resistance training. People who did tai chi improved more than 30% in lower-body strength and 25% in arm strength — almost as much as those who participated in resistance training, and more than those assigned to brisk walking.
"Although you aren't working with weights or resistance bands, the unsupported arm exercise involved in tai chi strengthens your upper body," says internist Dr. Gloria Yeh, an assistant professor at Harvard Medical School. "Tai chi strengthens both the lower and upper extremities and also the core muscles of the back and abdomen."
Flexibility. Women in the 2006 Stanford study significantly boosted 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. But in the Japanese study, only participants assigned to brisk walking gained much aerobic fitness. 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.
Selected resources
Tai Chi Healthwww.taichihealth.com
Tai Chi Productionswww.taichiforhealth.com
Tai chi for medical conditions
When combined with standard treatment, tai chi appears to be helpful for several medical conditions. For example:
Arthritis. In a 40-person study at Tufts University, presented in October 2008 at a meeting of the American College of Rheumatology, an hour of tai chi twice a week for 12 weeks reduced pain and improved mood and physical functioning more than standard stretching exercises in people with severe knee osteoarthritis. According to a Korean study published in December 2008 in Evidence-based Complementary and Alternative Medicine, eight weeks of tai chi classes followed by eight weeks of home practice significantly improved flexibility and slowed the disease process in patients with ankylosing spondylitis, a painful and debilitating inflammatory form of arthritis that affects the spine.
Low bone density. A review of six controlled studies by Dr. Wayne and other Harvard researchers indicates that tai chi may be a safe and effective way to maintain bone density in postmenopausal women. A controlled study of tai chi in women with osteopenia (diminished bone density not as severe as osteoporosis) is under way at the Osher Research Center and Boston's Beth Israel Deaconess Medical Center.
Breast cancer. Tai chi has shown potential for improving quality of life and functional capacity (the physical ability to carry out normal daily activities, such as work or exercise) in women suffering from breast cancer or the side effects of breast cancer treatment. For example, a 2008 study at the University of Rochester, published in Medicine and Sport Science, found that quality of life and functional capacity (including aerobic capacity, muscular strength, and flexibility) improved in women with breast cancer who did 12 weeks of tai chi, while declining in a control group that received only supportive therapy.
Heart disease. A 53-person study at National Taiwan University found that a year of tai chi significantly boosted exercise capacity, lowered blood pressure, and improved levels of cholesterol, triglycerides, insulin, and C-reactive protein in people at high risk for heart disease. The study, which was published in the September 2008 Journal of Alternative and Complementary Medicine, found no improvement in a control group that did not practice tai chi.
Heart failure. In a 30-person pilot study at Harvard Medical School, 12 weeks of tai chi improved participants' ability to walk and quality of life. It also reduced blood levels of B-type natriuretic protein, an indicator of heart failure. A 150-patient controlled trial is under way.
Hypertension. In a review of 26 studies in English or Chinese published in Preventive Cardiology (Spring 2008), Dr. Yeh reported that in 85% of trials, tai chi lowered blood pressure — with improvements ranging from 3 to 32 mm Hg in systolic pressure and from 2 to 18 mm Hg in diastolic pressure.
Parkinson's disease. A 33-person pilot study from Washington University School of Medicine in St. Louis, published in Gait and Posture (October 2008), found that people with mild to moderately severe Parkinson's disease showed improved balance, walking ability, and overall well-being after 20 tai chi sessions.
Sleep problems. In a University of California, Los Angeles, study of 112 healthy older adults with moderate sleep complaints, 16 weeks of tai chi improved the quality and duration of sleep significantly more than standard sleep education. The study was published in the July 2008 issue of the journal Sleep.
Stroke. In 136 patients who'd had a stroke at least six months earlier, 12 weeks of tai chi improved standing balance more than a general exercise program that entailed breathing, stretching, and mobilizing muscles and joints involved in sitting and walking. Findings were published in the January 2009 issue of Neurorehabilitation and Neural Repair.
Tai Chi Chuan Exercise for Patients with Cardiovascular Disease
Ching Lan,1 Ssu-Yuan Chen,1 May-Kuen Wong,2 and Jin Shin Lai1
1Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University, College of Medicine, 7 Chung-Shan South Road, Taipei 100, Taiwan
2Department of Physical Medicine and Rehabilitation, Chang-Gung Memorial Hospital and Department of Physical Therapy, Post-Graduate Institute of Rehabilitation Science, Chang-Gung University, Taoyuan 333, Taiwan
Received 17 December 2012; Revised 19 August 2013; Accepted 23 September 2013
Academic Editor: Ka Kit Hui
Copyright © 2013 Ching Lan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Exercise training is the cornerstone of rehabilitation for patients with cardiovascular disease (CVD). Although high-intensity exercise has significant cardiovascular benefits, light-to-moderate intensity aerobic exercise also offers health benefits. With lower-intensity workouts, patients may be able to exercise for longer periods of time and increase the acceptance of exercise, particularly in unfit and elderly patients. Tai Chi Chuan (Tai Chi) is a traditional Chinese mind-body exercise. The exercise intensity of Tai Chi is light to moderate, depending on its training style, posture, and duration. Previous research has shown that Tai Chi enhances aerobic capacity, muscular strength, balance, and psychological well-being. Additionally, Tai Chi training has significant benefits for common cardiovascular risk factors, such as hypertension, diabetes mellitus, dyslipidemia, poor exercise capacity, endothelial dysfunction, and depression. Tai Chi is safe and effective in patients with acute myocardial infarction (AMI), coronary artery bypass grafting (CABG) surgery, congestive heart failure (HF), and stroke. In conclusion, Tai Chi has significant benefits to patients with cardiovascular disease, and it may be prescribed as an alternative exercise program for selected patients with CVD.
1. Introduction
Regular exercise is beneficial to cardiovascular health and longevity. The Centers for Disease Control and Prevention and the American College of Sports Medicine (ACSM) recommend a minimum of 30 minutes of moderate-intensity physical activity on most days of the week [1]. According to the National Institutes of Health-American Association of Retired Persons (NIH-AARP) Diet and Health Study [2], achievement of activity levels approximate the recommendations for moderate activity (at least 30 minutes on most days of the week) may decrease 27% of mortality in men and women. In developing countries, the fast increase of CVD mortality may partly be attributed to the decrease of physical activity. The death rate of CVD in China, for example, nearly increased 50% from 1990 to 2009, and the decrease of exercise participation played an important role in the increase of mortality. A recent investigation in 9 provinces and cities of China showed that the physical activity in 2006 declined by 27.8% in men and by 36.9% in women in comparison with those in 1997 [3].
Nonvigorous exercise training is a central focus of health promotion and is the core component of rehabilitation for patients with CVD. According to a recent meta-analysis evaluating the effect of light-to-moderate physical activity [4], 2.5 hour/week moderate-intensity activity (equivalent to 30 min exercise 5 days a week) compared with no physical activity was associated with a reduction in mortality risk of 19%, while 7 hour/week of moderate activity compared with no activity reduced the mortality risk by 24%.
Tai Chi Chuan (Tai Chi) is a Chinese traditional mind-body exercise. Although the exercise intensity of Tai Chi is low to moderate [5, 6], previous studies have shown that it offers benefits for aerobic capacity [7–9], muscular strength [10, 11], balance, and cardiovascular risk factors. Further, Tai Chi appears to be safe and effective for patients with acute myocardial infarction, coronary artery bypass grafting surgery, congestive heart failure, and stroke. From the standpoint of exercise prescription, Tai Chi is a suitable exercise for patients with CVD because it is easily accessible and of low cost and can be easily implemented in the community setting. The aim of this literature review is to provide an overview of Tai Chi benefits on cardiovascular health and to introduce the potential application of Tai Chi for patients with CVD.
2. Effect of Tai Chi on Cardiovascular Risk Factors
2.1. Hypertension
Hypertension is a major risk factor of coronary artery disease, heart failure, stroke, and peripheral vascular disease. About 54% of stroke and 47% of ischaemic heart disease worldwide were attributable to hypertension [12]. Lowering blood pressure (BP) in hypertensive individuals significantly reduces cardiovascular morbidity and mortality. Regular aerobic exercise and lifestyle change are important for preventing and treating high blood pressure. Systemic review of randomized clinical trials indicated that aerobic exercise training leads to reductions in resting BP of 5–7 mm Hg [13] and the reductions appear to be more pronounced in hypertensive subjects [14, 15]. The American College of Sports Medicine recommends the following exercise guidelines for individuals with hypertension: (1) frequency: aerobic exercise on most, preferably all days of the week; resistance exercise 2-3 days per week; (2) intensity: moderate-intensity aerobic (i.e., 40%–60% heart rate reserve or oxygen uptake reserve) and resistance exercise (60–80% of one repetition maximum); (3) time: 30–60 minutes per day of aerobic exercise and resistance training at least one set of 8–12 repetitions for each of the major muscle groups [13].
Tai Chi is a moderate-intensity exercise program fulfilling the ACSM recommendations and thus Tai Chi may be beneficial to individuals with hypertension. In most of the Tai Chi intervention studies, 6- to 12-week training programs have been shown to lower the systolic and diastolic BP at rest or after exercise, and hypertensive patients exhibit the most favorable improvement [16–20]. The decrease of BP during submaximal exercise may lower the rate pressure product, which indicates the decrease of myocardial oxygen consumption. In a recent pooled analysis of 26 studies (11 in English, 15 in Chinese), Yeh and colleagues [21] reported positive effect of Tai Chi on BP control. In individuals with hypertension, Tai Chi training may reduce systolic BP (range: −7 to −32 mm Hg) and diastolic BP (−2.4 to −18 mm Hg). In studies for noncardiovascular populations or healthy patients, the decreases ranged from −4 to −18 mm Hg in systolic BP and from −2.3 to −7.5 mm Hg in diastolic BP.
2.2. Diabetes Mellitus
Type 2 diabetes mellitus (DM) is a fast growing risk factor for cardiovascular disease. Exercise is a key to lifetime management of Type 2 diabetes or impaired glucose tolerance [22–24]. The benefits of regular exercise in individuals with Type 2 DM and prediabetes include improved glucose tolerance, increased insulin sensitivity, and decreased Glycated hemoglobin (HbA1C). Additionally, exercise can help prevent the development of diabetes in patients with impaired glucose tolerance. In the Da Qing Diabetes Prevention Study for people with impaired glucose tolerance [25], lifestyle intervention groups (diet and exercise) had a 43% lower incidence of DM over the 20-year follow-up period. The Diabetes Prevention Program study in America [26] also found that participants who lost a modest amount of weight through dietary changes and increased physical activity reduced the incidence of DM by 58%.
Several studies have shown the benefits of Tai Chi for diabetic patients. In a pilot study for 12 patients with DM, Wang [27] reported that an 8 wk Tai Chi program could decrease blood glucose. Additionally, high- and low-affinity insulin receptor numbers and low-affinity insulin receptor binding capacity were increased. In another study, Zhang and Fu [28] randomly assigned 20 female diabetic patients to Tai Chi or control group. The exercise protocol was one-hour Tai Chi per day and 5 days a week. After 14 weeks of training, the Tai Chi group had significantly lower fasting plasma glucose and glycated serum proteins and higher fasting plasma insulin compared to the control group. The results showed that Tai Chi could be used as an exercise intervention to improve diabetic control. For obese patients with diabetes, Chen and colleagues [29] reported that a 12-week of Chen Tai Chi training induced significant improvement in body mass index, triglyceride, and high-density lipoprotein cholesterol. In addition, serum malondialdehyde (oxidative stress indicator) and C-reactive protein (inflammation indicator) decreased significantly.
In diabetic patients complicated with peripheral neuropathy, Ahn and Song [30] recruited 59 diabetic patients with neuropathy and assigned them into a Tai Chi group or a control group. The Tai Chi group participated in an exercise program comprised 1 hour of Tai Chi twice a week for 12 weeks. After training, patients in the Tai Chi group showed improvement in glucose control, balance, neuropathic symptoms, and some dimensions of the quality of life compared to the control group. However, the dropout rate was high (34%) in this study.
A 12-week Tai Chi program for diabetic patients might obtain significant benefits in the quality of life. In a study reported by Liu and colleagues [31], 41 patients with diabetes were randomly assigned to Tai Chi ( ) or usual care group ( ). After training, the Tai Chi group revealed significant improvements in the Short Form 36-item Health Survey (SF-36) subscales of physical functioning, role physical, bodily pain, and vitality.
A recent meta-analysis conducted by Yan and colleagues [32] pooled 4 randomized controlled trials (RCT) and 5 nonrandomized controlled trials (NRCT) to assess the effect of Tai Chi in patients with Type 2 DM. The weighted mean differences from RCT were −14.82 mg/dL ( ) for fasting blood glucose, −0.19% ( ) for HbA1c, and −0.34 units ( ) for homeostasis model assessment of insulin resistance (HOMA) index (indicator of insulin resistance). The weighted mean differences from NRCT were −11.22 mg/dL ( ) for FBG and −0.41% ( ) for HbA1c and −0.60 units ( ). Because most Tai Chi studies have only a small group of subjects, further large-scale randomized trials are needed to clarify the potential health effect of Tai Chi for diabetic patients.
2.3. Dyslipidemia
Regular exercise may ameliorate the trend toward abnormal blood lipid profile. A meta-analysis of 31 randomized controlled trials with exercise training reported a significant decrease in total cholesterol, low density lipoprotein cholesterol (LDL-C), and triglyceride (TG) and an increase in high-density lipoprotein cholesterol (HDL-C) [33].
Several studies have shown beneficial effects of Tai Chi training on lipid profile. In a study reported by Tsai and colleagues [19], 88 patients with Stage I hypertension were randomly assigned to a Tai Chi or a sedentary control group. After 12 weeks of classical Yang Tai Chi training, total cholesterol, TG, and LDL-C concentration decreased by 15.2, 23.8, and 19.7 mg/dL, respectively, and HDL-C increased 4.7 mg/dL. In healthy elderly individuals, however, Thomas and colleagues [34] reported no significant change in total cholesterol, TG, LDL-C, and HDL-C after 12 months of Tai Chi training. In another study, Zhang and Fu [28] randomly assigned 20 female diabetic patients to Tai Chi or control group. After 14 weeks of training, the Tai Chi group only showed significantly lower TG compared to the control group, whereas there were no significant differences in total cholesterol, HDL-C, and LDL-C. All these studies were not specifically focused on dyslipidemic patients, and difference among results may be attributed to differences in study design, baseline lipid concentrations, training amount and intensity, changes in body composition, or the adjunctive interventions such as diet or lipid-lowering agents.
In a recent study, Lan and colleagues [35] enrolled 70 severe dyslipidemic patients to attend a one-year Yang Tai Chi training program. The inclusion criteria were as follows: (1) patients’ initial level of total cholesterol > 300 mg/dL and/or TG > 500 mg/dL prior to medical treatment, (2) patients who had received lipid-lowering medication and diet therapy for at least 6 months, but the lipid profile remained abnormal (total cholesterol > 200 mg/dL or TG > 150 mg/dL). After training, the Tai Chi group showed a significant decrease of 26.3% in TG (From 224.5 ± 216.5 to 165.9 ± 147.8 mg/dL), 7.3% in total cholesterol (from 228.0 ± 41.0 to 211.4 ± 46.5 mg/dL), and 11.9% in LDL-C (from 134.3 ± 40.3 to 118.3 ± 41.3 mg/dL), whereas the HDL-C did not increase significantly. In addition, the Tai Chi group also showed a significant decrease in fasting insulin, HOMA index, and high-sensitivity C-reactive protein. Conversely, the usual care group showed no significant improvement in these cardiovascular risk factors.
2.4. Low Exercise Capacity
Low exercise capacity is a strong predictor of cardiac and all-cause mortality. Myers and colleagues [36] reported that the peak exercise capacity measured in metabolic equivalents (MET) was the strongest predictor of the risk of death. Each 1-MET increase in exercise capacity conferred a 12% improvement in survival. Kavanagh and colleagues [37] have reported that the risk of death for coronary patients had inverse relationship with the values of peak oxygen uptake ( ) during exercise testing. values of 15, 15–22, and >22 mL·kg−1·min−1 yielded respective multivariate adjusted hazard ratios of 1.00, 0.62, and 0.39 of cardiac death, respectively.
Regular Tai Chi training for older individuals may improve aerobic capacity. In a cross-sectional study, Lan and colleagues [7] reported that elderly Tai Chi practitioners displayed 18-19% greater than their sedentary counterpart. In a 5-year follow-up study, Lan and colleagues [38] reported that regular Tai Chi training attenuated the age-related decline in for nearly 40% compared with the control group. Entering a Tai Chi program can also improve the aerobic capacity for sedentary elderly individuals. After one year of Tai Chi training, elderly participants showed an increase of 16.1% and 21.3% in in men and women, respectively [8].
A meta-analysis on 14 studies conducted by Taylor-Piliae [39] reported that Tai Chi was effective in improving aerobic capacity. Large significant effects of Tai Chi on aerobic capacity were found for subjects enrolled in the cross-sectional studies, in both genders, among adults ≧55 years old and when comparing sedentary subjects with those in Tai Chi exercise groups. In a recent meta-analysis study [40], however, the existing evidence does not indicate that Tai Chi is an effective way of increasing aerobic capacity. This study pooled 5 randomized studies and included 124 Tai Chi participants, and the training only included 5 to 15 Tai Chi movements. Most of the training protocols were 12-week “Tai Chi calisthenics,” and the exercise intensity appeared significantly lower than classical Tai Chi. Classical Tai Chi consists of 108 movements and it takes long time to learn and practice. Lan and colleagues [5] reported that the average HR during classical Yang Tai Chi practice was 58% of the heart rate reserve (HRR) and the oxygen uptake was 55% of the peak oxygen uptake. Tai Chi participants usually need 12 weeks of intensive training (with an exercise frequency 5–7 times per week) to familiarize all movements. During the familiarization phase, the exercise intensity and amount of training are inconsistent. If the goal of Tai Chi training is to increase aerobic capacity, a classical Tai Chi program for at least 6 months may be more appropriate than short-term Tai Chi-like calisthenics.
2.5. Endothelial Dysfunction
Nitric oxide (NO) is an endothelium-dependent vasodilator and plays an important role in the vasodilatory response during exercise. Lack of exercise is associated with endothelial dysfunction and arthrosclerosis due to low shear stress status. Low shear stress to the vessel wall predisposes to endothelial proliferative status and may lead to the pathogenesis of arthrosclerosis.
Regular practice of Tai Chi may enhance endothelium-dependent dilation in skin vasculature of older individuals. Wang and colleagues [41] have reported that older Tai Chi practitioners displayed a higher skin blood flow and level of plasma NO metabolite than sedentary subjects at rest and after maximal exercise. In addition, Tai Chi subjects had higher arterial blood flow and acetylcholine-induced cutaneous perfusion than the sedentary controls.
Tai Chi training also has benefits to microcirculation. Wang and colleagues [42] measured skin blood flow and vascular conductance in elderly men before and after a maximal exercise by using impedance plethysmography. Additionally, different doses of 1% acetylcholine and 1% sodium nitroprusside were iontophoretically applied to the skin of subjects’ lower legs, and cutaneous microvascular perfusion responses were determined by laser Doppler measurements. In comparison with older individuals with sedentary life, older Tai Chi participants had higher lower leg arterial blood flow (LABF), LABF in response to reactive hyperemia, and lower leg venous capacity, tone, and blood flow. Additionally, the older Tai Chi group displayed similar arterial and venous hemodynamic variables to the younger sedentary group. The older Tai Chi group showed a higher ACh-induced cutaneous perfusion and a higher ratio of ACh- to SNP-induced cutaneous perfusion than those of the older sedentary group. The results showed that regular practice of Tai Chi is associated with enhanced endothelium-dependent dilation in the skin vasculature of older individuals. Moreover, Tai Chi training may delay the age-related decline of venous compliance and hyperemic arterial response.
2.6. Depression
Depression and depressive symptoms are prevalent in patients with coronary heart disease. Depression in patients with AMI showed 4–6-fold increase in risk of death than in patients with no depression [43, 44]. Major depression following AMI runs a chronic course if untreated, but the prevalence significantly decreased following exercise training [45]. Depressed coronary patients who completed rehabilitation had lower mortality compared with those who did not complete training (8% versus 30%).
Jimenez and colleagues [46] reviewed 35 Tai Chi intervention articles and reported that Tai Chi training could improve psychological function. In those studies, 9 out of 11 studies confirmed significant improvements in mood and depressive symptoms; 7 out of 8 studies showed reduction in anger and tension; 6 out of 10 studies displayed improvements in anxiety reduction.
In a recent study, Yeung and colleagues [47] randomized 39 patients with major depressive disorder into a 12 wk Tai Chi intervention or a wait-listed control group. The results showed trends toward improvement in the Tai Chi intervention group, compared with the control group, in positive treatment-response rate (24% versus 0%) and remission rate (19% versus 0%).
Taylor-Piliae and colleagues [48] have applied a 60-minute Tai Chi program (3 times per week for 12 weeks) to 39 subjects with cardiovascular risk factors. Improvement in mood state, reduction in anxiety, anger-tension, and perceived stress were found after training. Tai Chi training also benefits psychological function for patients with heart failure. In a recent study, Yeh and colleagues [49] enrolled 100 outpatients with systolic heart failure (New York Heart Association, NYHA classes I–III) and randomly assigned them to a 12-week Tai Chi exercise group or time-matched education group. After training, patients in the Tai Chi group showed greater improvements in quality of life, exercise self-efficacy, and mood than the controls.
3. Application of Tai Chi in Cardiovascular Disease
Exercise is a major component of rehabilitation for patients with cardiovascular disease. The benefits of cardiac rehabilitation (CR) exercise training include exercise tolerance enhancement, amelioration of CVD risk factors, improvement of psychological well-being, and reduction of mortality [50]. Cardiac rehabilitation usually begins during hospitalization (phase I), followed by supervised outpatient program lasting 3–6 months (phase II), and continues in a lifetime maintenance stage in minimally supervised or unsupervised setting (phase III). Tai Chi can be prescribed as an alternative exercise training program for patients who need cardiac rehabilitation. In a recent cross-sectional study, Taylor-Piliae and colleagues [51] evaluated 51 patients who participated in a CR program. Twenty-three patients attended a group-based Wu Tai Chi class plus CR, while 28 subjects attended conventional CR only. Subjects attending Tai Chi plus CR showed better balance, perceived physical health, and Tai Chi self-efficacy compared to those attending CR only. The results suggest that Tai Chi can be easily implemented in the community setting or in CR facility and may offer additional exercise options for cardiac patients.
3.1. Coronary Artery Disease
Acute myocardial infarction is the most common cause of mortality in patients with CVD but exercise significantly reduces the mortality rate of patients with AMI. In a recent Cochrane review [52] involving 47 studies randomizing 10,794 patients with AMI to exercise-based cardiac rehabilitation or usual care, patients receiving exercise training reduced the risk for total mortality by 13%, the risk for cardiovascular mortality by 26%, and the risk for hospital admissions by 31%. Patients recovering from AMI are recommended to receive cardiac rehabilitation services; however, many patients feel inconvenient to attend CR courses. Tai Chi is easily accessible and can be practiced individually or in group settings. Channer and colleagues [16] randomly assigned 126 patients with AMI to a Tai Chi, an aerobic exercise, or a nonexercise support group. The Tai Chi group and the aerobic exercise group participated in an 8 wk training program, attended twice weekly for three weeks and then weekly for a further five weeks. The results of this study showed that Tai Chi was effective for reducing systolic and diastolic BP and was safe for patients after AMI.
Lan and colleagues [9] applied Tai Chi in the treatment of patients after CABG and found improvement of aerobic capacity. Patients with CABG participated in a 12-month classical Yang Tai Chi program 3 times weekly as a Phase III CR program. After training, the Tai Chi group showed a significant improvement of oxygen uptake at the peak exercise and the ventilatory threshold. At the peak exercise, the Tai Chi group showed 10.3% increase in (from 26.2 ± 4.4 to 28.9 ± 5.0 mL·kg−1 min−1) and 11.8% increase in peak work rate, while the control group did not show any improvement. At the ventilatory threshold, the Tai Chi group increased 17.6% in while the control group did not display significant change. It should be noted that even a small increase in at the ventilatory threshold improves the functional level in activities of daily living.
3.2. Congestive Heart Failure
Congestive heart failure (HF) is characterized by the inability of the heart to deliver sufficient oxygenated blood to tissue. Exercise training improves functional capacity and symptoms in patients with HF, and the increase in exercise tolerance may be attributed to increased skeletal muscle oxidative enzymes and mitochondrial density. Previous studies have shown that low-intensity Tai Chi training has benefits to patients with HF (Table 1). In a study by Barrow and associates [53], 52 patients with HF (NYHA classes II–III) were randomly assigned to either a Tai Chi group or a standard medical care group. The Tai Chi group practiced Tai Chi twice a week for 16 weeks. After training, the Tai Chi group did not show significant increase in exercise tolerance but had improvement in symptom scores of heart failure and depression scores compared with the control group.
tab1
Table 1: Effect of Tai Chi in patients with heart failure.
Yeh and colleagues [54, 55] reported that a 12-week Tai Chi training in patients with HF revealed improvement in quality of life, sleep stability, 6-minute walking distance, and decreased serum B-type natriuretic peptide (BNP). BNP is produced by ventricular cardiomyocytes and correlates with left ventricular dysfunction. In a recent study, Yeh and colleagues [49] randomly assigned 100 patients with systolic HF to a Tai Chi group or a control group. Tai Chi participants practiced 5 basic simplified Yang Tai Chi movements twice weekly, while the control group participated in a HF education program. After 12 weeks of training, the Tai Chi group showed greater improvements in quality of life, exercise self-efficacy, and mood. For patients with HF, low-intensity exercise such as simplified Tai Chi may increase the acceptance. Interval training protocol by using selected Tai Chi movements is suitable for HF patients with very low endurance.
Caminiti and colleagues enrolled 60 HF patients and randomly assigned them into a combined training group (CT) performing Tai Chi plus endurance training and an endurance training group (ET) [56]. After 12 weeks of training, 6-minute walking distance increased in both groups with significant between-groups differences. Systolic BP and BNP decreased in the CT group compared to the ET group. The Tai Chi group had a greater significant improvement in physical perception and peak torque of knee extensor compared to the ET group.
In patients with heart failure with preserved ejection fraction (HFPEF), Yeh and colleagues [57] randomly assigned 16 subjects to 12-week Tai Chi or aerobic exercise. Change in was the same between groups, but 6-minute walking distance increased more after Tai Chi training, which implied improvement in exercise endurance at submaximal workload. Both groups had improved Minnesota Living With Heart Failure scores and self-efficacy, but the Tai Chi group showed a decrease in depression scores in contrast to an increase in the aerobic exercise group. Overall, the Tai Chi group displayed similar improvement as the aerobic exercise group despite a lower training workload.
In a recent meta-analysis study, Pan and colleagues [58] pooled data from four randomized controlled trials ( ). The results found that Tai Chi significantly improved quality of life but is not associated with significant reduction in BNP, systolic/diastolic blood pressure, improved 6-minute walking distance, or peak oxygen uptake. Further larger randomized controlled trials are needed to prove the beneficial effects of Tai Chi to HF patients.
Depressive disorders are prevalent in patients with heart failure. Patients with depression are associated with increased mortality, clinical events, and hospitalization [59]. Depression-related somatic symptoms such as fatigue and sleep disturbances may lead to physical inactivity and create a spiraling decline in physical and cardiac function. In a recent study, Redwine and colleagues [60] assigned patients with HF to a 12-week Tai Chi training group ( ) or a usual care group ( ). After training, the Tai Chi group showed a reduction in somatic symptoms of depression but not in cognitive symptoms of depression.
3.3. Stroke
Stroke results in a significant decrease in quality of life, which is determined not only by the neurological deficits but also by impairment of cognitive function. In a recent meta-analysis study, Stoller and colleagues [61] reported that stroke patients benefited from exercise by improving peak oxygen uptake and walking distance. Stroke patients usually have impaired balance and motor function, thus Tai Chi exercise may have potential benefits in rehabilitation. Studies of Tai Chi in the treatment of stroke are summarized in Table 2.
tab2
Table 2: Effect of Tai Chi in patients with stroke.
Hart and colleagues [62] enrolled 18 community-dwelling stroke patients and assigned them to a Tai Chi group or a control group. The study group received Tai Chi one hour twice weekly for 12 weeks, while the control group received conventional physical therapy. After training, the Tai Chi group showed improvement in social and general functioning whereas the control group showed improvement in balance and speed of walking. The results implied that physical therapy should be served as a main treatment program for stroke patients but Tai Chi can be used as an alternative exercise program.
Au-Yeung and colleagues [63] randomly assigned 136 stroke patients to a Tai Chi group or a control group practicing general exercises. The Tai Chi group practiced 12 short-form Tai Chi for 12 weeks. After training, the Tai Chi group showed greater excursion in the center of gravity (COG) amplitude in leaning forward, backward, and toward the affected and nonaffected sides as well as faster reaction time in moving the COG toward the nonaffected side. The result indicated that 12 weeks of Tai Chi training improved the standing balance for stroke patients.
Wang and colleagues [64] randomly assigned 34 stroke patients to Tai Chi exercise or conventional rehabilitation in group sessions once a week for 12 weeks. After training, significant time-by-group interactions were found for sleep quality, general health score, anxiety/insomnia score, and depression score. The results implied that Tai Chi exercise is beneficial to cognitive function in stroke patents.
In a recent study, Taylor-Piliae and Coull [65] recruited 28 stroke patients to participate in a community-based Yang Tai Chi training program. Patients practiced Tai Chi exercise ≥150 minutes/week. The results showed good satisfaction, and the adherence rates were high (≥92%). There were no falls or other adverse events. Tai Chi appears to be safe and can be considered as a community-based exercise program for stroke patients.
4. Conclusion
Tai Chi exercise may promote cardiovascular health and can be considered as an alternative exercise program for patients with CVD. Previous studies prove that Tai Chi is safe and effective for patients with acute myocardial infarction, coronary artery bypass grafting surgery, congestive heart failure, and stroke. In addition, Tai Chi has benefits to cardiovascular risk factors, such as hypertension, diabetes, dyslipidemia, poor exercise capacity, endothelial dysfunction, and depression. However, the study design and training protocols among Tai Chi studies vary significantly, and hence the results are difficult to compare. In future research, large-scale randomized controlled trials using standardized training protocols should be performed in accordance with the guidelines of exercise prescription for patients with cardiovascular disease.
Tai Chi Benefits Heart Patients
Tai Chi Exercise Improves Mood and Health of Heart Failure Patients, Study FindsBy Bill Hendrick WebMD Health News Reviewed by Elizabeth Klodas, MD, FACC
WebMD News Archive
April 25, 2011 -- Tai chi, often called “meditation in motion,” appears to improve the quality of life in people with heart failure, say researchers at Harvard Medical School.
The ancient Chinese exercise of tai chi features physical movements that are slow and gentle and require concentration.
“Historically, patients with chronic systolic heart failure were considered too frail to exercise and, through the late 1980s, avoidance of physical activity was a standard recommendation,” the researchers write. And, until now, the effects of meditative exercise have not been rigorously studied in a large group of heart failure patients.
Scientists at Harvard and Beth Israel Deaconess Medical Center followed 100 outpatients who had reduced heart-pumping function (“systolic heart failure”) and put them into two random groups of 50. One group took part in a 12-week tai chi-based exercise program, and the other group received time-matched education sessions. Both groups attended their sessions twice per week and were similar in terms of baseline demographics, severity of heart disease, and rates of other medical conditions.
A Visual Guide to Heart Disease
Tai Chi Lifts Mood, Helps Heart Failure Patients
By the end of the study, people practicing tai chi had greater improvements in quality of life, including increased confidence to perform various forms of exercise, increased daily activity levels, and greater feelings of well-being, as compared to people in the education-only cohort.
The exercise encourages gentle, flowing circular movements, balance and weight shifting, and practicing of breathing techniques. According to the researchers, tai chi for heart failure patients is “safe and has good rates of adherence."
This form of exercise may also be beneficial for people with hypertension, balance problems, and an impaired exercise capacity, the researchers write. The exercise appears to decrease anxiety, enhance vigor, and improve mood and is a safe alternative to moderate-intensity conventional exercise training.
The study is published in the April 25 issues of the Archives of Internal Medicine.
Bagua Eight Palms
White Crane Temple Style Tai Chi
Grand Master Sunyata Saraswati
2874B Willow Cove Dr. Winston-Salem NC.
(336) 650-0369
September 16, 2001
Letter of Reference
Dear Sir or Madam:
Mr. Hackett as a skilled and proficient Tai Chi instructor with over 20 years of Chinese Martial Arts training has provided his services and demonstrated Tai Chi at various times for public and civic Organizations. He & his students have participated in demonstrations with us in High Point NC.
He has also assisted me in providing insight and instructional assistance to many of my senior students to help them better understands the principles and concepts of Tai Chi Chuan. His has an excellent knowledge of Internal Martial Arts and has studied the history, concepts and philosophy of Chinese Martial Arts in-depth.
Mr. Hackett has obtained a rare and not widely known skill in Tai Chi Chuan, Pa-Kua Chang Chuan & Hsing -I Chuan 'Which are the three Major Chinese Internal Martial Arts and has exemplified accurate knowledge of all three Systems and continues to progress and develop these skills.
We will continue to have Mr. Hackett participate in training seminars and other events demonstrating some of the more traditional Chinese Internal Martial Arts skills he has developed over the past 20 years and hope that many other organizations can get a chance to take advantage of this rare and unique set of skills.
Sincerely,
Grand Master Sunyata Saraswati
MOSES CONE HEALTH SYSTEM
The Women's Hospital of Greensboro 801 Green Valley Road
Greensboro, NC 7408-7079
Writer's Direct Number. 336.832.5500
March 8, 1999
Clifton Hackett
2005 Gray Dawn Court
High Point, NC 27265
Dear Clifton:
Thank you for agreeing to teach the extra class of T'ai Chi. We have had such an overwhelming response, we decided to add a second session to accommodate the interest of people who will be attending the Saturday program.
The Women's Education Center of The Women's Hospital of Greensboro will sponsor the ninth Saturday for Me program on Saturday, March 1 3, 1 999. The theme is Saturday lor Me: Hearing the Body and Mind. Women and men will be given the opportunity to attend three program sessions during the morning from 8:45 a.m. - 12:45 p.m. at The Women's Hospital. Based on past interest and attendance, we expect at least 200 people to attend.
I am pleased you have accepted our invitation to participate in this program and make a presentation titled T'ai Chi Ch'uan. The description of your session that will be included in promotional materials reads as follows:
T'ai Chi Ch'uan
The gentle, relaxed movements of this ancient Chinese system of exercise, meditation and self-defense are easy for people at any age and fitness level. A certified instructor will show you the basics and talk about the benefits which may include stress reduction, lower blood pressure and help for other conditions. Dress comfortably for this program.
Each program session will be one hour. Some time should be reserved at the beginning for a brief introduction and at the end for questions. Your program session is scheduled from 8:45-9:45 a.m. in Classroom 3 on the first floor.
In addition to the program sessions, there will be exhibits and door prizes. You may display brochures or materials to promote your practice or organization on the counter in the room where your session will be held. There will be no honorarium for this program. We thank you for this community service contribution. In return, we expect that you will receive wide visibility for your classes and skill.
Thank you for your willingness to participate in the Saturday for Me: Healing the Body and Mind program. I am glad you will be part of tiie teaching team. Your expertise and contribution will make it a special day to help us make the participants more aware of how to create health.
Sincsrely, Sheron K. Sumner, Ph.D. Manager, Community Education
