Tai_Chi_and_the_Elderly

Tai Chi and the Elderly Michele Jackson Wright State University Abstract In the period of the Three Kingdoms (220 to 265 AD) there was a physician Hua-tu'o who relied not only on medicine but also taught the 'movements of the five creatures' -- tiger, deer, bear, ape and birds -- a system he called Wu-chi chih hsi. He believed that the body needed to be regularly exercised to help with digestion and circulation and only by doing so could a long and healthy live be achieved. He advocated a system of imitating the movements of these animals to help exercise every joint in the body. His teaching, and its connection with the movements of animals, is probably the earliest pre-cursor of Tai Chi (Majka). There have been different studies about the effects of Tai chi on the elderly. This paper will look at the different findings related to the effects of Tai Chi on the elderly. What is Tai Chi In most of the English literature, Tai Chi Chuan (abbreviated to TCC, but expressed in the Chinese phonetic alphabet as Taijiquan) is described as a traditional Chinese form of exercise derived from martial arts folk traditions. The word “Chuan” means “boxing”, but in some of the literature it has been omitted. To understand this set of systematic callisthenic exercises, one must first appreciate the origin and broad significance of the term “Tai Chi”. The term first appeared in the books of “I Ching”, and indicated the encompassing state of the universe before the creation of heaven and earth. Therefore, all TCC movement is considered circular. TCC is used to seek serenity in action, and action in serenity. The emphasis is on the exercise of mind and consciousness. TCC movements are continuous from beginning to end, and from one posture to the next, in a completely integrated circle. TCC is a moderate intensity exercise that is beneficial to cardiorespiratory function, immune capacity, mental control, flexibility, and balance control; it improves muscle strength and reduces the risk of falls in the elderly. (J X Li, 2001) Tai Chi (Tai Chi Chuan, Taijiquan) is a traditional form of martial art used more for promoting health than for fighting. Its gentle, dance-like moves are said to strengthen and balance the body’s “energy.” The net results, according to tradition, include increased physical stamina, enhanced sense of well-being and comfort, and improved resistance to illness (Tai Chi, 2010). Tai chi, also known as “shadow boxing,” combines routines of deep breathing, posturing, stretching, swaying, and other controlled movements combined with meditation. While it is related to martial arts such as karate, it is often called an “internal martial art” because it is graceful and soft, rather than hard and gymnastic. Tai chi is often practiced in groups, so it has the added benefit of increasing socialization. (O’Boyle, 2002) Tai Chi is used to exercise the mind as well as the body. As stated in the Tai chi: physiological characteristics and beneficial effects on health (J X Li, 2001), it is focusing on maintaining the homeostasis of the body. A cross between yoga and meditation, tai chi consists of a series of movements and breathing exercises designed to build strength, restore balance and increase flexibility while helping a person attain a heightened state of being (Devitt, 2001). Tai Chai envelopes the mind and body into a total body workout experience. As stated in Tai chi: Discover the many possible health benefits (Mayo Clinic staff, 2009) most forms are gentle and suitable for everyone. So you can practice tai chi regardless of your age or physical ability — tai chi emphasizes technique over strength (Mayo Clinic staff, 2009). In fact, because tai chi is low impact, it may be especially suitable if you're an older adult who otherwise may not exercise (Mayo Clinic staff, 2009). Tai Chi soothes the mind, allowing the body to relax, to perform the balancing exercises. The mind becomes focused on the workout, which aides to alleviate the stressors of life. The Elderly As the body ages, physical changes occur. The body may develop arthritis. The body systems may deteriorate causing diseases of various body organs. Although physical strength tends to decline with age, the primary reason for this is due to decreasing use of the musculoskeletal system and changes in lifestyle (Jancewicz, 2001). Each year, one in every three adults age 65 and older falls. Falls can lead to moderate to severe injuries, such as hip fractures and head traumas, and can even increase the risk of early death (Injury Prevention & Control: Home and Recreational Safety, 2010). Fortunately, falls are a public health problem that is largely preventable (Injury Prevention & Control: Home and Recreational Safety, 2010). Active ageing is the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age (Ageing and life course , 2010). Functional capacity (such as ventilatory capacity, muscular strength, and cardiovascular output) increases in childhood and peaks in early adulthood, eventually followed by a decline. The rate of decline, however, is largely determined by factors related to adult lifestyle – such as smoking, alcohol consumption, levels of physical activity and diet – as well as external and environmental factors. The gradient of decline may become so steep as to result in premature disability. However, the acceleration in decline can be influenced and may be reversible at any age through individual and public policy measures (World Health Organization, 2002). The Effects of Tai Chi on Arthritis A pair of new studies involving older populations - one conducted at the Case Western Reserve University in Cleveland, Ohio, the other at the Oregon Research Institute - have found that tai chi can reduce pain levels in people with arthritis and increase mobility and physical functioning in otherwise sedentary senior citizens (Devitt, 2001). Studies have shown that tai chi provides relief for those suffering from chronic pain. According to medicalnewstoday.com, performing tai chi can help to alleviate the disabling pain experienced by arthritis sufferers (Brown, 2010). Studies show that there have been positive effects when taking Tai Chi among patients with the diagnosis of arthritis. As stated in, Tai Chi May Ease Arthritis Pain (Hitti, 2009), arthritis pain is reduced and the physical disabilities are reduced. The review shows a drop of 10 points, on a scale of 0-100 points, in the self-reported pain and disability scores of arthritis patients after taking tai chi (Hitti, 2009). Those patients also reported less tension and more satisfaction with their health, compared to patients who didn't take tai chi (Hitti, 2009). Another study of seniors with arthritis showed that those who took a 12-week tai chi course got around better and had less pain in their legs. Yet another study found that people with arthritis who took a 12-week tai chi class had stronger abdominal muscles and better balance afterward (Davis, 2005). Our study proves that Tai Chi relieves pain and disability among people with arthritis and shows a positive trend towards effects for overall physical health (Tai Chi Benefits For Arthritis Shown, 2009). As an effective program for people with arthritis, Tai Chi for Arthritis incorporates exercises that improve muscular strength, flexibility and fitness.  Muscle strength is important for supporting and protecting joints. It is essential for normal physical function. Flexibility exercises enable people to move more easily. Flexibility also facilitates the circulation of body fluid and blood, which enhances healing. Many arthritic conditions such as fibromyalgia, scleroderma and spondylitis are characterized by joint stiffness and impaired physical function. Tai chi gently frees up stiff joints and muscles. Fitness is important for overall health and proper functioning of the heart, lungs and muscles. Tai Chi for Arthritis can improve all of these components. (Dr Paul Lam) Tai Chi has been helpful in alleviating joint pain, increasing muscle strength, flexibility and balance without further deterioration to the joints in older patients with osteoarthritis (OA) (Ching-Huey Chen, 2008). In the The Effects of Tai Chi Exercise on Elders with Osteoarthritis: A Longitudinal Study (Ching-Huey Chen, 2008), the study determined that Tai Chi is beneficial for the elderly with arthritis. Ching-Huey Chen et al. (2008) determined that physical functioning increased and bodily pain improved after long term adherence to the program. The Effects of Tai Chi on Falls Falls in the elderly occur for numerous reasons. Poor balance capacity, decreased muscle strength and flexibility, and the changes in gait that come with ageing are some of the risk factors associated with falls (Arianne P Verhagen, 2004). A third to half of all people _65 years old fall each year (Arianne P Verhagen, 2004). Research has shown that moderate Tai Chi exercise can help to reduce falls and has physiological benefits for the older person (Jancewicz, 2001). Jancewicz (2001), states that Tai Chi uses posture control, which helps to improve balance. Poor balance capacity, decreased muscle strength and flexibility, and the changes in gait that come with ageing are some of the risk factors associated with falls. TCC (Tai Chi Chuan) exercise emphasizes continuous slow movement, with small to large expressions of motion, unilateral to bilateral shifts of body weight, the progressive flexion of the knees, and rotation of the trunk, head, and extremities (J X Li, 2001). These movement components seem to help to reduce the risk factors of falling (J X Li, 2001). Several studies have been done to assess the effects of Tai Chi on falls. In one study, A systematic review of the effectiveness of Tai Chi on fall reduction among the elderly (Serena Low, 2009), stated that falls can be reduced in those that are younger and non-frail. However, the effectiveness of the Tai Chi intervention may be affected by several factors (Serena Low, 2009). The age of the study sample might have influenced the outcomes of the intervention (Serena Low, 2009). The participants were generally younger in Studies 1, 4 and 6 with mean age 69, 77.5 and 76.2 years, respectively, when compared to those in Study 2 with mean age 84.7 years (Serena Low, 2009). The participants were generally ambulant in all the studies (Serena Low, 2009). However, the study sample in Study 2 was frailer than those in previous studies (Serena Low, 2009). Similarly, the study sample in Study 3 was in the transition phase to fragility (Serena Low, 2009). The contribution of fragility as a determinant of the outcomes was reflected in the findings in Study 5 which found that Tai Chi reduced the risk of fall in the pre-frail but not in the frail participants (Serena Low, 2009). There were less fall counts among the Tai Chi group (or Tai Chi inspired in balance exercise group) than the control group (Serena Low, 2009). There was a study done that showed strength training help to reduce falls in the elderly. In the first study, Steven L. Wolf, Ph.D., and colleagues at the Emory University School of Medicine, Atlanta, Ga., found that older people taking part in a 15-week Tai Chi program reduced their risk of falling by 47.5 percent (Tai Chi for Older People Reduces Falls, May Help Maintain Strength, 1996). A second study, by Leslie Wolfson, M.D., and colleagues at the University of Connecticut Health Center, Farmington, found that several interventions to improve balance and strength among older people were effective (Tai Chi for Older People Reduces Falls, May Help Maintain Strength, 1996). These improvements, particularly in strength, were preserved over a 6-month period while participants did Tai Chi exercises (Tai Chi for Older People Reduces Falls, May Help Maintain Strength, 1996). The Wolf study included 200 participants age 70 and older. The participants were divided into groups for Tai Chi, computerized balance training, and education (Tai Chi for Older People Reduces Falls, May Help Maintain Strength, 1996). The most notable change involved the reduction in the rate of falling for the Tai Chi group (Tai Chi for Older People Reduces Falls, May Help Maintain Strength, 1996). Another study found that practicing tai chi exercises could reduce dangerous falls by about 50% (O’Boyle, 2002). Another study showed that elders with decreased sensation in the feet benefited from practice by improving balance related to loss of sensation. Damage to nerve endings in the feet can increase risk of falls (Blanchard, 2009). Tai Chi exercises reduce fall risk among the elderly by improving sensation in the feet (Blanchard, 2009). The objective of tai chi is to achieve physical balance by strengthening muscles and improving co-ordination, while at the same time improving mental balance (Dr Paul Lam). This is why tai chi is effective for fall prevention (Dr Paul Lam). TCC exercise demands precise joint movement, stability, and balance. Performing TCC depends on either double stance weight bearing or single stance weight-bearing maneuvers, which further require the pivoting of the whole body or the twisting of the trunk. In performing TCC, the roles of the muscles continually change between those of stabilizers and movers, weight-bearers and non-weight bearers, and between contraction and relaxation. It has been suggested that the practice of TCC may increase the repertoire of motor programs stored in the brain14, and therefore serve to train the various balance systems to promote greater steadiness. The results indicated that TCC participants substantially reduced their risk of multiple falls by as much as 47.5%, in addition to other positive influences such as increases in hand grip strength and increased ambulating speed. (J X Li, 2001) The Effects of Tai Chi on Cardiorespiratory Function Tai Chi has also been studied for its effects on the respiratory function of the elderly. In 1995 a research project was conducted in a hospital-based exercise physiology laboratory, into cardiorespiratory function among older individuals regularly practicing Tai Chi (Lai et al. 1995). Eighty-four healthy adults, with an average age of 64 years took part (Jancewicz, 2001). Twenty-three males and 22 females had been practicing Tai Chi regularly for between 6.7 and 3.3 years (Jancewicz, 2001). The control group consisted of 18 female and 21 male sedentary subjects of the same body size and age as the practicing Tai Chi group (Jancewicz, 2001). This study compared the cardiorespiratory function of both groups over a period of 2 years (Jancewicz, 2001). The results suggest that with regular practice, Tai Chi maintain and slow down the gradual loss of cardiorespiratory function in ageing people (Jancewicz, 2001). As stated in Stress Management (Mayo Clinic staff, 2009), can lower blood pressure, improve cardiovascular fitness in older adult, and increasing energy and endurance. Tai Chi concentrates on harmonizing muscles and blood flow to the heart, due to deep breathing, which in turn allows a "greater amount of oxygen [to be] available for consumption (Hasel, 1998)."  This circulation is beneficial to the heart as it prevents many "diseases of the heart and the viscera and inflexibility of the cardiac muscle" (Hasel, 1998). A study by Lai, Lan, Wong, and Teng (1995) analyzed the effects of T'ai Chi on "the cardiorespiratory function of older individuals" (Lai, et.al. 1995: page 1222).  The subjects of the study lived in the same community and practiced relatively active lifestyles. The subjects' resting heart rates and blood pressures were tested before and after a bicycle exercise test, the flexibility of their thoracic/lumbar spines were evaluated, and their triceps and subscapular skin folds were measured. In the follow-up tests 2 years later, the T'ai Chi male group decreased its maximal oxygen uptake by 2.8%, and the male control group decreased its maximal oxygen uptake by 6.6%.  The T'ai Chi group of females decreased their maximum oxygen uptake by 2.9%, which was not significantly different from that of the female control group.  However, in the sedentary female group, subjects displayed a "greater decline of maximal aerobic capacity" (Lai, et.al. 1995: page 1225).  These results proved that the practice of T'ai Chi is "beneficial for maintaining the cardiorespiratory function in older individuals" and it may "decrease the rate of decline in cardiorespiratory function". (Hasel, 1998) In a study, Cardiorespiratory Function, Flexibility, and Body Composition Among Geriatric Tai Chi Chuan Practitioners (Ching Lan, 1996), TCC subjects were recruited from a Tai Chi club and sedentary subjects from several senior citizen centers. First, medical and activity histories were obtained by questionnaire. To determine cardiorespiratory function, an exercise test was arranged for each subject. The TCC group included 22 men and 19 women; they had been regularly practicing classical Yang TCC for 11.8 _ 5.6 (SD) years. The sedentary control group included 18 men and 17 women with matched age and body size. To assess differences between the TCC and the control group, the unpaired t test was used to compare physiological variables at the peak exercise and the ventilatory threshold. The chi squared test was used to analyze the difference of disease frequency in both groups. In addition, the same statistical method was used to compare differences in FVC, trunk flexibility, and percentage of body fat between the TCC and the control groups. In the present study, our subjects practiced TCC 4.3 + 1.3 times per week, and the duration was 24 minutes. In addition, the exercise intensity during the performance of TCC exceeded 70% of the HRmax, which corresponds to a moderate exercise intensity. Therefore, TCC is a suitable exercise for the elderly to develop and maintain cardiorespiratory fitness. In summary, our data show that long-term practice of TCC may benefit cardiorespiratory function, flexibility, and body composition in the elderly. In addition, the exercise characteristics of TCC fulfill the criteria proposed by the ACSM for developing and maintaining cardiorespiratory fitness. (Ching Lan, 1996) Conclusion There remain to be few studies on the effects of Tai Chi on the elderly, or the older population. Studies have shown that this form of exercise can benefit this population. Not only can it be used in a preventative manner, it can help to improve physical and emotional disparities of the older population. The performance of activities of daily living (ADL’s), increases, which decreases the need for assistance from others. Tai Chi enhances the life of the elderly population, allowing the elderly to become and stay independent. Performing more studies on the effects of Tai Chi and the elderly, can provide more insight into the cost effectiveness Tai Chi can have on medical costs. Using Tai Chi as a preventive measure can assist with reducing these costs. It has been shown that Tai Chi can improve pain levels, which can reduce the need for medications, reducing medication costs. It has been shown that Tai Chi can increase balance and steadiness, which can reduce falls. Reducing falls, reduces costs in a variety of ways, such as reducing surgical costs, reducing the need for pain medications and reducing the need for other fall interventions. Tai Chi is a low impact form of exercise that can be performed by the elderly. The slow steady movements can be performed by the elderly. The exercise allows social interaction among the elderly. 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