Promoting Health and Well-Being within an Aging Population

Sifu David P. Brown, M. Sush May
Four Winds Center for Personal Enrichment

A steadily growing body of evidence suggests that increased physical activity and fitness are clearly associated with reductions in the risk of cardiovascular disease. It is also widely recognized that an aging population is at highest risk for poor heart health. Getting older Americans to exercise is not always easy, but an exercise program that is simple and non-threatening and which provides a quantifiable degree of improved general health and quality of life will encourage participation. T'ai Chi Ch'uan is exactly such an exercise. A low-impact, meditative system, T'ai Chi Ch'uan promotes health and well-being by increasing functionality in the general and at-risk populations. Additionally, T'ai Chi Ch'uan has been found to be a beneficial adjunctive treatment that enhanced quality of life and functional capacity in patients with chronic heart failure.

Numerous studies have been conducted on the benefits of exercise on cardiovascular health. A randomized study reported in the New England Journal of Medicine examined the effect of amount and intensity of exercise on lipoproteins. The study found that a relatively high amount of regular exercise, even in the absence of clinically significant weight loss, can significantly improve the overall lipoprotein profile. The second major finding of the study was that the improvements on lipoprotein profile were related to the amount of activity and not to the intensity of exercise or improvement in fitness. Several studies have shown that low-intensity exercise can result in improvements in lipoproteins.

T'ai Chi Ch'uan, specifically, has been the subject of recent studies involving cardiac patients. A steadily increasing collection of evidence suggests T'ai Chi practice, even over short periods of time, may improve cardiovascular health. A U.S. study of 30 patients conducted by a joint research group examined the effects of a 12-week T'ai Chi program on quality of life and exercise capacity in patients with heart failure. At 12 weeks, patients in the T'ai Chi group showed improved quality of life scores, increased distance walked in six minutes, and decreased serum B-type natriuretic peptide levels compared with patients in the control group. A trend towards improvement was seen in peak oxygen uptake. The larger phase III trial will randomize 150 heart failure patients to 12 weeks of T'ai Chi and is scheduled to conclude in June 2008.

A randomized controlled trial examined the effects of aerobic exercise and T'ai Chi on blood pressure in 62 mildly hypertensive older adults. Over a 12-week study period, T'ai Chi was found to be equally effective as aerobic exercise in reducing both systolic and diastolic blood pressure. Lai, et al., conducted a study comparing two-year trends in cardiorespiratory function of a group of elderly T'ai Chi practitioners. Their results suggest that T'ai Chi may delay the decrease in aerobic capacity usually found with aging. Lan, et al., conducted a cross-sectional, case-controlled study to evaluate the health benefits of long-term geriatric T'ai Chi practitioners. The study revealed that peak oxygen uptake was greater for T'ai Chi practitioners compared to age-matched sedentary subjects. No adverse effects related to the short- or long-term practice of T'ai Chi were reported in any of these studies.

In a study involving 39 Chinese adults with at least one cardiovascular disease risk factor, statistically significant improvements were observed in balance, muscular strength and endurance and flexibility measures after six weeks of T'ai Chi exercise and a further increase after 12 weeks of T'ai Chi exercise. The study concluded that T'ai Chi is a potent intervention that improves balance, upper and lower-body muscular strength and endurance and upper and lower-body flexibility. A report of the study by the American Heart Association revealed: "Most exercise programs for women with coronary heart disease have high dropout rates, but 96 percent of participants completed the T'ai Chi program, and there was a waiting list to join."

The Journal of the American Geriatrics Society published conclusions of a study which substantiated that practicing T'ai Chi regularly may delay the decline of cardiorespiratory function in older individuals. It further recommended that T'ai Chi may be prescribed as a suitable aerobics exercise for older adults.

A first-of-its-kind randomized study conducted by researchers from the University of Pennsylvania's Division of Geriatric Medicine evaluated 23 African American men and women, average age 64, who were recently hospitalized with New York Heart Association class II or III congestive heart failure. The study concluded that stress-reducing meditation techniques can significantly reduce the severity of congestive heart failure. The results of this study indicate that meditation can be effective in improving the functional capacity and quality of life of congestive heart failure patients. T'ai Chi does, in fact, have such meditative elements inherent within its practice.

There is a vast existing body of research which draws a connection between exercise and cardiovascular health, and further research which specifically outlines the benefits of T'ai Chi to persons with higher risk of heart disease. T'ai Chi is characterized by movements which are continuous, smooth, and natural, with the upper and lower parts of the body following each other. The entire body is always in motion with the movements performed gently and at a uniform speed. As such, T'ai Chi, more so than any other form of aerobic exercise, is ideal for patients at risk for, or suffering from, cardiovascular disease.

The clear majority of patients suffering from heart disease are elderly, and "frailty in older adults is increasingly a recognized syndrome of decline, sometimes subtle, in function and health that may be amenable to available approaches to care." Thus, an exercise regimen calculated to improve cardiovascular health among an at-risk population must take into account this factor of aging.

According to an article on frailty and aging by Boockvar and Meier, one feature associated with frailty in older adults is weakness or loss of strength. T'ai Chi increases core stability by strengthening the spinal erectors and abdominal muscles. An American College of Rheumatology press release, dated November 11, 2001, reported conclusions of a randomized study which found significant improvements in abdominal muscle strength and balance among participants after a 12-week T'ai Chi program. Increased strength results in increased confidence in movement and improves another feature associated with frailty, which is slowed performance. T'ai Chi practitioners improve daily functionality by increasing joint flexibility and range of motion.

A third feature of frailty in older adults is fatigue. T'ai Chi builds mental and physical endurance, resulting in increased energy levels. When the mind and body are active, the patient is less likely to experience fatigue. This is also relevant to yet another feature of frailty, which is a low level of physical activity. As evidenced by the Taylor-Piliae study, T'ai Chi is an engaging activity with a comparatively low dropout rate, which is an encouraging indication that participants voluntarily maintain an increased level of physical activity. Clients that participate in a regular routine of T'ai Chi report deeper rest and improvement in sleep patterns, which addresses the insomnia experienced by many aging adults. Other features of frailty in aging, such as onset of depression and anxiety stemming from inactivity and lack of physical functionality, are also ameliorated by participation in T'ai Chi.

The final and most critical element to be considered is that the slow and methodical movements which characterize T'ai Chi minimize the potential for exercise-related injuries in an older population. T'ai Chi is a meditative activity. Through the mindful application of T'ai Chi postures, the patients are more cognizant of their level of physical exertion, allowing them to modulate their participation in the activity at any given moment during exercise. Finally, T'ai Chi in a group setting, as it is most commonly practiced, promotes social interaction, thus reducing the sense of isolation and depression which may accompany an aging population or persons undergoing cardiac rehabilitation.

Although a great deal of research is currently in progress regarding the potentially beneficial effects of T'ai Chi Ch'uan on health in general and on the well-being of cardiac patients in particular, much has already been discovered. T'ai Chi is, in fact, an ideal exercise for an aging population contending with physical challenges and limitations. It is an aerobic exercise embodied within a non-threatening low-impact activity which is especially attractive to an older population. The variety of exercises and activities available within T'ai Chi allow all patients to participate regardless of their level of functionality and physical limitations. Flexibility within T'ai Chi as a system allows each patient to choose his or her level of activity, whether low, moderate or intense, depending upon the patient's age, energy level or disease process. For these reasons, and for the reason that T'ai Chi offers an opportunity for social interaction with like-minded individuals, the participants have a greater tendency to continue with the activity as compared with other forms of exercise. Also, the rate of exercise-related injury is very low as compared with other forms of aerobic activity.

The long tradition of practice of T'ai Chi Ch'uan (since the 13th century) has often been credited for the health and longevity enjoyed by the Chinese people. The fact that it is now the subject of extensive research among Western scientists is an indication of its potential benefit within the sphere of modern preventive and rehabilitative medicine.


APPENDIX
MORE RESEARCH ON T'AI CHI AND CARDIAC HEALTH:

PEER REVIEWED ARTICLES

Barrow D, Barrow R et al. Changes in haemodynamic parameters following Tai Chi Chuan and aerobic exercise in patients recovering from acute myocardial infarction. POSTGRAD MED J 1996;72:349-351. Complementary Medicine for the Physician, 4(7):52, 1999 Sep, 4(7), 52

Brown, D.D., Mucci, W.G., Hetzler, R.K., & Knowlton, R.G. (1989). Cardiovascular and ventilatory responses during formalized T'ai Chi Chuan exercise. Research Quarterly for Exercise & Sport, 60(3), 246-250.

Lan C, Chou S W, Chen S Y, Lai J S, Wong M K. The aerobic capacity and ventilatory efficiency during exercise in Qigong and Tai Chi Chuan practitioners. Am J Chin Med 2004; (32): 141-150.

Jong S Y, Fang Y Y, Chao Y F. [The effect of Tai-Chi-Qui-Gong exercises on patients' pulmonary function, exercise capacity, and quality of life after lobectomy.]. Hu Li Za Zhi 2004; (51): 46-54.

Ades P A, Wu G. Benefits of tai chi in chronic heart failure: body or mind? Am J Med 2004; (117): 611-612.

Channer, K.S., Barrow, D., Barrow, R., Osborne, M., & Ives, G. (1996). Changes in haemodynamic parameters following Tai Chi Chuan and aerobic exercise in patients recovering from acute myocardial infarction. Postgraduate Medical Journal, 72(848), 349-351.

Fontana, J.A. (2000). The energy costs of a modified form of T'ai Chi exercise [corrected] [published erratum appears in NURS RES 2000 May-Jun; 49(3): 145]. Nursing Research, 49(2):91-6, 2000 Mar-Apr, 49(19 ref), 91-96.

Lai, J.S., Lan, C., Wong, M.K., & Teng, S.H. (1995). Two-year trends in cardiorespiratory function among older Tai Chi Chuan practitioners and sedentary subjects. J Am Geriatr Soc JID - 7503062, 43(11), 1222-1227.

Lan, C., Chen, S., Lai, J., & Wong, M. (1999). The effect of Tai Chi on cardiorespiratory function in patients with coronary artery bypass surgery. Medicine & Science in Sports & Exercise, 31(5):634-8, 1999 May, 31(29 ref), 634-638.

Lan, C., Chen, S., Lai, J., & Wong, M. (2001). Heart rate responses and oxygen consumption during Tai Chi Chuan practice. American Journal of Chinese Medicine, 29(3/4):403-10, 2001, 29(19 ref), 403-410.

Lan, C., Lai, J.S., Wong, M.K., & Yu, M.L. (1996). Cardiorespiratory function, flexibility, and body composition among geriatric Tai Chi Chuan practitioners. Archives of Physical Medicine & Rehabilitation, 77(6), 612-616.

Lee E N. [The effects of tai chi exercise program on blood pressure, total cholesterol and cortisol level in patients with essential hypertension.]. Taehan Kanho Hakhoe Chi 2004; (34): 829-837.

Li, J.X., Hong, Y., & Chan, K.M. (2001). Tai chi: physiological characteristics and beneficial effects on health. British Journal of Sports Medicine, 35(3):148-56, 2001 Jun, 35(44 ref), 148-156.

Schneider, D., & Leung, R. (1991). Metabolic and cardiorespiratory responses to the performance of Wing Chun and T'ai Chi Chuan exercise. International Journal of Sports Medicine, 12(3), 319-323.

Vaananen, J., Xusheng, S., Wang, S., Laitinen, T., Pekkarinen, H., & Lansimies, E. (2002). Taichiquan acutely increases heart rate variability. Clin Physiol Funct Imaging JID - 101137604, 22(1), 2-3.

Wang, J.S., Lan, C., Chen, S.Y., & Wong, M.K. (2002). Tai Chi Chuan training is associated with enhanced endothelium-dependent dilation in skin vasculature of healthy older men. [see comments.]. Journal of the American Geriatrics Society, 50(6), 1024-1030.

Zhuo, D., Shephard, R.J., Plyley, M.J., & Davis, G.M. (1984). Cardiorespiratory and metabolic responses during Tai Chi Chuan exercise. Canadian Journal of Applied Sport Sciences - Journal Canadien des Sciences Appliquees au Sport, 9(1), 7-10.

Wang, J., Lan, C., & Wong, M. (2001). Tai Chi Chuan training to enhance microcirculatory function in healthy elderly men. Archives of Physical Medicine & Rehabilitation, 82(9):1176-80, 2001 Sep, 82(35 ref), 1176-1180.


NON-RESEARCH ARTICLES ON TAI CHI AND CARDIAC HEALTH:

Ackerman, S. (1999). Tai chi: an exercise alternative for cardiac rehab... commentary on Channer KS,

Fontana, J.A., Colella, C., Baas, L.S., & Ghazi, F. (2000). T'ai Chi Chih as an intervention for heart failure. [Review] [52 refs]. Nursing Clinics of North America, 35(4), 1031-1046.

Jeng, C., Chu, F.L., & Tsao, L.I. (2002). Empowering: the experiences of exercise among heart transplantation patients in Taiwan. J Adv Nurs JID - 7609811, 40(5), 560-567.

Kreitzer, M.J., & Snyder, M. (2002). Healing the heart: integrating complementary therapies and healing practices into the care of cardiovascular patients. Progress in Cardiovascular Nursing, 17(2):73-80, 2002 Spring, 17(36 ref), 73-80.

Luskin, F.M., Newell, K.A., Griffith, M., Holmes, M., Telles, S., Marvasti, F.F., Pelletier, K.R., & Haskell, W.L. (1998). A review of mind-body therapies in the treatment of cardiovascular disease. Part 1: Implications for the elderly. [Review] [181 refs]. Alternative Therapies in Health & Medicine, 4(3), 46-61.

Oz, M. (1999). Bypass surgery and Tai Chi. Newsweek, 134(24A Spec Ed):84-7, 1999 Dec-2000 Feb, 134(24A Spec Ed), 84-87.

Whyte, N. (1997). Tai Chi for clients in cardiac rehabilitation. Ot Practice, 2(10):38-41, 1997 Oct, 2(10 bib), 38-41.