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The Wu Yi Jie He Family System of Chinese Healing and Martial Arts

Tai Chi - Arthritis

Posted May 1st, 2007 in Articles, Research

Can Tai Chi Have An Impact For People With Arthritis?

Arthritis Practitioner - ISSN: 1 - Volume 3 - Issue 3 - May 2007 - Pages: 16 - 18

By Asphodel Yang, PhD, RN

People with arthritis often have limited range of motion, decreased muscle strength, functional limitation and general deconditioning. In addition, osteoarthritis is one of the most common chronic conditions and is the largest single cause of long-term disability in the elderly. For many years, the conventional thinking was that people with arthritis should not exercise because it would damage the joints.

However, research has shown that exercise is a critical component in managing arthritis. The National Arthritis Action Plan and Healthy People 2010 emphasize the importance of exercise among people with arthritis.1,2

Despite the well documented benefits of exercise for managing arthritis, people with arthritis are less engaged in exercise than those without the disease. Interestingly, your beliefs and attitude regarding exercise, and whether you initiate discussion with the patient about the role of exercise do influence a patient’s willingness to engage in an exercise regimen or even physical activity. In one study that explored perceived barriers of exercise among adults with arthritis, both exercising participants and non-exercising participants described their health care providers’ emphasis on medication and failure to mention exercise.3

In order to be a strong advocate of exercise, one should encourage physical activity as a part of everyday health promotion strategies for people with arthritis even though their range of motion may be limited. Having a strong awareness of the many forms of exercise and how your patients with arthritis can benefit from these exercises is essential to promoting an informed selection of exercise modalities.

According to the author, Tai Chi Chuan is a proven and effective exercise modality for patients who are struggling with the management of chronic arthritis.

A Closer Look At Tai Chi Chuan

Tai Chi Chuan (TCC) is a traditional Chinese martial art based on the beliefs that good health results from balanced qi and that regular practice of TCC stimulates and balances the body's qi. Apart from the biological approach of Western medicine, traditional Chinese medicine views health as a state of spiritual and physical harmony with nature. Illness is the end result of violating this harmony. The concept of qi, “the vital energy,” is widely adopted in traditional Chinese medicine, which views chronic pain, especially musculoskeletal pain, as a result of a disturbance of the circulation of qi.

Performing a TCC routine involves making slow, controlled movements that slowly and gently stimulate all the muscle groups, one after another. Relaxed breathing and mental attention are essential during the practice of TCC in order to achieve a balance between body and mind.

What The Studies Reveal About Tai Chi

Clinicians and researchers have reported that TCC has a myriad of physical and physiological therapeutic effects, and have recommended TCC as an example of recreational exercise that is safe and effective for people with arthritis.4-6

Researchers have noted various advantages of TCC for people with arthritis.7 Anyone can perform TCC as long as the individual is able to stand. There is no need for special equipment or large space. In addition, the length of each session is flexible, according to the individual’s needs and tolerance. Studies have found that TCC exercises do not appear to have the adverse effects on arthritic joints that may occur with conventional forms of exercise.5,8

Several randomized controlled studies have demonstrated improvement in arthritic joint pain and stiffness, and reported fewer perceived difficulties in physical functioning among older adults with arthritis who practiced TCC for 12 weeks.9-11

A Cochrane review previously scrutinized the effectiveness and safety of TCC as a treatment option for patients with rheumatoid arthritis (RA). The study found that TCC has statistically significant and clinically important improvements in lower extremity range of motion (ROM), particularly in ankle ROM, and the level of participation in comparison to traditional ROM exercises. In the three controlled clinical trials evaluated in the Cochrane review, researchers reported no adverse effects from the exercises, which ranged from one hour of TCC exercise a day to once per week.8

Over the past decade, growing evidence from randomized controlled trials suggests that TCC may be beneficial for a wide range of health outcomes. Routine practice may improve physical functions including: one’s level of activities, gait and balance, flexibility, and cardiovascular and ventilatory function. Researchers have also found a favorable impact in fall prevention and decreased pain with various chronic conditions.10-16

Tai Chi Chuan exercise also offers the potential for promoting overall well-being, enhancing the general enjoyment of life and improving psychological health. Studies also show that improvement of self-efficacy and self-esteem occurred in older adults who participated in TCC exercise. Moreover, evidence demonstrates improvement in health-related quality of life and psychological health among individuals in TCC groups.11,13-15

Recommending A Tai Chi Program For Patients With Arthritis

In regard to TCC, it is a dynamic sequence of movements that requires complex whole body coordination. There are inherent challenges posed by single leg stances (during transitional moves), backward/side stepping and intricate arm and body swaying movements, which are all accompanied by demands for mental concentration and selective attention.15 Although all TCC styles have the same fundamental theoretical ideas and standard principles, there are nevertheless postural differences that emphasize the contraction and stretching of different muscle groups, as well as a difference in the speed and type of energy one uses.

With all the differences among styles of TCC, you may ask which style is most effective therapeutically. Would one style be more suited to people with arthritis?

Routine practice of TCC may improve physical functions including one’s level of activities, gait and balance, and flexibility. Tai Chi From Arthritis Foundation (TCAF), a program adopted by the Arthritis Foundation, is based upon the Australian Sun style (one of the four major recognized styles of TCC) and is particularly designed to improve the quality of life for people with arthritis.10 This style is effective for those with arthritis because it includes agile steps and exercises that may improve mobility, breathing and relaxation. In addition, the movements have higher stances, which make the program easier and more comfortable to learn.16

The program consists of 12 movements (six basic and six advanced), a warm-up and a cool-down using the Sun style of TCC exercises. Individuals perform each movement slowly and walk or move at their own pace while simultaneously breathing in and out. After an individual becomes familiar with the 12 movements, the program provides a continual challenge by reversing the direction of the movements.

One randomized control trial confirmed the therapeutic effects of TCAF in people with arthritis.10 Findings from this study revealed that 12 weeks of TCAF practice significantly improved arthritis symptoms, balance and physical functioning. Participants in the TCAF group reported a significant reduction in pain and stiffness in their arthritic joints, and fewer difficulties in physical functioning.10

Understanding The Challenges Of Learning TCC

In regard to cognition and coordination, learning TCC can be somewhat difficult for beginners. I have observed two common challenges among senior beginners.

First, learning the sequence is a cognitive challenge. I have observed that participants are usually too occupied with mastering a single form to consider learning a sequence of movement and related techniques and principles.

This exercise also requires high levels of coordination between upper and lower extremities, such as exact foot or hand placement in any particular posture. A common comment heard during TCC sessions was “I got lost in the transition.” Essentially, older adults have had to pause and recall the movement that connects one posture to the other. Accordingly, a group of no more than 15 people may benefit new beginners as the instructor can provide more individual attention due to the small group size.

Indeed, instruction by a professional is the best way for beginners to learn TCC. Learning TCC independently is not recommended due to its dynamic sequence of movements. The TCAF is offered at many local chapters of Arthritis Foundation and community centers. Usually, these classes are led by an experienced TCC instructor, who is certified by the Arthritis Foundation.

People with arthritis may use videotapes as an aid or reinforcement once they are familiar with all the movements, and are able to practice on their own. Individuals may also elect to continue with a group for the social support.

In Conclusion

Tai Chi Chuan provides a viable exercise option for people with arthritis who may be seeking easy and affordable variety in their exercise routine. It has many beneficial effects for persons with arthritis and provides a relatively safe and enjoyable exercise. Accordingly, practitioners should consider recommending TCC as a possible exercise option for patients with arthritis.

  1. Arthritis Foundation Association of State and Territorial Health Officials and Centers for Disease Control and Prevention. National Arthritis Action Plan: a public health strategy. Atlanta (GA): Centers for Disease Control and Prevention; 1999.
  2. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and improving health. 2nd ed. Washington (DC): US Government Printing Office; 2000
  3. Wilcox S, Der Ananian C, Abbott J, et al. Perceived exercise barriers, enablers, and benefits among exercising and nonexercising adults with arthritis: results from a qualitative study. Arthritis Rheum 2006;55(4):616-627.
  4. Kirsteins A, Dietz F, Hwang S. Evaluating the safety and potential use of a weight-bearing exercise, Tai-Chi Chuan, for rheumatoid arthritis patients. American Journal of Physical Medicine & Rehabilitation 1991;70(3):136-141.
  5. Lumsden DB, Baccala A, Martire J. T'ai chi for osteoarthritis: an introduction for primary care physicians. Geriatrics 1998;53(2):84.
  6. Westby MD, Minor MA. Exercise and Physical Activity. In: Bartlett SJ, ed. Clinical Care in the Rheumatic Disease. Atlanta, GA: Association of Rheumatology Health Professionals; 2006:211-220.
  7. Komagata SN, R. The effectiveness of Tai Chi on improving balance in older adults: an evidence-based review. Journal of Geriatric Physical Therapy 2003;26(2):9-16.
  8. Han A, Robinson V, Judd M, Taixiang W, Wells G, Tugwell P. Tai chi for treating rheumatoid arthritis. The Cochrane Database of Systematic Review. 2004(3):CD004849.
  9. Adler P, Good M, Roberts B, Snyder S. The effects of tai chi on older adults with chronic arthritis pain. Journal of Nursing Scholarship 2002;32(4):377.
  10. Song R, Lee E-O, Lam P, Bae S-C. Effects of tai chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with osteoarthritis: a randomized clinical trial. Journal of Rheumatology 2003;30(9):2039-2044.
  11. Hartman CA, Manos TM, Winter C, Hartman DM, Li B, Smith JC. Effects of T'ai Chi training on function and quality of life indicators in older adults with osteoarthritis. Journal of American Geriatrics Society 2000;48(12):1553-1559.
  12. Li F, Fisher KJ, Harmer P, McAuley E. Delineating the impact of Tai Chi training on physical function among the elderly. American Journal of Preventive Medicine 2002;23(2 Suppl):92-97.
  13. Li F, Harmer P, McAuley E, Fisher KJ, Duncan TE, Duncan SC. Tai Chi, self-efficacy, and physical function in the elderly. Prev Sci 2001;2(4):229-239.
  14. Li FH, P Chaumeton, NR Duncan, T Duncan, S. Tai Chi as a means to enhance self-esteem: a randomized controlled trial. Journal of Applied Gerontology. 2002;21(1):70-89.
  15. Fisher KJ, Li F, Shirai M. Promoting health through tai chi: Results from a controlled study. California Journal for Health Promotion 2003;1(4):79-87.
  16. Lam, P. & Horstman, J. Overcoming arthritis. New York: Dorling Kindersley; 2002.


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