The Health Benefits of Tai Chi Ch’uan
This discussion of the scientific basis and support for health benefits derived from the practice of tai chi ch’uan will be an ongoing project. The topic is complex and new ideas and research data are being presented frequently. Simplistic and misleading assertions do not contribute to our understanding. An evidence-based discussion, even with its limited conclusions, is essential. Equally essential is the directive to people interested in tai chi to begin or continue the practice regardless of any biomedical consensus about health benefits. If you find that tai chi ch’uan is good for your life, then just do it!
Data from the 2012 National Health Interview Survey showed that almost seven million Americans had practiced tai chi ch’uan at some point during their life time with almost three million having practiced during the preceding 12 months. Within the latter group, the most common reason given for practice was “general wellness or disease prevention.”(1) But what is actually known about the health benefits of tai chi ch’uan?
First, it must be stated that non-competitive tai chi ch’uan is safe. As one would expect from a typically slow, low impact type of exercise, tai chi is unlikely to result in serious injury (2). Nevertheless, individuals who have any problems associated with standing or walking for extended periods should consult a physician prior to beginning the practice. Of course, regardless of age or physical condition, understanding one’s own limits and being able to distinguish acute pain from post-exercise soreness are of primary importance in preventing adverse consequences of activity.
Despite continuing debate about the origins of tai chi ch’uan and its precise evolutionary connections to Daoism and traditional Chinese medicine, tai chi practitioners have for centuries recognized the benefits of greater mobility, flexibility, balance, and overall vigor. However, acceptance by and incorporation of tai chi into Western medicine has been slow. There are many reasons for this slowness. Differences between Asian and western cultures and language are part of the problem. But the main issue is epistemological: what criteria do we use to establish truth in science, or in other words, “How do we know when we really know something?”
Modern western medicine seeks scientific justification prior to recommending any drug, device, or change in behavior to patients. This justification comes in two steps. First, an idea must be viewed as plausible, i.e. worthy of study. This is often determined when there is anecdotal evidence (e.g. Susan and Joe think something works) and the idea seems to have some basis in what is already known about human anatomy and physiology. Second, the idea must be shown to lead to results that are probable, i.e. it can be predicted with great certainty that doing X will result in Y. This probability is determined by experiments, which in the case of most potential new medical therapies are known as “trials.” Conducting trials is challenging because scientists must be sure that it is precisely the X therapy, and nothing else, that is causing the good medical outcome Y. A simple correlation between X and Y is not sufficient.
In the case of tai chi ch’uan, it seems very plausible that improved health may be an outcome of regular practice. There are many correlations between tai chi practice and improvements in a wide variety of medical conditions. And scientists are discovering that tai chi practice can lead to changes in many physiological systems that underlie cardiovascular, immune, and nervous function. A particularly interesting 2012 study found that regular tai chi practice resulted in increases in brain volume and improved cognition in Chinese adults, ages 60-79.(3) Even qi (“chi”) energy, a nebulous Daoist cosmological concept that underlies much of the mystique of tai chi ch’uan, is receiving indirect attention via studies of thermoregulatory processes in human subjects performing relaxation exercises. (4) The Harvard Medical School Guide to Tai Chi (available free online) contains an excellent overview of the potential health benefits of tai chi ch’uan.(5)
Unfortunately, experimental validation of the plausible claims is difficult to achieve. The existing scientific literature is a hodgepodge of data due to lack of standardization of tai chi experimental programs. In fact, many studies have not considered the modality of tai chi practice (martial, sports, or therapeutic) or identified the specific style or form being used.(6) Some tai chi study subjects only meet weekly for formal sessions but others are also encouraged/expected (?) to engage in daily practice at home. Numerous other confounding factors make the results of these studies almost impossible to interpret. In addition, even when tai chi is found to be of greater benefit than doing nothing at all, the benefits are often found equivalent to those obtained by other generic exercises.
[Thus, be wary of programs claiming to be specially designed for a specific health condition (e.g. arthritis, depression, cardiovascular disease). Too little is known about the therapeutic benefits of tai chi generally to justify assertions that any one class has elements that are uniquely beneficial for one condition.]
It is important to remember that the goal of biomedical studies is to make valid generalizations. However, generalizations by definition do not apply to all individuals. If modern medicine says that X therapy is good for Y health problem, there is still a chance (because there is always uncertainty) that X will not help you. But it is also true that even if modern scientists cannot make the generalization for (i.e. cannot "prove") the benefits of X, it may still work for you! In other words, try not to be fooled, but if something seems to help, don’t stop doing it.
Behavioral intervention therapies that may rely heavily on manifestations of mind-body connections (e.g. imagination and intention) are not amenable to study. While research on placebo effects has demonstrated the therapeutic value of expectation and belief, we may never be able to conduct the kind of randomized controlled trials that underlie the use of most valuable drugs and devices. Thus, many questions about the benefits of tai chi ch'uan will not be answered to the satisfaction of western science. In the end, and in the words of Iris Dement, we may need to “Let the mystery be.”
*******************************
1. Lauche, R. et al. 2016. Prevalence, patterns, and predictors of t’ai chi and qigong use in the United States: Results of a nationally representative survey. J Alternative Complementary Med 22 (4): 336-342.
2. Wayne, P.M. et al. 2014. What do we really know about the safety of tai chi?: A systematic review of adverse event reports in randomized trials. Arch Phys Med Rehabil 95(12):2470-83.
3. Mortimer, J.A. et al. 2012. Changes in brain volume and cognition in a randomized trial of exercise and social interaction in a community-based sample of non-demented Chinese elders. J Alzheimers Disease 30(4): 757-766. [Free download]
4. Iuliano, B. et al. 2011. Physiologic correlates of t’ai chi chuan. J Alternative Complementary Med 17 (1): 77-81.
5. Wayne, P.M. 2013. The Harvard Medical School Guide to Tai Chi: 12 weeks to a healthy body, strong heart, and sharp mind. Shambhala Publications, Inc. 225 pp. [Free download]
