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  Literature Review: Fitness A Comprehensive Review of Health Benefits of Qigong and Tai Chi Roger Jahnke, OMD; Linda Larkey, PhD; Carol Rogers, APRN-BC, CNOR, PhD; Jennifer Etnier, PhD;Fang Lin, MS   Abstract Objective.  Research examining psychological and physiological benefits of Qigong and Tai Chi is growing rapidly. The many practices described as Qigong or Tai Chi have similar theoretical roots, proposed mechanisms of action, and expected benefits. Research trials and reviews, however, treat them as separate targets of examination. This review examines the evidence for achieving outcomes from randomized controlled trials (RCTs) of both. Data Sources.  The key words Tai Chi, Taiji, Tai Chi Chuan, and Qigong were entered into electronic search engines for the Cumulative Index for Allied Health and Nursing (CINAHL), psychological literature (PsycINFO), PubMed, Cochrane database, and Google Scholar. Study Inclusion Criteria.  RCTs reporting on the results of Qigong or Tai Chi interventions and published in peer-reviewed journals from 1993 to 2007. Data Extraction.  Country, type and duration of activity, number/type of subjects, control conditions, and reported outcomes were recorded for each study. Synthesis.  Outcomes related to Qigong and Tai Chi practice were identified and evaluated. Results.  Seventy-seven articles met the inclusion criteria. The nine outcome category groupings that emerged were bone density (n  5 4), cardiopulmonary effects (n  5 19), physical  function (n  5 16), falls and related risk factors (n  5 23), quality of life (n  5 17), self-efficacy (n  5 8), patient-reported outcomes (n  5 13), psychological symptoms (n  5 27), and immune  function (n   5  6). Conclusions.  Research has demonstrated consistent, significant results for a number of  health benefits in RCTs, evidencing progress toward recognizing the similarity and equivalence of Qigong and Tai Chi. (Am J Health Promot 2010;24[6]:e1–e25.) Key Words:   Tai Chi, Taiji, Meditation, Qigong, Mind-Body Practice, Mindfulness,Meditative Movement, Moderate Exercise, Breathing, Prevention Research.Manuscript format: literature review; Research purpose: Setting: health care,community; Health Focus: fitness/physical activity, psychosocial/spiritual health,stress management; Strategy: education, skill building; Target population: all adults,seniors; Target population circumstances: all SES, international, race/ethnicity  INTRODUCTION  A substantial body of publishedresearch has examined the healthbenefits of Tai Chi (also called Taiji), a traditional Chinese wellness practice.In addition, a strong body of researchis also emerging for Qigong, an evenmore ancient traditional Chinese well-ness practice that has similar charac-teristics to Tai Chi. Qigong and Tai Chihave been proposed, along with yoga and pranayama from India, to consti-tute a unique category or type of exercise referred to currently as med-itative movement. 1 These two forms of meditative movement, Qigong and TaiChi, are close relatives, having sharedtheoretical roots, common operationalcomponents, and similar links to the wellness and health-promoting aspectsof Traditional Chinese Medicine(TCM). They are nearly identical inpractical application in the health-enhancement context and share muchoverlap in what TCM describes as the‘‘three regulations’’: body focus (pos-ture and movement), breath focus, andmind focus (meditative, mindful com-ponents). 1,2 Because of the similarity of Qigongand Tai Chi, this review of the state of the science for these forms of medita-tive movement will investigate thebenefits of both forms together. Inpresenting evidence for a variety of health benefits, many of which areattributable to both practices, we willpoint to the magnitude of the com-bined literature and suggest under what circumstances Qigong and TaiChi may be considered as potentially equivalent interventions, with recom-mendations for standards and furtherresearch to clarify this potential. Roger Jahnke, OMD, is with the Institute of Integral Qigong and Tai Chi, Santa Barbara,California. Linda Larkey, PhD, Carol Rogers, APRN-BC, CNOR, PhD, and Fang Lin, MS, are withtheArizonaStateUniversityCollegeofNursingandHealthcareInnovation,Phoenix,Arizona. Jennifer Etiner, PhD, is with the University of North Carolina, Greensboro, North Carolina. Send reprintrequests to Linda Larkey, PhD, Arizona State University College of NursingandHealthcareInnovation, 500 N 3rd Street, Phoenix, AZ 85004; larkeylite@msn.com. This manuscript was submitted October 13, 2008; revisions were requested June 2, 2009; the manuscript was accepted for  publication July 21, 2009.Copyright  E  2010 by American Journal of Health Promotion, Inc.0890-1171/10/$5.00   +   0  DOI: 10.4278/ajhp.081013-LIT-248  July/August 2010, Vol. 24, No. 6 e1 Author PDF.May be distributed widely by e-mail.Posting on Web sites prohibited.  OBJECTIVES Previously published reviews havereported on specific outcomes of eitherTai Chi or Qigong, mostly addressingonly one of these practices, and rarely taking into account the similarity of thetwo forms and their similar outcomes.These reviews have covered a wide variety of outcomes, with many focusedon specific diseases or symptoms, in-cluding hypertension, 3 cardiovasculardisease, 4,5 cancer, 6–8 arthritic disease, 9 stroke rehabilitation, 10 aerobic capaci-ty, 11 falls and balance, 12,13 bone mineraldensity, 14 and shingles-related immuni-ty, 15  with varying degrees of support noted for outcomes in response toQigong or Tai Chi.Otherreviewshaveaddressedabroadspectrum of outcomes to demonstratehow Qigong 16–19 or Tai Chi 20–26 hasdemonstrated improvements for par-ticipants with a variety of chronic healthproblems or with vulnerable olderadults. Although many of these reviewshave utilized selection criteria that restrict their focus to rigorous empiricalstudies, others have used less stringent criteria. The purpose of this review is toevaluate the current evidence for a broad range of health benefits for bothQigong and Tai Chi using only ran-domized controlled trials (RCTs), andto evaluate the potential of treatingthese two forms of meditative move-ment as equivalent forms. A completedescription of Qigong and Tai Chi ispresented and the equivalence of theirtheoretical roots and their commonelements of practice are established.Then, the body of evidence for out-comes in response to Qigong and TaiChi is reviewed to examine the range of health benefits. Finally, to more criti-cally evaluate similarities across studiesof the two practices, we discuss thepotential of treating them as equivalent interventions in research and the in-terpretation of results across studies.Research question 1: What healthbenefits are evidenced from RCTs of Qigong and Tai Chi?Research question 2: In examiningthe Qigong and Tai Chi practicesincorporated in research, and theevidence for health benefits commen-surate with each, what claims can bemade for equivalence of these twoforms of practice/exercise that havetypically been considered to be sepa-rate and different? Overview of Qigong and Tai Chi Qigong is, definitively, more ancient in srcin than Tai Chi, and it is theoverarching, more srcinal disciplineincorporating widely diverse practicesdesigned to cultivate functional integ-rity and the enhancement of the lifeessence that the Chinese call Qi. BothQigong and Tai Chi sessions incorpo-rate a wide range of physical move-ments, including slow, meditative, flow-ing, dance-like motions. In addition,they both can include sitting or stand-ing meditationpostures as well as eithergentle or vigorous body shaking. Most importantly, both incorporate the pur-poseful regulation of both breath andmind coordinated with the regulationof the body. Qigong and Tai Chi areboth based on theoretical principlesthat are inherent to TCM. 1 In theancient teachings of health-orientedQigong and Tai Chi, the instructionsfor attaining the state of enhanced Qicapacity and function point to thepurposeful coordination of body,breath, and mind (paraphrased here):‘‘Mind the body and the breath, andthen clear the mind to distill theHeavenly elixir within.’’ This combina-tion of self-awareness with self-correc-tion of the posture and movement of the body, the flow of breath, andmindfulness, are thought to comprise a state that activates the natural self-regulatory (self-healing) capacity, stim-ulating the balanced release of endog-enous neurohormones and a wide array of natural health recovery mechanismsthat are evoked by the intentful inte-gration of body and mind.Despite variations among the myriadforms, we assert that health-orientedTai Chi and Qigong emphasize thesame principles and practice elements.Giventhese similar foundationsandthefashion in which Tai Chi has typically been modified for implementation inclinical research, we suggest that theresearch literature for these two formsof meditative movement should beconsidered as one body of evidence. Qigong Qigong translates from Chinese tomean, roughly, to cultivate or enhancethe inherent functional (energetic)essence of the human being. It isconsidered to be the contemporary offspring of some of the most ancient (before recorded history) healing andmedical practices of Asia. The earliest forms of Qigong make up one of thehistoric roots of contemporary TCMtheory and practice. 2 Many branches of Qigong have a health and medicalfocus and have been refined for wellover 5000 years. Qigong purportedly allows individuals to cultivate the nat-ural force or energy (Qi) in TCM that is associated with physiological andpsychological functionality. Qi is theconceptual foundation of TCM inacupuncture, herbal medicine, andChinese physical therapy. It is consid-ered to be a ubiquitous resource of nature that sustains human well-beingand assists in healing disease as well as(according to TCM theory) havingfundamental influence on all life andeven on the orderly function of celes-tial mechanics and the laws of physics.Qigong exercises consist of a series of orchestrated practices including body posture/movement, breath practice,and meditation, all designed to en-hance Qi function (that is, drawingupon natural forces to optimize andbalance energy within) through theattainment of deeply focused and re-laxed states. From the perspective of  Western thought and science, Qigongpractices activate naturally occurringphysiological and psychological mecha-nisms of self-repair and health recovery. Also considered part of the overalldomainofQigongis‘‘externalQigong,’’ wherein a trained medical Qigong ther-apist diagnoses patientsaccording to theprinciples of TCM and uses ‘‘emittedQi’’ to foster healing. Both internalQigong(personalpractice)andexternalQigong (clinician-emitted Qi) are seenas affecting the balance and flow of energy and enhancing functionality inthebodyandthemind.Forthepurposesofour review,wearefocusedonlyontheindividual, internal Qigong practice of exercises performed with the intent of cultivating enhanced function, inner Qithat is ample and unrestrained. This isthe aspect of Qigong that parallels what is typically investigated in Tai Chiresearch.There are thousands of forms of Qigong practice that have developedin different regions of China during various historic periods and that have e2 American Journal of Health Promotion Author PDF.May be distributed widely by e-mail.Posting on Web sites prohibited.  been created by many specific teachersand schools. Some of these forms weredesigned for general health-enhance-ment purposes and some for specificTCM diagnostic categories. Some weresrcinally developed as rituals forspiritual practice, and others to em-power greater skill in the martial arts. An overview of the research literaturepertaining to internal Qigong yieldsmore than a dozen forms that havebeen studied as they relate to healthoutcomes (e.g., Guo-lin, ChunDo-SunBup, Vitality or Bu Zheng Qigong,Eight Brocade, Medical Qigong). 2,27–29 The internal Qigong practices gen-erally tested in health research (andthat are addressed in this review)incorporate a range of simple move-ments (repeated and often flowing innature) or postures (standing or sit-ting) and include a focused state of relaxed awareness and a variety of breathing techniques that accompany the movements or postures. A key underlying philosophy of the practiceis that any form of Qigong has an effect on the cultivation of balance andharmony of Qi, positively influencingthe human energy complex (Qi chan-nels/pathways) that functions as a holistic, coherent, and mutually inter-active system. Tai Chi Tai Chi translates to mean ‘‘GrandUltimate,’’ and in the Chinese culture,it represents an expansive philosoph-ical and theoretical notion that describes the natural world (i.e., theuniverse) in the spontaneous state of dynamic balance between mutually interactive phenomena including thebalance of light and dark, movement and stillness, waves and particles. TaiChi, the exercise, is named after thisconcept and was srcinally developedboth as a martial art (Tai Chi Chuan ortaijiquan) and as a form of meditativemovement. The practice of Tai Chi asmeditative movement is expected toelicit functional balance internally forhealing, stress neutralization, longevi-ty, and personal tranquility. This formof Tai Chi is the focus of this review.For numerous complex sociologicaland political reasons, 2 Tai Chi hasbecome one of the best-known formsof exercise or practice for refining Qiand is purported to enhance physio-logical and psychological function.The one factor that appears to differ-entiate Tai Chi from Qigong is that traditional Tai Chi is typically per-formed as a highly choreographed,lengthy, and complex series of move-ments, whereas health-enhancement Qigong is typically a simpler, easy-to-learn, more repetitive practice. How-ever, even the longer forms of Tai Chiincorporate many movements that aresimilar to Qigong exercises. Usually,the more complex Tai Chi routinesinclude Qigong exercises as a warm-up,and emphasize the same basic princi-ples for practice, that is, the threeregulations of body focus, breath focus,and mind focus. Therefore Qigongand Tai Chi, in the health promotionand wellness context, are operationally equivalent. Tai Chi as Defined in theResearch Literature It is especially important to note that many of the RCTs investigating what isdescribed as Tai Chi (for healthenhancement) are actually not investi-gating the traditional, lengthy, com-plex practices that match the formaldefinition of traditional Tai Chi. TheTai Chi used in research on bothdisease prevention and used as a complement to medical intervention isoften a ‘‘modified’’ Tai Chi (e.g., TaiChi Easy, Tai Chi Chih, or ‘‘short forms’’ that greatly reduce the numberof movements to be learned). Themodifications generally simplify thepractice, making the movements morelike most health-oriented Qigong ex-ercises that are simple and repetitive,rather than a lengthy choreographedseries of Tai Chi movements that takemuch longer to learn (and, for many participants, reportedly delay the ex-perience of ‘‘settling’’ into the relaxa-tion response). A partial list of exam-ples of modified Tai Chi forms fromthe RCTs in the review is: balanceexercises inspired by Tai Chi, 30 Tai Chifor arthritis, five movements from SunTai Chi, 31 Tai Chi Six Form, 32  YangEight Form Easy, 33,34 and Yang FiveCore Movements. 34 In 2003, a panel of Qigong and TaiChi experts was convened by theUniversity of Illinois and the Blueprint for Physical Activity to explore this very point. 35 The expert panel agreed that it is appropriate to modify (simplify) TaiChi to more efficiently disseminate thebenefits to populations in need of cost-effective, safe, and gentle methods of physical activity and stress reduction.These simplified forms of Tai Chi are very similar to the forms of Qigongused in health research.For this reason, it is not only reasonable but also a critical contribu-tion to the emerging research dialogueto review the RCTs that explore thehealth benefits resulting from both of these practices together, as one com-prehensive evidence base for the med-itative movement practices srcinatingfrom China. METHODSData Sources The following databases were usedto conduct literature searches forpotentially relevant articles: Cumula-tive Index for Allied Health andNursing (CINAHL), psychological lit-erature (PsycINFO), PubMed, GoogleScholar, and the Cochrane database.The key words included Tai Chi, Taiji,Tai Chi Chuan, and Qigong, combined with RCT or with clinical researchterms. Additional hand searches(based on word-of-mouth recommen-dations) completed the search forarticles. Study Inclusion Criteria Criteria for inclusion of articlesrequired that they (1) were publishedin a peer-reviewed English-language journal between 1993 and December2007; (2) were cited in nursing, med-ical, or psychological literature; (3) were designed to test the effects of TaiChi or Qigong; and (4) used an RCTresearch design. The literature searchresulted in the identification of 576articles to be considered for inclusion.The full texts of 158 articles appearingto meet initial criteria 1 through 4 wereretrieved for further evaluation and to verify which ones were, in fact, RCTs,resulting in a final set of 77 articlesmeeting all of our inclusion criteria. Data Abstraction  Articles were read and results wereentered into a table according tocriteria established by the authors forcategorization and evaluation of thestudies and outcomes. Included in July/August 2010, Vol. 24, No. 6 e3 Author PDF.May be distributed widely by e-mail.Posting on Web sites prohibited.  Table 1 for review and discussion aretype and number of patients random-ized, duration and type of interventionand control condition, measured out-comes, and results. As the information was entered into the table, it becameapparent that some of the authorsreported results from the same study inmore than one article. Thus, the 77articles selected actually represented66 unique studies, with one study reporting a range of outcomes acrossfive articles, and five other studies’results published in two articles each. An additional two articles were not entered into the table 36,37 because thesame results were reported in newerarticles. Other than these two droppedarticles, multiple articles are enteredinto the table as representing onestudy (see Table 1) so that the fullrange of outcomes reported across thearticles can be reported without inflat-ing the number of studies. Synthesis Three authors independently re- viewed the articles selected for inclu-sion and considered categorizing stud-ies by type of patient or diseaseoutcome. Many of the studies drew participants from a general, healthy population (n  5 16), so a category schema based on patient type ordisease would not have included all of the studies. The authors revisited thelong list of health benefits and out-comes assessed across the studies andgenerated broad categories that com-bined related health outcomes intolarger groups. These initial categories were defined based on identifying themost frequently measured primary outcomes, and then refining thegroups to develop an investigationframework that accommodated all of the research outcomes into at least oneof the categories. These categories of outcomes related to Qigong and TaiChi practice were discussed and con-tinually reworked until we had clear,nonoverlapping boundaries for eachcategory based on similar symptoms orhealth indicators related to a commonfunction or common target organsystem. These groupings are not in-tended to be conclusive taxonomiesbut rather are used for this review asconvenient and meaningful tools forevaluating similar groups of outcomes.In this way, examining health out-comes across a variety of study designsand populations (including healthy,diseased, or at-risk patients) waspossible. RESULTSStudy Description  A total of 6410 participants wereincluded across these reported studies. Although some of the studies com-pared Qigong or Tai Chi to otherforms of exercise (n 5  13), many compared Qigong or Tai Chi to a nonexercise treatment control groupsuch as education or usual care (n  5 43) and some used both exercise andnonexercise comparison groups toevaluate effects of Qigong or Tai Chiinterventions (n 5  11). Many studiesincluded healthy adults (n 5  16studies), while other studies includedparticipants based on specific riskfactors or diagnosis of disease, includ-ing arthritis (n 5  5), heart disease (n 5  6), hypertension (n 5  5), osteopo-rosis risk (e.g., perimenopausal status;n 5 3), fall risk determined by age andsedentary lifestyle or poor physicalfunction and balance (n  5 18), breast cancer (n 5  1), depression (n  5 2),fibromyalgia (n  5  2), immune dys-function, including human immuno-deficiency virus/acquired immune de-ficiency syndrome and varicella history or vaccine response (n 5 3), musculardystrophy (n 5 1), Parkinson’s disease(n 5  1), neck pain (n 5  1), sleepcomplaints (n 5 1), chronic disease (n 5  1), and traumatic brain injury (n 5 1). Some of the studies (n  5 9)monitored adverse effects during theinterventions and none reported anadverse event.The studies srcinated from 13 coun-tries (USA, n 5 34; China [includingHong Kong], n 5 9; Korea, n 5 4; Australia and New Zealand, n 5 5;Sweden,n 5 4;GreatBritain,n 5 3;Italy and Taiwan, each n 5 2; Netherlands,Israel, Poland, and Spain, each n 5 1). Outcomes From all of the studies, 163 different physiological and psychological healthoutcomes were identified. Many of thestudies assessed outcomes across morethan one category (e.g., physical func-tion as well as a variety of psychosocialand fitness outcomes), so some studiesare discussed in more than one sectionin the review of categories that follows.The nine outcome category group-ings that emerged are bone density (n 5  4); cardiopulmonary effects (n 5 19); physical function (n  5 16); falls,balance, and related risk factors (n  5 23); quality of life (QOL; n 5 17); self-efficacy (n 5  8); patient-reportedoutcomes (PROs; n 5  13); psycholog-ical symptoms (n 5  27); and immune-and inflammation-related responses (n 5  6). Within each category of out-comes, there were both Qigong andTai Chi interventions represented. Bone Density Resistance training and other weight-bearing exercises are known toincrease bone formation 38 and havebeen recommended for postmeno-pausal women for that purpose. 39 Interestingly, most Qigong and Tai Chipractices involve no resistance and only minimal weight bearing (such as gentleknee bends), yet the four RCTs (totalsample size 5  427) included in thisreview reported positive effects onbone health. One study examined theeffect of Qigong 40 and three examinedTai Chi. 41–43 Bone loss was retardedand numbers of fractures were lessamong postmenopausal women prac-ticing Tai Chi compared to usualcare. 41 In another study, bone loss wasless pronounced for postmenopausalfemales practicing Tai Chi or resis-tance training compared to no-exercisecontrols, but this effect was not foundin the older men participating in thestudy. 43 Shen et al. 42 compared Tai Chito resistance training and reportedsignificant changes in biomarkers of bone health in both groups. Bonemineral density increased for womenfollowing Qigong exercises as com-pared to no-exercise controls. 40 Insummary, current research suggests a favorable effect on bone health forthose practicing Tai Chi or Qigong. Cardiopulmonary Nineteen studies (Qigong, n 5  7;Tai Chi; n  5 12) reported favorablecardiovascular and/or pulmonary out-comes. Participants in this grouping of studies were generally older adults(mean age  5  61.02) and inclusioncriteria varied from history of diseaseto reported sedentary behavior. Mea- e4 American Journal of Health Promotion Author PDF.May be distributed widely by e-mail.Posting on Web sites prohibited.

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Aug 16, 2019
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