Tai chi and arthritis
With slow movements as fluid as silk, the gentle Chinese practice of Tai Chi seems tailor-made for easing sore joints and muscles.

Every day, in community centers, parks, gyms and living rooms across America, people are practicing tai chi. As they move together through a series of slow and synchronized postures, it may look as though they are performing some kind of dance.

What they are actually doing is an ancient Chinese practice designed to exercise body, mind and spirit. As they move through tai chi postures, they are gently working muscles, focusing concentration, and, according to Chinese philosophy, improving the flow of "qi,"the vital life energy that sustains health and calms the mind. (Qi is pronounced "chee,"and is often spelled "chi.")

In China, where tai chi has been practiced for some 600 years, tai chi isn't just a feel-good workout: it's therapy, a preventive measure and a remedy for almost every ailment, including arthritis.

Along with other Chinese imports, such as acupuncture and herbs, tai chi is becoming popular in the West. It appeals to people of all ages because it's not intimidating. Seniors particularly like tai chi because the slow, synchronized movements are easy to learn and to perform.

Once scarce, classes can now be found through YMCAs, some churches, community centers, karate schools and even through some health maintenance organizations. Tai chi is taught at some summer camps for children with juvenile arthritis. In Australia, a tai chi program designed especially for people with arthritis is supported and taught by the Arthritis Foundation of Australia.

Doctors recommend tai chi for people with a variety of musculoskeletal conditions because it improves flexibility and builds muscle strength gradually.

"There's no doubt that tai chi, done properly, can be a beneficial exercise for people with arthritis,"says Paul Lam, MD, a Sydney-based family practitioner and tai chi master who designed the Australian arthritis program.

Martin Lee, a tai chi authority and author of many books who has directed classes for years, says he has seen many people's overall health improve as they do tai chi. "Tai chi relieves stress,"he says. "It can be very healing."

Tai chi is an exercise almost anyone who can walk can do safely, says Dr. Lam, who began doing tai chi nearly 30 years ago for his own osteoarthritis. Tai chi takes the joints gently through their range of motion, he says, while the emphasis on breathing and inner stillness relieves stress and anxiety. Classes are inexpensive, and it can be practiced almost anywhere at any time, with no special equipment or clothing.

Peter Stein, MD, a Greenbrae, Calif., rheumatologist, says he finds tai chi especially good for people with fibromyalgia and those with a high level of muscle pain. "People in pain often can't even do yoga,"he says. "They need something milder and more soothing, and tai chi is very good for relieving pain."

Philip Mease, MD, a Seattle rheumatologist, says people who say they don't like exercise enjoy and stick to tai chi. "When people enjoy it, they are more likely to continue to exercise alone, or in a group, which I think is more fun,"he says.

Meditation in Motion
Tai chi, with its focus on breathing and flowing gestures, is often described as "meditation in motion."It emerged sometime between the 1300s and 1600s in China. Some say it was developed by monks, others by a retired general. They agree its ancient roots are in the martial arts, but tai chi movements are never aggressive. They are based on shifting body weight through a series of light, controlled movements that flow rhythmically together into one long, graceful gesture. The sequences have poetic names, such as "waving hand in the cloud"or "pushing the mountain,"and can be quite beautiful to an observer.

Tai chi movements are intended to balance the flow of qi in mind as well as body. They use the whole body and are performed slowly, with concentration on breathing and inner stillness.

The concept of qi is at the heart of tai chi. In Chinese medicine, it's believed that disease is due to blocks or imbalances in the flow of qi. Chinese use acupuncture, herbs and tai chi in the belief they can help balance the flow of qi to cure illness and maintain health.

Most Western doctors question the concept of qi, since it hasn't been scientifically proven to exist or to aid health and healing. Nevertheless, some physicians who treat the elderly or those with musculoskeletal conditions such as arthritis have been impressed by how tai chi improves pain, range of motion and physical balance.

health benefits of tai chi or chi gong

What the Science Says
Several studies have shown that regular tai chi practice has benefits: It can reduce falls in the elderly or those with balance disorders — sometimes dramatically. In one 1996 Atlanta study, elderly people who practiced tai chi for 15 weeks reduced their risk of multiple falls by 47.5 percent. Falls are a particular danger for elders and others with brittle bones, or osteoporosis. For such people, falls frequently result in broken bones.

Research has shown tai chi has other benefits, too. Participants in the Atlanta study also had lower blood pressure at the end of the study; and a 1999 study that looked at people with multiple sclerosis who practiced tai chi found that it contributed to an overall improvement in quality of life for people with chronic, disabling conditions.

While there are no good, controlled studies that prove tai chi specifically benefits people with arthritis by reducing pain or inflammation, there is a study from 1991 that evaluates its safety for rheumatoid arthritis patients. It concluded that 10 weeks of tai chi classes did not make joint problems worse, and says the weight-bearing aspects of this exercise has the potential to stimulate bone growth and strengthen connective tissue.

And a recent University of Arizona opinion paper on mind-body alternatives, such as tai chi and meditation, for rheumatic diseases concluded that stress and pain are closely related, and therapies that focus on psychological as well as physical function could be beneficial, when used along with conventional medications.

But doctors don't need proof to approve an exercise as safe and soothing as tai chi — even for themselves. Dr. Lam, who is 52, developed osteoarthritis in his neck, back and hands when he was in his 20s, and began practicing and then teaching tai chi to keep his own arthritis under control.

"Given its low impact and evidence that it tends to increase muscle strength and balance and give general pain relief, we think it's a worthwhile option for arthritis patients,"says William L. Haskell, PhD, deputy director of the Stanford [University] Center for Research in Disease Prevention in California.

Stanford has offered tai chi classes for years, and is launching a major National Institute on Aging study to assess benefits of various types of exercise on healthy aging. A year-long study of tai chi for those 60 and older is part of the project. While this study won't look at arthritis specifically, the data is expected to provide evidence of tai chi's general benefits.

Suitable Styles
Tai chi classes are usually small, with fewer than 20 people of diverse ages. It's common to see people in their 80s alongside students in their 20s and every age in between.

There are five distinct styles of tai chi and many variations within each style. Most gentle and, therefore, suitable for people with arthritis, says Dr. Lam, are the Yang, Sun, Wu and Hao styles. Dr. Lam's program for arthritis is based on the Sun style, which is performed without deep knee bending. He says beginners should avoid the Chen style, a more brisk and active style not recommended for most people with arthritis.

You may encounter a tai chi class that teaches a variation on a style or one that combines several styles. The "right"version for you is one that you can do easily, without making hard or forceful movements and without stressing your joints or muscles.

Tai chi classes usually last about one hour, and may be held once or twice a week. They begin with a gentle warm-up and breathing exercises or a meditation to quiet the mind.

The teacher demonstrates individual poses and then leads the class through the sequences, step by step, gradually linking the movements together in longer sequences. The sequences can be done slowly, or with more speed and energy. But movements are always soft and graceful, with careful attention to breathing and posture.

Classes end with cooling down exercises and, sometimes, a short meditation. At the end of class, you should feel relaxed. If you have pain that lasts more than a few hours after class, talk to the instructor about how to change the movements to work within your limits.

Good Advice
Before you begin any exercise program, be sure to ask your doctor's advice about specific movements to avoid.

It's best to learn from a teacher who can make sure you are doing the movements correctly. You can learn from a reputable book DVD/video if no teacher is available.
Choose your teacher carefully. Make sure the instructor has experience teaching people with arthritis and can guide you to the safest movements.
Warm up before class and cool down afterward. Tai chi may not seem strenuous, but it does work joints and muscles.
Modify the movements if necessary. For example, many tai chi postures are done with bent knees. If you have knee involvement, you may need to adapt those movements to be safe and comfortable.
Be cautious when you have a flare or sore joint. Many experts say you can still exercise, but carefully. Check with your doctor if you aren't sure, and stop if it makes you hurt more or if you feel pain two hours after the class.
Never push or exert yourself. Most teachers believe the meditative effects of qi are as important as the physical exercise.
Practice daily. The practice can take as few as five minutes or can last as long as an hour per session.
Remember that while tai chi is a good adjunct exercise, it doesn't provide much in aerobic or weight-bearing benefits.

Mostly written by Judith Horstman a contributing editor to Arthritis Today.

health benefits of tai chi or chi gong

Altzimers disease
In the news recently it has been suggested that regular exercise may help reduce the onset of altzimers disease by as much a 20%

Tai Chi for Older People Reduces Falls, May Help Maintain Strength

EMBARGOED FOR RELEASE
Thursday, May 2, 1996

Public Information Office
(301) 496-1752

Tai Chi, a martial arts form that enhances balance and body awareness through slow, graceful, and precise body movements, can significantly cut the risk of falls among older people and may be beneficial in maintaining gains made by people age 70 and older who undergo other types of balance and strength training. The news comes in two reports appearing in the May 1996 issue of the Journal of the American Geriatrics Society.

The two studies are the first involving Tai Chi to be reported by scientists in a special frailty reduction program sponsored by the National Institute on Aging (NIA).

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. 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. These improvements, particularly in strength, were preserved over a 6-month period while participants did Tai Chi exercises.

The projects are among several in the NIA's Frailty and Injuries: Cooperative Studies of Intervention Techniques, or FICSIT, initiative, launched in 1990 to improve physical function in old age.

Research from these and other FICSIT trials has demonstrated the benefits of strength training for older people and the value and cost-effectiveness of targeted, fall prevention programs for the elderly. It is estimated that each year falls are responsible for costs of over $12 billion in the U.S., and the costs due to physical frailty are much higher.

The news on Tai Chi is a reminder that relatively "low tech" approaches should not be overlooked in the search for ways to prevent disability and maintain physical performance in late life. "The FICSIT studies have shown that a range of techniques, from the most sophisticated medical interventions to more 'low tech' methods, can help older people avoid frailty and falling," says Chhanda Dutta, Ph.D., Director of Musculoskeletal Research in the NIA's Geriatrics Program. "We must make sure that we look at every approach, especially relatively inexpensive ones like Tai Chi," says Dutta. "People can do this at home and with friends once they have had the proper training."

The Wolf study included 200 participants age 70 and older. The participants were divided into groups for Tai Chi, computerized balance training, and education. In addition to 15 weekly sessions in which they progressed to more complex forms of Tai Chi, the participants were asked to practice at home at least 15 minutes, twice daily. Another group received balance training using a computer-operated balance platform in which participants tried to improve control of their body sway under increasingly difficult conditions. The education group was asked to not change any of its current exercise regimens, and took part in weekly meetings on a variety of topics with a nurse gerontologist.

Wolf's group compared several factors before and after the interventions, and found improvements in certain key areas. The most notable change involved the reduction in the rate of falling for the Tai Chi group. The groups receiving computerized balance platform training did not have significantly lower rates of falling. The Tai Chi participants also took more deliberate steps and decreased their walking speed slightly compared to the other groups. Fear of falling also was reduced for the Tai Chi group. After the intervention, only 8 percent of the Tai Chi group said they feared falling, compared with 23 percent before they had the training.

"The Tai Chi group seemed to have more confidence," says Wolf, noting that "they had an increased sense of being able to do all that they would like to do." Wolf notes that almost half of the Tai Chi participants chose to continue meeting informally after the study was finished.

The Connecticut FICSIT site used sophisticated techniques for balance and strength training. Some 110 participants, averaging age 80, received training for 3 months. They were divided into four groups: one group received balance training in 45-minute sessions three times per week, including a computerized balance platform (of a different type than the one used in the Wolf study) as well as low-tech balance exercises; another took part in resistance training and weight lifting three times a week to improve strength; a third group did both balance and strength training, and a fourth "education" group participated in sessions on fall prevention and stress management. Everyone in the study took part in weekly Tai Chi classes for 6 months following the intensive training period.

The people in the study were evaluated before undergoing any training, immediately after the training, and after a 6-month follow-up Tai Chi program. The interventions of major focus in the study -- intensive balance and strength training -- produced marked effects. Participants had a 25 to 50 percent improvement in three different measures of balance after completing balance training, while strength training resulted in a 17 percent improvement in strength. Some of the gains immediately following the balance and strength training were lost after 6 months of the Tai Chi follow-up program. However, the participants tested significantly higher than they had before the interventions began.

Without a comparable group who did not receive Tai Chi training after exercise training, it is difficult to know for certain whether the Tai Chi contributed to maintaining gains in strength and balance. Wolfson noted that study participants might have done even better at the end of the maintenance phase had they continued the more intensive balance and strength training, but he also suggested that Tai Chi might be further studied as a less intensive way to hold onto the benefits of prior strength and balance training.

The NIA, part of the National Institutes of Health, leads the Federal effort conducting and supporting research on the aging process and the diseases and disabilities that accompany advancing age. The Institute's program focuses on biomedical, clinical, and social and behavioral research, and supports the Claude D. Pepper Older American Independence Centers at medical centers across the U.S., whose research is aimed at maintaining healthy function well into old age.

Note to broadcast media: Video b-roll is available upon request at 301-496-1752.

health benefits of tai chi or chi gong

Tai Chi Boosts Immunity to Shingles Virus in Older Adults, NIH-Sponsored Study Reports

FOR IMMEDIATE RELEASE
April 6, 2007

Media Contacts:
Susan Farrer or Linda Joy
301-496-1752
nianews3@mail.nih.gov

Tai Chi, a traditional Chinese form of exercise, may help older adults avoid getting shingles by increasing immunity to varicella-zoster virus (VZV) and boosting the immune response to varicella vaccine in older adults, according to a new study published in print this week in the Journal of the American Geriatrics Society. This National Institutes of Health (NIH)-funded study is the first rigorous clinical trial to suggest that a behavioral intervention, alone or in combination with a vaccine, can help protect older adults from VZV, which causes both chickenpox and shingles.

The research was supported by the National Institute on Aging (NIA) and the National Center for Complementary and Alternative Medicine (NCCAM), both components of NIH. The study’s print publication follows its online release in March. The research was conducted by Michael R. Irwin, M.D., and Richard Olmstead, Ph.D., of the University of California at Los Angeles, and Michael N. Oxman, M.D., of the University of California at San Diego and San Diego Veterans Affairs Healthcare System.

“One in five people who have had chickenpox will get shingles later in life, usually after age 50, and the risk increases as people get older,” says NIA Director Richard J. Hodes, M.D. “More research is needed, but this study suggests that the Tai Chi intervention tested, in combination with immunization, may enhance protection of older adults from this painful condition.”

“Dr. Irwin’s research team has demonstrated that a centuries-old behavioral intervention, Tai Chi, resulted in a level of immune response similar to that of a modern biological intervention, the varicella vaccine, and that Tai Chi boosted the positive effects of the vaccine,” says Andrew Monjan, Ph.D., chief of the NIA’s Neurobiology of Aging Branch.

The randomized, controlled clinical trial included 112 healthy adults ages 59 to 86 (average age of 70). Each person took part in a 16-week program of either Tai Chi or a health education program that provided 120 minutes of instruction weekly. Tai Chi combines aerobic activity, relaxation and meditation, which the researchers note have been reported to boost immune responses. The health education intervention involved classes about a variety of health-related topics.

After the 16-week Tai Chi and health education programs, with periodic blood tests to determine levels of VZV immunity, people in both groups received a single injection of VARIVAX, the chickenpox vaccine that was approved for use in the United States in 1995. Nine weeks later, the investigators did blood tests to assess each participant’s level of VZV immunity, comparing it to immunity at the start of the study. All of the participants had had chickenpox earlier in life and so were already immune to that disease.

Tai Chi alone was found to increase participants’ immunity to varicella as much as the vaccine typically produces in 30- to 40-year-old adults, and Tai Chi combined with the vaccine produced a significantly higher level of immunity, about a 40 percent increase, over that produced by the vaccine alone. The study further showed that the Tai Chi group’s rate of increase in immunity over the course of the 25-week study was double that of the health education (control) group. The Tai Chi and health education groups’ VZV immunity had been similar when the study began.

In addition, the Tai Chi group reported significant improvements in physical functioning, bodily pain, vitality and mental health. Both groups showed significant declines in the severity of depressive symptoms.

“This study builds upon preliminary research funded by NCCAM and we are delighted to see this rigorous trial of Tai Chi for varicella zoster immunity come to fruition,” said Ruth L. Kirschstein, M.D., NCCAM Acting Director.

Shingles, or herpes zoster, affects the nerves, resulting in pain and blisters in adults. Following a case of chickenpox, a person’s nerve cells can harbor the varicella-zoster virus. Years later, the virus can reactivate and lead to shingles. More information about shingles is available from the NIA at http://www.niapublications.org/agepages/shingles.asp and from www.NIHSeniorHealth.gov, a Web site for older adults developed by the NIA and the National Library of Medicine, also a part of NIH. More information on Tai Chi can be found on NCCAM’s website at http://nccam.nih.gov/health/taichi/.

The NIA leads the federal effort supporting and conducting research on aging and the medical, social and behavioral issues of older people. For more information on research and aging, go to www.nia.nih.gov. Publications on research and on a variety of topics of interest on health and aging can be viewed and ordered by visiting the NIA website or can be ordered by calling toll-free 1-800-222-2225.

The NCCAM’s mission is to explore complementary and alternative medical (CAM) practices in the context of rigorous science, train CAM researchers, and disseminate authoritative information to the public and professionals. For additional information, call NCCAM’s Clearinghouse toll-free at 1-888-644-6226, or visit www.nccam.nih.gov .

NIH--the nation's medical research agency--includes 27 institutes and centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov .

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Reference: Irwin, M.R., et al. Augmenting immune responses to varicella zoster virus in older adults: A randomized, controlled trial of Tai Chi. Journal of the American Geriatrics Society (2007), 55(4):511-517.

To reach Dr. Michael Irwin, University of California at Los Angeles, contact Mark Wheeler at 310-794-2265 or mwheeler@mednet.ucla.edu.

The text here is extracted from a report created from a collaboration by: Tricia Yu, T'ai Chi enter Madison, Wisconsin USA; Jill Johnson, PT Physical Therapy, Thomas M. Krapu, h.D. Licensed Psychologist T'ai Chi Ch'uan Instructor Saint Louis, Missouri USA
Summary: Current research indicates that T'ai Chi Ch'uan is a weight bearing and moderate intensity cardiovascular exercise. Practice of T'ai-Chi Ch'uan can improve balance, reduce falls and increase leg strength. It also lowers stress hormones, enhances respiratory and immune function and promotes emotional well-being.
Tai Chi Improves Lung Function In Older People By Jacqueline Stenson c.1995 Medical Tribune News Service:
Practicing a Chinese martial art may help some elderly people stave off age-related breathing problems, a new report shows. In a study of 84 people whose average age was 64, those who practiced tai chi regularly over two years had less of a decline in lung function than those who were more sedentary. Tests given before and after the study showed that the sedentary men and women experienced more than twice the decline in the amount of oxygen they could take into their lungs, compared to those who practiced tai chi. The tai chi group also had greater spinal flexibility and less body fat than their sedentary counterparts, according to the study, published in the November issue of the Journal of the American Geriatrics Society.
As people age, they experience a natural decline in their lung capacity. While many experts believe endurance training can slow this decline, many exercises are considered too taxing for older people, the researchers said, because these people often suffer other types of disability that preclude strenuous exercise. Tai chi, also known as shadow boxing, is an ancient discipline that uses graceful movements, deep breathing and mental concentration to achieve mind-body harmony, according to the researchers, led by Dr. Jin-Shin Lai of the department of physical medicine and rehabilitation at the National Taiwan University Hospital in Taipei.
The deep-breathing component of tai chi may explain why those who practiced the activity maintained better lung function than those who did not, according to David Anderson, a registered nurse and certified tai chi instructor in Indianapolis. "Tai chi emphasizes deep abdominal breathing, which uses more of your lungs than usual chest breathing," Anderson said. Tai chi also increases a person's heart rate, and therefore helps improve overall heart and lung health, he said. Because tai chi is a low-impact activity, it is a good exercise for older people who may have joint degeneration and other physical problems, the Indiana expert said. "It's not outwardly strenuous like aerobics is," Anderson said. "And it's cheap - you don't need $100 shoes. You only need 10 square feet of empty floor space."
The Arthritis Foundation recommends tai chi for people with arthritis, many of whom cannot tolerate the jarring effects of other types of exercise. The range-of-motion exercises involved in tai chi benefit arthritis sufferers by helping them keep their joints flexible and reduce stiffness, according to the arthritis group. In the study, people in the tai chi group practiced the discipline about five times a week. These people had been doing tai chi an average of seven years prior to the study. Each exercise session consisted of 20 minutes of warm-up (including stretching exercises, calisthenics and balance training), 24 minutes of tai chi training and 10 minutes of cool-down.

Brown DD, Mucci WG, Hetzler RK, Knowlton RG. Cardiovascular and ventilatory responses during formalized T'ai Chi Chuan exercise. Research Quarterly for Exercise & Sport. 1989;60:246-250.
T'ai Chi chuan (TCC) is a widely practiced Chinese martial art said to physically develop balance and coordination as well as enhance emotional and mental health. TCC consists of a series of postures combined into a sequential movement providing a smooth, continuous, low-intensity a ctivity. The purpose of this study was to examine the ventilatory and cardiovascular responses to the Long Form of Yang's style TCC. In addition, the subjects' TCC responses were compared to their ventilatory and cardiovascular responses during cycle ergometry at an oxygen consumption (VO2) equivalent to the mean TCC V02.
Six experienced (M = 8.3 yrs) male TCC practitioners served as subjects with data collected during the Cloud H and movement of the TCC exercis-e. Significantly (p less than .05) lower responses for ventilatory frequency (Vf) (11.3 and 15.7 breaths.min-1), ventilatory equivalent (VE/VO2) (23.47 and 27.41), and the ratio of dead space ventilation to tidal volume (VD/VT) (20 and 270c) were found in TCC in comparison to cycle ergometry. The percentage of minute ventilation used for alveolar ventilation was significantly higher during TCC (p less than .03) than cycle ergometry, with mean values of 81.lt and 73.lt respectively. Cardiac output, stroke volume, and heart rate were not significantly different between TCC exercise and cycle ergometry at the same oxygen consumption. We concluded -that, during TCC, expert practitioners show significantly different ventilatory-responses leading to more efficient use of the ventilatory'volume than would be expected from comparable levels of exertion on a cycle ergometer.

Jin P. Changes in heart rate, noradrenaline, cortisol and mood during T'ai Chi. Journal of Psychosomatic Research. 1989;33:197-206.
Changes in psychological and physiological functioning following participation in Tai Chi were assessed for 33 beginners and 33 practitioners. The variables in the three-way factorial design were experience (beginners vs practitioners) , time (morning vs afternoon vs evening), and phase (before Tai Chi vs during Tai Chi vs after Tai Chi) . Phase was a repeated measures variable. Relative to measures taken beforehand, practice of Tai Chi raised heart rate, increased noradrenaline-excretion in urine, and decreased salivary cortisol concentration. Relative to baseline levels, subjects reported less tensioh, depression, anger, fatigue, confusion and state-anxiety, they felt more vigorous, and in -general they had less total mood disturbance.
The data suggest that Tai Chi results in gains that are comparable to those found with moderate exercise. There is need for research concerned with whether participation in Tai Chi has effects over and above those associated with physical exercise.

Lai JS, Wong N4K, Lan C, Chong CK, Lien IN. Cardiorespiratory responses of t'ai chi Ch'uan practitioners and sedentary subjects during cycle ergometry. J Formosan Med Assoc. 1993;92:894-899.
Tai Chi Chuan (TCC; shadow boxing) is a traditional Chinese conditioning exercise. To evaluate its beneficial effect on cardiorespiratory function, 21 male and 20 female TCC practitioners, ranging in age from 50 to 64 years, voluntarily participated in this study. The control group comprised 23 male and 26 female sedentary subjects. Breath-by-breath measurement of the cardiorespiratory function was obtained during the incremental exercise of leg cycling.
Lai JS, Wong N4K, Lan C, Chong CK, Lien IN. Cardiorespiratory responses of t'ai chi Ch'uan practitioners and sedentary subjects during cycle ergometry. J Formosan Med Assoc. 1993;92:894-899.
Tai Chi Chuan (TCC; shadow boxing) is a traditional Chinese conditioning exercise. To evaluate its beneficial effect on cardiorespiratory function, 21 male and 20 female TCC practitioners, ranging in age from 50 to 64 years, voluntarily participated in this study. The control group comprised 23 male and 26 female sedentary subjects. Breath-by-breath measurement of the cardiorespiratory function was obtained during the incremental exercise of leg cycling.
Lai JS, Wong N4K, Lan C, Chong CK, Lien IN. Cardiorespiratory responses of t'ai chi Ch'uan practitioners and sedentary subjects during cycle ergometry. J Formosan Med Assoc. 1993;92:894-899.
Tai Chi Chuan (TCC; shadow boxing) is a traditional Chinese conditioning exercise. To evaluate its beneficial effect on cardiorespiratory function, 21 male and 20 female TCC practitioners, ranging in age from 50 to 64 years, voluntarily participated in this study. The control group comprised 23 male and 26 female sedentary subjects. Breath-by-breath measurement of the cardiorespiratory function was obtained during the incremental exercise of leg cycling.

TAI CHI FOR ATTENTION DEFICIT HYPERACTIVITY DISORDER
Attention Deficit Hyperactivity Disorder Benefits from Tai Chi
~
Maria Hernandez-Reif, Tiffany M. Field and Eric Thimas
Touch Research Institute University of Miami School of Medicine
Acknowledgements
The authors thank the children and teachers who participated in this study. This research was supported by an NIMH Research Scientist Award (#MHO0331) and an NIMH Research Grant (#MH46586) to Tiffany Field, and a grant from Johnson and Johnson to the Touch Research Institute. Correspondence and requests for reprints should be sent to Dr. Tiffany Field, Touch Research Institute, University of Miami School of Medicine, P.O. Box 016820, Miami, FL 33101
Abstract
Thirteen adolescents with ADHD participated in Tai Chi classes twice a week for 5 weeks. Teachers rated the adolescents' behaviors on the Conners Scale during the baseline period, after the 5 week Tai Chi period and two weeks later. After the 10 Tai Chi sessions the adolescents displayed less anxiety, daydreaming behaviors, inappropriate emotions and hyperactivity an,d improved conduct. These changes persisted over the two-week follow up (no Tai Chi) period.
.
Attention Deficit Hyperactivity D'isorder Benefits from Tai Chi
Attention Deficit Hyperactivity Disorder (ADHD) is characterized by cognitive and behavioral deficits including inattention, impulsivity and hyperactivity levels inappropriate for age and gender (DSM-III-R, American Psychiatric Association, 1987). Although short-term improvements have been reported in academic and social functioning ~lit.h drug therapy such as methylphenidate or Ritalin (Schachar & Tannock, 1993; Swanson et aI, 1995), side-effects such as motor tics, insomnia, headaches, and social withdrawal make this treatment controversial (Handen, Feldrnanm Gosling, Breaux et al., 1991; Parraga & Cochran, 1992).
Non-pharmacological treatments include counseling, parent/family training in behavior modification techniques, relaxation and massage therapy. Counseling treatments have received little empirical attention and reports are mostly anecdotal (Schwiebert, Sealander & Tollerud, 1995). Behavior modification techniques have attempted to facilitate the child's performance and attention by including scheduling changes, rearranging home and classroom settings, and training teachers, parents and siblings in differential reinforcement techniques (Blakemore, Shindler & Conte, 1993). Although some studies have shown that behavioral modification is effective (Damico & Armstrong, 1996), one study showed that ADHD adolescents had a weak behavioral inhibition system (Iaboni, Douglas & Blaine, 1997), which made them poor candidates for behavioral programs. Although relaxation therapy has alleviated depression in adolescents (Platania-Solazzo, et al, 1992), it has had limited effects in treating ADHD (Field, Quintino & Hernandez-Reif, 1997) perhaps because of the demands relaxation therapy places on concentration. Massage therapy, in contrast, has been effective in i~creasing time spent on task, reducing fidgeting, improving mood and lowering hyperactivity scores in adolescents with ADHD (Field, Quintino & Hernandez-Reif, 1997).
Tai Chi has been effective with adults by reducing stress and stress hormones (Jin, 1992), anger and confusion, and improving, mood (Brown, Wang, Ward, Ebbeling, Fortlage, Puleo, Benson & Rippe,
1995; Wolf, Barhhart, Kutner, McNeely, Coogler & Xue, 1996). In addition, Tai Chi results in lower blood pressure (Channer, Barrow, Barrow, Osborne & Ives, 1996) and improved balance (Wolfson, Whipple, Derby, Judge, King, Amerman, Schmidt & Smyers, 1996). The present study examined the effects of Tai Chi on anxiety, mood, hyperactivity and conduct in adolescents with ADHD.
Method Participants
Thirteen adolescents (11 males), with a mean age of 14.5 years, (R = 13-16) and a DSM-IIIR diagnosis of ADHD were recruited from a remedial school for adolescents with developmental problems. The adolescents carne from middle class f~ilies (~= 2.2 on Hollingshead Two Index Factor) and were ethnically distributed 70% Caucasian, 15% Hispanic and 15% African American.
Procedure
Tai Chi. The adolescents engaged in Tai Chi postures for 30- minute sessions twice a week for 5 weeks. Each mid-afternoon session began with slow raising and lowering of the arms in synchrony with breathing exercises for 5 minutes. The adolescents were then taught to perform slow turning and twisting movements of the arms and legs, shifting body weight from one leg to the other, rotating from side to side and changing directions in a sequence of Tai Chi forms.
An A1B1A2 design was used consisting of a baseline phase (without Tai Chi) (A1) , as-week Tai Chi phase (B1), and a two week follow up phase without Tai Chi (A2). At the end of each phase, the teachers, who were not aware of which adolescents were receiving Tai Chi at what time completed the Conners Teacher Rating Scale.
Conners Teacher Rating Scale - Revised (CTRS-R; Goyette, Conners & Ulrich, 1978). This 28 item teacher rating scale yields a total hyperactivity score in addition to the subcategories of anxiety, asocial behavior, conduct, daydreaming, emotion and hyperactivity. Test-retest reliability coefficients of .97 have been reported over a one-week period for this scale (Goyette, Conners & Ulrich, 1978).
Results Repeated measures analyses of variance were performed on the subcategories and total hyperactivity score of the Conners. As can be seen in Table 1, repeated measures effects were obtained for all but the asocial scale.
Insert Table 1 about here
Bonferroni t-tests suggested the following baseline to Tai Chi therapy changes: 1) less anxiety, 2) improved conduct, 3} less daydreaming, 4} less inappropriate emotions, and 5} less hyperactivity during Tai Chi versus before Tai Chi (see Table I). Bonferroni t-tests also revealed that these improved scores persisted over the two-week follow-up (no Tai Chi) period.
DISCUSSION
The results of this study and our earlier massage therapy study (Field, Quintino & Hernandez-Reif, 1997) suggest that at least two non-drug therapies are effective for adolescents with ADHD. The positive effects of Tai Chi on the adolescents with ADHD parallel the positive effects for adults including reduced mental and emotional stress (Jin, 1992) and improved mood (Jin, 1989).
Although stress hormone levels were not assayed in this study, the adolescents were perceived by their teachers as being less anxious, emotional and hyperactive following Tai Chi. The adult literature has reported reduced stress hormones (cortisol) with Tai Chi (Jin, 1992) .
Tai Chi research on adults has identified changes in cardiovascular, respiratory, electroencephalographic, and biochemical levels (e.g., lower cortisol stress hormone levels) (Brown, Mucci, Hetzler, & Knowlton, 1989; Jin, 1989). Reduced sympathetic activity, or enhanced parasympathetic activity, has been considered a potential underlying mechanism (Hsu, Wang & Kappagoda, 1985). This mechanism might also account for the marked behavioral changes observed in the adolescents in this study and our earlier ADHD massage study (Field, Quintino & Hernandez-Reif, 1997). The lower stress hormones (cortisol) observed following at least the massage ~herapy in our other studies (Field, et al, in press, Field; Seligman, Scafidi & Schanberg, 1996; Ironson, et al, 1996) is consistent with a mechanism of enhanced parasympathetic activity.
Future studies might compare Tai Chi and massage therapy effects on the reduction of stress hormones (e.g., salivary cortisol or urinary catecholamines) in ADHD adolescents. The comorbidity of ADHD with other psychiatric disorders, such as depression and anxiety, and the potential side effects of a multidrug therapy makes Tai Chi and massage therapy attractive alternative treatments. In addition to little or no side effects, especially appealing are the documented effects of Tai Chi and massage therapy on reducing anxiety and hyperactivity, the major and most difficult symptoms in ADHD children.
References
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Table 1. Means (and standard deviatio . arentheses) on Conners Teacher Ratin Scale
for baseline, Tai Chi and two-week foll~w-up period.
Baseline Tai Chi No Tai Chi
Variables First Day Last Day 2-weeks later F= p-value- CONNERS
-Anxiety 56.7(11.3). 43.5( 9.6)1)3 44.5( 6.3)1)3 11.94 .000 -Asocial 52.3(15.2)a 46.5( 9.7)a 48.7(10.9)a 1.42 .262 -Conduct 56.2( 8.0)& 49.0(11.8)b1 50.5(11.9)b1 5.18 .013 -Daydream 61.0( 6.4)& 48.4(11.6)b3 50.5( 7.0)b3 13.75 .000
;.
-Emotion 60.4( 8.9)a 50.2(13.5)b2 52.0(12.3)b2 9.04 .001 -Hyperactive 60.1( 7.9)& 45.8(1~.1)b4 51.7( 8.2)1)4 23.25 .000
- Total 81.5(11.6)a 58.6(17.8)b4 66.2(13.9)b4 19.49 .000
Hyperactivity means. Superscript indicates level of significant difference between first and last days
-and between first day and 2-weeks later based on Bonferroni t-test (1 p = .05, 2p = .01, 3p = .005, 4p = .001).

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