RMTC Teach Tai Chi Foundations Resource Manual

Home , Pressure point, Shifu, Silk reeling

RMTC Teach Tai Chi Foundations

Resource Manual

Author: Jenny Harrison

0418 566 216

Teach Tai Chi Foundations

Table of Contents Welcome to Tai Chi ...... 5 Student Support and Application of Skills and Knowledge ...... 6 Continuing Education Credits (CECs) ...... 7 Code of Ethical Practice ...... 8 Grievance and Appeals Procedure ...... 8 History of Tai Chi ...... 9 Tai Chi Defined ...... 10 Qigong Defined ...... 11 Standing Meditation ...... 12 Benefits ...... 13 Terminology and Concepts ...... 14 ‘Qi’ (or ‘chi’) ...... 14 Yin and Yang ...... 15 Breathing ...... 15 The Dantians ...... 16 Pressure Points ...... 16 The Kua ...... 17 Correct Tai Chi Posture ...... 18 The Six Harmonies ...... 19 Stand Like a Tree (Zhan Zhuang) ...... 20 Tai Chi Stances ...... 21 Wuji stance ...... 21 Bow stance ...... 21 Horseback riding stance ...... 21 Empty Cat Stance ...... 21 Silk Reeling ...... 22 Being Professional ...... 24 Scope and Practice for Registered Fitness Professionals ...... 24 Medical Waivers ...... 24 Orientation and Health Screening ...... 25 The Venue ...... 25 Environmentally Sustainable Work Practices ...... 25 The Exercises ...... 26 A Fitter, Healthier Australia ...... 27 3

Teaching Effectively ...... 29 The 4 Stages of Learning ...... 29 Styles of Learning ...... 30 Personality Types ...... 30 Engaging Each Student ...... 31 Self-Evaluation ...... 32 Class Basics ...... 33 The Salute ...... 33 Music ...... 33 Cueing ...... 34 Teaching Image ...... 34 Postural Functions of Tai Chi ...... 36 For Your Library ...... 37 Other Resources ...... 38 National Institutes of Health – US Department of Health and Human Services – ‘Tai Chi Boosts Immunity to Shingle Virus in Older Adults’ ...... 39 BBC News: Tai Chi ‘Helps Improve Diabetes ...... 41 The World’s Largest Fall Prevention Study 2007 ...... 42 Harvard Medical School Studies, May, 2009 ...... 43 Tai Chi for Medical Condtions ...... 43 The Effect of Tai Chi on Arthritis ...... 44 Summary of Research On T'ai Chi Ch'uan ...... 46 Tai Chi for Health Institute and Tai Chi Association of Australia Submission to the Department of Health, 2013 ...... 48 References ...... 55 About the Author ...... 56

Welcome to Tai Chi The world of tai chi and qigong is truly an amazing one. It is layer upon layer of learning, understanding, practice, paitence and commitment.

This course focusses on the foundations of tai chi, giving you a good grounding in understanding the principles and benefits of this beautiful form of exercise.

This Foundation course will introduce you to tai chi and qigong principles and theory. You will learn a number of qigong exercises and tai chi postures and will explore different methods of teaching these to a small group of beginner tai chi students.

An effective tai chi shifu (teacher, or ‘skillful person’), can change people’s lives, through inspiring, educating and opening a student’s mind to the holistic benefits of tai chi. The shifu gradually builds upon knowledge and skill level, developing an extensive background in practical tai chi training, a knowledge of its history, its benefits, its forms and its techniques. Practising and instructing tai chi is a lifetime of study which encourages a teaching pedagogy of enquiry, reflection and connectedness that builds gradually, layer upon layer. It is a continuous and enjoyable pursuit of cultivating energy, stillness and balance.

The Foundation course is more heavily weighted towards learning the principles of tai chi movement, rather than teaching skills. However, teaching methods such as mirror image, cueing and managing individuals within a group are an intrinsic part of any group exercise programme and as such, are included in this course.

This course is designed to be the beginning of your journey into teaching tai chi and it is hoped that at its conclusion you will continue this journey through practising, extensive reading and thorough research so you are well equipped to teach tai chi and hopefully progress to the Teach Tai Chi Level 1 course.

Student Support and Application of Skills and Knowledge The RMTC Teach Tai Chi Foundations course prides itself on the level of support it can offer its students. YouTube links of relevant tai chi forms and qigong exercises are available and students are encouraged to email the facilitator with questions, which will be promptly answered. Videos which are available specifically for students of this Foundation course are: • Standing Meditation • Qigong: Rooster Crowing in the Morning • Qigong: Wise Owl Turns its Head • Qigong: Warrior Punch • Qigong: Separating Heaven and Earth • Zhan Zhuang (Stand Like a Tree) • Silk Reeling • Tai Chi Stepping

Students are encouraged to video themselves during their practice and seek appraisal from the facilitator. The Rising Moon Tai Chi website is an excellent source of information, with newsletters, general information readily available. Students are encouraged to form a network with other students so they feel supported by their peers throughout the duration of the course, as well as after its completion. Students are also encouraged to attend tai chi classes at their local community or fitness centre. Shadowing an instructor and offering to assist with classes is an excellent way to hone teaching and tai chi skills. Please feel free to contact the course facilitator on 0418 566 216, or email [email protected], if you have any questions or concerns during the course.

Continuing Education Credits (CECs) The RMTC Tai Chi Foudation course offers Continuing Education Credits (CECs) towards re-registration. To obtain ‘competency’, attendees will be assessed in three different ways: Observation, Demonstration and Written Assessment. During the course, the facilitator will observe each participant during the practical sessions and identify areas on which to improve. Participants will demonstrate competencies related to basic knowledge of silk reeling, Zhan Zhuang and qigong exercises. The ability to modify and adapt exercisees to suit all levels of abilities will also be assessed. Assessment will also take the form of a short Written Assessment. Completed off site, the completed assessment will be emailed before the final face to face session: [email protected]. Certificates will not be distributed until all types of assessments have been completed successfully. Students deemed ‘NYC’ can reapply for assessment after a period of 2 weeks from the initial assessment. During this time, it is expected the student will practice and develop skills the RMTC facilitator has identified as in need of consolidating. Support from RMTC will continue during this time. Reassessment will incur a fee of $80 and is to be completed within 2 months of first assessment. Other costs such as venue hire will be met by the student.

Certificates will be distributed on the successful completion of the Assessment criteria. If a replacement Certificate is requested, a $20 fee applies, paid at the time of request.

Code of Ethical Practice RMTC Facilitators of Tai Chi Foundation course will provide: • qualified and experienced facilitator for the duration of the course • a safe physical and emotional environment in which to train • a respectful and accepting environment where participants feel free to pose questions and ask for assistance • a fully transparent learning environment • an environment based on equality and fairness at all times Before undertaking this Tai Chi course, the relevant enrolment form must be signed and dated, disclosing any medical conditions.

Grievance and Appeals Procedure The team RMTC pride themselves on delivering quality courses specifically designed for those embarking on teaching Tai Chi. If you feel dissatisfied with the service, content or delivery of this course, please email your complaint to the lead trainer of the workshop: [email protected] The following information should be provided: • your name, contact details and date of correspondence • the date and time of the incident • parties involved and what transpired • how you were affected

All complaints should be submitted within 7 days of the completion of the course. You will be contacted within 7 working days to discuss the concerns raised and actions to take to resolve the issue. All complaints are dealt with in the strictest confidence and with the utmost respect to all parties concerned.

History of Tai Chi The earliest known references to tai chi date from the T’ang Dynasty (618-960 AD), where tai chi patterns were practiced by recluses who had retired to the Chinese mountain regions. As with many events in history, facts and myth are intermingled and it is difficult to be specific with dates. However, historical records state that Zhang Sanfeng (1279-1368) studied under a Taoist recluse living in northwest China. Taoists believe there is a natural balance in all things, and we should live in spiritual and physical harmony with nature. In order to attain a happy existence in harmony with the Tao, it advocates a life of simplicity and naturalness and of non-interference with the course of natural events. The Tao is the natural underlying order of the universe and is intrinsically related to the concepts of yin and yang. Taoism means ‘truth’ and ‘natural movement of nature’. Zhang Sanfeng followed the tai chi process which leads the student from body to mind to spirit and eventually back to the ‘Great Void’ to merge with the cosmos. He studied in the Wudang Shan, a mountain held sacred by Taoists. Zhang Sanfeng spent nine years studying nature and discovered the martial potential of yielding (rather than continuous attacking) while watching a snake and bird fight. This encounter is often shown in artistic forms as the ‘Crane and the Snake’. This realisation began the cultivation of energy through qigong, or ‘soft’ fighting1. It is not until 17th century that details become more accurate, with 5 different schools (or families) teaching their own style of ‘tai chi’ – Chen, Yang, Wu (Hao), Wu and Sun. The Chen school was well established by 1800s, but only members of the Chen family could be students. However, a poor worker in the household spied on these sessions and became an excellent fighter – so much so, that he was welcomed into the Chen family. His name was Yang and he went on to develop his own style of tai chi. Chen style is known for its dynamic and physically challenging style. Yang’s style was developed to suit the limitations of the Emperor’s courtiers who had no martial arts training. Therefore, Yang style is more gentle and flowing. Wu, a student of Yang, also developed his own style, incorporating features of both Chen and Yang. T'ai chi ch'uan, literally means Supreme Ultimate Fist, and was originally taught as a martial art and longevity exercise. The principles of tai chi are based on Taoism, the ancient Chinese philosophy. It is believed that there is a natural balance in all things and we should live in spiritual and physical harmony with nature. In the early 20th century the health benefits of tai chi became well known and it took on a new role as a preventative medicine or wellness exercise. In 1956 the Chinese government sponsored the Chinese Sports Committee, which commissioned several tai chi masters to create a short form, to keep their citizens healthy. This form is known as Beijing 24, or 24 Form Yang style and is much simpler to learn and practice than the 108 Long Form, on which it is based. 9

In the 21st century, there are many different short forms, styles and hybrid styles of tai chi, all of them beneficial to the physical, mental and spiritual well being of practitioners.

Tai Chi Defined Tai chi is an ‘internal’ martial art, practised for defence training and health benefits. Tai Chi Chuan, the full title, literally means Supreme Ultimate Fist (or boxing) and is often shortened to ‘tai chi’. Tai Chi Chuan is a pathway to awareness and harmony of body, mind and spirit. Phsycaill, the slow movements encourage relaxation, accuracy of position, balance, evenness of motion and correct breathing. Based on martical arts, it develops muscle strength and intent,. It cultivates fullness of movement, opening the energy pathways so that internal energy or 'chi' can better circulate. Not only is tai chi physically benefitial, it helps to culitvate mindfulness and relaxed and calm concentration. For the spirit, it is a system of meditation. Although there are many different styles of tai chi, the fundamental theory is much the same within each style, but approaches to training differ considerably. In the 21st Century, there are many new styles and hybrid styles, and the five family schools are now known as the ‘orthodox’ styles. The course material in this manual focusses on Yang style tai chi. There are many different tai chi forms, some of which are below:

• 5 Form • 10 Form • Beijing 24 • 42 Form • Long Form (108) • Sword Form • Fan

Qigong Defined Also known as ‘qi gong’, ‘chi kung’, ‘chi gung’, qigong and tai chi are both health giving exercises and although there are some similarities, it is important to know the differences. Qigong involves coordinated movement, breath, and awareness used for health, meditation, and martial arts training. Qigong plays an important role in training for tai chi chuan, but also, many tai chi chuan postures are part of qigong exercises. The focus of qigong is on health or meditation, not self defence. Internally the main difference is the flow of qi, which, in qigong is held at a gate point for a moment to aid the opening and cleansing of the channels. In tai chi the flow of qi is continuous, which allows the development of power. When practising tai chi chuan, joints are never locked, whereas some qigong exercises require straightened joints. Posture, movement, breathing, visualization, meditation and focus are central to both. However, Tai Chi has martial applications, while qigong does not. Qigong is largely a solo practice, whereas tai chi has some interaction with others. Qigong means ‘energy work’ and focusses on cultivating qi, (life energy), to promote well-being and vitality2. Qigong are separate, individual exercises, whereas tai chi is a linking of different postures. Qigong exercises do not ‘travel’ and tend to be more stationary, focussing on internally building and moving energy. Qigong is suitable for those just beginning their tai chi journey as the exercises are less complex, with the focus on breath and relaxation. There are many, many different qigong exercises, below are just six simple ones, suitable for the beginners through to advanced practioners. Inhale and exhale deeply, relaxing and drawing the mind toward the qi.

• Rooster Crowing in the Morning • Wise Owl Turns Its Head • Warrior Punch • Separating Heaven and Earth • Zhan Zhuang • Silk Reeling

View the Qigong videos on the RMTC YouTube channel

In Summary Posture, movement, breathing, visualization, meditation and focus are central to both Qigong and Tai Chi. However, Tai Chi has martial application, but qigong does not. Qigong is largely a solo practice, whereas Tai Chi has some interaction with others. Qigong means ‘energy work’ and focuses on cultivating Qi, life energy, to promote well-being and vitality. Qigong are separate, individual exercises, whereas Tai Chi is a linking of different postures. Qigong exercises do not ‘travel’ and tend to be more static, focusing on internally building and moving energy. In Tai Chi, the flow of qi is continuous, which allows the development of power. When practicing Tai Chi, joints are never locked, whereas some qigong exercises required straightened joints. Tai chi takes many years to master, whereas Qigong can be learned relatively quickly.

Standing Meditation Standing meditation is the simplest form of qigong and is very beneficial for the beginner practitioner. The order and number of repetitions of exercises does not matter, which relieves the stress of trying to remember what comes next. Emphasis is on relaxation, whole body movement in a fluid, balanced and coordinated manner. The breathing is relaxed, and all tension is released from the muscles and tendons. The flowing, constant movement allows mind, body and spirit to experience a sense of calm and peacefulness. Standing meditation is an excellent way to begin a class, or it can be used to settle energy at the end of a session.

View the Standing Meditation video on the RMTC YouTube channel.

Benefits Tai chi and Qigong can be called the ‘ultimate low-impact exercise’, an exercise that can be done standing up, or sitting down. It is believed tai chi can improve cardiovascular endurance as well as improve posture, strength and balance3.

Scientific studies have found that it can lower blood pressure, improve balance, improve circulation and make seniors feel empowered4.

However, it is important to note that there have been issues with studying the benefits of tai chi, as results are difficult to measure. Often studies report on patients ‘feelings’ rather than measuring actual physical evidence. Patients ‘feel’ better, or they report feeling ‘less stressed’. When the Australian Government reviewed the Private Health Insurance rebate scheme, tai chi was one of the many natural therapies studied, but the research was limited and results inconclusive5.

According to Dr Robert Whipple, a gait and balance expert, “T'ai-chi has come up with the best possible biomechanical scenarios for keeping a person stable - to maximize your standing base by widening your stance, and to keep your head and torso as vertical as possible. The methods showing the best results have the feet in a wide stance position, with the back and head held straight upwards, as if suspended from above. There should be no leaning over, forward, back or to the side6.”

If people who practice tai chi experience improvements in balance, coordination and general well being then this is a positive outcome.

Terminology and Concepts ‘Qi’ (or ‘chi’) All things, animate and inanimate – have ‘qi’. Humans have several different types of qi, a combination of kinetic and potential energy. This is a different ‘qi’ or ‘chi’ to ‘tai chi’. ‘Qi’, or ‘energy’ is said to flow through the body along meridians, pathways which connect all parts of the body.

Qi is always moving. It is the source of movement, as well as the movement itself. Qi holds things together. It controls an object’s ability to keep its shape and form. Qi warms and protects the body from outside influences. Qi transforms food so we can utilize its nutrients.

When the qi runs through the body strongly, without being inhibited, the body is at its peak. If the meridians are blocked, inhibiting the flow of qi, the body becomes weak and sickness can develop. At optimum conditions, yin and yang are balanced, both physically and mentally and we feel strong and healthy.

Qi is our life energy. The ancient masters believed that we are all born with qi – it animates us and gives us our individuality. It is our true self. Qi is also the source of consciousness, awareness and life. Without qi, nothing lives. Qi seeks balance and harmony. Qi energy can be cultivated through practising tai chi and qigong, including Shibashi.

Note that the word ‘qi’ when referring to energy is different to the word ‘chi’ in Tai Chi.

Dr Greg Yuen MD, has indicated there are seven elements of qi cultivation8:

1. Believe that Qi (energy) exists

2. Focus your mind on your body (energy levels)

3. Feel your body and relax any tension

4. Feel grounded and connect to the sky

5. Breathe effectively through abdominal breathing

6. Visualise positive energy within your body

7. Move your legs, then waist, then arms

Sources of Qi • Yun Qi, or Prenatal Qi, is the primary source of our individual qi. This is given to us at the moment of conception and determines our ‘soundness’ of our constitution throughout our lifetime. Yun Qi is thought to be stored in the kidneys. It cannot be replaced or repaired. Tai chi practice promotes the fostering and protection of Yun Qi from exhaustion. • The other source of qi is through the food we eat and the air we breathe. Eating unprocessed, fresh, whole foods and breathing fresh, open, unpolluted air will allow the absorption of qi easily. This is illustrated in the deep breaths we take when we’re by the seaside or in a forest. The air is pure, clean and full of pure qi energy7.

Yin and Yang The Taoist philosophy embraces the concepts of yin and yang, two opposing but equally balanced and complementary forces. Neither is dominant. Neither is ‘better’. Yin and yang is constantly changing to be in perpetual balance.

Living things which are perfectly balanced are said to be in harmony, are at peace, which in turn, leads to longevity. Balance manifests in a sense of ‘completeness’, or tranquility and peaceful mind.

When practicing tai chi and qigong we see Yin and Yang constantly at interplay with each other. A Yin movement becomes Yang, Yang becomes Yin through constantly flowing, balanced movements. Breathing There are many different types of breathing which can be used in tai chi, qigong and Shibashi, including ‘dantian breathing’ and ‘differentiated breathing’ but there are 2 simple forms which everyone can practice: • Abdominal Breathing (or ‘diaphragmatic respiration’, or ‘natural breathing’): Inhale through the nose and expand the abdomen. When exhaling, the abdomen returns to the resting position. Abdominal breathing is the general breathing method for ‘wellbeing tai chi’. • Reverse Breathing: This is the reverse of abdominal breathing – as the breath is inhaled, the abdomen gently contracts – exhale and the abdomen expands. Reverse breathing is used in ‘tai chi self defence’. Ideally, inhaling and exhaling should be done through the nose, but if nostrils are blocked this can be modified by breathing through the nose and exhale through the mouth. The tongue should be on the top of the mouth, as if saying the letter ‘t’ and the mouth is neither opened or closed (meaning the jaw is relaxed and sitting naturally). Inhaling and exhaling through the nose allows the body to process qi energy effectively. Generally speaking, tai chi postures ‘open’ and ‘close’. We exhale when opening and inhale when closing. For example, the posture of Part the Wild 15

Horses’s Mane is an open movement, and as the arm travels upward and forward, the breath is exhaled. Similarly, during the transition, when the hands are ‘holding the ball’, the posture is closed and the breath is inhaled. There are, of course, exceptions, but a a general rule of thumb, the Yang movement is the exhale, inhale on the Yin.

The Dantians There are three dantians (or dan t’ian, dan tien or tan t’ien) – upper, middle and lower. Loosely translated, ‘dantian’ means ‘energy centre’ or ‘sea of qi’ or ‘elixir field’. The lower dantian is particularly important as it is the focal point of breathing, it is the centre of balance and gravity. The dantians are also the focal points for the transformation of the three treasures, jing (essence), qi (vitality) and shen (spirit). The lower dantian is situated approximately three finger widths below the navel and two fingerwidths behind the navel. Here begins the process of purifying jing (essence) into vitality (qi). The middle dantian is at the level of the heart, and is the place where qi is refined into shen (spirit). The upper dantian is at the forehead between the eyebrows (or third eye). This is where shen (spirit) is refined into wu (emptiness)8.

Pressure Points Pressure points are a point on the surface of the body sensitive to pressure. They are derived from the meridian points in Traditional Chinese Medicine and Indian Ayurveda and Siddha medicine. In tai chi, pressure points are used (through massage or focus) to cultivate energy (qi) flow throughout the body. 1. Bai Hui (or hundred convergences or gateway to the heavens) is located at the top of the skull, in line with the apex of the ears. We can visualise yang chi (energy) entering from the atmosphere, filling our entire body with a positive energy. 2. Yongquan (Bubbling Spring) is a point located on each foot just on the indent in the middle and below the transverse arch. Massage these points for health and grounding. 3. Ming Men (Gate of Life) point, is located on the back, directly on the vertebrae in horizontal alignment with the navel. To locate this pressure point, take your index fingers and start from your belly button to draw an invisible belt line that leads back to your spinal column, and you will find the location of this point. When qi energy is blocked here, low back pain can result. Massaging this point can relieve discomfort. 4. Laogong (Palace of Toil) point is located on each palm of your hands. Curling your middle finger to touch upon the indent of your palm will pinpoint the pressure point on each hand. These pressure points can be massaged for regulating qi energy and blood pressure9. 16

The Kua The kua (singlualr or plural) is the hip joint, the groin, crotch or the ‘trouser crease’. It is the area responsible for the transmission of power through the lower dantien. The kua ‘opens’ and ‘closes’, the movements of which are rotational. ‘Opening the kua’, a movement at the beginnig of a transition, partiuclary when the weight shifts from one leg to the other, aligns the knee, ankle, and foot. To facilitate this ‘opening’ the lower back is relaxed, thereby opening the ming-men pressure point.

Correct Tai Chi Posture To gain the many benefits of tai chi and qigong, correct posture is imperative, allowing for the meridians to open and the unihibited flow of qi. Although tai chi posture is upright, it is relaxed, as if suspended by a string from the top of the head (the bai hui). The posture is upright, but the chest remains ‘sunk’ or relaxed. Head is straight, with the eyes looking forward (meaning the chin is neither tilted up or down). Knees are off lock, and feet are shoulder width apart, facing directly forward. Below is an excellent explanation of correct and incorrect posture, taken from Beginners Tai Chi.com10.

Correct Alignments Incorrect Alignments 1. Feet parallel, shoulder width apart 2. Knees slightly bent. Centre of knee 1. Feet not parallel over centre of foot 2. Knees locked and not over 3. Pelvis slightly tucked under, centre of foot tailbone perpendicular to the 3. Buttocks and tailbone ground protruding backwards 4. Spine gently straightened 4. Back not straight, excessively 5. Chest slightly rounded and arched dropped without collapsing 5. Chest pushed out and raised 6. Head and neck straight, eyes and 6. Head tilting backwards nose parallel to floor

The Six Harmonies To assist with correct posture, it is helpful to understand the concept of the ‘Six Harmonies’, an ancient tai chi principle (suggested by Dai Long Bang, 1750), comprising three internal and three external harmonies. The Six Harmonies refer to the coordiation between three exertnal joigs and coordination between three internal processes that align emotion and intention. Although the Internal Harmonies require a deep appreciation of qi and energy flow, the External Harmonies can be used very effectively, even with those just beginning their tai chi journey. These will bring greater connection with your tai chi practice11. External Harmonies: Shoulders harmonize with the hips Elbows harmonize with the knees Hands harmonize with the feet

Internal Harmonies: The heart harmonises ith the intention The intention harmonises with the qi The qi harmonises with the movement

When one part moves, all parts move.

Energy is rooted in the feet, developed in the legs, directed by the waist and manifested in the fingers. We try to manifest perfect unity from feet to legs, to the waist. Every hand movement is connected to a waist movement, which in turn is connected to the feet. The spiritual energy of the eyes follow the feet. The entire body is united, from the feet to the crown of the head.

Stand Like a Tree (Zhan Zhuang) This exercise is a traditional and fundamental qigong practice. Unlike qigong, however, there is no movement as the sole purpose is to focus on posture, relaxation and mindfulness. Its named is derived from the notion that the legs and torso form the trunk of the tree and the arms form the branches. During this practice, the feet sink into the ground, they are the roots, extending beneath and into the ground.

The Benefits of Zhan Zhuang As with all qigong exercises, Zhan Zhuang cultivates energy. The method is simple enough – opening the joints, creating a circular shape with arms and legs, relaxing and breathing. In doing this, we become more aware of our body and how we naturally hold ourselves. The majority of people do not have a ‘perfect posture’, as muscles, tendons, ligaments and fascia are damaged throughout a lifetime of repetitive movement and overuse. Poor posture creates fatigue as the energetic pathways are not aligned, inhibiting the flow of energy through the body. These energetic pathways are known as meridians in traditional Chinese medicine and in a healthy body the chi flows freely through these vessels or channels. A blockage, or blockages within a pathway causes chi to stagnate, which is considered the cause of physical and mental ailments. The purpose of Zhan Zhuang is to create a smooth pathway along which the chi (through the breath) can be distributed throughout the body.

Health benefits derived from this standing practice include12:

• Increased red blood cells • Increased haemoglobin production • Better nerve excitation • Increased oxygen in the body • Higher quality cerebral cortex excitation • Improved sleep

View the Zhan Zhuang video on the RMTC YouTube channel.

Tai Chi Stances There are four main stances in Yang style tai chi, including the ‘commencing stance’ used to settle the qi before beginning Wuji stance is a stance commonly used before commencement. Balance in the legs and feet is 50/50, with the knees soft and the body upright, the arms are by the side, with space under the armpits. The purpose of this stance is to clear the mind and to bring focus to the lower dantian, to settle the breathing and to release tension from body and the mind and to feel grounded and connected to the earth. Bow stance - one leg in front of the other, shoulder width apart, front foot facing forward, back foot slightly turned out (about 45o), back knee off lock. 70% of weight is on the front leg, with the calf muscle vertical and the knee not protruding over the toe but is in line with the foot. Hips face forward. This is a strong stance because of its triangle shape at the base.

Horseback riding stance - legs are wide, as if sitting on a horse, with 50% weight distribution on each leg. The lower back is not curved or hunched, both kua (groins) are open and the coccyx (tail bone) facing the floor, or ‘tucked in’.

Empty Cat Stance - one leg forward (with either toe or heel on the floor), with 10% weight, while the back leg has 90% weight distribution. This stance is ready for an attacking kick.

The height and distance of the stances will be determined by the capabilities of the practitioner and it is important not to strain the muscles or overextend the joints. It must be remembered that tai chi is made up of connecting postures, so transitions from one to the other must be slow and controlled. Postures must always allow for smooth flow of qi and maintain integrity for strength and balance.

View the Stances video on the RMTC YouTube channel.

Silk Reeling Silk reeling refers to a set of internal (neigong) movement principles expressed in traditional styles of tai chi chuan. Although it is more prevalent in Chen and Wu styles, Yang style tai chi also uses silk reeling principles in its movements. With many tai chi principles, concepts and movements, ‘silk reeling’ takes its name from nature, this time, from the silkworm. As the silkworm lava wraps itself in its cocoon, it twists and spirals itself, neither too fast nor too slow. In order to draw out the silk successfully the action must be smooth and consistent without jerking or changing direction sharply. Too fast, the silk breaks, too slow, it sticks to itself and becomes tangled. Putting silk reeling into tai chi practice, movements patterns are continuous, cyclic and spiralling. Movement is performed at constant speed with the lightness of drawing silk. Silk reeling is practised individually or with a partner, in the form of pushing (or listening) hands. Silk reeling principles can be seen in all tai chi movements and requires the opening of the kua as the weight shifts from one side to the other.

View the Silk Reeling video on the RMTC YouTube channel.

Health and Safety

Being Professional Scope and Practice for Registered Fitness Professionals It is important to understand your role, responsibilities and professional boundaries as a registered fitness instructor. Excellent guidelines have been developed by Fitness Australia, which state, “The core role of a Registered Fitness Professional is to plan and deliver safe and effective exercise programs for individuals and groups13.” It is essential that you are familiar with, and understand, these guidelines. The safety of students must always be a priority with any form of exercise, and tai chi is no exception. Although Yang style is a soft form of tai chi, injuries can occur if a student hyper extends, locks joints or attempts exercises which are unsuitable for their physical ability. Instructors should be aware of potential contraindications for each student and should always stress that students ‘work within their comfort range’, or ‘follow the guidelines of their health care professional’. To assist with a student’s health and safety, it is recommended that a referral process is followed, including screening and assessing client needs, evaluating whether you, as the instructor, require guidance from a health professional to meet those needs. If guidance from a health professional is required, it is necessary to work with your student to compile accurate, relevant and concise information for the referral. This will then guide you in effective and appropriate exercises for your student14. Medical Waivers A medical waiver should be signed by new students, stating that, if they have a medical condition, their medical practitioner has given them approval to commence tai chi. It should also state that it is the student’s responsibility to communicate with the instructor any issues they may have and explain procedures if medical attention is required. The medical waiver requires emergency phone numbers. These should be checked to ensure accuracy and stored so they are readily accessible. A folder with emergency procedure and all medical forms should be brought to every class. Students with asthma, diabetes, blood pressure, heart and mental health conditions can benefit from tai chi. If, however, a student experiences any discomfort the instructor must be recognize signs of distress, which may include loss of colour unsteadiness, disorientation, shortness of breath, reddened face or sweating. The instructor must be prepared if and when signs of discomfort are apparent. Always advise students to rest if they feel unwell and to consult their doctor if symptoms persist. Offer a chair, fresh air, a drink of water, or, worst case scenario, call an ambulance. Basic first aid training, including CPR, is required and this should be updated on a regular basis. Tai chi instructors are not medical professionals so must not offer advice as to injury management. Information regarding duty of care within WHS framework can be found on page 38. 24

Instructors should not physically adjust a student’s posture. An instructor should be able to use a variety of imagery and effective verbal instructions that negate the use of physically contacting students. However, if adjustments are required, the instructor must ask permission first. Touch only shoulders, elbows, knees, hand, wrist, feet and ankles (avoid the ‘soft’ areas) Orientation and Health Screening New students will often feel nervous and unsure when first attending a class, so it is important that the instructor puts them at ease by greeting them in a friendly and courteous manner. New students will need to undergo orientation prior to beginning class, and this should include a discussion about their goals and expectations. The benefits of tai chi can be explained so the student feels confident that this form of exercise is appropriate to their needs. During this initial introduction, an explanation of the venue facilities, class protocol, timetable and social events can be given. Introductions to other students can also be made so the new student feels at ease and comfortable. Information regarding health screening, particularly for the elderly can be found on page 38. The Venue Not only do instructors need to be aware of students’ health and safety, the physical environment needs to be safe. Practicing tai chi in the local park can be a delightful experience, but care must be taken that the ground is not damp, nor slippery or sloping. The area needs to be clear of branches, twigs, un-level ground, holes, dog excrement. The weather needs to be neither too hot nor too cold, with sunblock used if required. The use of water bottles should be encouraged to avoid dehydration. The area for indoor classes needs to be large enough to accommodate numbers, the floor must be non-slippery and clear of obstacles. All venues should have easy access, good natural ventilation and toilet facilities close by. The use of fans and air conditioners in summer and heaters in winter can disturb the flow of qi. However, the comfort and safety of students is paramount, so the use of artificial temperature control is at the discretion of the instructor, based on student’s needs. Environmentally Sustainable Work Practices Tai Chi classes often fall under the auspices of community programmes or within the group exercise timetable of fitness centre and as such, facilitators need to follow each organisation’s workplace procedures to ensure compliance. This includes the reporting of dangerous, damaged or outdated equipment, including flooring, heating and cooling appliances. At the conclusion of the class, the venue needs to be secured (including turning off all lights and appliances). These facilities are used by many different community groups or hirers and it is important to respect others by leaving the venue in a clean and safe condition.

The Exercises Yang style tai chi has soft, rounded movements, so all exercises within the session should be similar to this style. Warm-up exercises should be gentle and controlled. Neck rotations, and neck flexing should be kept to within each student’s comfort range, as should hip rotations and bending exercises. Range of movement exercises (arm rotations and swings, leg swings and kicks) should be within a student’s capabilities. The instructor can demonstrate modifications and encourage students to work within their comfort range. Although exercises are completed in the standing position, offering seated exercises for those physically challenged is an excellent way to include all students of varying abilities. Postures should be flowing and constantly moving to avoid stress and over working the joints. Students who are not comfortable with any exercise should be encouraged to rest or facilitator should modify to suit specific needs. Always encourage modifications. Some exercises require over the head movements which can be problematic for some students. Some exercises may be uncomfortable for those experinceing knee, hip or ankle pain. Exercise caution and good judgement and ensure all students keep within their comfort level. An effective instructor becomes adept at modifying stances, postures and exercises so each student feels safe and confident. When instructors listen to students concerns, a mutual respect develops, and the class becomes a friendly, inclusive and safe environment for everyone.

A Fitter, Healthier Australia Offering a tai chi programme within a group fitness timetable, or as a stand- alone class in a community centre allows many groups to participate in exercise which, under normal circumstances, they may not be able to attend. Groups which may be under-represented in fitness and community centre activities include: • Retirees • The elderly • New mothers • Those with physical disabilities that preclude them from normal fitness activities • The mentally challenged • Those suffering stress and anxiety

Tai chi may be the only form of exercise which can be suitably modified for the physically disabled, the mentally challenged and the aged. Seated exercises and modified co-ordination exercises (using only arms, or only legs) are effective ways to include these special populations in the tai chi program. Offering a tai chi programme to these special populations will enrich their health and well-being and provide a platform for personal development and social interaction. A link to resources for active adults can be found on page 38.

The Art of Teaching

Teaching Effectively Teaching tai chi to a varied and diverse group is a challenging but rewarding experience. An instructor’s role is to guide, educate, encourage and support each student as they embark on their own tai chi journey. There is no one correct method of teaching effectively, as each of us learn in different ways. Some people need to process a concept before doing it physically, others need to see written instructions so they can analyze them, others need to see it done so they can copy the move, others need to repeat it over and over before they understand it. No matter how a person learns, it is recognized that there are 4 stages within the learning process: The 4 Stages of Learning Always be aware of the stages of learning and the different personality types and learning styles within your class. It is widely acknoweldged, there are 4 stages of learning: 1. As novices, we are happy in our ignorance, as we don’t know what we don’t know (unconscious incompetence).

2. As we begin learning a new skill, we become aware of what we need to learn (conscious incompetence).

3. As we continue with practice (which may take months or years), we become more able to execute the new skill, but we are still thinking about how to perform the skill (conscious competence).

4. After many months or years, we are able to perform the skill without thinking about its mechanics (unconscious competence). We have now ‘mastered’ the skill.

It is important that the tai chi instructor understands these stages of learning. To keep saying to students to ‘relax’ will mean nothing, if they are still at the ‘conscious incompetence’ stage. It is better to draw focus to awareness: feel the tension leave your shoulders/exhale fully as you open/inhale as you close. Tai chi is a constant lesson in humility, and we become aware that the more we learn, the more we don’t know! Because there is so much to learn and practice in tai chi, the learning curve is endless. Encouraging students on their journey and ensuring that they have success along the way is important for their continued enjoyment and fulfillment.

Styles of Learning As well as different stages in learning there are several different styles of learning: • Visual: the learner must see it being done • Auditory: the learner must hear the instructions • Kinesthetic: the learner needs to do it to understand it • Logical/Mathematical: the learner uses reason, systems and sequence to help remember new information. • Verbal: some learners need to repeat instructions or verbalise their actions when a new concept has been presented • Social: some learners prefer to work with a group, discussing new concepts and processing data • Solitary: some learners prefer to work on their own, quietly processing information The instructor needs to be aware of these differences in the learning process, as it will impinge on the structure and activities of the class.

Not only do people learn differently, individuals have certain personality styles which influence how they interact with the group. Personality Types There are five different personality types: • Open – these people are curious, original, intellectual, creative and open to new ideas • Conscientious – these people are well organized, systematic, punctual, achievement oriented and dependable • Extravert – these people are outgoing, talkative and social • Agreeable – these people are affable, tolerant, sensitive, trusting, kind and warm • Neurotic – these people are anxious, temperamental and moody Knowing that personality and learning styles differ from person to person will allow the instructor to understand why a student responds in a particular way and what is the best way to organize the class. It would be unwise, for example, to put a ‘solitary’ learner in a group of ‘social’ learners, or a ‘logical’ thinker partnered with an ‘open’ personality who may enjoy exploring off-task tangents.

Engaging Each Student Understanding that a group of adults will have a variety of personalities and learning styles is important to effective teaching. The way a student responds to the leader, or to other students in the group, may not necessarily reflect their attitude towards the leader or student, but rather, a reflection on that person’s personality and the way they process information.

Although it seems unlikely to successfully embrace all these personalities and learning styles, it is possible to create a positive and accepting learning environment for all students.

How to engage students: • Mix up your own teaching style, so it is sometimes leader based, other times group based, other times it embraces discussions or demonstrations • If a new concept is being introduced, provide notes for students • Make eye contact with students and smile • Acknowledge each student and use their names when speaking with them • Identify which students enjoy leading a group and identify those students who do not want to be singled out • Encourage by word and by action • Ensure each student leaves the class feeling that he/she has achieved something • Each class should include familiar exercises for consolidation and reinforcement, as well as new exercises for interest and challenge. • Learn to gauge the effectiveness of the content of the session and be intuitive as to whether it is suitable for the group. Just because a session has been planned, does not mean it must be delivered. • Be mindful of the reasons why a student attends class. It may be to learn the form, it may be for exercise, it may be a form of relaxation, or a student may attend class for the social interaction. A student might attend class because he/she has been advised by a medical practitioner that it could be beneficial as part of a rehabilitation programme. • Cue effectively, so each student knows how to move, when to move and where to move.

Self-Evaluation It is important that the instructor evaluates his/her teaching method, class organization, communication and skill level. Consider the following: • Do I include all students in class activities? • Do I vary the content of the session? • Am I patient when students ask questions? • Does the class run at a good pace? • Do I respond appropriately to the student who requires more attention? • Do I use effective ways to encourage students? • Do I challenge all students while keeping the content appropriate? • Do I demonstrate clearly? • Are my communication skills effective? • Is my cueing consistent and timely? • Are my instructions and cueing simple enough to be effective? • Do I engage all students? • Am I aware of disengagement? • Do I respond positively to all questions? • Do I modify the class content if required? • Do I have the knowledge to answer most students’ questions?

A shifu, especially one who is newly trained, should be under the guidance of a master or a school to ensure his/her own skills remain at a high level. An isolated instructor, who has no connection to other tai chi schools or organisations can become complacent with their own ability. Attending courses, workshops and other events will keep you motivated and true to the tai chi philosophy of always searching for improvement in skills and knowledge. To gauge the effectiveness of your classes, asking students to complete a survey is an excellent way to keep abreast of opinions and attitudes. These must be considered as a tool to enhance classes, and all responses should be read clinically. If some responses are negative, or less than glowing, they should not be seen as a personal attack, but rather they should be used to improve and develop classes.

Class Basics Establishing an inclusive and respectful class culture is an important aspect in encouraging camaraderie and social interaction, which, in turn, will produce a positive learning environment. The tai chi class should be based on mutual respect between students and instructor. Classes should be delivered in a professional manner, with the instructor displaying qualities of integrity, compassion and empathy. The shifu’s knowledge of the content should be sound and the use of appropriate teaching methodology should be adhered to. It is the duty of the shifu to plan classes which meet the desired outcomes of each student, to identify special needs and to modify content and teaching style to enhance the learning process of all students, while motivating in a positive and respectful manner. The Salute Before class begins (and at its conclusion) it is customary for the shifu and students to show mutual respect for one another’s skills and abilities by saluting. This tradition of saluting (rather than shaking hands) stems from the feudal times in China, when one had to be wary of meeting and greeting others. A hand shake could be seen as too threatening, or an invitation to attack. The salute signifies respect for others and humility of self. The arms form a circle at chest height and eyes look forward. A fist is made with the right hand, thumb on the outside, The left palm covers the fist, with the left thumb bent. The fist (yang) signifies martial ability, and in making the fist, the tai chi school will teach the martial application of postures. The palm (yin) shows civility. The bent thumb on the left hand represents humility. The four fingers represent Virtue, Wisdom, Health and Art. These are known as the four nurturing elements in martial practice. The fist can also be described as the sun, and the palm the moon – the two great sources of lightness and brightness19. If a student is late to class, he/she should salute the shifu and begin a warm up quietly and then join the class. If a student needs to leave early, he/she should move away from the group quietly, salute the shifu and leave quietly. Students should inform shifu before the session begins if they need to leave before the completion of the class. Music Using music in classes is up to the discretion of the instructor. Many tai chi schools run classes with no music, and the calm, relaxed atmosphere and the flowing qi energy can be felt within the group. Some schools use music very effectively, bringing a relaxing mood before (and during) the session. If music is played, it should only be used for background and the instructor must ensure it is at a low enough volume, so it is not the focal point of the class. Listening to music can lead to loss of focus, which will be detrimental to the outcomes of the session.

When playing music publicly, there are public performance guidelines and regulations regarding licensing. Information can be found at www.ppca.com.au

There are a number of websites that offer royalty free music. MediaMusicNow (www.mediamusicnow.co.uk) is one example. Cueing Cueing is a system of instructions, either verbal or nonverbal, which allows the class to know in advance the next transition, posture, direction, weight transference, etc. Many students (and in fact, all, new students) rely on shifu to guide the class with timely, consistent and clear instructions. Cueing is an acquired skill and is developed with practice and constant self-evaluation. Effective verbal cueing uses minimal words, it is given with enough time for processing, but not too early that students will move into the next posture too quickly. Verbal instructions should be spoken clearly but softly so the atmosphere of the tai chi class can remain calm and focused. Non-verbal cueing (arm and hand gestures) should be done with an open palm. Teaching Image When teaching either a group of people, or an individual, there are three different ‘teaching images’ which can be used; participant image or mirror image. Mirror Image: As the name suggests, this method is like looking in a mirror. Shifu stands in front, facing students, while completing the warm-up, qigong, or Shibashi. This method can also be effective when learning a new tai chi posture. Cueing when in mirror image can be difficult, as right and left are opposites. Always use the participant’s right and left when cueing. So, when stepping out to begin, shifu will step with the right foot, but cue ‘left foot’. Mirror image is useful for simple exercises which require minimal stepping. It promotes good eye contact and connection with students and shifu can assess the degree of difficulty the students are having with the posture. However, teaching Yang style stepping in mirror image is often confusing, as are some transitional movements. Participant Image: Shifu stands with back to students, so students can follow exactly – right steps forward, or left steps to the side. Using this teaching image is often clearer for students to follow, but it has its drawbacks as shifu cannot see students and students cannot see arm movements easily.

Useful Information

Postural Functions of Tai Chi

The following is from Tai Chi Chu’an Ching and explains exactly the Postural Functions of Tai Chi T'AI CHI CH'UAN CHING Attributed to Zhang Sanfeng (est. 1279 -1386) as researched by Lee N. Scheele: • In motion the whole body should be light and agile, with all parts of the body linked as if threaded together • The ch'i (vital life energy) should be excited, the shen (spirit of vitality) should be internally gathered • The postures should be without defect, without hollows or projections from the proper alignment • In motion the Form should be continuous, without stops and starts • The chin (intrinsic strength) should be rooted in the feet, generated from the legs, controlled by the waist, and manifested through the fingers • The feet, legs, and waist should act together as an integrated whole, so that while advancing or withdrawing one can grasp the opportunity of favorable timing and advantageous position • If correct timing and position are not achieved, the body will become disordered and will not move as an integrated whole: The correction for this defect must be sought in the legs and waist • The principle of adjusting the legs and waist applies for moving in all directions; upward or downward, advancing or withdrawing, left or right • All movements are motivated by I, (or Yi), (mind-intention), not external form • If there is up, there is down; when advancing, have regard for withdrawing; when striking left, pay attention to the right • If the I, (or Yi), wants to move upward, it must simultaneously have intent downward • Alternating the force of pulling and pushing severs an opponent's root so that he can be defeated quickly and certainly • Insubstantial and substantial should be clearly differentiated. At any place where there is insubstantiality, there must be substantiality; every place has both insubstantiality and substantiality • The whole body should be threaded together through every joint without the slightest break

For Your Library Below is a list of some books which may prove interesting reads. A search of ‘Tai Chi Books’ on Google brings hundreds of different titles, many of which are very informative. • Chen, Y 2003, Tai-ChiCh’uan Its Effects and Practical Applications, Wildside Press, USA

• Clark, A 1998, The Complete Illustrated Guide to Tai Chi, Element Books Inc, Australia • De Graffenried 2007, Anatomy of Yang Family Tai Chi, Nomentira, USA

• Khor G 1999, Living Chi, Tuttle, USA

• Khor, G 2000, Tai Chi The Way to a Healthy Life, New Holland Publishers, Australia

• Lam, P 2011, Teaching Tai Chi Effectively, Tai Chi Productions, Australia

• Liao, W 1990, T’ai Chi Classics, Shambhala, USA

• Liao, W 1995, The Essence of T’ai Chi, Shambhala, USA

• Liao, W 2009, Chi, Shambhala, USA

• Lo, B Inn, M, Amacker, R & foe, S 1979, The Essence of T’ai Chi Ch’uan, Nth Atlantic Books, USA

• Mellish, M 2011, The Tai Chi Imagery Workbook, Singing Dragon, UK

• Qiu, P & Zhu, W 2013, Tai Chi Illustrated, Human Kinetics, Australia

• Ting, W 2015, Essential Concepts of Tai Chi, Xlibris, USA

Other Resources

Senior’s Guide to Activity https://www1.health.gov.au/internet/main/publishing.nsf/Content/phd- physical-choose-health

COTA (VIC) Agenda for Ageing https://www.cotavic.org.au/wp-content/uploads/sites/2/2019/03/Agenda- for-Ageing-in-Victoria-Web-Version-Embargoed.pdf

Health Screening https://sma.org.au/sma-site-content/uploads/2019/05/ADULT_PRE- EXERCISE_SCREENING_SYSTEM__APSS__2019FINALv2.pdf

Duty of Care Guidelines https://fitness.org.au/articles/risk-management-research-reports/liability-for- workplace-health-and-safety-in-the-australian-fitness-industry/20/64/19

User Guide for Pre-Exercise Screening https://bp-fitnessaustralia- production.s3.amazonaws.com/uploads/uploaded_file/file/386442/ADULT_P RE-EXERCISE_SCREENING_SYSTEM__APSS__USER_GUIDE_FINAL2.pdf

Learn how to Manage Risks for your Clients https://bp-fitnessaustralia- production.s3.amazonaws.com/uploads/uploaded_file/file/390582/APSS_FA CT_SHEET__3_.pdf

Fitness Australia has a number of fact sheets and PDFs relating policies and guidelines for health screening and risk management

Reports and Studies The following reports and studies are for your interest only and are not intended to be used as guidelines for treatment of pain through tai chi

National Institutes of Health – US Department of Health and Human Services – ‘Tai Chi Boosts Immunity to Shingle Virus in Older Adults’ 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.

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.

Source: NIH.gov

BBC News: Tai Chi ‘Helps Improve Diabetes

Tai Chi exercises can help people with type 2 diabetes control their condition, research suggests.

Two separate studies found a 12-week programme of exercise was enough to boost the immune system, and to cut blood sugar levels.

The traditional Chinese martial art combines deep breathing and gentle movement to boost relaxation levels.

Both studies, by researchers in Taiwan and Australia, appear in the British Journal of Sports Medicine.

Around 1.8 million people in the UK have type 2 diabetes and another 750,000 are thought to be undiagnosed.

The first study, by a team in Taiwan, compared 30 people with diabetes with 30 healthy people acting as controls.

Over 12 weeks the participants learned 37 Tai Chi movements under the guidance of an expert, and took home a video to study the correct poses.

They took part in three hour-long sessions a week.

At the end of the programme, tests on the group with type 2 diabetes showed a drop in their blood sugar levels, and a boost in the level of cells and chemicals key to a healthy immune response.

Strenuous physical activity is known to depress the immune system, but the latest study suggests that more moderate exercise may have the opposite effect.

Other effects Previous research has suggested Tai Chi boosts cardiovascular and respiratory function, as well as improving flexibility and relieving stress.

The researchers said that if Tai Chi improves the way the body breaks down sugar, it could have a beneficial impact on the immune system, which is sparked into excessive activity by the presence of high levels of sugar in the blood.

Alternatively, the exercise may simply boost the immune system by raising fitness levels, and engendering a feeling of wellbeing.

The second study by the University of Queensland, based on just 11 participants, produced similar results.

In this study the participants - who all had raised blood sugar levels - attended sessions of Tai Chi, and another similar martial art, Qigong, for 60 to 90 minutes three times a week.

As well as a drop in blood sugar levels, the participants lost weight, and recorded significant falls in blood pressure. Insulin resistance was also improved.

Participants also said they slept better, had more energy, felt less pain and had fewer food cravings while on the programme.

Cathy Moulton, of the charity Diabetes UK, said moderate exercise had been shown to have a beneficial impact on type 2 diabetes.

Diabetes UK recommends that people with diabetes do a minimum of 30 minutes of moderate physical activity on at least five days of the week.

Ms Moulton said: "Any activity that leaves you feeling warm and slightly breathless but still able to hold a conversation counts as moderate exercise - including vigorously cleaning the house, briskly walking the dog and of course Tai Chi.

"In addition to the importance of moderate physical activity, the relaxation element of Tai Chi may help to reduce stress levels, preventing the release of adrenaline which can lead to insulin resistance and high blood glucose levels." Source: newsvote.bbc.co.uk

The World’s Largest Fall Prevention Study 2007 Summary of "A Randomized, Controlled Trial of tai chi for the Prevention of Falls: The Central Sydney tai chi Trial" By Dr Paul Lam

Authors of the study: Alexander Voukelatos, MA (Psychol) et al Published on the Journal of American Geriatric Society, August 2007. 55:1185–1191, 2007 This largest fall prevention study in the world involved 702 people in the community. After 16 weeks of learning and practicing a Tai Chi program (80% of the participants did the Tai Chi for Arthritis program), the results showed that Tai Chi significantly reduced the number of falls. Tai Chi also significantly reduced the risk of multiple falls by approximately 70%. The study concludes: "the findings from this study indicates that participation in weekly community-based tai chi classes can reduce falls in relatively healthy, community-dwelling older people. Given that the tai chi program used existing community facilities, the study suggests that tai chi is an effective and sustainable public health intervention for falls prevention for older people living in the community." Congratulations to the Central Area Health Promotion Unit! This is one of the most effective works anyone can do for health promotion. And it adds to the mounting evidence of the many tai chi's health benefits.

Related articles: Tai Chi for Arthritis study (same Tai Chi program) published in the Arthritis Care and Research Journal April 2007 "The Effects of Sun-Style Tai Chi Exercise on Physical Fitness and Fall Prevention in Fall-Prone Adults" Published in the journal of Advanced Nursing 51(2), 150-157 by Dr Choi J.H., Moon J.S. and Song R. (2005) Effects of tai chi exercise on pain, balance, muscle strength, and physical functioning in older women with osteoarthritis: A randomized clinical trial" Published by the Journal of Rheumatology Sept 2004

Source: taichiforhealthinstitute.org

Harvard Medical School Studies, May, 2009 No pain, big gains. Although tai chi is slow and gentle and doesn't leave you breathless, it addresses the key components of fitness — muscle strength, flexibility, balance, and, to a lesser degree, aerobic conditioning. Here's some of the evidence:

Muscle Strength. In a 2006 study published in Alternative Therapies in Health and Medicine, Stanford University researchers reported benefits of tai chi in 39 women and men, average age 66, with below-average fitness and at least one cardiovascular risk factor. After taking 36 tai chi classes in 12 weeks, they showed improvement in both lower-body strength (measured by the number of times they could rise from a chair in 30 seconds) and upper- body strength (measured by their ability to do arm curls).

In a Japanese study using the same strength measures, 113 older adults were assigned to different 12-week exercise programs, including tai chi, brisk walking, and resistance training. People who did tai chi improved more than 30% in lower-body strength and 25% in arm strength — almost as much as those who participated in resistance training, and more than those assigned to brisk walking.

"Although you aren't working with weights or resistance bands, the unsupported arm exercise involved in tai chi strengthens your upper body," says internist Dr. Gloria Yeh, an assistant professor at Harvard Medical School. "Tai chi strengthens both the lower and upper extremities and also the core muscles of the back and abdomen."

Flexibility. Women in the 2006 Stanford study significantly boosted upper- and lower-body flexibility as well as strength.

Balance. Tai chi improves balance and, according to some studies, reduces falls. Proprioception — the ability to sense the position of one's body in space — declines with age. Tai chi helps train this sense, which is a function of sensory neurons in the inner ear and stretch receptors in the muscles and ligaments. Tai chi also improves muscle strength and flexibility, which makes it easier to recover from a stumble. Fear of falling can make you more likely to fall; some studies have found that tai chi training helps reduce that fear.

Aerobic Conditioning. Depending on the speed and size of the movements, tai chi can provide some aerobic benefits. But in the Japanese study, only participants assigned to brisk walking gained much aerobic fitness. If your clinician advises a more intense cardio workout with a higher heart rate than tai chi can offer, you may need something more aerobic as well.

Tai Chi for Medical Condtions When combined with standard treatment, tai chi appears to be helpful for several medical conditions. For example: Arthritis. In a 40-person study at Tufts University, presented in October 2008 at a meeting of the American College of Rheumatology, an hour of tai chi twice a week for 12 weeks reduced pain and improved mood and physical functioning more than standard stretching exercises in people with severe knee osteoarthritis. According to a Korean study published in December 2008 in Evidence-based Complementary and Alternative Medicine, eight weeks of tai chi classes followed by eight weeks of home practice significantly improved flexibility and slowed the disease process in patients with ankylosing spondylitis, a painful and debilitating inflammatory form of arthritis that affects the spine.

Low Bone Density. A review of six controlled studies by Dr. Wayne and other Harvard researchers indicates that tai chi may be a safe and effective way to maintain bone density in postmenopausal women. A controlled study of tai chi in women with osteopenia (diminished bone density not as severe as osteoporosis) is under way at the Osher Research Center and Boston's Beth Israel Deaconess Medical Center.

Breast Cancer. Tai chi has shown potential for improving quality of life and functional capacity (the physical ability to carry out normal daily activities, such as work or exercise) in women suffering from breast cancer or the side effects of breast cancer treatment. For example, a 2008 study at the University of Rochester, published in Medicine and Sport Science, found that quality of life and functional capacity (including aerobic capacity, muscular strength, and flexibility) improved in women with breast cancer who did 12 weeks of tai chi, while declining in a control group that received only supportive therapy.

Heart Disease. A 53-person study at National Taiwan University found that a year of tai chi significantly boosted exercise capacity, lowered blood pressure, and improved levels of cholesterol, triglycerides, insulin, and C-reactive protein in people at high risk for heart disease. The study, which was published in the September 2008 Journal of Alternative and Complementary Medicine, found no improvement in a control group that did not practice tai chi.

Heart Failure. In a 30-person pilot study at Harvard Medical School, 12 weeks of tai chi improved participants' ability to walk and quality of life. It also reduced blood levels of B- type natriuretic protein, an indicator of heart failure. A 150-patient controlled trial is under way.

Hypertension. In a review of 26 studies in English or Chinese published in Preventive Cardiology (Spring 2008), Dr. Yeh reported that in 85% of trials, tai chi lowered blood pressure — with improvements ranging from 3 to 32 mm Hg in systolic pressure and from 2 to 18 mm Hg in diastolic pressure.

Parkinson's Disease. A 33-person pilot study from Washington University School of Medicine in St. Louis, published in Gait and Posture (October 2008), found that people with mild to moderately severe Parkinson's disease showed improved balance, walking ability, and overall well-being after 20 tai chi sessions.

Sleep Problems. In a University of California, Los Angeles, study of 112 healthy older adults with moderate sleep complaints, 16 weeks of tai chi improved the quality and duration of sleep significantly more than standard sleep education. The study was published in the July 2008 issue of the journal Sleep.

Stroke. In 136 patients who'd had a stroke at least six months earlier, 12 weeks of tai chi improved standing balance more than a general exercise program that entailed breathing, stretching, and mobilizing muscles and joints involved in sitting and walking. Findings were published in the January 2009 issue of Neurorehabilitation and Neural Repair.

The Effect of Tai Chi on Arthritis The largest study of Tai Chi for Arthritis, by Professor Leigh Callahan from the University of North Carolina, shows significant health benefits for people with all types of arthritis. This landmark study was presented at the annual Scientific Meeting of the American College of Rheumatology on 8th November 2010.

In the study, 354 participants were randomly assigned to two groups. The Tai Chi group received 8 weeks of lessons, while the other group was a control group waiting for Tai Chi classes. It was found that there was significant pain relief, less stiffness and better ability to manage daily living. The participants felt better about their overall wellness, as well as experiencing improved balance.

In September 2003, the Journal of Rheumatology published a study that compared older adults with arthritis. After 12 weeks, those that practiced the Tai Chi for Arthritis form had 35% less pain, 29% less stiffness, 29% more ability to perform daily tasks (like climbing stairs), as well as improved balance, compared to the control group. The Journal of Advanced Nursing reports the results of a 2005 study on “The Effects of Sun- Style Tai Chi Exercise on Physical Fitness and Fall Prevention in Fall-Prone Adults”. Subjects 44 were tested, before and after, practicing Tai Chi for Arthritis three times a week for 12 weeks for strength of the knee and ankle, flexibility and mobility, and the risk ratio of falls. It concluded that this tai chi program can safely improve physical strength and reduce fall risk in fall-prone older adults in residential care facilities.

Arthritis Care and Research published a study in April, 2007, which observed that older, sedentary people with chronic osteoarthritis (OA) of the knee or hip, gained significant and sustained improvement in physical function as well pain relief with Tai Chi for Arthritis classes.

The largest tai chi for fall prevention study in a community setting was published by the American Journal of American Geriatric Society in August 2007. Subjects practiced a modified tai chi program, which incorporated 80% of the Tai Chi for Arthritis program. The results indicate that recurring falls were reduced by nearly 70%.

A two-year tai chi study, published by Asian Nursing Research in December 2008, discovered that practicing Tai Chi for Arthritis led to improving six out of eight quality of life measurements for older adults. And, after a half year, there were practically no drop outs.

Source: Tai Chi School of Gentle Exercise.com/medical-studies.html and http://www.medicalnewstoday.com/releases/207055.php

Summary of Research On T'ai Chi Ch'uan T'ai Chi Ch'uan is often translated from Chinese as the "Supreme Ultimate Martial Art". In addition to being a self-defense art, current research indicates that T'ai Chi Ch'uan is a weight bearing and moderate intensity cardiovascular exercise (http://www.krapu4.com/taichi/WhatIs.htm) 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. One summary of research can be found in (Sandlund and Norlander, 2000). And more specifically regarding the following areas: Balance, Specific Medical Conditions, Cardiovascular, Elderly or Aging Populations, Immune Response (Blood T-Cells), Mood States (Self Reports), Reduced Falls, Respiratory, Stress Hormones (Salivary Cortisol Levels), Weight Bearing Exercise

Balance Improved strength, mobility, balance, endurance (Tse & Bailey, 1992) Significant improvement in balance maintained (Wolfson, et al.,1993 and 1996) Significant improvement in balance among Parkinson Disease patients. (Hackneya & Earhart, 2008) Other balance related studies (Judge, et al., 1993)

Specific Medical Conditions Significant improvement in balance among Parkinson Disease patients. (Hackneya & Earhart, 2008) (also listed under Balance) Most recommended aerobic exercise for coronary artery disease (Ng 1992) (also listed under Cardiovascular) For rheumatoid arthritis (Kirstens,et al., 1991) (also listed under Weight Bearing Exercise) And Dementia (Gibb, et al., 1997

Cardiovascular Lowers resting blood pressure (Sun, 1994), (Sun, et al., 1996), (Young, 1999) Low to moderate intensity exercise (Zhou, 1984) Safe exercise for individuals at high risk for cardiovascular disease (Schneider & Leung 1991) May delay decline of cardiorespiratory function in older adults (Lai, et al., 1995) May be prescribed as suitable aerobic exercise for older adults (Lai, et al., 1993) Most recommended aerobic exercise for coronary artery disease (Ng 1992) In relation to recovery from heart attack (Channer, et al., 1996) Other cardiovascular related studies (Gong, et al., 1981), (Lan, et al., 1996)

Elderly or Aging Populations General studies (Ross & Preswalla, 1998), (Sun, 1994), (Lan, et al., 1998), (Zhou, 1982)

Immune Response (Blood T-Cells) Marked increase during and after practice (Sun, et al., 1989). Increase after 16-week program (Irwin, et al, (2007).

Mood States (Self Reports) Reduced tension, anxiety fatigue, depression and confusion (Jin 1989) Improved mood states, reduction of anxiety states (Jin 1992) Reduced Anxiety (Chen & Sun 1997) Other Self Report studies (Kutner, et al., 1997), (Blinde & McClung, 1997)

Reduced Falls Reduced falls by up to 47%, reduced fear of falling (Wolf, et al., 1993,and 1996, and 1997), (Henderson, 1998), (Myers & Weiner, 1996), (Province, et al, 1995) Preventing Falls (Carbary, 1991), (Smith, 1998), (Kessenich, 1998)

Respiratory Increased efficiency in use of ventilatory volume (Brown, et al., 1989) Enhanced ventilatory capacity without cardiovascular stress (Brown et al, 1995) Efficient use of ventilatory volume, efficient breathing patterns (Schneider & Leung, 1991) Medical Tribune News Service article discussing research led by Dr. Jin-Shin Lai of the department of physical medicine and rehabilitation at the National Taiwan University Hospital in Taipei.

Stress Hormones (Salivary Cortisol Levels) Significant drop during and after practice (Jin 1989, Jin 1992)

Weight Bearing Exercise No exacerbation in joint symptoms of individuals with RA (Kirstens,et al., 1991) Alternative exercise therapy as part of Rehabilitation Program (Kirstens, et al., 1991) Increased joint flexibility (Sun, 1994 and 1996)

Other Benefits Referenced Relaxation therapy for chronically ill (Jin 1992) Therapeutic action for diminished range of motion (Kirstens, et al., 1991) Reduced blood pressure, improved muscle relaxation and flexibility (Chen & Sun 1997), (Sun 1994 and 1996) And Dementia (Gibb, et al., 1997)

Other General or Summary Studies Other studies (Kirsteins, 1998), (La Forge, 1997), (Lam, 1998), (Lutz, 1996), (Sandlund and Norlander, 2000), Achiron, et al., (1997), Chewning (2000a), Chewning (2000b), Bottomley (2000)

For Research References go to www.krapu4.com/taichi The above information was gathered through a collaboration by:

Thomas M. Krapu, Tricia Yu Ph.D. Saint Louis T'ai Chi Center Missouri USA Madison, Wisconsin USA Executive & Corporate Coach (608) 257-4171 Licensed Psychologist web: www.taichihealth.com T'ai Chi Ch'uan Instructor email [email protected], web: www.krapu4.com/taichi

Source: www.krapu4.com/taichi

Tai Chi for Health Institute and Tai Chi Association of Australia Submission to the Department of Health, 2013

Introduction This submission starts with an introduction to tai chi, follow by the evidence of tai chi’s effect on health and how it works. There is very robust evidence of tai chi’s benefits to health. It is safe especially when modern knowledge of sport medicine for exercising safely is incorporated. It is very cost effective, in a large study by ANU and the former Greater Southern Area Health Service (GSHAS) as attached “the attached report has been redacted because of privacy and/or copyright issues”, the cost is estimated to be $76 per person per year! We believe this is a strong case for financial support by the private funds, indeed, by all level of health planning in the future.

Introduction of tai chi Tai Chi, also known as Tai Chi Chuan, taiji, or taijiquan, is a moderately intense aerobic exercise characterized by continuous movements that embrace the mind, body, and spirit. The unique feature of Tai Chi is that it builds inner strength from within by building strength of mind and serenity. It strengthens internal structures such as the internal organs and deep stabilizer muscles. Tai Chi emphasizes the cultivation of Qi, the life energy. By combining training of mind, joints and internal and external muscles, Tai Chi represents a powerful holistic approach to health and wellness.

Tai Chi stresses the integration and balance of mind and body using fundamental principles that are common to all of its styles and forms. Tai Chi practitioners use visualization such as imagining moving against a gentle resistance. The slow, smooth, and continuous Tai Chi movements require complex motor control. Tai Chi practitioners are mindful of transferring weight with each step while maintaining an upright and supple posture and coordinating their breathing with their movement while focusing and calming their minds as they loosen and relax their joints and ligaments.

There are many styles and forms of Tai Chi, but the four major styles (in the order of the time of origin) are Chen, Yang, Wu, and Sun. Although each style has its own features, they all share the same essential principles. Any style of Tai Chi will bring health benefits as long as the essential principles are incorporated, and safety precaution based on modern medicine is incorporated.

In the 1670s, Chen Wangting developed the Chen style based on martial arts, the ancient Taoist philosophical understanding of nature, and Chinese traditional medicine. Chen is characterized by slow and soft movements intermixed with fast and hard ones. It involves explosive power and low stances. The Chen style is rich with combat techniques and has more vigorous movements with a higher risk of injury than other styles. Chen is therefore more suitable for younger and fitter participants. Yang Lu-chan (1799–1872) created Yang style in the early 19th century. This style is characterized by gentle, graceful, and slow movements, which are easier to learn than Chen style. The Yang style has become the most popular in modern times. Wu Quan-you (1834–1902) and his son Wu Jian-quan (1870–1942) created the Wu style. Its movements are gentle and soft, with emphasis on redirecting incoming forces. Many Wu stylists use a forward leaning posture, while upright posture—whereby the body is vertically aligned relative to the ground—is considered to be the best for most other styles. In Wu style, the body is aligned along a straight line from the head to the back foot, which produces a forward leaning posture. The most recent style is the Sun style, created by Sun Lu- tang (1861–1932). It is characterized by agile steps, unique Qigong (method of generating life energy), and a higher stance than other styles. Qigong cultivates strong internal power, which is especially effective for healing and relaxation. The higher stance minimizes the risk of injury and makes it easier for older people to learn. The great depth of Sun style holds learners’ interest as they progress.

Scientific evidence is accumulating that Tai Chi is one of the most effective forms of exercise for health and wellness. The many health benefits of Tai Chi have spurred an exponential increase in the number of published reports of studies on the subject over recent years. A PubMed search of articles published between 2000 and April 2012 yielded 544 research articles with keywords Tai Chi, T’ai Chi, or Taiji. One hundred thirty-three randomized trials and 51 meta-analyses or systematic reviews were published during this time period. In contrast, only 48 articles were published between 1990 and 1999, and included only 10 randomized trials and one systematic review.

STUDIES OF THE EFFECTS OF TAI CHI The following sections describe selected Tai Chi studies that are randomized clinical trials or meta-analyses. Health outcomes were selected to highlight consistent and emerging effects of Tai Chi. In those instances, when the styles of Tai Chi are identified, the style name is only used.

Pain Tai Chi for pain management has been studied primarily in arthritic conditions using visual analog scales and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). In a meta-analysis of randomized controlled trials of pain (Hall et al., 2009), Tai Chi was associated with significant pooled effect sizes (ES) of 10.1 (range 0–100) for persons with osteoarthritis (Abbott et al., 2007; Adler, Roberts, Good & Synder, 2000; Brismee et al., 2007; Fransen et al., 2007; Hartman et al., 2000; Song, Lee, Lam & Bae, 2007) and rheumatoid arthritis (Lee & Jeong, 2006). The pain reduction effects of 12 weeks of Tai Chi persisted during 36 weeks of home practice (Wang et al., 2009). Similar improvements in back pain and associated bother have been found for ten weeks of Sun style (Hall, Maher, Latimer, & Ferreira, 2011).

Postural Stability Each of the major types of Tai Chi (Chen, Sun, and Yang) has been consistently found to increase postural control (Rogers et al., 2009; Wong & Lan, 2008). Participants in Tai Chi were able to stand on one leg for significantly longer (Audette et al., 2006; Choi, Moon & Song 2005; Gatts & Woollacott, 2006; Li et al., 2005; Li, Xu & Hong, 2008; Song et al., 2003; Wong & Lan, 2008; Zhang, Ishikawa-Tkata, Yamazaki, Morita & Ohta, 2006), and displayed greater functional reach than were a control group (Li et al., 2012; Wolf et al., 2006). Using the movements of the center of pressure (COP) from a force plate, those performing Tai Chi had greater stability (Tsang & Hui-Chan, 2003), directional control of weight shifts (Li et al., 2012; Tsang & Hui-Chan, 2004), and smaller area of movement for the COP (Wu, Zhao, Zhou & Wei 2002). Similar differences were found under various challenging sensory conditions (Au-Yeung et al., 2009; Lin, et al. 2000; Wong, Lin, Chou, Tang & Wong, 2001). The inconsistent findings of some subsequent studies may be attributable to the use of samples of older adults at high risk of falls and disability rather than the healthy older adults used in other studies (Day et al., 2012; Logghe et al., 2009), the small number of Tai Chi movements used in the intervention (Tsang, Orr, Lam, Comino & Singh, 2007), and a concurrent government campaign to increase exercise (Woo, Hong, Lau & Lynn, 2007).

Muscle Strength While Tai Chi involves the muscles of the trunk and arms, those most involved are in the lower extremities. Not surprisingly, the dorsal flexors and knee extensors of Tai Chi practitioners have greater isokinetic strength (Tsang & Hui-Chan, 2005; Wu et al., 2002; Xu, Li & Hong, 2006; Xu, Hong & Li, 2008) and endurance (Lan, Lai, Chen & Wong, 2000) than non-practitioners. Long- term practitioners also have greater strength in ankle dorsal flexors but not plantar flexors relative to regular joggers and sedentary adults (Xu et al., 2008). Compared with a control group, Tai Chi significantly increased knee extensor strength in some studies (Cheung et al., 2007; Choi et al., 2005; Day et al., 2012; Lan et al., 2000) but not others (Song, Roberts, Lee, Lam & Bae, 2010). Strength was greater for those after Tai Chi when compared to brisk walking (Audette et al., 2006), health education (Li et al., 2009), physical activity (Mustian, Katula & Zhao, 2006), or psychosocial therapy (Mustian, Palesh & Flecksteiner, 2008). Those in a Tai Chi group did not have significantly greater knee flexor strength relative to a control group (Li et al., 2009) or jogging and sedentary older adult groups (Xu et al., 2008).

Disability Many older adults suffer pain and disability from arthritis that contribute to disability. Several studies assessed disability with the WOMAC. In a pilot study (N=20), subjects in a 12-week Tai Chi program twice a week had significantly lower disability compared with the control group (Wang, 2008). Similar findings were found among older adults (N=41) in a 6-week Tai Chi program followed by 6 weeks of in-home training (Brismee et al., 2007).

In contrast, older adults enrolled in 12 weeks of Tai Chi exhibited similar improvements in disability relative to those in hydrotherapy, but disability was significantly lower in the control group than the two experimental groups (Fransen et al., 2007). Using the 12-item Short Form health questionnaire (SF-12), greater improvements in disability were found for Tai Chi than wait-listed control (Li et al., 2001) low-impact exercise (Li et al., 2004) and stretching (Li et al., 2005).

Unlike studies of disability in persons with musculoskeletal disease, Day and associates (2012) selected people (N=503) with preclinical disability. They used the Late Life Disability and Function Index, which is a more comprehensive measure of disability than the WOMAC and SF-12. Attrition was 32% in the Tai Chi group and 25% in the flexibility group, and only 53% completed at least 75% of the intervention sessions. Disability was not significantly different after 12 weeks of either intervention. The investigators attributed findings to attrition bias, possible similar effects of flexibility exercise on disability, and inadequate intervention dose. The disabilities of the participants also may not have been severe enough to benefit from either intervention because they were selected for preclinical disability that would precede the onset of disability. Day’s study also demonstrates the cost effectiveness of tai chi.

Falls Tai Chi has been found to reduce falls in older adults in large studies where the inherently low rate of falls in this population could be ascertained. In the first large study of community-living older adults, 15 weeks of Tai Chi reduced the risk of repeat falls by 47% but not on the incidence of new falls (Wolf et al., 1996). Although the relative risk for falls was not significant in a transitionally frail older adults (N=291), the fall rate was 47.6% in the Tai Chi group and 60.3% in the wellness education group (Wolf et al., 2003). In persons with Parkinson’s disease, the incidence of falls was significantly lower for Tai Chi than resistance exercise (Li et al., 2012). In a larger randomized clinical trial (Voukelatos, Cumming, Lord & Rissel, 2007), older adults (N=710) completed a 16 weeks of weekly Tai Chi. Twenty-two Tai Chi instructors from the community provided classes consistent with the styles that they normally taught. Participants paid a small amount for the sessions. At 16 weeks, the unadjusted and adjusted hazard ratios (HRs) for one or more falls approached significance (p<0.07) but were significant for two or more falls (HR=0.33 and 0.25, respectively). At 24 weeks, the HRs were significant for one or more falls (HR=0.67 and 0.66, respectively) and for two or more falls (HR=0.33 and 0.27, respectively).

Blood Pressure Systematic reviews support the positive effects of Tai Chi in individuals with hypertension (Dalusung-Angosta, 2011; Jahnke, Larkey, Rogers, Etnier, & Lin, 2010; Yeh, Wang, Wayne, & Phillips, 2009b). Investigators mostly used Yang-style performed 3–5 times weekly for between 12 weeks and 12 months. In randomized clinical trials, Tai Chi had greater clinically significant reductions in blood pressure when compared with no treatment (M. S. Lee, Lee, Kim, & Ernst, 2010) or education (Wolf et al., 2006).

The effects of Tai Chi are similar to the effects of other types of physical exercise. In a randomized clinical trial involving women with type 2 diabetes (Zhang & Fu, 2008), resting blood pressure improved significantly after performing Yang-style five times a week for 14 weeks compared to those in a free activity program. In elderly subjects with chronic heart failure (Caminiti et al., 2011), Yang-style combined with endurance training four times per week for 12 weeks significantly reduced systolic blood pressure relative to cycling or walking.

Cholesterol Aerobic exercise is known to be effective in managing blood lipids in various populations with cardiovascular disease. In an early randomized trial (Tsai et al., 2003), individuals with dyslipidemia showed significant improvement in cholesterol, triglycerides, those performing Yang-style three times per week for 12 weeks had higher low-density lipoprotein (LDL) cholesterol and lower high-density lipoprotein (HDL) cholesterol compared to a sedentary control. When compared to usual care, middle-aged adults with dyslipidemia had significant decreases of 26.3% in triglycerides, 7.3% in total cholesterol, and 11.9% in LDL after 12 months of Yang-style three times per week (Lan, Su, Chen, & Lai, 2008). In a randomized study using Chen-style three times per week for 12 weeks (Chen, Ueng, Lee, Sun, & Lee, 2010), obese patients with type 2 diabetes and elevated lipid profiles experienced significantly improved triglycerides and HDL when compared to conventional exercise.

In persons without abnormal lipid profiles, clinically significant changes in lipids would not be possible because of floor effects. For example, after 12 months of Chen-style, no significant differences in lipid profiles were found in healthy adults with borderline or normal lipid profiles at the baseline relative to resistance training or control groups (Thomas et al., 2005).

Glucose Metabolism Exercise has been found to improve diabetes control. Tai Chi may be a beneficial alternative, but research findings have been inconsistent. In randomized clinical trials, no significant changes in glucose control were found after 16 weeks of a combined form of Sun and Yang styles (Tsang & Hui-Chan, 2008), 12 months of Yang-style (Thomas et al., 2005) or Sun style (Song, Ahn, Roberts, Lee, & Ahn, 2009).

In other randomized studies, glucose control significantly improved with Tai Chi. In a case– control study of 12 weeks Chen-style, HbA1c (a marker of diabetes control) was significantly lower in patients with type 2 diabetes compared to age-matched controls (Yeh et al., 2009a). In women with type 2 diabetes, Yang-style at a moderate aerobic intensity [50–85% maximum oxygen consumption (VO2max)] significantly improved glucose control after 14 weeks of five sessions per week (Zhang & Fu, 2008). Hui and associates (2009) found similar changes in blood glucose of sedentary middle-aged men after 12 weeks of Yang-style or walking exercise. In obese patients with type 2 diabetes, beneficial decreases in HbA1c were found after 12 weeks of Chen style five times per week (from 8.9% to 8.3%) and walking (from 8.8% to 8.5%) (Chen et al., 2010).

Stress, Anxiety, and Other Emotions Several studies have found that Tai Chi increases psychological health. Jin (1992) randomly assigned subjects to four treatment groups: Tai Chi, brisk walking, meditation, and neutral reading. State anxiety was decreased more in the Tai Chi and brisk walking groups than the other two groups. Compared to a stretching and wellness education, depression among community-dwelling adults with rheumatoid arthritis was significantly lower in the group performing Yang-style one hour twice-weekly for 12 weeks (Wang et al., 2005). When people with traumatic brain injury completed 6-weeks of Chen-style, sadness, confusion, anger, tension and fear significantly decreased, and energy and happiness increased (Gemmell & Leathem, 2006). Similarly, in persons with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), groups engaged in 8 weeks of either Tai Chi or aerobic exercise had better mood states than in the control group (Galantino et al., 2005). A recent meta-analysis described effect sizes (ES) of one hour to one-year Tai Chi on psychological well-being in community-dwelling healthy participants and those with chronic conditions (Wang et al., 2010). Beneficial effects of Tai Chi included reductions in stress (ES=0.66), anxiety (ES=0.66), and depression (ES=0.56), and increased mood (ES=0.45).

Quality of Life Quality of life (QOL) is derived from the complex process of a person’s perceived physical health, psychological state, personal beliefs, social relationships, and relevant features of the external environment. Several randomized studies involving diverse populations of healthy chronically ill adults have consistently found that Tai Chi improves QOL.

Irwin and associates (2003) reported that the role-physical and physical functioning components of QOL [36-item Short Form questionnaire (SF-36)] were better in healthy older adults after completing 15 weeks of Tai Chi compared with the wait-listed control group. In randomized clinical trials in persons with heart failure, QOL was improved after 12 weeks of Yang-style performed for one hour twice a week as compared with those receiving usual care (Yeh et al., 2004, 2008, 2011). Galantino and associates (2005) also reported that health- related QOL of persons with AIDS was significantly greater after 8 weeks of Tai Chi and aerobic exercise than in controls.

Community-dwelling persons with lower-extremity osteoarthritis reported improved QOL (WOMAC) after one-hour Yang-style twice weekly for 12 weeks compared to those receiving usual care (Hartman et al., 2000). In persons with rheumatoid arthritis, the vitality components of QOL (SF-36) were significantly higher with 12 weeks of twice weekly Yang-style when compared with wellness education (Wang et al., 2005). Lee and associates (2007) studied residents of a care facility in Hong Kong and reported that health-related QOL improved more after 26 weeks of Tai Chi than the control group who continued their usual daily activities. In a randomized trial involving breast cancer survivors, Mustian and colleagues (2004) also found significant improvements in health-related QOL after 12 weeks of 60 minutes Yang-style Tai Chi and Chi Kung three times a week compared to those who received psychosocial support.

Sleep Improved sleep has also been reported following Tai Chi, which could be associated with decreases in stress and anxiety induced by this exercise (Li et al., 2004; Wall, 2005). Using the Pittsburgh Sleep Quality Index, Li and associates (2004) found improvements in sleep quality, sleep efficiency, and sleep disturbances were better for the participants who performed Yang-style three times per week for 24 weeks than for those engaged in low-impact exercise. Older adults with moderate sleep complaints involved in 25 weeks of Tai Chi had greater sleep quality, efficiency, and duration, and less sleep disturbance than those who received health education (Irwin, Olmstead & Motivala, 2008).

Sleep stability was also improved following Tai Chi in patients with heart failure compared with usual care (Yeh, Wayne, & Phillips, 2008). The Tai Chi group had greater high-frequency cardiopulmonary coupling and lower low-frequency coupling on sleep spectrograms.

Immune Function A few randomized clinical studies reveal Tai-Chi-induced immune-related responses. Combining vaccination with Tai Chi three times a week for 25 weeks was significantly more effective at increasing varicella zoster virus cell-mediated immunity in healthy older adults than was vaccine alone (Irwin, Olmstead & Oxman, 2007).

Based on a psychoneuroimmunology paradigm, McCain and associates (2008) explored 10 weeks of alternative stress-management interventions on immune function in subjects with HIV. The weekly 90-minute sessions of Tai Chi and psychosocial interventions (spiritual and cognitive-behavioral relaxation) significantly enhanced immune function (lymphocyte proliferation counts). Because other indicators for stress management including salivary cortisol were not significantly changed by the interventions, the mechanism underlying this enhanced immune function has yet to be established (McCain et al., 2008).

Immune function and inflammation are closely related and are often assessed using biomarkers, such as interleukin-6 (IL-6) or C-reactive protein (Jahnke et al., 2010). Irwin and Olmstead (2011) found that older adults performing Tai Chi for 16 weeks had reduced IL-6, while it remained high among those who had received health education. A psychoneuroimmunological mechanism potentially underlies the effects of Tai Chi because changes in depression and IL-6, were significantly correlated. In a randomized clinical trial, obese patients with type 2 diabetes engaged in Chen-style three times per week for 12 weeks experienced significantly decreased inflammation (high-sensitivity C-reactive protein) compared to the conventional-exercise group (Chen et al., 2010).

MECHANISMS UNDERLYING THE EFFECTS OF TAI CHI

Physical Function Tai Chi is more challenging to postural control than normal walking. Compared to normal gait, Tai Chi movements involve a longer-duration single-leg stance (Wu et al., 2004) but a greater proportion of time in double-stance support (Hong, Mao & Li, 2008; Wu et al., 2002). The duration of the transition from one stance to another is also longer for Tai Chi movements. The greater postural control and shorter transitions required for Tai Chi may account for the improvement in postural stability found in many studies.

The characteristics of Tai Chi may also explain its muscle-strengthening effects. During Tai Chi, the muscles responsible for knee flexion and extension, ankle dorsal and plantar flexion, and hip flexors and abductors are coactivated longer than during normal walking and involve greater proportions of alternating concentric and eccentric contractions (Wu, Liu, Hitt & Millon, 2004). Moderate-to-large correlations between the strength of the knee extensors and duration of muscle activation of the knee extensors and ankle dorsal flexors were found during Tai Chi gait (Wu et al., 2004) and movements (Chan et al., 2003; Wu, 2008) but not normal walking. In summary, Tai Chi movements are more challenging than normal walking and require sustained motor control of the muscles of the lower extremities (Wu et al., 2004; Wu, 2008). The cumulative effects of performing Tai Chi may thus increase the strength of these muscles.

Although Tai Chi does not involve training for the specific skills required for activities of daily living, the characteristics of this exercise appear to mimic neurological adaptations that are transferable to the performance of these activities (Hong & Li, 2007). The motor patterns required for Tai Chi are also essential for mobility and many instrumental activities of daily living (Fontana, Colella, Wilson & Baas, 2000; Schneider & Leung, 1991). Overall, people who learn Tai Chi ultimately develop a larger repertoire of postural and motor responses that are required for a wide variety of the activities of daily living and challenging environmental conditions.

Cardiovascular Functioning The potential mediating mechanism underlying the blood-pressure-lowering effect of Tai Chi could be increased vagal stimulation from abdominal (Dantian) breathing (Thornton, 2008). Further studies are required to confirm other potential physiological mediators of Tai Chi on hypertension.

Tai Chi consists of moderate intensity endurance and resistance exercise, which is equivalent to the intensity of aerobic exercise recommended for patients with type 2 diabetes (Colberg et al., 2010). The more vigorous, moderate-intensity forms of Tai Chi, such as the Yang and Chen, require more than 4 metabolic equivalents (METs corresponding to 58% of VO2max) that may be more beneficial for cardiovascular functioning (Zhuo, Shephard, Plyley, & Davis, 1984) than would the 2.7–3.0 METs for Sun style or a combination of Sun and Yang styles (K. Y. Lee, Jones, Hui-Chan, & Tsang, 2011).

Psychological Functioning The psychological benefits of Tai Chi may be attributed to its capacity to endow periods of great calm and mental tranquility, which are based mainly on the mind–body connection through relaxation and meditation components of the exercise (Jimenez, Melendez, & Albers, 2012). Further studies are required to examine whether the psychological benefits of Tai Chi are related to its Qigong component.

Immune Function The mechanisms underlying the association between Tai Chi and immune function are unclear. Based on a psychoneuroimmunology paradigm, the psychological health effects due to the meditation or Qigong components of Tai Chi as a mind–body exercise may explain the improvement in immune function (Jahnke et al., 2010).

For full Reference List, go to http://www.health.gov.au/internet/main/publishing.nsf/Content/submission2

Source: The Department of Health, www.health.gov.au

References

1. Clark, A 1998, The Complete Illustrated Guide to Tai Chi pp20-23 Harper Collins, UK

2. Clark, A 1998, The Complete Illustrated Guide to Tai Chi p236 Harper Collins, UK

3. Consumer Reports (Feb 2000, p 45) http://www.krapu4.com/taichi/research/tairesum.htm#Wolfson1

4. Consumer Reports http://www.krapu4.com/taichi/research/tairesum.htm#Wolfson1

5. Review of Australian Government Rebate on Natural Therapies for Private Health Insurance

6. https://it-dumps-pdf.blogspot.com/2019/09/tai-chi-chuan-benefits-and- history.html

7. https://gregyuenmd.com/seven-elements-of-chi-cultivation

8. https://en.wikipedia.org/wiki/Dantian

9. http://www.chikung-unlimited.com/Pressure-Point Meditation.html

10. http://www.beginnerstaichi.com/tai-chi-standing.html

11. http://taichibasics.com/six-harmonies/

12. Scott Jeffrey: https://scottjeffrey.com/zhan-zhuang

13. Fitness Australia: Policies and Guidelines: Scope of Practice for Registerd Exercise Professionals

14. Fitness Australia: Policies and Guidelines: Referral Process Flowchart

About the Author

Jenny’s interest in Tai Chi began almost 30 years ago when she was studying Goju Ryu karate. After watching a demonstration of Tai Chi and the martial application of the postures, Jenny developed an interest in the concept of strength through softness, and soon the physical and cognitive benefits of slow, flowing movements became apparent. Over the years, and under the guidance of Master Ming Shao, Master Jesse Tsao, Master Deming Liu and Master Su Rule, Jenny has become proficient Yang and Sun style tai chi. She studied under Master Cheung in Shibashi and in 2019 Jenny studied under Professor Yang YuBing at Beijing Sports University Jenny is an approved Tai Chi (sword) instructor with WTQA and she has completed the Tai Chi for Mental Health and Cognitive Improvement course through Exercise Medicine Australia. Her tai chi school, Rising Moon Tai Chi, which is based on the beautiful Mornington Peninsula, offers classes in Qigong, Shibashi, Sun and Yang style tai chi, including Beijing 24, and Tai Chi for Mental Health and Cognitive Improvement. Rising Moon Tai Chi delivers accredited tai chi courses to fitness professionals and those members of the tai chi community who wish to embark on their own teaching journey. Her qualifications include: • Bachelor of Education • Diploma of Teaching (Primary) • Certificate IV in Fitness – Australian Institute of Fitness • Certificate IV in Training and Assessment • Cert III in Fitness – Australian Institute of Fitness • Tai Chi Bang – Eight Immortal Flute Instructor (Advanced Level) • Tai Chi Instructor – Ziranmen Kung Fu Academy • Exercise Medicine Australia: Tai Chi for Cognitive Function • Exercise Medicine Australia; Tai Chi for Falls Prevention • Wudang Bamboo Form Accredited Instructor – Master Su Rule • Member Instructor (Shibashi) – Tai Chi Qigong, Feng Shui Institute • Group Exercise Instructor – Australian Institute of Fitness • THUMP and Punchfit Boxing Instructor • MTT Bootcamp and Outdoor Group Fitness Trainer • TRX Trainer • Advanced First Aid

Rising Moon Tai Chi 0418 566 216 [email protected] www.risingmoontaichi.net