Arthritis Foundation Recommends Tai Chi!

By Judith Horstman

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Don't try to learn tai chi from a video or book: It's best to learn from a teacher who can make sure you are doing the movements correctly. As you learn the basics, you can practice on your own or with a video.
  • Choose your teacher carefully. Make sure the instructor has experience teaching people with arthritis and can guide you to the safest movements.
  • Warm up before class and cool down afterward. Tai chi may not seem strenuous, but it does work joints and muscles.
  • Modify the movements if necessary. For example, many tai chi postures are done with bent knees. If you have knee involvement, you may need to adapt those movements to be safe and comfortable.
  • Be cautious when you have a flare or sore joint. Many experts say you can still exercise, but carefully. Check with your doctor if you aren't sure, and stop if it makes you hurt more or if you feel pain two hours after the class.
  • Never push or exert yourself. Most teachers believe the meditative effects of Qi are as important as the physical exercise.
  • Practice daily. The practice can take as few as five minutes or can last as long as an hour per session.
  • Remember that while tai chi is a good adjunct exercise, it doesn't provide much in aerobic or weight-bearing benefits.

Judith Horstman is the author of four books, including "Overcoming Arthritis" with Dr. Paul Lam that details a tai chi program to improve mobility; and of "The Arthritis Foundation's Guide to Alternative Therapies." Her new book, "The Scientific American Day in the Life of Your Brain," was published in August 2009.