Tai-Chi for Fibromyalgia

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Despite the fact that the term “Qigong” (pronounced chee-gung) was first coined in the 1900s, the origin of the practices it describes span beyond recorded history. Qigong refers to the ancient Chinese practices that combine movements or postures, breathing, and mind-body interaction to promote health and well-being. One of the most well-known types of Qigong is tai chi (also referred to as tai chi chuan), which is an ancient form of Chinese martial arts that was originally developed for the purposes of self-defense. Qigong, however, is not a form of martial arts (Langhorst et al., 2011). Over time, tai chi has evolved into a calming and fluid form of exercise that is known for its ability to reduce stress and promote healing.

Tai chi is in essence a noncompetitive and self-paced method of gentle exercise and stretching motions. It involves performing a series of postures and movements in a deliberate and slow manner. The movement between postures is seamless, which gives tai chi its fluid characteristics and ensures that the body remains in constant motion. There are a variety of styles of tai chi, including yang and wu, and each style places individual emphasis on certain methods and principles of tai chi. Within each style, there are also a number of variations, some of which focus on maintaining health, while others emphasize the martial arts roots of tai chi. In turn, there are over 100 possible movements and positions that are possible with tai chi, a majority of which are named after animals or elements of nature. Despite the considerable number of variations, all forms of tai chi incorporate rhythmic movements with breathing to help facilitate a feeling of inner calmness. Tai chi requires extensive concentration that demands participants focus on the present and eliminate any distressing thoughts or feelings.

Tai chi can be performed at varying levels of intensity, which are usually dictated by the form or style of tai chi that one chooses to practice. The majority of tai chi forms are appropriate for anyone. This makes tai chi suitable for individuals of practically any age and physical ability, as tai chi focuses on technique rather than physical strength. The low-impact nature of tai chi makes it especially appealing to older adults who may otherwise not be able to exercise. Furthermore, tai chi is appealing for a variety of other reasons as well: it is inexpensive, requires no equipment, can be done solo or with a group, and can be done indoors or outside.

Tai chi is generally regarded as an extremely safe form of exercise. Nevertheless, discuss your plans with your doctor prior to starting any tai chi, especially if you have joint problems (including the spine), heart problems, or severe osteoporosis, or if you are pregnant or have any bone fractures. Tai chi is generally considered safe with no negative side effects, however it is possible to get injured if you do not understand how to properly perform tai chi. Therefore, although videos and books about tai chi are readily available, the best and safest way to begin tai chi is to consult a qualified tai chi instructor who can adequately describe and teach the proper techniques. They can teach you the individual positions as well as how to appropriately regulate your breathing. In addition, they can provide instruction on safe tai chi movements for individuals with prior injuries, chronic health problems, or issues with balance and coordination.

Tai chi classes are widely offered in many areas. Examples of organizations and places that may offer tai chi classes include the following: YMCA or YWCA, health and fitness clubs, community education centers, and senior centers. It is important to also understand that there are no licensing requirements for tai chi instructors, nor are there any standard training programs. Therefore, it is important to ask about a potential instructor’s training and experience, and to even ask for personal recommendations from others who have tried tai chi.

By requiring the mind and body to work in tandem, tai chi can help to reduce stress levels among those who practice it. The focus during tai chi is on movement and breathing, a combination that facilitates a calm and relaxed sense. Furthermore, the calming effects of tai chi persist following a tai chi session. And, while it cannot be considered a suitable alternative for traditional medicine, tai chi may help to improve overall health by decreasing the physical side effects often associated with stress. It is important to note that in order to gain the most beneficial rewards from tai chi in terms of stress reduction and overall well-being, tai chi should be practiced regularly.

Tai Chi Research

Tai chi has only recently begun to be studied from a scientific point of view, and further research is clearly needed. However, emerging evidence has shown that tai chi may be useful at reducing anxiety and depression, improving balance, coordination, and strength, as well as reducing falls, improving sleep quality, reducing elevated blood pressure, improving cardiovascular fitness (particularly in older adults), easing chronic pain, increasing energy, endurance, and agility, and improving overall well-being. Many of these symptoms and conditions are commonly experienced by fibromyalgia patients; therefore, tai chi may have important therapeutic value to those suffering from fibromyalgia.

A considerable amount of research exists related to tai chi as a therapy for improving fibromyalgia symptoms. A small study that looked at the effects of a four month tai chi intervention on tenderness, functional capacity, symptoms, and quality of life in men with fibromyalgia demonstrated improvements in lower body flexibility. It is important to note, however, that this study included only six patients all of whom were men (Carbonell-Baeza et al., 2011). An earlier study by Taggart et al. (2003) investigated the effects of tai chi as an exercise method to treat fibromyalgia symptoms and impact health-related quality of life. This pilot study involved the use of one hour tai chi exercises classes, twice a week, for a total of six weeks. The Fibromyalgia Impact Questionnaire (FIQ) and the Short Form-36 (both frequently used, validated assessment tools to measure fibromyalgia symptoms and health-related quality of life) were administered to each participant before and after exercise. Of the 39 original participants, 21 completed at least 10 of the 12 exercise sessions. Despite the rather high dropout rate, participant responses to the questionnaires indicated significant improvements in both symptom management and health-related quality of life. While the authors suggest that tai chi has potential for use in combined therapy for fibromyalgia patients, they note that continued research is necessary to provide additional evidence in support of its use (Taggart et al., 2003).

More recent research has continued to investigate the utility of tai chi as a treatment for fibromyalgia symptoms. A randomized controlled trial by Wang and colleagues found vast improvements in quality of life and health status beyond what is typically reported in the literature for conventional exercise and drug therapies. Wang et al. used a randomized trial design to compare the Yang-style of tai chi to a control intervention that included wellness education and stretching exercises. Sessions for both groups were 60 minutes in duration and were conducted twice a week for a total of 12 weeks. During their first session, the tai chi group (33 participants; 28 female, 5 male) was educated about the theories behind tai chi and given instructions regarding its principles and techniques. Participants were also asked to practice tai chi at home for a minimum of 20 minutes per day. At the conclusion of the 12 week intervention period, those in the tai chi group were asked to continue their home-based tai chi practice using an instructional DVD until the follow-up study visit at 24 weeks.

Those who were randomized to the control intervention of wellness education and stretching (33 participants; 29 female, 5 male) followed a similar pattern. Each session consisted to a 40 minute instructional lesson on a topic pertaining to fibromyalgia, including: diagnostic criteria, coping strategies, techniques for problem solving, diet and nutrition, sleep disorders, pain management therapies, medication, physical and mental health, exercise, and wellness/lifestyle management. During the last 20 minutes of each class, all participants in the group practiced stretching exercises led by the research staff. These exercises targeted the upper and lower body and trunk (abdomen/back), and were held for 15 to 20 seconds a piece. Like those in the tai chi group, participants in the control group were also asked to continue their stretching at home for 20 minutes a day.

Similar to the Taggart et al. (2003) study, the researchers used the Fibromyalgia Impact Questionnaire and the Short Form-36 to evaluate symptom improvement and both physical and mental health-related quality of life. At the end of the 12 week session, the researchers found that those in the tai chi group had greater improvements in overall fibromyalgia severity as measured by declines in their FIQ scores. Those in the tai chi group saw scores drop an average of 27.8 points versus an average drop of 9.4 points among the control group. In addition, at the end of the 24 week follow-up period, the tai chi group showed significant improvements over the control group with regard to symptom improvement, as indicated by declines in FIQ scores of those measures (28.6 points vs. 18.3 points). Furthermore, the tai chi group also experienced sustained improvements in sleep quality, overall functioning, and various indicators of overall physical and mental health. In their discussion, the authors conclude that tai chi holds the potential to be a useful therapy to help treat many of the common symptoms associated with fibromyalgia. Furthermore, they note that their findings support those of other previously-published papers that have demonstrated benefits for tai chi in treating musculoskeletal pain, depression, and improving quality of life (Taggart el al., 2003; Wang et al., 2004). However, the authors also state the need for longer-term studies using a larger sample size in order to determine the broader validity of their findings (Wang et al., 2010).

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References

1.        Langhorst J, Klose P, Dobos GJ, Bernardy K, Hauser W. Efficacy and safety of meditative movement therapies in fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials. Rheumatol Int. 2012. Feb 15 Epub ahead of print.

2.        What is Qi? And What is Qigong? The Qigong Institute.Accessed April 6, 2012.

3.        Tai Chi: Discover the Many Possible Health Benefits.Mayo Clinic, November 14, 2009. Accessed April 6, 2012.

4.        Carbonell-Baeza A, Romero A, Aparicio VA, Ortega FB, Tercedor P, Delgado-Fernandez M, Ruiz JR. Preliminary findings of a 4-month Tai Chi intervention on tenderness, functional capacity, symptomatology, and quality of life in men with fibromyalgia. Am J Mens Health. 2011;5(5):421-429.

5.        Wang C, Schmid CH, Rones R, et al. A randomized trial of tai chi for fibromyalgia. N Engl J Med. 2010;363:743–754.

6.        Taggart HM, Arslanian CL, Bae S, Singh K. Effects of T’ai Chi exercise on fibromyalgia symptoms and health-related quality of life. Orthop Nurs. 2003;22(5):353-360.

7.      Wang C, Collet JP, Lau J. The effect of Tai Chi on health outcomes in patients with chronic conditions: a systematic review. Arch Intern Med. 2004;164:493-501.

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