TAI CHI FOR
Hain, MD• Last updated on
August 23, 2020->
STUDY: N.I.H. Office of Alternative
Medicine (OAM). "Tai Chi for Balance Disorders." 1993-1994,
Reference # 1R21RR09535-01. Site, Rehabilitation Institute of Chicago. Sponsoring
Institution: Northwestern University, Chicago Illinois, USA. Principal Investigator:
T. C. Hain, MD. Other investigators: J. Kotsias, Lynne Fuller (PT), L. Weil
Our aim was to determine if eight weeks of daily practice of an alternative
health care exercise, T'ai Chi, can significantly improve balance of persons
with mild balance disorders. We studied 22 persons with stable and mild balance
disorders, with numbers distributed equally between 3 age groups : 20-44, 46-60,
and 61 and beyond. We evaluated efficacy of T'ai Chi through comparison of functional
tests of balance (Romberg, Duncan Reach Test, Moving Platform
Posturography) and self-reports of balance and falls (Medical Outcomes Study
(MOS) questionnaire, Dizziness Handicap Inventory (DHI) questionnaire), obtained prior to and
following the Tai Chi course.
The Tai Chi movements that we used were selected from several different schools
of T'ai Chi and included the following sequence: Hold the Ball (Wu style), Turning
the Wheel (Yang style, as illustrated to the right), Brush Knee and Twist Step
(Yang style), Step Back to Repulse Monkey (Yang style), Walking the Circle (Pa-Kua
style), Kick heel to left and right (Wu style), Partition of the Wild Horse's
Mane (Wu style), Hold the Ball.
Highly significant improvements were noted in posturography (average score
improved from 59.5 to 64.3) and the MOS and DHI tests. An insignificant improvement
was found in the Romberg test (although there was a strong trend). There was
no effect on the Duncan reach test scores. Improvements were found in all age
Eight weeks of Tai Chi was associated with significant improvement in balance.
You can download the Taichi handout (about 650K,
pdf format, 20 pages) which are the instructions that were used in our study.
See the journal article by Hain et al, 1999 ( full
citation below) for more detail about the study. This article can be downloaded
through the web as a PDF
file from the archives of otolaryngology site. You will need Adobe
acrobat to read a pdf file.
Tai Chi forms used in our study
- Chou, JR. Pa Kua Palm Practice (Chinese), Tai Ping
Book Store, Hong Kong, 1969
- Kotsias, J. The Essential Movements
of Tai Chi. Paradigm Publications, 1989 (available through Redwing Books,
- Ru HS. Wue (Hao )style T'ai Chi (Chinese), People's
athletic publishers, Beijing, 1964
- Yang Cheng Pu. Practical use of T'ai Chi Chuan (Chinese),
Ching Martial Arts Pub, Taipei, Taiwan, 1935
- Wu CC. Wu Style Tai Chi (Chinese), People's athletic
publishers, Beijing, 1958
These references came from Mr. Kotsias's library and
we do not know where most of them are obtained at present. They may be out of
print. However, numerous similar books are available through Redwing Books (see
link list at end).
Measures used in our study. These can be obtained through medical libraries.
- Stewart AL, Hays RD, Ware JE. The MOS short-form general
health survey. Medical Care, 26, 1988, 724-735
- Jacobson GP, Newman CW. The
development of the dizziness handicap inventory. Arch Otol HNS, 116, 1990,
- Duncan PW, Studenski S, Chandler
J, Prescott B. Functional reach: predictive validity in a sample of elderly
male veterans. J. Gerontology, 1992, 47, M93-M98
Health Effects of Tai Chi as well as some other martial arts. These references
can be obtained through medical libraries and interlibrary loan.
T'ai Chi is hot ! There are an immense number of recent references concerning the health benefits of T'ai Chi. As of 2015, there were 326 in PubMed. As of 1994, when we did our study, there were only about 10, so almost all of them were published after our study (done in 1993-1994 and published in 1999). Many of these studies seem to be somewhat high on enthusiasm and low on scientific rigor. Nevertheless, there is no reasonable argument with the general idea that regular balance exercise (such as T'ai Chi) improves balance. There is also little argument about the point that T'ai Chi, done in a group or with an exercise video, is much less expensive than the typical twice/week physical therapy for 3 months or even personal trainers. We doubt that there is much difference between the different schools of T'ai Chi, other than activities done sitting are likely less beneficial.
One would think that Yoga, cycling, hiking, or just walking around the pond out back would also have considerable benefits over more sedentary activities and perhaps we will also see a surge of publications concerning other group activities in the future.
Here is a small selection of the numerous publications on T'ai Chi and health benefits.
- Azimzadeh, E., et al. (2015). "Effect of Tai Chi Chuan on balance in women with multiple sclerosis." Complement Ther Clin Pract 21(1): 57-60.
- Brown, D. D., W. G. Mucci, et al. (1989). "Cardiovascular and ventilatory
responses during formalized T'ai Chi Chuan exercise." Research Quarterly for
Exercise & Sport 60(3): 246-50.
- Brown, D. R., Y. Wang, et al. (1995). "Chronic psychological effects of
exercise and exercise plus cognitive strategies." Medicine and science in
sports and exercise 27(5): 765-775.
- Carande-Kulis, V., et al. (2015). "A cost-benefit analysis of three older adult fall prevention interventions." J Safety Res 52: 65-70.
- Chen, B. L., et al. (2015). "Effect of Traditional Chinese Exercise on Gait and Balance for Stroke: A Systematic Review and Meta-Analysis." PLoS One 10(8): e0135932.
- Forrest WR. Anticipatory postural adjustment and T'ai Chi Ch'u. Biomedical
Sciences Instrumentation, 1997;33;65-69
- Hain TC, Fuller L, Weil L, Kotsias J. Effects
of T'ai Chi on Balance. Arch Otolaryngol Head Neck Surg 1999 Nov;125(11):1191.
Also see https://archotol.ama-assn.org/issues/v125n11/pdf/ooa9002.pdf" PDF
file on Arch Otolaryngol site.
- Hain TC, Kotsias J, Pai CY. Tai Chi: Applications to Neurology. Chapter
19. Alternative and complementary treatment in Neurologic Illness, Weintraub
MI, Ed. (Micozzi MS, senior editor). Churchill Livingstone, 2001. 248-254
- Huang, Y. and X. Liu (2015). "Improvement of balance control ability and flexibility in the elderly Tai Chi Chuan (TCC) practitioners: a systematic review and meta-analysis." Arch Gerontol Geriatr 60(2): 233-238.
- Jacobson, B. H., H. C. Chen, et al. (1997). "The effect of T'ai Chi Chuan
training on balance, kinesthetic sense, and strength." Perceptual & Motor
Skills 84(1): 27-33.
- Jin, P. (1992). "Efficacy of Tai Chi, brisk walking, meditation, and reading
in reducing mental and emotional stress." Journal of Psychosomatic Research
- Judge, J. O., C. Lindsey, et al. (1993). "Balance improvements in older
women: effects of exercise training." Physical Therapy 73(4): 254-62; discussion
- Kirsteins, A. E., F. Dietz, et al. (1991). "Evaluating the safety and potential
use of a weight-bearing exercise, Tai-Chi Chuan, for rheumatoid arthritis
patients." American Journal of Physical Medicine & Rehabilitation 70(3): 136-41.
- Koh, T. (1981). "Tai Chi and ankylosing spondylitis -- a personal experience."
Am. J. Chinese Ed 9: 15-22. Koh, T. (1981). "Tai Chi Chuan." American Journal
of Chinese Medicine IX: 15-22.
- Kutner, N. G., H. Barnhart, et al. (1997). "Self-report benefits of Tai
Chi practice by older adults." Journals of Gerontology. Series B, Psychological
Sciences & Social Sciences 52(5): 242-6.
- Lai, J. S., C. Lan, et al. (1995). "Two-year trends in cardiorespiratory
function among older Tai Chi Chuan practitioners and sedentary subjects."
Journal of the American Geriatrics Society 43(11): 1222-7.
- Lai, J. S., M. K. Wong, et al. (1993). "Cardiorespiratory responses of Tai
Chi Chuan practitioners and sedentary subjects during cycle ergometry." Journal
of the Formosan Medical Association 92(10): 894-9.
- Lan, C., J. S. Lai, et al. (1998). "12-month Tai Chi training in the elderly:
its effect on health fitness." Medicine & Science in Sports & Exercise 30(3):
- Lan, C., J. S. Lai, et al. (1996). "Cardiorespiratory function, flexibility,
and body composition among geriatric Tai Chi Chuan practitioners." Archives
of Physical Medicine & Rehabilitation 77(6): 612-6.
- lansheng, g., J. Q, et al. (1981). "Changes in heart rate and electrocardiogram
during taijiquan exercise. Analysis by telemetry in 100 subjects." Chinese
Medical Journal 94(9): 589-592.
- Katrancha, E. D., et al. (2015). "Effects of a video guided T'ai Chi group intervention on center of balance and falls efficacy: a pilot study." Geriatr Nurs 36(1): 9-14.
- Kim, H., et al. (2015). "Effects of therapeutic Tai Chi on balance, gait, and quality of life in chronic stroke patients." Int J Rehabil Res 38(2): 156-161.
- Lumsden, D. B., A. Baccala, et al. (1998). "T'ai chi for osteoarthritis:
an introduction for primary care physicians." Geriatrics 53(2): 84.
- Perrin P, Deviterne D, Hugel F, Perrot C. Judo, better than dance, develops
sensorimotor adaptabilities involved in balance control. Gait and Posture,
15:2, 187, 2002
- E. C. Hadley, et al. (1995). "The effects of exercise on falls in elderly
patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries:
Cooperative Studies of Intervention Techniques [see comments]." JAMA 273(17):
- Rahal, M. A., et al. (2015). "Analysis of static and dynamic balance in healthy elderly practitioners of Tai Chi Chuan versus ballroom dancing." Clinics (Sao Paulo) 70(3): 157-161.
- Ryan, A. (1974). "Tai Chi Chuan for Mind and Body." The physician and Sports
Medicine(March 1974): 58-61. Schaller, K. (1996). "Tai Chi Chih. An exercise
option for older adults." J. Gerontological Nursing 22(10): 12-17.
- Saravanakumar, P., et al. (2014). "The influence of tai chi and yoga on balance and falls in a residential care setting: A randomised controlled trial." Contemp Nurse 48(1): 76-87.
- Schneider, D. and R. Leung (1991). "Metabolic and Cardiorespiratory Responses
to the performance of Wing Chun and T'ai Chi Chuan Exercises." Int J. Sports
MEd 12: 319-323.
- Song, R., et al. (2015). "Effects of t'ai chi on balance: a population-based meta-analysis." J Altern Complement Med 21(3): 141-151.
- Tse, S. K. and D. M. Bailey (1992). "T'ai chi and postural control in the
well elderly." American Journal of Occupational Therapy 46(4): 295-300. Weiser,
M., I. Kutz, et al. (1995). "Psychotherapeutic aspects of the martial arts."
American Journal of Psychotherapy 49(1): 118-27.
- Vallabhajosula, S., et al. (2014). "Tai chi intervention improves dynamic postural control during gait initiation in older adults: a pilot study." J Appl Biomech 30(6): 697-706.
- Wolf, S. L., H. X. Barnhart, et al. (1997). "The effect of Tai Chi Quan
and computerized balance training on postural stability in older subjects.
Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies on Intervention
Techniques." Physical Therapy 77(4): 371-81; discussion 382-4.
- Wolf, S. L., H. X. Barnhart, et al. (1996). "Reducing frailty and falls
in older persons: an investigation of Tai Chi and computerized balance training.
Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention
Techniques [see comments]." Journal of the American Geriatrics Society 44(5):
- Wolf, S. L., C. Coogler, et al. (1997). "Exploring the basis for Tai Chi
Chuan as a therapeutic exercise approach [see comments]." Archives of Physical
Medicine & Rehabilitation 78(8): 886-92.
- Wolf, S. L., N. G. Kutner, et al. (1993). "The Atlanta FICSIT study: two
exercise interventions to reduce frailty in elders." Journal of the American
Geriatrics Society 41(3): 329-32.
- Wolfson, L., R. Whipple, et al. (1996). "Balance and strength training in
older adults: intervention gains and Tai Chi maintenance [see comments]."
Journal of the American Geriatrics Society 44(5): 498-506.
- Zhang, T. Y., et al. (2015). "Effects of Tai Chi and Multimodal Exercise Training on Movement and Balance Function in Mild to Moderate Idiopathic Parkinson Disease." Am J Phys Med Rehabil 94(10 Suppl 1): 921-929.
- Zhuo, D., R. J. Shephard, et al. (1984). "Cardiorespiratory and metabolic
responses during Tai Chi Chuan exercise." Canadian Journal of Applied Sport
Sciences - Journal Canadien des Sciences Appliquees au Sport 9(1): 7-10.
- Zhou, J., et al. (2015). "Effects of 24 weeks of Tai Chi Exercise on Postural Control among Elderly Women." Res Sports Med 23(3): 302-314.
- Golden Tai Chi: https://www.taichiforseniors.com/.
Dr. Hain has reviewed this videotape. It is a modified Tai Chi similar to
the sequence used in our study. The tape does not indicate the source of exercises,
and the naming convention is not conventional. Nevertheless, it is a commercial
Tai Chi format that may be helpful. It is formated so that one can use it
as an exercise video. The exercises are more difficult than the ones above,
and persons with significant balance disorders may not be able to perform
the more difficult movements.
- www.redwingbooks.com -- The Redwing
Book company (617-738-4664) in Brookline Mass carries an immense selection
of Tai Chi Books and videos.
- National center for complementary and alternative medicine (NCCAM, https://nccam.nih.gov/)
- Stay Healthy with Tai Chi: https://www.medicalalertadvice.com/resources/stay-healthy-with-tai-chi/