
Study at Emory University shows significant decrease in the incidents
of falling after practicing the ancient art of Tai Chi (Taijiquan)

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Those of us with a regular Tai Chi practice intrinsically understand
its value for everything from physical fitness to spiritual fulfillment.
In communicating our enthusiasm for Tai Chi, what we often lack is the kind
of hard evidence for Tai Chi's value that can break through the wall of
skepticism put up by many westerners.
That's why a recent study sponsored by the National Institute on Aging
(NIA) is so encouraging. As published in the May 3, 1995 issue of the Journal
of American Medical Association (JAMA), Tai Chi was the only exercise/activity
to show a statistically significant decrease in the number of falls among
the elderly study participants. The Tai Chi practitioners recorded a 25%
decrease in injuries from falls. Some of the other exercise modules showed
increased falls, merely because the patients were moving more. In resistance
or flexibility training there's the tendency to go too far too fast. That's
where people get hurt. The nature of Tai Chi is helping people understand
the value of moderation, which has always made it the safest of exercise.
While preventing falls may not be high on your list of reasons for studying
Tai Chi, it's certainly an important goal for the senior population. Over
30% of people aged 65 or more experience at least one fall per year and
15% of those falls result in serious injuries. Falls are the sixth largest
cause of death among seniors and contribute to a general health decline
even when they're not the direct cause of death. Falls are expensive. The
last figures are from 1984 -- before the aging trend got into full swing,
and before the recent inflation of medical costs. Even back in 1984, falls
in senior citizens cost $3.7 billion per year.
Unlike anecdotal evidence that the skeptical can shrug off as Eastern
mysticism, this study involved 8 medical facilities, including some of the
most esteemed names in Western medical science: Harvard, Yale, Centers for
Disease Control, Washington University School of Medicine and Emory University.
The slow pace so emphasized in Tai Chi is alive and well in Western medical
research. It's been 12 years from inception in 1984 to publication of this
research into preventing falls. That's not a bad thing, per se. In fact,
it highlights how good research is careful research that isn't hurried.
By 1989, the NIA came together with the National Center for Nursing Research
and the Centers for Disease Control to issue a Request for Applications.
Of 42 proposals, 8 were chosen and funded as of April 1990. The studies
took place over the next three years, concluding in March 1993. Since then
it's been a matter of followup -- tracking the incidence of falls, data
analysis and peer review. Addressing the ongoing value of Tai Chi training,
the JAMA article notes, "It is encouraging that the reduction in risk
persists... for a median time of 1.5 years."
The Tai Chi component of the study took place at Emory University in
Atlanta under the supervision of Dr. Steve Wolf from the Department of Rehabilitative
Medicine. While the JAMA article did much to open doctors' eyes to Tai Chi's
benefits, it didn't go into detail about the Tai Chi study. Wolf forged
ahead with a more detailed report for the Journal of the American Geriatic
Society. After some frustrating delays in the process, Wolf is relieved
that his report is finally in the May, 1996 issue of the Journal. Emory
is known for its open minded approach to finding health care solutions and
in a typically Taoist example of convergence, it so happened that Tai Chi
Master Tingsen Xu was a visiting professor of Biochemistry at Emory in 1990
when it came time to put together this study. Wolf said, "we worked
with Xu to synthesize the 108 moves down to 10 that we felt from a physiotherapeutic
and rehab perspective represented movements that often become compromised
in folks as they get older -- most notably trunk and body rotation and the
ability to maintain a narrower base of support."
The Emory site compared Tai Chi to the expensive, technologically advanced
Chattecx Balance System of Chatanooga Corp. Chattecx uses an independently
mounted balance platform for each foot. The subjects' feet are hooked to
sensors, four on each foot -- front left, front right, rear left, rear right.
They view a cursor that represents their center of balance on a computer
monitor. Subjects were told to keep their balance aligned perfectly and
trained to improve their performance, kind of like an interactive video
game for senior citizens. The premise relies on biofeedback; showing participants
their actual center of balance is intended to help them better maintain
that center of balance even when they're not hooked up to the machine. And
it did work.
Wolf points out that the balance platform participants could maintain
their center of balance better than Tai Chi students, but that this didn't
help them outside the laboratory. "...the notion of training people,
especially older people, to maintain their center of mass within their base
of support as the way to secure safety, is not necessarily correct."
The world isn't a place where we stand with our feet parallel and try to
orient ourselves to a computer screen. In the real world, we walk in poor
light, encounter unfamiliar obstacles and traverse uneven ground. "You
have to be placed in dynamic situations so you can develop strategies that
will enable you to succeed in regaining your balance," said Wolf. In
these real world situations, Tai Chi's renowned centering principles made
the difference that no other exercise could match.
The Emory study looked at seven therapeutic benefits for Tai Chi:
- Continuous movement.
- Small to large degrees of motion depending on the individual.
- Flexed knees with distinct weight shifts between legs.
- Straightening and extending head and trunk for less 'flexed' posture.
Attention developed to prevent leaning of trunk or protrusion of the sacrum.
- Trunk and head rotates as a unit during circular movements that emphasize
rotation. Eyes follow movement, promoting head and trunk rotation through
eye centering and eye movements.
- Asymmetrical and diagonal arm and leg movements promote arm swing and
rotation around the waist axis.
- Unilateral weight bearing with constant shifting to and from right
and left legs to build strength for unilateral weight bearing and improve
unilateral balance through knowledge of one's balance limitations and practice
of movements within those limitations.
Compare these benefits with the list of conditions that all exercise
programs for the elderly must address:
- Slowed movement.
- Reduced range of motion and strength.
- Increased flexed / stooped/ posture.
- Reduced rotational movements.
- Limited arm swing.
- Decreased unilateral weight bearing.
This list of Tai Chi's benefits is a virtual recipe for alleviating these
common problems in the elderly. The most significant difference between
Tai Chi and other exercises is awareness. There's nothing special about
the Tai Chi moves in and of themselves. As any master will confirm, if the
moves are performed without concentration, Tai Chi is merely exercise. But
there is something very 'present' about its emphasis on awareness. And according
to the study, "training for balance may partly work not just because
it increases the limits of stability and balance per se, but because the
subject becomes aware of his or her limits of stability and allows compensation
for the deficits."
As such, it's worth seeking out elderly populations and the health care
professionals who serve them with proposals for Tai Chi classes designed
specifically to meet the particular needs of senior citizens. At the same
time, the structure of a Tai Chi class for seniors should take into account
their special needs and interests. That applies to everything from the moves
taught to the underlying motivating factors for learning the moves.
The Tai Chi moves in this study are a simplified selection from the first
third of the Yang style. This modified form begins, naturally enough, with
Commencement. The following nine moves are:
- Ward off left.
- Push Left
- Cloudy Hands
- Single Whip
- Ward off Left
- Brush Left Knee, Push Right
- Kick Right
- Kick Left
- Close.
Even with such a simple selection of Yang moves it's significant that
Xu taught less than one move each week, despite meeting twice per week.
Think how that compares to the more common goal of teaching two moves per
week.
For impatient youth, two moves a week may be necessary to maintain student
interest. But that needn't be the case. While everyone wants to feel that
they're making progress, that progress can take shape in ways other than
'new moves.' Xu was able to keep his students interested in the principles
and the details by showing them the immediate benefit to their training.
By emphasizing their growing 'awareness' and 'centeredness' Xu showed his
students a greater insight into their selves, which was more than enough
to make them enthusiastic students.
This calls into question the traditional teaching method of 'just do
the form'. Xu's real success as a motivator was his ability to relate stories
from his student's own lives. As a youthful man in his 60s, when he explained
how they can be distracted by thoughts of their grand children that might
cause them to miss a step and incur a fall, they saw the value of 'being
in the moment.' Showing how Tai Chi kept them in the moment occurred by
his explanation, not merely by his demonstration of a move. While some may
complain that it's spoonfeeding, it's also what kept more than the hard-core
in the class. Wolf points out one similarity between this Tai Chi module
and every other known activity, the biggest obstacle was getting them to
"commit to dedicated discipline." Once they saw the value, then
they became more serious students.
Wolf was particularly impressed with the fact that over 50% of the Tai
Chi students returned to studying after the four month break required by
the experiment. Many teachers operate on the 'week in week out' premise
to keep students in the fold. The experience of these students suggests
that with proper motivation, time off only builds enthusiasm and commitment
to the art.
It's important to consider that seniors aren't particularly seeking out
Tai Chi. They're not willing to pass any test imposed by masters to prove
their seriousness as students. They're not 'serious' students in the traditional
martial arts definition of the term, so it's counterproductive to impose
such standards. You wouldn't expect someone who has never heard of Catholicism
to understand the nuances or etiquette of a Catholic High mass without a
gradual explanation. In the same way, willing seniors deserve to be introduced
to Tai Chi with the gentle awareness that they're open minded enough to
consider this very foreign activity. It's important to recognize that they're
merely considering it, not already committed to the practice.
This study reveals the value of learning only part of the form -- a benefit
to many older people who have a hard time remembering moves as the form
grows longer and more complex. It's not condescending -- but ammunition
for explaining why it's OK not to torture yourself over your slow progress
or your frustration at learning new moves. When students are encouraged
to see the value of what they already know, they're less frustrated by feelings
of inadequacy. In fact, building self esteem is a significant benefit to
Tai Chi study. The Tai Chi students had a greatly improved sense of control
over their own health. Given the growing body of evidence for the power
of positive thinking, this is hardly surprising. Without trying to deny
the impact of objective physical maladies, there's a lot of validity in
the maxim: You're as healthy as you think you are. Tai chi gives people
confidence that they can move in ways they might have been afraid to try
without this training. By so doing, Tai Chi builds the confidence that leads
to more independent and thus more fulfilling lives.
The study's short length (only 10 weeks ) also belies the fallacy that
it takes years to benefit from Tai Chi. While it's true that the Tai Chi
journey is a lifetime affair, it behooves teachers to emphasize that the
benefits accrue from the first lesson. While serious Tai Chi study cultivates
humility, it's hardly appropriate in the early stages of study. The common
statement that 'I still know only very little' is a statement of philosophy,
a recognition that there is still a long way to go on the Tai Chi journey.
It's a statement suitable for a lesson in attitude, rather than a helpful
way to reach the population who are interested in Tai Chi primarily for
health. Once students see the physical value of the form, then they're more
open to how that physical awareness transfers to the psychological realm.
At that point, it may make sense to speak gently of the ebb and flow of
life and how Tai Chi expresses the Yin/Yang dichotomy and our own humble
place in the universe based upon that understanding. But just as timing
and sensitivity are important in the form, they're important in teaching
to a specialized audience. Certainly, teaching seniors isn't for everyone.
But if you're a teacher with that extra dose of patience and the flexibility
of teaching methods to consider students who have goals that may be different
from your own, then seeking out seniors in your area can be a rewarding
new teaching opportunity.
Studies like this one present both an opportunity and a responsibility
to everyone interested in Eastern thought and practice. We need to take
advantage of good news like this to show people that Tai Chi works not just
from our own Eastern flavored view of the world, but also when seen through
the eyes of Western medical scientists. Too often, when a supportive article
does show up in scientific literature, it doesn't get the play us converts
might like in the popular press. That's the difference between having highly
paid corporate PR teams who pitch the story to the decision makers and the
decentralized low profile that is the very foundation of a practice like
Tai Chi. That's not to say Tai Chi needs a Tony Robbins. It's more a recognition
that we should all take advantage of the persuasive power of a study like
the one out of the National Institute on Aging to subtly make our case for
Tai Chi in our quiet way.
While it's true, to paraphrase Lao Tsu, that 'words can't reveal the whole
truth,' words can guide people in the right direction. Tai Chi won't become
the next fad, and will be healthier for that. But by telling the curious
or the confused how Tai Chi's benefits have been demonstrated by mainstream
western physicians, we can slowly help more people live healthier lives
through the joys of Tai Chi. |