Those of us with a regular T'ai Chi practice intrinsically understand its value for everything from physical fitness to spiritual fulfillment. In communicating our enthusiasm for T'ai Chi, what we often lack is the kind of hard evidence for T'ai Chi's value that can break through the wall of skepticism put up by many Westerners.
That's why a 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), T'ai Chi was the only exercise/activity to show a statistically significant decrease in the number of falls among the elderly study participants. The T'ai Chi practitioners recorded a 25 percent 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 when people get hurt. The nature of T'ai Chi is helping people understand the value of moderation, which has always made it the safest of exercise.
More than 30 percent of people aged 65 or older experience at least one fall per year, and 15 percent 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 of senior citizens cost $3.7 billion a year.
Unlike anecdotal evidence that the skeptical can shrug off as Eastern mysticism, this study involved eight 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 T'ai Chi is alive and well in Western medical research. This groundbreaking study lasted 12 years, resulting in final publication of results in 1984. 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, eight were chosen and funded as of April 1990. The studies took place over the ensuing three years, concluding in March 1993. Since then, it's been a matter of follow-up—tracking the incidence of falls, data analysis, and peer review. Addressing the ongoing value of T'ai Chi training, the JAMA article notes, "It is encouraging that the reduction in risk persists...for a median time of 1.5 years."
The T'ai Chi component of the study took place at Emory University in Atlanta, Georgia, under the supervision of Dr. Steve Wolf from the Department of Rehabilitative Medicine. While the JAMA article did much to open doctors' eyes to T'ai Chi's benefits, it didn't go into detail about the T'ai Chi study. Wolf forged ahead with a more detailed report for the Journal of the American Geriatric Society. After some frustrating delays in the process, the report finally appeared in the May 1996 issue of the Journal. Emory is known for its open-minded approach to finding healthcare solutions. In a typically Taoist example of convergence, it so happened that T'ai Chi Master Tingsen Xu was a visiting professor of Biochemistry at Emory in 1990 when it came time to put this study together. 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 study compared T'ai Chi to the expensive, technologically advanced Chattecx Balance System of Chattanooga 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 T'ai 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," he stated. 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, T'ai Chi's renowned centering principles made the difference that no other exercise could match.
The Emory study looked at seven therapeutic benefits for T'ai Chi:
1. Continuous movement.
2. Small to large degrees of motion depending on the individual.
3. Flexed knees with distinct weight shifts between legs.
4. Straightening and extending head and trunk for less "flexed" posture. Attention developed to prevent leaning of trunk or protrusion of the sacrum.
5. 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.
6. Asymmetrical and diagonal arm and leg movements promote arm swing and rotation around the waist axis.
7. 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 T'ai Chi's benefits is a virtual recipe for alleviating these common problems in the elderly. The most significant difference between T'ai Chi and other exercises is awareness. There's nothing special about the T'ai Chi movements in and of themselves. As any Master will confirm, if the moves are performed without concentration, T'ai 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."
The T'ai Chi moves in this study are a simplified selection from the first third of the yang style. This modified form begins, naturally enough, with Origin. The following nine moves from the study were:
1. Ward off Left.
3. Cloudy Hands.
4. Single Whip.
5. Ward off Left.
6. Brush Left Knee, Push Right.
7. Kick Right.
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 doing the form. Xu's real success as a motivator was his ability to relate stories from his students' own lives. As a youthful man in his 60s, when Xu explained how his students can become distracted by thoughts of their grandchildren that might cause them to miss a step and incur a fall, they saw the value of "being in the moment." Showing how T'ai Chi kept them in the moment occurred by his explanation, not merely by his demonstration of a move. While some may complain that that's spoon-feeding, it's also what kept more than the hard core in the class.
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 rather an explanation of why it's okay not to torture yourself over slow progress or 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 T'ai Chi study. The T'ai 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. T'ai Chi gives people confidence that they can move in ways they might have been afraid to try without this training. By so doing, T'ai 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 T'ai Chi. While it's true that the T'ai Chi journey is a lifetime affair, it behooves teachers to emphasize that the benefits accrue from the first lesson. While serious T'ai 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 T'ai Chi journey.
Studies such as 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 such as this to show people that T'ai Chi works not just from our own Eastern flavored view of the world, but also when seen through the eyes of Western medical scientists.
While it's true, to paraphrase Lao Tzu, that "words can't reveal the whole truth," words can guide people in the right direction. T'ai Chi won't become the next fad, and will be healthier for that.
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