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On and off I have written about the health benefits of Taiji [1] and Qigong.  Recently an article “A Comprehensive Review of Health Benefits of Qigong and Tai Chi” was published in the American Journal of Health Promotion. [2]   The authors are Roger Jahnke – OMD, LInda Larkey – Ph.D., Carol Rogers – Ph.D., J. Etnier, Ph.D., and F. Lin – MS.  They have reviewed a vast amount of clinical trials whose results were published in peer-reviewed English-language journals between 1993 and December 2007, and found that there is substantial evidence indicating that there is a variety of health benefits associated with Qigong or Tai Chi.  We provide a short summary of the findings of their review article.

Jahnke et. al. performed a review and analysis of the published research articles on the health benefits of Qigong and Tai Chi.  These research studies were all based on randomized controlled trials (RCTs). [3]  They searched five medical databases:  Allied Health and Nursing, psychologial literature, PubMed, Google Scholar, and the Cochrane database.  After filtering articles through a few filters, such as articles were published in a peer-reviewed English-language journal between 1993 and December 2007 and whose methodology was based on RCT, they found 67 articles, which formed the basis of their review and analysis.  The 67 studies originated from 13 countries:  USA – 34, China (including Hong Kong) – 9, Korea – 4, Australia and New Zealand combined – 5, Sweden – 4, Great Britain – 3, Italy and Taiwan – 2 each, Netherlands, Israel, Poland, and Spain – 1 each.

Before we discuss their analysis results, we first explain a little about the Tai Chi exercises usually performed in these clinical trials.  Since clinical trials are usually of short durations, like 12 weeks, the researchers of those clinical trials often use versions of Tai Chi that are simpler than the traditional longer form sets that are practiced when one is learning Tai Chi, especially from a martial arts perspective.  Otherwise,  it would take too long for the students to learn these longer form sets during the relative short durations of the clinical trials.  Instead, they take certain Taiji form movements (e.g., Wave Hands Like Clouds, Grasp the Sparrow’s Tail,  Kick with Heels, Brush Knee and Twist Step, Step Back and Repulse the Monkey) and then repeat them many times.  In a sense, they are similar to some of the warm-up exercises many Tai Chi instructors have the students do at the beginning of each class.  The Qigong exercises that are practiced in these clinical trials [e..g, Eight Silk Brocade (八段錦), Lian Gong 18 Form (練功十八法)] are also similar to some of the warm-up exercises many Tai Chi instructors have the students do at the beginning of each class.  Thus, the differences between the Tai Chi exercises and the Qigong exercises in the clinical trials are reduced.

In both the Qigong and Tai Chi exercises in the clinical trials, emphasis was also put on breathing.  But in beginning Tai Chi courses, many Tai Chi instructors may not emphasize breathing because there are already too many things that the beginning students need to remember in learning the longer form sets.  For example, when I teach the Simplified Yang Style 24 Forms, usually I do not integrate breathing with learning the forms until about half way through the course [4].   However, because as explained in the previous paragraph, Tai Chi in the clinical trials usually involves shorter form sets, so  there is room for integrating breathing with doing the forms even for beginning students.  Thus, the differences between the Qigong exercises and the Tai Chi exercises in the clinical trials are again reduced.  This is why in their article Jahnke et. al. lumped Qigong and Tai Chi into the same category of exercise.

Some of the clinical trials involved Qigong, some involved Tai Chi, and some involved both.  In their analysis of the health benefits of Qigong and Tai Chi, the authors considered nine categories of health benefits.    They are:

• Bone Density
• Cardiopulmonary
• Physical Function
• Falls and Balance
• Immune Function and Inflamation
• Quality of Life
• Self-Efficacy
• Patient-Reported Outcomes
• Psychological

The first five categories are easy to measure whether the Qigong and Tai Chi exercises result in any statistically relevant improvements.  The last four categories are more subjective and will be explained later.

Bone Density: It is known that resistance training and other weight-bearing exercises are known to increase bone formation and have been recommended for postmenopausal women.  Although Qigong and Tai Chi involve no resistance and minimal weight bearing, the four RCTs that tested bone density on the whole did find that there was a favorable effect on bone health, such as bone loss was retarded and number of fractures was less among postmenopausal women.

Cardiopulmonary: A consistent finding was a significant reduction in blood pressure for people practicing Qigong or Tai Chi as compared to inactive control groups.  Even when compared to active control groups such as aerobic exercise or balance training, two groups using Tai Chi found a significant reduction in blood pressure.  The preponderance of studies on cardiopulmonary outcomes show that Qigong and Tai Chi are effective compared to inactive controls, or at least approximately equal to the expected benefits of conventional exercise.

Physical Function: A wide variety of performance indicators (e.g., chair rise, 50-ft walk, muscle contraction strength, hand grip) was used to measure physical function.  It was found that the control groups using Tai Chi showed significant improvement as compared to several minimal activity controlled groups, as well as one exercise-therapy control intervention group.  However, in several studies including participants with osteoarthritis or multiple comorbidities, some of the physical function measures were not significantly different for Tai Chi or Qigong in comparison to inactive controls.

Falls and Balance: In several studies, it was found that measures assessing balance (e.g., one-leg stance) were consistently significantly improved for participants who were sedentary or deemed at risk for falls when Tai Chi or Qigong was added to their routine.  Several studies also showed that adding Tai Chi resulted in similar improvements as adding conventional exercise or physical therapy control interventions aimed at improving balance.  However, in a study of stroke survivors, adding Tai Chi did not show improvement in balance, although an exercise controlled group did.

Immune Function and Inflammation: It was found that there were improvements in a number of immune-related blood markers when Tai Chi or Qigong exercises were added.  The immunity associated with flu vaccinations or shingles vaccinations was found to increase as a result of adding Tai Chi or Qigong exercises.

Quality of Life: Quality of life (QOL) is defined by Jahnke, et. al. as “a broad-ranging concept derived in a complex process from measures of a person’s perceived physical health, psychological state, personal beliefs, social relationships, and relationship to relevant features of the person’s environment.”  Unlike the previous five categories, QOL is a category that involves some subjectivity.  Their analysis found that “in 13 studies of a wide range of participants (including healthy adults, patients with cancer, poststroke patients, patients with arthritis, etc.) at least one of the components of QOL was reported to be significantly improved by Tai Chi or Qigong compared to inactive or active controls.”

Self-Efficacy: Self-efficacy is the confidence a person feels in performing one or several behaviors and the perceived ability to overcome the barriers associated with the performance of those behaviors.  For example, falls self-efficacy is a person’s confidence that he/she will not fall when walking, getting up from a chair, or performing other physical activities.  Significant improvements in self-efficacy were reported in the studies analyzed by Jahnke, et. al.

Patient Reported Outcomes: Patient reported outcomes (PROs) include reports of symptoms related to disease as perceived by the patient.  Several studies found that PRO associated with arthritic pain decreased significantly in response to Tai Chi compared to inactive controls, and one study also found that PRO associated with neck pain and disability improved in response to Qigong to the same extent as in response to exercise intervention controls.

Psychological: Psychological refers to factors such as anxiety, depression, stress, mood, fear of falling, and self-esteem.  It was found that various psychological factors improved significantly with Tai Chi or Qigong as compared to inactive controlled groups, but the improvement difference is non-significant as compared to active controlled groups.

Conclusion:  Jahnke, et. al., have reviewed a vast amount of clinical trials whose results were published in peer-reviewed English-language journals between 1993 and December 2007 and whose methodology was based on randomized controlled trials (RCTs).  They analyzed 67 such studies.  They found that there is substantial evidence indicating that there is a variety of health benefits associated with Qigong or Tai Chi as compared to inactive controlled groups, and the health benefits are often comparable to active controlled groups.  Sometimes they may not be as good as active controlled groups, but sometimes they may even be better.

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[1]  We will use the words “Taiji” and “Tai Chi” interchangeably.

[2]  R. Jahnke, L. Larkey, C. Rogers, J. Etnier, and F. Lin, American Journal of Health Promotion, 2010 July/August;  24(6), e1-e25. More information about the work of R. Jahnke and his collaborators can be found in the following links: http://IIQTC.org, http://FeeltheQi.com, http://TaiChiEasy.org.

[3]  Randomized controlled trials (RCTs) are trials under identified and controlled circumstances involving two trial groups, one performing Qigong and Tai Chi exercises and another doing nothing special or performing some other exercises, with the participants randomly selected for the two groups.

[4]  Depending on the duration of each class and the type of students in the class, half way through the course may be six or twelve weeks into the course.