Tai chi helps Parkinson’s patients with balance and fall prevention (Article Reprint)

For release: Thursday, May 10, 2012

Exercise is important for a healthy lifestyle but it is also a key part of therapy, rehabilitation and disease management. For Parkinson’s disease, exercise routines are often recommended to help maintain stability and the coordinated movements necessary for everyday living. An NIH-funded study, reported in the February 9, 2012 issue of the New England Journal of Medicine,* evaluated three different forms of exercise – resistance training, stretching, and tai chi – and found that tai chi led to the greatest overall improvements in balance and stability for patients with mild to moderate Parkinson’s disease.

Parkinson’s disease is a movement disorder that is caused by the loss of brain cells which control coordinated and purposeful motions. This cell loss results in tremor, rigidity, slowed movement (known as bradykinesia) and impaired balance (postural instability). While some symptoms, such as tremor, at least benefit from drug therapy initially, the medications currently available to treat Parkinson’s are not as effective in restoring balance. This is a special concern for Parkinson’s patients because postural instability frequently leads to falls.

Several studies have demonstrated that resistance training, for instance with ankle weights or using weight-and-pulley machines, has positive effects on balance and gait. As a result, doctors often suggest exercise or prescribe physical therapy to address problems with instability.

Fuzhong Li, Ph.D., research scientist at the Oregon Research Institute in Eugene, was part of a team of researchers who, in 2007, published a pilot study showing that tai chi was a safe exercise for individuals with mild to moderate Parkinson’s disease. “We had been using tai chi for balance training in healthy older adults, “ Dr. Li commented, “and older adults and patients with Parkinson’s disease share some difficulties with falls.”

Tai chi is a balance-based exercise that originated in China as a martial art. While there are many different styles, all are characterized by slow, relaxed and flowing movements. In both the pilot study and the recent New England Journal of Medicine study, patients performed a tai chi routine designed to challenge patients’ stability and address the balance and stability-related symptoms of Parkinson’s. The routine included slow, intentional, controlled movements that maximized the swing time of arm and leg motions, and repeatedly incorporated gradual shifts of body weight from one side to another, varying the width of their base of support by standing with feet together or further apart.

With support from the NIH’s National Institute of Neurological Disorders and Stroke (NINDS), Dr. Li and colleagues conducted a larger clinical trial to compare tai chi to resistance training and stretching. The study assigned a total of 195 patients with mild to moderate Parkinson’s disease to one of three exercise groups: tai chi, resistance training, or stretching. Patients attended class twice a week for 24 weeks. The investigators assessed balance and movement control by testing how far patients could lean and shift their center of gravity without losing balance, and how directly the patients could reach out to a target, with a minimum of extraneous movement.

After six months, the patients in the tai chi group showed the greatest amount of improvement in balance and stability. Furthermore, patients in the tai chi and resistance training groups had a significantly fewer falls over the six month period compared to participants in the stretching group.

 “There is a learning curve involved,” Dr. Li noted, adding that improvement is seen after four to five months of continued practice twice a week, and this trend is similar to what he had noted in his studies of older people.

Dr. Li described tai chi as similar to resistance training, the more commonly recommended physical therapy, in that it requires repetitive movement. Tai chi, however, not only involves shifting a person’s weight and center of gravity, but it is also practiced at a dramatically slow speed and greatly emphasizes intentional control of movement.

“In tai chi we emphasize very slow and intentional movement,” Dr. Li commented. “That imposed a lot of challenge, especially to those in the tai chi group who were used to fast movement.”

Dr. Li also noted that tai chi is very safe and can be performed without equipment and in limited space.

Beth-Anne Sieber, Ph.D., a program officer at NINDS, said that falls are a dangerous side effect of Parkinson’s disease and commented on the significance of Dr. Li’s work. “The key observation in Dr. Li’s study is that a specifically designed sequence of tai chi movements improves postural stability and prevents falls for an extended period of time in persons with Parkinson’s disease. In addition, tai chi sequences can be tailored to improve balance in a spectrum of patients with mild to moderate symptoms.” Dr. Sieber also noted that this study is indicative of a growing interest in examining how physical activity may improve symptoms of Parkinson’s disease. Further research will provide additional information on ways in which physical activity can improve disease symptoms and quality of life for people with Parkinson’s disease.

- By Nicole J. Garbarini, Ph.D.

For more information about Parkinson’s disease, visit: www.ninds.nih.gov/PD.

Manage Diabetes with Tai Chi (Article Reprint)

From Mark Stibich, Ph.D., former About.com Guide Updated May 08, 2008 About.com Health's Disease and Condition content is reviewed by our Medical Review Board

If you ever travel to China and go out early in the morning, you will find the parks filled with older Chinese men and women practicing tai chi, which looks like a combination between a slow motion dance and martial arts sequence. For generations, Chinese people have been turning to tai chi for its longevity and other benefits. Think of it as if it were meditation in motion.

Of course, you have to wonder if tai chi really works. More specifically, you have to wonder how it works. How does this slow motion practice slow the aging process? Does it reduce stress? Does it increase physical activity? Does it, as the practitioners believe, help balance energy and promote health? Researchers looked into this and found a surprising result: tai chi helps with diabetes.

Two small studies in Taiwan looked at diabetes and tai chi practice. The first study followed 30 people with Type 2 diabetes and matched them to 30 people with the same age and gender (but who did not have diabetes). All participants took a one-hour tai chi class three times a week for 12 weeks. At the end of the 12-week period, the people with diabetes showed a decrease in their HbA1c level -- HbA1c is used to measure how well the body can control blood sugar, an important sign of diabetes.

The other study, done in Australia, looked at 11 adults with elevated blood sugar (pre-diabetic). The researchers designed a special program that combined tai chi with another practice known as Qigong (a practice of creating and moving “chi” in the body through deep breathing and other exercises). Some of the 11 participants also had high blood pressure, obesity and high cholesterol (altogether making up metabolic syndrome). Like the first study, the participants underwent a 12-week program. Overall, blood pressure was improved and waist size in some of the participants even shrunk.

Both these studies are very small, but it is promising that such a simple practice can improve the overall health of the body. Combining tai chi with a healthful diet, other daily exercises and solid medical care could help diabetics and pre-diabetics increase their health, manage their condition and prevent further symptoms.

Tai chi can also help with the aging process by improving balance, lowering blood pressure, reducing stress and improving flexibility. Tai chi is often done in a group, so there are social benefits as well. In addition, the benefits that tai chi masters report are that tai chi balances the body’s inner energy (chi), which promotes health and longevity. Tai chi is low impact, and its motions can be adapted for people who have trouble standing. This is a great exercise for anyone, but especially for older adults.

Shu-Hui Yeh, Hau Chuang, Li-Wei Lin, Chiu-Yueh Hsiao, Pei-Wen Wang, Rue-Tsuan Liu, and Kuender D Yang. Regular Tai Chi Chuan exercise improves T cell helper function of type 2 DM patients with an increase in T-bet transcription factor and IL-12 production. Br. J. Sports Med., Apr 2008.

Tai Chi Benefits People With COPD (Article re-print)

WebMD Health News
Reviewed byLouise Chang, MD
practicing tai chi

Graceful Exercise Increases Endurance, Balance, and Quality of Life

Aug. 9, 2012 -- The gentle movements of Sun-style tai chi (SSTC) can improve the lives and boost the exercise endurance of people with chronic obstructive pulmonary disease, according to a new study by Australian researchers.

After 12 weeks, practitioners of this form of tai chi could walk longer distances and reported better quality of life compared to those whose treatment did not include any exercise training.
This is good news for people with COPD because it gives them more fitness choices, according to researcher Regina Wai Man Leung of Concord Repatriation General Hospital and the University of Sydney.

"With increasing numbers of people being diagnosed with COPD, it is important to provide different options for exercise that can be tailored to suit each individual," Leung, a cardiorespiratory physiotherapist, said in a news release that accompanied the study.

Testing Tai Chi

Forty-two people with COPD participated in the study. Their average age was 73. Half of them received standard rehab. The others, meanwhile, attended twice-weekly, hour-long sessions of a modified version of SSTC, which was comprised of 21 exercises, or forms, as well as controlled breathing. They practiced tai chi at home for 30 minutes on days when they did not have a class.

This type of tai chi, the researchers write, is an excellent choice for their COPD patients.

"Each form can be broken down into several movements which are easy to teach and learn. Compared to some other styles of tai chi, SSTC involves less difficult movements, such as less deep-knee bending and single-leg standing, which may make it more suitable for older people," the researchers write.

Each of the participants underwent several tests before and after the 12-week study period. The primary test evaluated how far and for how long they were able to walk at progressively faster speeds before becoming breathless.

The researchers also measured their balance, the strength of their quadriceps, and overall physical performance. Finally, the participants completed questionnaires to determine if they had symptoms of depression and/or anxiety and to gauge how highly they rated their quality of life.

Practice Leads to Improvements

The tai chi group showed significant improvements across the board. By the end of the 12 weeks, they were, on average, able to walk about 60 yards farther and for 348 seconds longer than the group that did not practice tai chi. They were also steadier on their feet and showed greater quad strength, both of which are important for COPD patients.

"Impairment in balance and lower limb muscle strength are common in people with COPD and are some of the major risk factors for falls," the researchers write. "Interestingly, conventional pulmonary rehabilitation has not been shown to improve balance in people with COPD."

The researchers also found that, in addition to getting the benefits of a good workout, the tai chi group was significantly less anxious and that they felt better in general than the other study participants.

"This study," they conclude, "provides compelling evidence that tai chi training achieved an appropriate training intensity and that it may be an effective alternative training modality in people with COPD."

COPD is the third leading cause of death in the United States. As many as 90% of cases are caused by smoking. In 2008, more than 13 million American adults had COPD, a blanket term for emphysema and chronic bronchitis. Both make breathing progressively more difficult. In 2007, nearly 125,000 U.S. adults died of COPD.

The study is published in the online edition of the European Respiratory Journal.

In With Learning, Out With Grade Worry Part II: Grade-less Learning

by Alan Kandel

On May 24, 2012, I penned the Baby Boomer Sensei blog post, “In With Learning, Out With Grade Worry.” Today, I introduce another aspect of learning: learning absent performance measures and assigned grades.

So, I try to imagine what training in the martial arts would be like without rank being attached to it. In my way of thinking, this would be analogous to getting an education without grades being assigned. To get a better grasp of what I’m referring to here, I liken this to instruction being conducted by schoolmasters in early 19th century America. Think one-room schoolhouses and groupings of students comprising a wide range of ages.

I make it no secret that I have entertained the thought for some time regarding what education would be like if students simply were to learn in an atmosphere where grades were non-existent. Students might feel less pressured to “pass,” anxiety or worry that can at times be manifested from such “pressure,” would likely be lessened if not completely eliminated, and cheating would be unheard of.

So, the first question you may be asking yourself is how performance and progress would be measured. My question in response to this is: Is it necessary that performance and progress be gauged? Would instruction and learning this way, that is, without quizzes, tests and other progress and performance measuring instruments, be any less effective? Radical though this may sound, I, nevertheless, think it’s a good question and an idea worth contemplating and exploring further.

Perhaps a person can think of this idea in these terms:

Ever see the movie “Castaway” starring Tom Hanks? The character he played in the movie in the jet he was flying in slammed into an ocean somewhere. Seemingly marooned on a remote and uninhabited island, Hanks’ character wound up fighting for his very survival. That Hanks’ character (in the movie) had been in the employ of a well-known package courier company, perhaps had given him somewhat of an edge in that he was successful regarding his survival. For Hanks’ character, the overarching message here is really quite simple: “Adapt or die!” As a castaway Hanks’ character survived, based upon using, quite innovatively and resourcefully I might add, the tools that were available to him, that and no doubt his reliance on knowledge he had acquired in the past, gained prior to this unfortunate soul getting into the seemingly dire predicament he found himself in. In fact, Hanks’ character had become so adept and resourceful, he taught himself how to create fire, secure food and even perform dental work on his own teeth! I realize “Castaway” is a fictional story. Nevertheless, Hanks’ character was quite motivated and determined to not only live but, as well, get off the island and back to civilization.

I realize that which is depicted in “Castaway” is extreme. But, what better example is there to drive home the message I’m trying to get across?

Okay, so I have to now ask how you would feel if you went through a training program, be it a martial arts or any other type of training regimen, and never received a grade, rank or score? Would this make you any less inclined to want to learn?

To help you perhaps better decide, consider this: People learn to cross streets safely. This is done absent grades. There is a saying: “Give a person a fish and that person eats for a day. Teach a person to fish and that person eats for a lifetime.” Bottom line is it is not important that a grade be assigned to the learning involved in feeding oneself for a lifetime, only that a person be able to fend for him or herself to keep him or herself alive.

So, keeping this notion in mind, what I have come to understand or learn is: Everyone learns, whether assigned grades for the learning that takes place or not. We learn how to hold and write with a pencil and/or pen. We learn how to hold a cup and to drink and/or sip through a straw. We learn how to walk, run, hop, skip and jump. These skills do not require assigned grades in order for these activities, skills, processes, what-have-you, to be learned and to occur.

Somewhere along the line, someone came up with the concept of gauging learning by assigning grades; learning that took place in a structured setting no doubt. I’m not saying learning in this manner is a bad thing. But, at the same time, I can’t help but wonder if learning would be any less effective and if people would be any less inclined to want to learn if the grading process were to be completely removed. That’s all.

Copyright © Alan Kandel. August 10, 2012.

Intangibles: So Important In Martial Arts and Life

by Alan Kandel

Intangibles – non-physical properties that cannot be heard, held, seen, smelled, tasted or touched – are very much real. And they are every bit as important in life as their tangible counterparts.

One intangible is pride.

As an intangible, and unlike tangible matter, pride is something that cannot be taken from someone no matter how much another may try. Think about that for a moment: Something having no physical form whatsoever, cannot be affected by another in any way, shape or form. That is a profound and powerful notion.

So let’s talk about pride for a moment.

Pride comes from the heart, as in the pride a teacher has learning that a student or former student has done well in some aspect of life, for example. Another would be a completed, do-it-yourself project that one can take pride in.

In my first Baby Boomer Sensei blog post: “Putting Karate Practice Into Words,” posted May 14, 2012, I discussed what I encountered in becoming a professional writer. So, imagine the feeling that came over me when my first article was published. I felt tremendous pride. The unmistakable satisfaction, the result of the hard work put forth in order to get that first article published and the fact the article was published at all, was all too real.

It’s no different in martial arts.

Students studying the arts are awarded in the physical sense when they receive a promotion or advancement in level or rank. And that a tangible award such as this can evoke a non-tangible one such as pride is indeed a powerful construct. Having said that, I firmly believe it is completely acceptable to feel pride from having accomplished such a goal.

Another topic I wish to bring front-and-center is winning and losing, which are also intangibles. This is extremely relevant, particularly with the Summer Olympic Games being held in London, England right now.

Master Teruyuki Okazaki – Chief Instructor and Chairman of the International Shotokan Karate Federation – in his book: “Perfection of Character: Guiding Principles For The Martial Arts & Everyday Life” (a book given me by Najib Amin, a good friend and instructor I formerly practiced karate under), notes: “When you truly understand that you are training solely to better yourself, you will abandon your concerns about winning, losing, advancing in rank, and being attached to results, and you will become a better, more balanced karate-ka and human being.”

Master Okazaki goes on to write: “Think about it: What will happen if you meditate intently before a match saying to yourself, ‘I don’t have to lose. I am not attached to the result. If I do my best, I will be proud.’ You will have unburdened yourself of any expectation, and you’ll be allowing life to flow naturally.”

When all is said and done, intangibles really do matter and on some level, I wholeheartedly believe, are more substantive than their physical counterparts – the tangible properties.

Copyright © Alan Kandel. August 8, 2012.

Be Faithful and Endeavor As A Martial Artist and in Life

by Alan Kandel

In Shotokan karate-do there are five dojo precepts and these are: 1) Seek perfection of character; 2) Respect others; 3) Be faithful; 4) Endeavor; and 5) Refrain from violent behavior. They are referred to as the Dojo Kun.

In the spirit of karate training, when entering the dojo, the world outside of karate training is to remain there, the one outside the dojo, that is, and the reason for this is so the mind can be free of extraneous, inhibiting thought. In other words, as one prepares to practice, one should clear the mind. This is important in the sense that an empty mind then becomes a medium that can facilitate learning in the most efficient and effective way possible, and this idea doesn’t just limit itself to the dojo. It is something that can have relevance in terms of learning in general, whether it’s with regard to martial arts or not.

Contrarily, upon exiting the dojo, the presumption is the martial artist has acquired new information that can now be taken and carried with them into the outside world. (As you read on, it should become clearer and clearer why this is both relevant and important). As long as the training is continued that very process is perpetuated. But what if a person suddenly stops practicing, what happens then? This in no way means that what has been learned in the dojo should be forgotten. This would be tantamount to saying that even if it no longer were to apply, everything we have ever learned over time should be forgotten too. 

Strike that last notion as it is utterly preposterous.

In an earlier post, I mentioned that I carry the spirit of my karate training with me in life, or something to that effect, and this is as it should be. Meanwhile, in another prior Baby Boomer Sensei blog post I discussed three of the five dojo kun, even if only briefly, and these were: 1) Seek perfection of character; 2) Respect others; and 3) Refrain from violent behavior. 

Today I want to talk about the remaining two: 1) Be faithful and 2) Endeavor.

I’ll be the first to admit I didn’t exactly fit that bill – being faithful and endeavoring – in every one of my academic pursuits, but as far as my vocational endeavors went, I poured my heart and soul into practically every job I ever worked. What this exemplifies is the endeavor part. Okay, let’s see how being “faithful” applies here.

One might endeavor or try to do something by giving it his or her all but if in carrying out required duties becomes futile or is done with less-than-scrupulous ideals in mind, then it makes little if any sense to continue in this vein. So, a person can endeavor to perform, say, a task at the best of his or her abilities, but if in carrying the task out satisfactorily and completing the task according to established criteria becomes an impossibility or the tactics employed in doing so are less than wholesome ones, then being faithful to that particular cause or endeavor too makes little if any sense.

Which brings me back to karate practice and martial arts. Practice what martial art you will. Practice (endeavor) with verve (with passion and enthusiasm) and perseverance (with persistence and a purpose) and be true (faithful) to your study. And, in the final analysis, if we carry with us in everyday life not only these guiding precepts (dojo kun) but the three others mentioned previously, not only do I wholeheartedly believe we will become much better people for having done this, but I believe likewise as well that the world will be far, far improved for us having done so. A win-win most assuredly!

Copyright © Alan Kandel. August 5, 2012.