Microsoft Corporation research determines Goldfish have a longer attention span than people…Our attention span has dropped from 12 seconds of coherent thought to just 8 seconds since 2000. Goldfish remain at 9 second attention spans!

Well Chris, today is your lucky day!

Harvard Medical School Guide to Tai Chi Review

A Healing Mind-Body Therapy

COL (Ret.) John P. Drobnica, MPAS, PA-C

Tai Chi Presentation Objectives: The Harvard Medical School Guide to Tai Chi: 12 weeks to a Healthy Body, Strong Heart & Sharp Mind

Written by Peter M. Wayne, PhD, with Mark L. Fuerst

• Overview of Tai Chi, the Ancient Promise and Modern Need for Tai Chi

• Introduction to the Eight Active Ingredients of Tai Chi and 21st Century Medicine

• PubMed Research Update Since Publication

• Strategies for Implementing Tai Chi at Home and On-the-Job

Overview of Tai Chi, the Ancient Promise

• Tai Chi is a mind-body exercise rooted in multiple Asian traditions, including martial arts, traditional Chinese medicine, and philosophy…

• Tai Chi abbreviated translates into ‘Supreme Ultimate’ and the formal name is Tai Chi Chuan which translates into ‘Supreme Ultimate Boxing’.

• Tai Chi training integrates slow, intentional movements with breathing and cognitive skills… it aims to strengthen, relax, and integrated the physical body and mind, enhance the natural flow of ‘Qi’, and improve health, personal development, and self-defense…

• Qi has many translations, air, vital energy, information, breath, or spirit…

• Choreographed routines called forms or sets, each have a certain number of movements or postures… ranging from eight movements to as many as 150 movements…

Yin and Yang-The Mother of Ten Thousand Things… Lao Tzu

Two complementary polar opposites that, together, create a dynamic, balanced, integrated, and inter-dependent whole.

Central concept in traditional Chinese medicine, philosophy, and science… one of the deepest pillars in Chinese culture.

Ancient Taoist Philosophy and The Tao of WillieLiteral translation of Tao means ‘way’ or ‘path’

History…

• Martial arts initially developed by the Bodihidarma to train Buddhist monks in the 6th Century… Shaolin Boxing… Kung Fu.

• Chang San-feng considered the father of Tai Chi further evolved the art in 13th Century… a Shaolin monk who left the monastery to become a Taoist hermit…

• Ming dynasty general Ch’i Chi-kuan (1528-87) authors “Boxing Classic” with many movements later appearing in Chen-style… also the oldest of all Tai Chi systems…

• Chinese families further evolve Tai Chi, with Chen Wan-ting in the mid 17th Century combines contemporary boxing with meditative and health promoting energizing exercises that further internalized the martial art emphasizing softness, circular movements and intrinsic strength…

History…

• Then Yang Lu-ch’an in the early 19th Century clandestinely learns the ‘secret family art’ by observing in Chen village masters ‘apply’ their martial art.

• Yang further develops Tai Chi to a broader growing public audience interested in health and personal development… less strenuous and less martial art application…

• Yang Lu-Ch’an’s grandson, Yang Cheng Fu is credited for today’s Yang-style Tai-Chi which is the most practiced style in the world.

• Yang Cheng Fu evolves Tai Chi into health promotion and self-development– Thirteen Posture Song… “What is the purpose of this discipline? To lengthen one’s life,

extend one’s years, and to give one an ageless springtime.”

– Leads to development of Beijing Form in 1956 by the National Physical Culture and Sports Commission of the People’s Republic of China…

• Cheng Man Ching, Master of the Five Excellences moves to NYC in 1964…

Chinese Healing Arts…

• The Internal Canon of the Yellow Emperor (2000-1600 B.C.E)

– Practices health-promoting exercises based on the movements of animals…

• Hua Tuo, famous Chinese medicine physician (145-208 C.E)

– Develops ‘five animal frolics’ each exercise targets a specific internal organ within the framework of traditional Chinese medicine (TCM), i.e. bear exercise targets the kidneys… tiger exercise targets the lungs…

– Objective is to enhance and balance the circulation of Qi among the organ systems and throughout the body as a whole…

– ‘Step Back to Repulse the Monkey’ and ‘Snake Creeps Down’

Modern Need for Tai Chi… Western Embrace

• Ancient Taoists were familiar with the scientific method, as alchemists and physicians, credited with discovery of anesthesia and many medicinal discoveries.

• Over 700 peer-reviewed papers published (2013); Osher Center for Integrative Medicine as of 2012 had more than 400 clinical studies (180 randomized trials) conducted in the West.

• Research focusing on balance, cardiovascular health, the immune and nervous system, sleep, and psychological well-being.

• 3 million plus Americans practice Tai Chi specifically for health.

• Contrast Western medicine “reductionist framework” (divide and conquer) verses Eastern holistic medicine with an ecological view of the body, mind and health.

Medicalization of Tai Chi…

• Development of simplified protocols

– Emory University evaluation of balance for the elderly, randomized controlled trial; Journal of the American Geriatrics Society, 1996

– Master Tingsen Xu develops 14 moves (movements/postures), done independently without sequencing.

– A clear hypothesis was associated with the impact of the movement patterns for the development of balance.

• Trademark Tai Chi programs evolve…

– Tai Chi for Balance, Tai Chi for Parkinson’s, Tai Chi for Multiple Sclerosis, Tai Chi for Arthritis and Tai Chi for Depression…

– Protocols based on evidence from scientific studies remain unclear if the unique characteristics of these ‘forms’ are uniquely therapeutic for the specified conditions…

• To date however… “No Western studies have compared any one Tai Chi form to another and demonstrated whether any specific protocol is better than any other, or better than Tai Chi programs in the community.”

Evolving Biomedical Research…

• Biomedical research on Qi and Qigong (diverse set of mind-body practices with focus on the cultivation or mastery of Qi) expands our “Western” demand for scientific understanding.

• Scientists are studying:

– Bioelectric properties of acupuncture points and meridians by monitoring energy wave form of Qigong masters and healers.

– Technologies used include: highly sensitive infrared sensors, infrasonic sound detectors, photon-emission spectroscopy and superconducting infrasonic quantum-interference devices (measure extremely subtle magnetic fields).

– Additional research on the biological impact of emitted Qi on cultures of cells in vitro as well as in controlled human clinical trials.

The Eight Active Ingredients of Tai Chi…conceptual framework to evaluate the clinical benefits of Tai Chi

Eight Active Ingredients of Tai Chi… # 1

AWARENESS (Mindfulness and Focused Attention)

The emphasis on moment-to-moment awareness results in mindfulness and improved focus.

Tai Chi is commonly known as “meditation in motion.” Lao Tzu’s observation “In non-doing, nothing is left undone.”

Calms the “monkey mind” or the wandering, ruminating negative thoughts and what-ifs; the more your mind wonders, the less happy you are… “A Wondering Mind is an Unhappy Mind,” Science 330, no. 6006 (2010): 932

Meditative exercises like Tai Chi can change the brain’s structure and function… modulating health, pain, immune function and mood… “Relationships between Mindfulness Practice and Levels of Mindfulness, Medical and Psychological Symptoms…“Journal of Behavioral Medicine 31, no. 1 (2007): 23-33

Monkey Mind…

Eight Active Ingredients of Tai Chi… #2

INTENTION (Belief and Expectation)

Active ingredients of imagery, visualization, and related cognitive tools alter intention, belief, and expectation, and contribute significantly to the therapeutic and physiologic effects of Tai Chi.

Just thinking about a movement uses the same parts of the brain as when actually moving; positive intention and imagery can significantly influence the brain and physiologic functions…. “Mental Training as a Tool in the Neuroscientific Study of Brain and Cognitive Plasticity,” Frontiers in Human Neuroscience 10, no.5 (2011): 17

Raising expectations of pain relief can induce a very specific effect to specific body parts, Dr. Fabrizio Benedetti using intradermal capsaicin versus placebo analgesic cream; followed by reversal of placebo effect by naloxone. “Somatotropic Activation of Opioid Systems by Target-directed Expectations of Analgesia,” Journal of Neuroscience 19, np. 9 (1999): 3639-48.

Motor Imagery… Cortex and Hippocampus

Eight Active Ingredients of Tai Chi… #3

STRUCTURAL INTEGRATION (Dynamic Form and Function)

Biomechanically efficient shapes and patterns of movement have functional consequences across many systems. Functional movement principles are classically described as being like “reeling silk from a cocoon.”

Body shape influences negotiations and even changes in endocrine function and mood… “Power Posing: Brief Nonverbal Displays Affect Neuroendocrine Levels and Risk Tolerance,” Psychological Sciences 21, no. 10 (2010): 1363-68

Potential anatomical bases for meridians (energy channels) and state of the art technology to characterize biophysical and bioenergetics correlates of energy flow…“Electrical Properties of Acupuncture Points and Meridians: A Systematic Review,” Bioelectromagnetics 29, no. 4 (2008): 245-56

MeridiansEnergy channels, the extracellular matrix and related organs…

According to Traditional Chinese Medicine (TCM), a continuous, integrated flow of information and energy, or Qi, exists in the body. This information and energy moves along pathways called jinglou (meridians) that link the viscera with different parts of the body, making the human body an integrated whole.

Eight Active Ingredients of Tai Chi… #4

ACTIVE RELAXATION (versus ‘stretching’)

Circular, flowing motion helps shift the body and mind into deeper levels of relaxation, and is a form of “meditation in motion.”

Tai Chi exemplifies moderation of effort, so as to reduce risk of injury and fatigue, and to facilitate greater, longer-lasting relaxation and improved range of motion. This reduces further or worsening injury and the resulting ‘kinesiophobia’ which is an impediment to healing tissues.

Viewed as a whole, the data suggests Tai Chi can significantly reduce the probability of falling, even when compared in randomized trials to other active exercise or balance training interventions. “Review of Tai Chi as an Effective Exercise on Falls Prevention in Elderly,” Research in Sports Medicine 20. 1 (2012): 37-58

Eight Active Ingredients of Tai Chi… #5

STRENGTH AND FLEXIBILITY

Slow, continuous, relaxed, integrated and repetitive movement results in dynamic active relaxation while in slightly flexed stances placing body weight on alternating lower extremities which increases loading on the skeleton promoting strong bones and enhanced flexibility.

Multiple studies show that Tai Chi training increases lower extremity muscle strength… Harvard studies shows that Tai Chi may help maintain strong bones and retard rates of bone loss, especially in post-menopausal women. “Impact of Tai Chi Exercise on Multiple Fracture-Related Risk Factors in Post-Menopausal Osteopenic Women: A Pilot Pragmatic, Randomized Trial. BMC Complementary and Alternative Medicine 12, no. 7 (2012)

Louisiana State University showed the impact of Tai Chi on people who had plantar peripheral neuropathy due to diabetes; 24 weeks of classes resulted in a increase in sensitivity of the soles of the feet, greater balance, and faster walking speed. “Long Term Tai Chi Exercise Improves Physical Performance among People with Peripheral Neuropathy,” American Journal of Chinese Medicine 38, no. 3 (2010): 449-59

Eight Active Ingredients of Tai Chi… #6

NATURAL, FREER BREATHING

Efficient breathing techniques improves gas exchange, massages body tissues, including internal organs and helps regulate nervous and endocrine systems, improves mood, and balances and moves Qi within the body and between the body and the environment.

“…breath-induced pressure changes and rhythms may also positively affect blood flow within the organs, including the kidneys and brain.” “Determination of Comprehensive Arterial Blood Inflow in Abdominal-Pelvic Organs: Impact of Respiration and Posture on Organ Perfusion,” Medical Science Monitor 17, no. 2 (2011): CR57-66

Greater breathing efficiency is associated with a reduced risk of heart disease, all-cause mortality, and cognitive decline. “Forced Expiratory Volume in 1 Second and Cognitive Aging in Men,” Journal of the American Geriatrics Society 59, no.7 (2011): 1283-92

Natural, Freer Breathing Activates…

Eight Active Ingredients of Tai Chi… #7

SOCIAL SUPPORT (Interaction and Community)

Group interaction has been proven therapeutic in various medical conditions, and students develop a strong sense of community participating in Tai Chi that is rich in social and physical contact with peers, along with support from both peers and their teacher(s). Profound personal journeys of self-discovery begin with Tai Chi.

A strong body of research suggests Tai Chi… have huge, positive impacts on health, in terms of disease prevention, recovery rates, and remission following events such as heart attacks and cancer. “Understanding the Links between Social Support and Physical Health,” Perspectives on Psychological Science 4 (2009): 236-55

Harvard study on IBS patients comparing “warm and fuzzy” clinician interactions with “non-fuzzy” interactions and limited interaction controls all receiving ‘fake’ acupuncture. Result, dose-like response with 62% improvement, compared to 44% and 28% respectively. “Components of Placebo Effect: Randomized Controlled Trial in Patients with IBS,” British Medical Journal 336, no. 7651 (2008): 999-1003

Cedar Park Tai Chi Association

Eight Active Ingredients of Tai Chi… #8

EMBODIED SPIRITUALITY (Philosophy and Ritual)

Creates a practical framework for practicing living with a more holistic, Eastern philosophy (Taoism) that integrates body, mind, and spirit. It has the potential to add a spiritual dimension to your life, and the ritualistic practice of Tai Chi can amplify and sustain the art’s therapeutic benefits.

Tai Chi led to large improvements in fibromyalgia patients’ symptoms listed on a clinically validated questionnaire, as well as separate measures related to pain, sleep quality, depression, and quality of life. Improvements were maintained for 6-months and Tai Chi subjects reduced their medication use compared to controls. “A Randomized Trial of Tai Chi for Fibromyalgia,” New England Journal of Medicine 363, no. 8 (2010): 743-54

Tai Chi improves what is called “self-efficacy,” or people’s beliefs in their capabilities to exercise control over their own functioning and over events that effect their lives. “Tai Chi, Self Efficacy, and Physical Function in the Elderly,” Prevention Science 2, no. 4 (2001): 229-39

Pub-Med Update: Since the Harvard Medical School Guide,

a key-word search of ‘Tai Chi’ lists 243 randomized trials since 2013.

New Highlights Include:

• Practitioners had higher levels of DHEAS (P<0.01) and lower levels of cortisol (P<0.05). “Higher DHEAS Levels Associated with Long-Term Practicing of Tai Chi,” Chinese

Journal of Physiology, 2017 Apr 30: 60 (2): 124-130.

• Tai Chi equally efficacious as physical therapy regarding physical functioning, however TC group had more improvement in depression symptoms and quality of life. “Comparative Effectiveness of Tai Chi Verses Physical Therapy for Knee Osteoarthritis. A Randomized Trial.” Annals of Internal Medicine, Jul 2016; 165(2):77-86.

• Tai Chi significantly improved cognitive function and moderately reduced physiological fall risks in older adults. “Effects of Tai Chi on Cognition and Fall Risk in Older Adults with Mild Cognitive Impairment: A Randomized Controlled Trial.” Journal of American Geriatric Society, 2017 Apr; 65(4): 721-727.

• Compared with usual activities, Tai Chi shows potential protective effects on healthy adults’ cognitive ability. “Tai Chi and the Protection of Cognitive Ability: A Systematic Review of Prospective Studies in Healthy Adults.” American Journal of Preventative Medicine, 2015 Jul; 49(1):89-97.

Pub-Med Update… continued

• Tai Chi yields psychological and physical benefits, and should be considered by higher education institutions as a possible means to promote the… well-being of their students. “A systemic review of the health benefits of Tai Chi for students in higher education.” Prevention Medicine Report, 2015 Dec 23;3:03-112.

• Tai Chi appears to be feasible and safe for veterans with symptoms of post-traumatic stress disorder, is perceived to be beneficial and is associated with high rates of satisfaction. “Feasibility, qualitative findings and satisfaction of a brief Tai Chi mind-body programme for veterans with post traumatic stress symptoms.” British Medical Journal Open. 2016; 6(11):e012464.

• Those in Tai Chi reported not only self efficacy and social support, but overall empowerment with additional gains such as internal locus of control, self-awareness and stress management. “The Impact of Tai Chi Exercise on Self-Efficacy, Social Support, and Empowerment in Heart Failure: Insights from a Qualitative Sub-Study from a Randomized Controlled Trial.” PLoS One. 2016 May 13;11(5):e0154678.

• Tai Chi was found to have improved fatigue more than conventional therapy, has positive effects in cancer-related fatigue, is more effective on vitality, sleep and depression. However no significant differences in MS-related fatigue or age-related fatigue. “Does Tai Chi relieve fatigue? A systematic review and meta-analysis of randomized controlled trials. PLoS One. 2017 Apr 5; 12(4):e0174872.

21st Century Medicine

• The doctor of the future will give no medicine but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease.

Thomas Edison

• The WHO recently rated the US as 37th in health care outcomes, on par with Serbia.

• “Today’s health care reform efforts must reestablish public health and prevention as priorities- transforming our country from a ‘sick’-care system to a health care system.” Susan Blumenthal, MD, former Assistant Surgeon General

• Chronic conditions contribute to 75% of health care costs in the US, yet only 3% of the US government’s health-care budget is invested in prevention, unchanged since 1934.

Wishing, reflecting versus mindfulness…

Rethinking Levels of Care

• Primary Care

• Secondary Care

• Tertiary Care

Donald Levy, MD, Director of Osher Clinical Center for Complementary and Integrative Medical Therapies at Brigham and Women’s Hospital emphasizes… two additional tiers to the health-care pyramid, preceding our traditional three levels of care…

Self-Care

Prevention

Willie’s Practical Wisdom…

Integrating Tai Chi and Related Mind-Body Practices Across the Entire Human Life Span

• Grade-School Kids

– Research on Qigong, yoga and other mind-body practices, including a review Harvard conducted, adds further support for Tai Chi-like exercise in the classroom. “Qigong for Schoolchildren: A Pilot Study,” Journal of Alternative and Complementary Medicine 11, no. 1 (February 2005): 41-47

• High School Alternative to ‘Gym” Class

– Randomized control trial of yoga verses physical education by Harvard showed that high school students who practiced yoga had a better mood overall and felt less anxiety, while the gym class group showed a worsening of these symptoms over the 10-week study. “Tai Chi and Mindfulness-based Stress Reduction in a Boston Public Middle School,” Journal of Pediatric Health Care 19 (2005): 230-37

• College and Medical School

– Studies report that college students who do Tai Chi for a few months have improved sleep quality and mood, and feel less stress. “Developing Mindfulness in College Students through Movement-based Courses: Effects on Self-regulatory Self-Efficacy, Mood, Stress, and Sleep Quality,” Journal of American College Health 58, no. 5 (2010); 433-42

Tai Chi- The Eastern Ambassador to Self-Care and Prevention

• Tai Chi’s niche:

– Young or old

– As disease prevention or disease rehabilitation

– As everyday stress management or self-discovery

– To enhance creativity or improve sports performance

• Tai Chi cultivates self-responsibility and self-empowerment.

– Tai Chi invites ‘active’ participation in the participant’s own health care

• “Tai Chi is China’s cultural ambassador to the world… Touching the lives of more westerners, and perhaps more deeply, than books, films, museums or college courses, Tai Chi is often an entrée to Chinese philosophy, medicine, meditation, and even language,” notes Chinese historian and scholar Professor Douglas Wile.

Strategies for Implementing a Tai Chi Program

• Professor Cheng Man Ching states two factors are needed to learn Tai Chi, “perseverance and right teaching.”

• Pearls in developing a Tai Chi practice:

– Some practice is better than no practice: consider your goal or intention.

– Pace yourself: remember the 70-percent rule! Better to do a little Tai Chi frequently than a lot all at once.

– Be patient with your progress: learn to learn slowly, organically and patiently.

– Don’t compare yourself to others: everyone moves at a different pace.

– Don’t be overly self-critical: turn off the internal ‘scoreboards.’

– Make Tai Chi part of your regular routine: use your smartphone alert.

– Keep a notebook or sketchbook: consider a journal of “aha” moments.

– Find ways to integrate Tai Chi throughout the day: are you breathing?? Practice ‘pouring’ while standing in line, performing mindful stretches when time permits!

– Join a Tai Chi program: never underestimate the power of fellowship shared by other students and your instructor.

Searching for a Tai Chi teacher or Program

• Look for or consider the following:

– An experienced teacher… ‘master’ status has no formal criteria; look at bio, and the range of knowledge and instruction of multiple forms.

– Good teachers tend to have long-term students: talk to other students about the instructor’s strength and weaknesses; sense of community, social interaction.

– A teacher with good teaching skills and good people skills: clear verbal articulation and a meditative voice.

– A teacher that focuses on learning to relax versus exacting, rigid technical forms.

– A comfortable environment in a practical location: clean, lighted facility; compatible schedule, close to work or home.

– Look for the right size class: little class, you stand out; big class you’re lost in the crowd.

– Trust your instincts: if you find a teacher, class or facility, but it doesn’t feel right...

– Consider the costs: health clubs, recreation centers, gyms and YMCAs.

– Understand your goals: seeking health improvement, martial arts skill, spiritualty?

– Pick a style: the principles of Tai Chi are the same throughout all styles.

Tai Chi Association of Colorado Springs

Tai Chi On-the-Job

• Institute for Stress health statistics show that occupational pressures and hazards are responsible for 30% of workers’ back pain, and that 60% of workers routinely complain of work-related neck pain, 44% say they have eyestrain, 38% feel hand pain, 34% have difficulty sleeping.

• December 2010 Harvard Business Review found that the return on each dollar a large company invests in an employee wellness program might be as high as $6… with savings realized within 12-18 months.

• Wellness pays off for the business, and the employees: – Reduced Medical Costs

– Increased Productivity

– Less Lost Time at Work

– Improved Morale

Integrating Tai Chi into the Workday

• Use Your Travel Time to and from Work to Practice Tai Chi Principles– Practice slow, deep-breathing exercises; perform simple shoulder, neck and hand relaxation; visualize

presentations, procedures and encounters…

– Public transportation: meditation, relaxing music, seated or standing forms…

• Set Up Your Work Space… Ergonomics – Postural alignment, good posture, regular deep breathing; standing desk provides movement options…

University of Vermont Older Nurses study, no missed work, 3% productivity increase and vast improvement in functional reach assessment.

• Move Around When You Can– Stretch-relaxation during conference calls, get up and use a white board, or poster paper on the walls to

organize your thoughts…

– If anxious, do a few Tai Chi deep breaths, warm-up stretches or calming movements…

• Mini Tai Chi Exercise Breaks– Take 1-3 minute stretches every couple hours, seated or standing, Spinal Cord Breathing, Hand Tai Chi,

Neck, Shoulder, Foot and Ankle stretching and relaxing…

– Mini breathing meditation, close your eyes, practice tan tien breathing…

– Walk ‘mindfully’ to the rest, break, exam and procedure rooms, inviting relaxation…

– Perform Swinging and Drumming, Washing Yourself with Qi from the Heavens

– If time (10 minutes) and space permit, practice some formal Tai Chi movements…

• When Appropriate, Invite a Colleague or Patient to Participate…

Drobnica’s Desideratum…From secret system, to fighting art, to military training to personal development and longevity exercise and today, a national exercise, sport and performing art… and a promising therapeutic option…

• Tai Chi Chuan:

– Exemplifies economy of motion; undisputed proof that less is more

– Hones your keen sense of the obvious

– The Yin to a type ‘A’ personality

– The Yang to a sedentary soul

– The Eastern cure for the monkey-mind

– The playground for the young at heart

– The recurrent vacation

– The perfect antidote to perfection

– The pursuit of speechless fellowship

– The beginning of endless self-discovery

– The quest of self mastery

Welcome Your Questions