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

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 spoon feeding, 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.

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Author: Tom Forsythe, Kanab, Utah

Reprinted from Qi: The Journal of Traditional Eastern Health & Fitness