Dragon River school of Tai Chi Chuan

Chen style Tai Chi Chuan, classes in Nottingham, Mansfield, Ravenshead & Alfreton

What's it good for?

My day job is finding evidence to answer questions in healthcare, so I'm used to looking for decent evidence to support different treatments for medical conditions and similar.  Consequently, I want to see good evidence for people's claims about things like Tai Chi and other complementary therapies. 

Anecdotal evidence - stories of what people may have seen or heard of from other people - is fine for generating a bit of folklore, but one of the more useful bits of my psychology degree showed me how easy it is to fool people into believing what they want to believe and mistake coincidence as cause and effect.

Fortunately for me, my day job gives me access to high quality international medical research databases and in the area of Tai Chi, decent research is being carried out which is showing that Tai Chi can have a lot of benefits for people's health.

There's a growing body of evidence that it can be useful for helping a number of different medical conditions, as well as being useful for maintaining health & wellbeing.


Following is a review of good quality research that's looked at Tai Chi and how it may help people's health (These are extracts from decent scientific journals, so they aren't as gushing as newspaper articles because their purpose is to be impartial and objective, stating exactly what happened when the research was conducted, rather than being sensationalist to try to sell newspapers).

I'll try and add more as I notice them and get chance, but if you want to look for yourself - check out http://www.ncbi.nlm.nih.gov/sites/entrez .  This is Pubmed - a free database of high quality medical research articles from around the world - just put in what you want to search for and it'll show you what it's got.  Be aware though that it can produce a lot of results, and many of them will be in sicentific journals that you have to pay for - but at the least you will probably be able to see a summary of what they did and what they found.

This is the public version of a database I use, and although you don't get quite as much detail as the 'paid for' version, there's still tons of research info about every subject under the sun, and its all (relatively) reliable - happy hunting.

This list was last updated 29th June 2020, and you'll see, not all of the results are wildly positive about Tai Chi - see the notes at the bottom for an explanation.



Tai Chi and Qi Gong: In Depth
The National Institutes for Health 

This is an American health organisation, funded by the government.  They look at the evidence for treatments for different conditions and make recommendations to healthcare staff treating patients and promote good health to the public.
They have a whole page of articles looking at the effectiveness of Tai Chi (and Qigong/ Chi Kung exercises) on different medical conditions and health in general.  This is a summary statement taken from their website 29th June 2020:

"What do we know about the effectiveness of tai chi and qi gong?

Practicing tai chi may help to improve balance and stability in older people and in those with Parkinson?s disease, reduce back pain and pain from knee osteoarthritis, and improve quality of life in people with heart disease, cancer, and other chronic illnesses. 
Tai chi and qi gong may ease fibromyalgia pain and promote general quality of life.
Qi gong may reduce chronic neck pain, but study results are mixed. Tai chi also may improve reasoning ability in older people."

More of their findings are available here


Health Benefits of Tai Chi: What Is the Evidence?

Canadian Family Physician, November 2016

"Main message: During the past 45 years more than 500 trials and 120 systematic reviews have been published on the health benefits of tai chi. Systematic reviews of tai chi for specific conditions indicate excellent evidence of benefit for preventing falls, osteoarthritis, Parkinson disease, rehabilitation for chronic obstructive pulmonary disease, and improving cognitive capacity in older adults. 

There is good evidence of benefit for depression, cardiac and stroke rehabilitation, and dementia. There is fair evidence of benefit for improving quality of life for cancer patients, fibromyalgia, hypertension, and osteoporosis. 

Current evidence indicates no direct benefit for diabetes, rheumatoid arthritis, or chronic heart failure. 

Systematic reviews of general health and fitness benefits show excellent evidence of benefit for improving balance and aerobic capacity in those with poor fitness. 

There is good evidence for increased strength in the lower limbs. 

There is fair evidence for increased well-being and improved sleep. 

There were no studies that found tai chi worsened a condition. 

A recent systematic review on the safety of tai chi found adverse events were typically minor and primarily musculoskeletal; no intervention-related serious adverse events have been reported.

Conclusion: There is abundant evidence on the health and fitness effects of tai chi. Based on this, physicians can now offer evidence-based recommendations to their patients, noting that tai chi is still an area of active research, and patients should continue to receive medical follow-up for any clinical conditions."

https://pubmed.ncbi.nlm.nih.gov/28661865/


Effectiveness of Tai Chi on Fibromyalgia Patients: A Meta-Analysis of Randomized Controlled Trials

Complementary Therapies in Medicine, October 2019

"Tai Chi exerts significantly greater effects on patients with FM than standard care; therefore, we suggest that Tai Chi can be used as an alternative treatment. However, more large-scale, high-quality, and multicenter trials are required to provide stronger evidence on the effectiveness of Tai Chi, as an alternative to aerobic exercise, compared with conventional therapeutic exercise."

https://pubmed.ncbi.nlm.nih.gov/31519264/


Systematic Review and Meta-Analysis: Tai Chi for Preventing Falls in Older Adults

British Medical Journal Open, February 2017

"Tai Chi is effective for preventing falls in older adults. The preventive effect is likely to increase with exercise frequency and Yang style Tai Chi seems to be more effective than Sun style Tai Chi."

https://pubmed.ncbi.nlm.nih.gov/28167744/


The Effects of Tai Chi on Depression, Anxiety, and Psychological Well-Being: A Systematic Review and Meta-Analysis

International Journal of Behavioural Medicine, August 2014

"The studies in this review demonstrated that tai chi interventions have beneficial effects for various populations on a range of psychological well-being measures, including depression, anxiety, general stress management, and exercise self-efficacy. Meta-analysis was performed on three RCTs that used depression as an outcome measure (ES=-5.97; 95% CI -7.06 to -4.87), with I2=0%.

In spite of the positive outcomes, the studies to date generally had significant methodological limitations. More RCTs with rigorous research design are needed to establish the efficacy of tai chi in improving psychological well-being and its potential to be used in interventions for populations with various clinical conditions."

https://pubmed.ncbi.nlm.nih.gov/24078491/


Does Tai Chi Relieve Fatigue? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

PLoS One journal collection, April 2017

"The results suggest that Tai Chi could be an effective alternative and /or complementary approach to existing therapies for people with fatigue. However, the quality of the evidence was only moderate and may have the potential for bias. There is still absence of adverse events data to evaluate the safety of Tai Chi. Further multi-center RCTs with large sample sizes and high methodological quality, especially carefully blinded design, should be conducted in future research."

https://pubmed.ncbi.nlm.nih.gov/28380067/


The Effects of Tai Chi on Quality of Life of Cancer Survivors: A Systematic Review and Meta-Analysis

Support Care Cancer, October 2019

"There is low-level evidence suggesting that Tai Chi improves physical and mental dimensions of QOL and sleep. There is moderate-level evidence suggesting Tai Chi reduces levels of cortisol and CRF and improves limb function. Additional studies with larger sample sizes and with higher-quality RCT designs comparing different regimens of Tai Chi are warranted."

https://pubmed.ncbi.nlm.nih.gov/31236699/


Efficacy and Safety of Tai Chi for Parkinson's Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

PLoS One journal collection, June 2014

"Tai Chi performed with medication resulted in promising gains in mobility and balance, and it was safe and popular among PD patients at an early stage of the disease. This provides a new evidence for PD management. More RCTs with larger sample size that carefully address blinding and prudently select outcomes are needed."

https://pubmed.ncbi.nlm.nih.gov/24927169/ 


*A bit about terminology:

The best types of research are Randomised, Controlled Trials (RCTs), with double blinding, or Systematic Reviews.  Sounds very complicated? This is what it actually means.

Controlled trials - As well as a group of people receiving a treatment (eg Tai Chi), there's also a Control group - a group of people with the same symptoms, so they're in the same situation as the Experimental group (the ones receiving the treatment), but they don't get any treatment. 
The idea is to see what would happen to people with the same situation who didn't get any treatment - would the symptoms get better on their own?  With Tai Chi studies, sometimes other types of exercise are used instead, such as aerobics, walking, balance exercises, etc., to compare the effects of different methods.

Randomised - The people are allocated to either the Experimental or Control groups in a random way, so there's no bias.  For example, if people were put into a Tai Chi treatment group because they wanted to do Tai Chi, and put into a Control group because they didn't want to, there might be bias  introduced with the Tai Chi group getting better because they were so enthusiastic and expected it to help, rather than the Tai Chi itself making any difference.

Double Blinding - This is a difficult one for Tai Chi research. Single Blinding is the idea is that the people in the Experimental and Control groups don't know which groups they're in. In other words, the people doing Tai Chi wouldn't know that they were doing Tai Chi, and the people not doing Tai Chi wouldn't know that either.  With medications, 'placebo' tablets - containing nothing useful - are used so that people don't know whether they are getting the real drug or just a 'sugar pill'. 

The reason for this is that the mere knowledge that a person is getting a treatment can make them feel better - the Placebo effect - which can be very powerful and in some respects shows how powerful the mind can be in affecting the body.  If the same number of people feel better after a sugar pill as after a new drug, then the new drug is seen as 'no better than a placebo' - the only benefit is in the mind. 

Double blinding means that even the people giving people the medication don't know whether they are giving a real drug or a placebo - so that they don't subconciously pass on any expectations or ideas to the people in the study that may give them clues whether they are taking a real drug or not.  With a study looking at Tai Chi this is difficult, so blinded trials aren't normally possible.  This is a shame as it's a good way of proving that its the treatment that's having an effect on people, rather than just the expectations that people may have.

Systematic Review - This is a review of all of the research available on a particular question, such as is Tai Chi useful for treating osteoarthritis?  All the available trials are reviewed by a team of researchers (so one person's own views don't influence the results) based on a set of criteria decided to select the sort of evidence deemed to be high enough quality to be worth looking at. For example only double blinded RCTs, only trials with at least 50 participants, only trials that had a duration of at least three months, etc. The idea is to only use the trials that are likely to provide a reliable set of results.

Once all the trials that fit the criteria are identified, each study is analysed for it's strengths and weaknesses, and the results are combined together to see if they show a clear answer.  There are three possible outcomes:

1. All the trials show that the treatment is effective. This is great and time to break out the champagne as it is the best possible result to support using a particular treatment!

2. Some trials show that the treatment works, some show that it doesn't. This is actually the most usual outcome of systematic reviews - sometimes because the trials used were fairly low quality which might have influenced the results one way or the other. The only possible conclusion here is that there is some evidence either way (there might be slightly more in one direction or the other), but that better quality trials need to be carried out to make the situation clearer.

3. None of the trials included in the review showed that the treatment worked. This is where some people get a bit upset that their favourite treatment, whether it be Tai Chi, homeopathy, anti-depressants, or whatever doesn't work, and try to find reasons why it might be the case.  Unfortunately, unless the reviewers did a pretty poor job (always possible), if a systematic review fails to show any evidence that a treatment works better than a placebo, it doesn't really get more conclusive than that.


There you go - how's that?

If you see any articles in the newspapers or anywhere else and want me to take a look to see if they're likely to be reliable, let me know, with as much detail as possible.

Dave.

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