Tai Chi and Qigong are traditional Chinese exercises that are widely practiced for their health benefits and as martial arts. Developed over hundreds and thousands of years, respectively, Tai Chi and Qigong are practiced worldwide in a variety of modern and traditional forms.
In 2002, there were more than 2.5 million Tai Chi users and 500,000 Qigong users in the United States.
Both Tai Chi and Qigong involve sequences of flowing movements coupled with changes in mental focus, breathing, coordination, and relaxation. There is significant overlap between the 2 practices in terms of movements and in the shared focus on breathing and mindfulness. Both practices are low-impact, moderate-intensity aerobic exercises that are suitable for a diverse patient population with regards to gender, age, and health status.
Tai Chi and Qigong have been characterized as mind-body interventions and as “meditative movements.” They are relatively safe, nonpharmacologic practices, which can be used for treatment and prevention of psychosomatic disorders, with few adverse events reported in the literature.
Both Tai Chi and Qigong have been known to improve the qualities of life in many diverse patient populations. Whether someone is suffering from a chronic physical illness, to anxiety and depression, practising Tai Chi and Qiquong on a regular basis can greatly impact the quality of one’s physical and mental states of health. The following research by Ryan Abbott. MD and Helen Lavretsky, MD, was published in The Psychiatric clinics of North America, 36(1), 109–119. doi:10.1016/j.psc.2013.01.011. They list all of the health outcomes of doing Tai Chi and Chi Quong, health-related quality of life-related to one’s physical and mental health, how practicing both of these exercises can reduce stress and minimize the effects of depression and anxiety.
Health Outcomes of Tai Chi and Qigong Interventions
Studies have shown that Tai Chi and Qigong may improve bone density, cardiopulmonary health, arthritis, fibromyalgia, tension headaches, and other medical conditions. Given the relationship between physical and mental health, general improvements in physical health or reductions of chronic disease symptoms may help to improve mental health. Chronic physical health problems are associated with stress, anxiety, depression, and poor mood.
Health-Related Quality of Life
Health-related quality of life (HRQOL) serves as a comprehensive measure of patient well-being, and it reflects patient perceptions of personal health and life satisfaction over a period of time. Individuals suffering from mental health conditions are particularly likely to report poor HRQOL. A study comparing patients with common medical disorders to those with mental health conditions found significant differences in HRQOL between the 2 groups. Individuals with mental health conditions had significantly greater impairment of HRQOL. The ability of Tai Chi and Qigong to improve HRQOL is an important consideration for treating patients with mental disorders. Although there is no evidence that Tai Chi and Qigong may be effective for a particular condition, they may still provide some benefit by improving HRQOL.
Tai Chi and Qigong as Exercise
Studies have tried to understand the effects of Tai Chi and Qigong as aerobic versus mindful exercise. Independent from any special benefits Tai Chi and Qigong may confer as meditative movements, they also benefit patients as general, low-impact, moderate-intensity aerobic exercise. There is extensive evidence of general exercise interventions with regards to mental disorders. Systematic reviews have found that exercise results in significant reductions in depression symptoms comparable to cognitive-behavioral therapy. Two studies found that exercise is comparable with sertraline (Zoloft) in terms of efficacy for the treatment of major depressive disorder. In studies comparing the benefits of Tai Chi and Qigong with general exercise, both interventions have been shown to have comparable effects at reducing anxiety. In general, evidence from clinical trials supports a positive association between physical activity and physical and psychological health.
The most logical clinical application of mind-body techniques is for stress reduction. Out of 5 RCTs, 4 found a significant association between Tai Chi and Qigong and positive effects on stress.
- Beneficial effects were found in a study in 200860 that evaluated a population infected with the human immunodeficiency virus (mean age 42 years, n = 252) randomized to practice Tai Chi for 90 minutes once weekly for 10 weeks or to a cognitive-behavioral relaxation group, spiritual growth group, or a wait-list control group.
- A study in 200161 that used a healthy geriatric population (mean age 73 years, n = 72) randomized to practice Tai Chi for 1 hour twice weekly for 24 weeks versus a wait-list control group also found that Tai Chi reduced stress.
- Tai Chi was shown to reduce stress in a study in 199662 that evaluated health among older adults (mean age 67 years, n = 20) who practiced Tai Chi for 2 hours, once weekly for 10 sessions compared with a routine physical activity group.
- Positive effects were found in a study in 199245 that looked at healthy adults (mean age 36 years, n = 96) who underwent a single, 1-hour session of Tai Chi versus meditation, brisk walking, or neutral reading.
- One RCT did not find positive results; a study in 200763 that evaluated individuals with hip or knee osteoarthritis (mean age 70 years, n = 152) who practiced Tai Chi for an hour twice weekly for 12 weeks found no significant difference compared with hydrotherapy or wait-list control group.
All studies used subjective stress measures, 1 measured body temperature,62 and 2 measured salivary cortisol levels,60 which decreased as a result of Tai Chi practice.
Mood, Anxiety, and Depression
Seven RCTs have found that Tai Chi significantly improves mood, including:
- A 2011 study of 100 outpatients (mean age 67 years) with systolic heart failure who received either a 12-week Tai Chi exercise program or time-matched education.
- A study published in 2009 randomized 21 obese women to either a 2-hour weekly session of Tai Chi or a conventionally structured exercise program and found that only the Tai Chi group experienced improvements in mood.
- Benefits to mood were also found in a 2005 study of 38 adults (20–60 years old) with advanced HIV/AIDS who participated in 8 weeks of twice-weekly, 1-hour-long Tai Chi practice versus aerobic exercise or usual activity.64
- A 1995 study of 135 healthy, sedentary adults (mean age 53 years) who practiced Tai Chi for 45 minutes, 3 times a week, for 16 weeks reported improved mood compared with exercise and relaxation control groups.65
- Three of the trials described earlier45,60,61 also found benefits to mood.
An RCT66 found no significant impact of Tai Chi on mood. That trial randomized 22 community-dwelling participants (mean age 68 years) with lower extremity osteoarthritis to 12 weeks of twice-weekly, 1-hour-long Tai Chi sessions or to a control group. Tai Chi was found to improve pain, physical function, and other arthritis symptoms (measured using the Arthritis Self-Efficacy Scale) as well as satisfaction with general health status, but it did not result in a statistically significant difference in mood.
Ten RCTs have investigated the effects of Tai Chi on anxiety, 9 of which showed significant positive effects.
- A Japanese trial in 201067 evaluated 34 community-dwelling elderly participants with cerebral vascular disorder who were randomized to receive either Tai Chi or standard rehabilitation in group sessions once weekly for 12 weeks. Participants in the Tai Chi group experienced improvements in sleep quality, anxiety/insomnia, and depression.
- A study in 200833 randomized 20 patients with rheumatoid arthritis to 12 weeks of twice-weekly sessions of Tai Chi or attention control. Participants in the Tai Chi group experienced greater improvements in anxiety and depression than the control group.
- A study in 200735 of 65 patients (mean age 70 years) with chronic heart failure received 16 weeks of either Tai Chi practice twice weekly or standard medical care without exercise rehabilitation. They reported that both groups had a significant reduction in anxiety scores, found no between-group differences in anxiety, and found that depression was reduced only in the Tai Chi group.
- A study in 200768 of 84 sedentary older people (mean age 70 years) contrasted Tai Chi with low-impact exercise for 12 weeks and found that both groups of patients experienced improvements in anxiety.
- A study in 200369 of 76 healthy individuals (mean age 52 years) found improvements in anxiety for participants who received 12 weeks of 50-minute Tai Chi sessions 3 times a week compared with a sedentary life control group.
- Improvements to anxiety were also found in 3 RCTs described earlier.45
- One RCT described earlier63 did not find a significant effect on anxiety.
Fourteen RCTs have evaluated the effects of Tai Chi and Qigong on depressive symptoms, 13 of which found positive results. Several of these RCTs have already been described.67
- A single-blind, 12-week study70 of participants with fibromyalgia (mean age 50 years, n = 66) published in 2009 found that Tai Chi produced greater improvements in depression than a stretching and wellness education group.
- Another single-blind, 12-week trial in 200971 randomized 40 patients (mean age 65 years) with knee osteoarthritis to receive either Tai Chi or wellness education and stretching and found that patients in the Tai Chi group experienced greater improvement in depression.
- An RCT in 2008 evaluated 14 community-dwelling older patients from a psychogeriatric outpatient clinic who were randomized to receive a 3-month Tai Chi intervention or to a wait-list control. Only the Tai Chi group experienced improvements in depressive symptoms.
- A trial in 2007 randomized 112 healthy older adults (aged 59–86 years) to 25 weeks of either Tai Chi or health education. Participants in both groups experienced improvements in depressive symptoms.
- An RCT in 200572 of 291 women and 20 men (aged 70–97 years) recruited from 10 matched pairs of congregate living facilities found that 48 weeks of Tai Chi led to a significantly greater reduction in depression than wellness education (P <0.001).
- A Chinese trial in 200421 randomized 14 elderly persons (mean age 73 years) with depression to 12 weeks of Tai Chi 3 times a week for 45 minutes or to a wait-list control group. Only the Tai Chi group experienced improvements in depressive symptoms.
- A trial in 199873 of 51 patients aged 18 to 60 years with chronic low back pain reported improvements in depressive symptoms compared with a control group after 6 weeks practicing Tai Chi once a week for 90 minutes.
- Only 1 RCT did not find evidence that Tai Chi and Qigong are effective in reducing depressive symptoms or had any effect on anxiety or stress management.63
Most of these studies were conducted in patient populations without known mental disorders. Only 2 studies involved participants with clinically diagnosed depression.72 A review in 200974 of Tai Chi and Qigong in older adults found 36 clinical trials with 3799 participants and concluded that Tai Chi and Qigong practice causes a significant improvement in depression and anxiety. Tai Chi has been particularly recommended as a first-line treatment of mild depression in geriatric populations given its known benefits in improving balance and reducing falls.75 Depression and falls are associated through a complex bidirectional relationship.76Antidepressant use has also been associated with falls,77 especially selective serotonin reuptake inhibitors, which are associated with fragility fractures to a higher degree than other classes of psychotropic medications.78,79
On the other hand, more recent research has produced mixed results on the effectiveness of Tai Chi and Qigong for the prevention of falls. One Cochrane collaboration meta-analysis80 found that Tai Chi had a moderate effect on reducing falls in community-based geriatric populations, and a second meta-analysis81found insufficient evidence to support the use of Tai Chi for prevention of falls. One of the most recent RCTs of Tai Chi as a community-based falls prevention intervention was an 11-site multicenter study conducted in New Zealand.82 A total of 684 community-residing older adults with at least 1 risk factor for falls were randomized to receive 20 weeks of either Tai Chi once a week, Tai Chi twice a week, or general exercise once a week. All groups experienced a reduction in the rate of falls; however, there was no statistically significant difference between groups over the 17-month follow-up period.
Tai Chi and Qigong may also be able to improve sleep quality, with the corresponding impact on mental health.
- An RCT6 of Tai Chi for improving sleep quality in older adults with moderate sleep complaints randomized67 112 participants to receive 25 weeks of either Tai Chi or health education. The study found that participants in the Tai Chi group were more likely to achieve a treatment response and to show global improvements in sleep quality.
- A second RCT83 in a geriatric (aged 60–92 years) population (n = 118) found that Tai Chi, practiced for an hour, 3 times weekly for 24 weeks, was more effective than general exercise at improving sleep quality and daytime sleepiness.
- A third RCT,67 described earlier, found that 12 weeks of Tai Chi practice once a week was more effective at improving sleep quality than a rehabilitation control group. Chronic sleep problems are associated with impaired health status and depressive symptoms.84
- A fourth RCT85 assigned 102 community-dwelling participants (mean age 68.9 years) in Vietnam to receive 6 months of Tai Chi training or to maintain their routine daily activities. Compared with the control group, individuals in the Tai Chi group experienced significant improvements in sleep quality, balance, and cognitive performance.
Abbott, R., & Lavretsky, H. (2013). Tai Chi and Qigong for the treatment and prevention of mental disorders. The Psychiatric clinics of North America, 36(1), 109–119. doi:10.1016/j.psc.2013.01.011