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    Tai Chi as an Exercise to Prevent Osteoporosis - Why is Osteoporosis a Concern?

    One of the growing health concerns reported by the surgeon general report in 2004 was the increased prevalence of osteopenia and osteoporosis amongst women in the USA.

    It was estimated that the number of women over the age of 50 with either the osteopenia or the osteoporosis conditions was approximately 44 million people.

    It is thought that the number of women over 50 with these conditions is likely to increase further in the coming years; this is because people born in the so called 'baby boom' years are now coming to an age where osteoporosis syndrome symptoms (which are often difficult to detect; hence its title as 'the silent disease'), such as fractures, are more likely to be detected.

    Diet and Exercise Can Help to Prevent Osteopenia Conditions

    It is well known that a healthy diet high in Magnesium, Calcium and vitamins D and K, and the use of weight bearing exercises such as walking and stair-climbing can go a long way towards preventing the development of osteoporosis. The use of exercise can also help to eliminate pain and help to strengthen bones in both men and women who are suffering from osteopenia.

    The prevalence of Traditional Tai Chi as an Exercise in Western Society

    One exercise that is carried out by many people over the age of fifty (and to a lesser extent by young people too) is Tai Chi. This is a traditional Chinese mind and body exercise that is very meditative in nature. It has long been practiced by millions of Chinese people who have found it to be beneficial in the maintenance of health and ones well being. The art of Tai Chi has become increasingly popular in both the USA and Great Britain in recent years.

    Tai Chi

    Photograph of people performing Tai Chi by Uno di Passaggio.

    The conventional medical world has welcomed the use of Tai Chi as they see it as a safe, low cost meditative exercise with many health benefits. Because of its slow and steady movements, Tai Chi is thought to be an ideal exercise for elderly people and is thought to help greatly in keeping the body supple and to help balance. Indeed it has recently been reported by the surgeon general of the USA that the use of Tai Chi is beneficial to osteoporosis sufferers as it can help to lower incidents of falls (one of the major causes of fractures in people with osteoporosis); it is also seen as a safe and effective way for people to maintain bone density.

    Studies on the Use of Tai Chi for Health Benefits by the Research Community

    The use of Tai Chi has increased dramatically in the western world during recent years. Many studies have looked into the health benefits of this mind and body exercise. Therapeutic exercise research includes investigations into musculoskeletal flexibility and strength; balance; posture; cardio respiration conditions; rheumatism; the immune system; dementia; stress; amongst many others.

    Tai Chi Helps to Maintain Balance

    With regards to osteoporosis, the use of Tai Chi has been suggested to help maintain balance and to help maintain bone density; these two things alone has led to Tai Chi being recommended to the medical community by the surgeon general in the USA as a way to help osteoporosis sufferers deal with their condition.

    Tai Chi Osteoporosis

    It is not just old people who practice Tai Chi, these young children are going a long way to develop healthy bones. Photograph by Burkland and Cook.

    In a recent review by Wayne et al, the association between Tai Chi and the maintenance of bone density in postmenopausal women has been investigated. They performed this by taken a look at the literature available of randomized control studies, cross sectional studies and cohort studies that had at least one outcome that measured bone mineral density.

    Nature of the Report on Osteoporosis and Osteopenia and the Relationship of Tai Chi

    The report first takes a look at the impact of osteoporosis in modern society, and the way that the condition is currently looked after. The fundamental principles of the traditional Chinese Tai Chi exercise/art form is then reviewed; this is done in a way that looks into its use and benefits for women who have a low bone mineral density. The available literature on the links between Tai Chi, bone mineral density and osteoporosis is then investigated before finally a look into the effects that secondary impacts of Tai Chi (such as increased balance) may have on postmenopausal women with osteoporosis is investigated.

    Why Tai Chi is a Healthy Exercise for People with Low Bone Density

    Although Tai Chi is a traditional Chinese martial art, it is more often used by modern society for its exercise benefits. Due to its slow flowing movements it seems to be an ideal exercise for people who may be susceptible to injury through partaking in exercises that are more vigorous. Tai Chi has long been thought of by Chinese society as a traditional health remedy, and has strong associations with the fields of traditional Chinese herbal medicines and acupuncture. It is thought to strengthen the balance of Qi (balance of life form) by use of breathing techniques, movement and use of the brain (internal awareness and external visualization).

    Tai Chi has Many Health Benefits

    Much research has been carried out that has focused on the health benefits of Tai Chi; many of these have concluded that it may make an ideal therapeutic exercise for people with low bone densities, and additionally help to maintain posture. Tai Chi may therefore have a positive impact upon people with osteopenia or osteoporosis by both internal and preventative methods.

    Many aspects of Tai Chi help it be a good exercise for both mind and body:

    • Using different body parts in turn to stabilize the body and move in smooth motions increases balance.
    • A slow but even tempo helps to increase the awareness of one’s senses.
    • Flexing of the knees helps to reduce the body's centre of gravity.
    • Shifting weight between legs is thought to facilitate leg strength and increase balance when standing.
    • The maintenance of a vertical position with a stretched head and trunk helps to promote an un-flexed posture.
    • Diagonal Arm movements promote arm swing, and an increase in waist suppleness.
    • Smooth circular movements help to promote flexibility in joints.

    It is thought that the use of Tai Chi will lead to an increase in the efficiency of biomechanical movements during one daily routine, and hence may lead to an increase in mechanical load that bones such as the hip are able to tolerate. Therefore, it is seen that Tai Chi may be an effective exercise for people who may have low bone density or mass and at risk of developing osteoporosis.

    The Effect of Tai Chi on Bone Density - Clinical Trials

    After following a database search Wayne et al. identified six articles of literature that could be used to look into the relationship between the effects of performing Tai Chi upon the bone mineral density of postmenopausal women. Two of these studies were randomized controlled studies, two were cohort studies, while the remaining two were static cross section comparisons.

    Unfortunately, the methodology used in most of the studies was of poor quality; however, the results were interpreted as best as possible. The investigations generally compared Tai Chi with other exercises such as skipping; martial arts; with sedate subjects; or with traditional Chinese herbal medicine or acupuncture.

    Findings from the Literature Search of Tai Chi and Bone Mass

    The literature search done by Wayne et al found a few interesting findings:

    • It was found that long term post menopausal practicer’s of Tai Chi had an higher bone mineral density than those of a similar age who were sedentary in nature. Additionally people who performed Tai Chi had a lower rate of bone loss in comparison to inactive people. It was observed that women who partook in Tai Chi tended to have a higher bone density in both the Femur and spine.
    • People who had not previously taken Tai Chi as a form of exercise, but took it up appeared to slow their rate of bone density loss. After a period of one year, it was found in one of the studies that the rate of bone loss could be reduced by as much as 3.6 times in the trabecular and 2.3 times in the cortical. A further study also revealed that two people performing Tai Chi together using the pushing hands method could increase their lumbar bone mineral density by as much as 3.4%.
    • A further study also suggested that the use of Tai Chi might help to reduce perimenopausal symptoms such as hot flashes.
    • None of the studies found any adverse impacts of carrying out Tai Chi exercises in both peri- and postmenopausal women.

    As mentioned previously there are many limitations with the studies carried out between the relationship of Tai Chi and bone density levels in postmenopausal women. These limitations were mainly in the methodology or design of the experiments themselves.

    Another thing needed to be considered is that all the reports came from China and hence analyze Asian women; who are known to have different prevalences of osteoporosis than other races. Therefore the findings should be taken with caution; however, it does look like Tai Chi may have a positive impact when used as an exercise for osteopenia sufferers.

    Other Benefits of Tai Chi in the Fight Against Osteoporosis

    People with osteopenia or osteoporosis have an increased risk of bone fractures due to a reduction in their levels of bone mineral density. Many people with osteoporosis may receive fractures from simple stumbles; for instance, they may reach out their hands to steady themselves when stumbling, and end up breaking their wrists.

    One of the advantages of Tai Chi is that it helps with ones balance. There have been numerous studies that have shown that people who take Tai Chi are able to reduce their risks of falling; mainly through better balance and posture. People who take Tai Chi regularly also tend to have better musculoskeletal strength; less fear of falling; better flexibility; and are able to carry out everyday activities in a more positive nature.

    It can therefore be seen that although there may be a co-relationship between Tai Chi and a lowering of the rate of bone loss, merely taking Tai Chi to increase posture and balance will have a major impact upon the lives of people with osteopenia. As these studies were carried out on older people it strongly suggests that Tai Chi can be safely carried out through out later life.

    Tai Chi as a Preventative Measure in the Fight Against Osteoporosis

    The above has described the impact of carrying out Tai Chi as an exercise for the prevention of osteopenia and osteoporosis. It was suggested that people who take prolonged and regular Tai Chi exercises are able to lower their rates of bone mineral density loss to a similar level that is seen in people who walk regularly as a form of exercises.

    Perhaps a more important aspect when considering taking Tai Chi as an exercise is the impact that it can have on one’s body and mind. It is beneficial in both posture, muscle skeletal strength, and in ones balance. The latter is very important for people with the osteoporosis syndrome as increased balance may lead to a lowering in the risk of fractures. Additionally the increase in the state of mind may help the sufferer get through life in a more confident manner. Again, this will help the person with osteopenia or osteoporosis get through their daily activities more safely.

    The use of Tai Chi was also found to be relatively safe in aging and frail people, making it an ideal exercise to carry out in later life.
    It was suggested by Wayne et al. that “Tai Chi may be an effective, safe and practical intervention for maintaining bone mineral density in postmenopausal women”. The paper then went onto suggest that further research into the use of Tai Chi as a preventative measure in the fight against osteoporosis should be carried out (on both men and women), and that these should focus on both internal factors, such as rates of bone mineral density loss, and on the incidence of fractures between people who take Tai Chi as a form of exercise and those who don't.

    References

    Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO study group. World Health Organ Tech Rep Ser 1994; 843: 1-129
    National Osteoporosis Foundation. America's bone health: the state of osteoporosis and low bone mas in the nation.
    Wayne et al. The effects of Tai Chi on Bone Mineral Density in postmenopausal Women: A systematic review. Arch Phys Med rehabil. Vol 88, pp673-680, 2007
    Wolf et al. Intense tai Chi exercise training and fall occurance in older, transitionally frail adults. J. Am Geriatr Soc 2003; 51:1693-701