THE HEALTH BENEFITS OF TAI CHI

Cancer Support Community-Benjamin Center has a tai chi class that meets every Tuesday from 5 -6pm.  At no cost for those affected by cancer.  Just drop in or call 310-314-2555 for information.

May 2009, Harvard Medical School Article

This gentle form of exercise can prevent or ease many ills of aging and could be the perfect activity for the rest of your life.

Tai chi is often described as "meditation in motion," but it might well be called "medication in motion." There is growing evidence that this mind-body practice, which originated in China as a martial art, has value in treating or preventing many health problems. And you can get started even if you aren't in top shape or the best of health.

In this low-impact, slow-motion exercise, you go without pausing through a series of motions named for animal actions — for example, "white crane spreads its wings" — or martial arts moves, such as "box both ears." As you move, you breathe deeply and naturally, focusing your attention — as in some kinds of meditation — on your bodily sensations. Tai chi differs from other types of exercise in several respects. The movements are usually circular and never forced, the muscles are relaxed rather than tensed, the joints are not fully extended or bent, and connective tissues are not stretched. Tai chi can be easily adapted for anyone, from the most fit to people confined to wheelchairs or recovering from surgery.

"A growing body of carefully conducted research is building a compelling case for tai chi as an adjunct to standard medical treatment for the prevention and rehabilitation of many conditions commonly associated with age," says Peter M. Wayne, assistant professor of medicine at Harvard Medical School and director of the Tai Chi and Mind-Body Research Program at Harvard Medical School's Osher Research Center. An adjunct therapy is one that's used together with primary medical treatments, either to address a disease itself or its primary symptoms, or, more generally, to improve a patient's functioning and quality of life.

Belief systems

You don't need to subscribe to or learn much about tai chi's roots in Chinese philosophy to enjoy its health benefits, but these concepts can help make sense of its approach:

•  Qi — an energy force thought to flow through the body; tai chi is said to unblock and encourage the proper flow of qi.
•  Yin and yang — opposing elements thought to make up the universe that need to be kept in harmony. Tai chi is said to promote this balance.

Tai chi in motion
A tai chi class might include these parts:

Warm-up. Easy motions, such as shoulder circles, turning the head from side to side, or rocking back and forth, help you to loosen your muscles and joints and focus on your breath and body.

Instruction and practice of tai chi forms. Short forms — forms are sets of movements — may include a dozen or fewer movements; long forms may include hundreds. Different styles require smaller or larger movements. A short form with smaller, slower movements is usually recommended at the beginning, especially if you're older or not in good condition.

Qigong (or chi kung). Translated as "breath work" or "energy work," this consists of a few minutes of gentle breathing sometimes combined with movement. The idea is to help relax the mind and mobilize the body's energy. Qigong may be practiced standing, sitting, or lying down.

Getting started

The benefits of tai chi are generally greatest if you begin before you develop a chronic illness or functional limitations. Tai chi is very safe, and no fancy equipment is needed, so it's easy to get started. Here's some advice for doing so:

Don't be intimidated by the language. Names like Yang, Wu, and Cheng are given to various branches of tai chi, in honor of people who devised the sets of movements called forms. Certain programs emphasize the martial arts aspect of tai chi rather than its potential for healing and stress reduction. In some forms, you learn long sequences of movements, while others involve shorter series and more focus on breathing and meditation. The name is less important than finding an approach that matches your interests and needs.

Check with your doctor. If you have a limiting musculoskeletal problem or medical condition — or if you take medications that can make you dizzy or lightheaded — check with your doctor before starting tai chi. Given its excellent safety record, chances are that you'll be encouraged to try it.

Consider observing and taking a class. Taking a class may be the best way to learn tai chi. Seeing a teacher in action, getting feedback, and experiencing the camaraderie of a group are all pluses. Most teachers will let you observe the class first to see if you feel comfortable with the approach and atmosphere. Instruction can be individualized. Ask about classes at your local Y, senior center, or community education center. The Arthritis Foundation (www.arthritis.org; 800-283-7800, toll-free) can tell you whether its tai chi program, a 12-movement, easy-to-learn sequence, is offered in your area.

If you'd rather learn at home, you can buy or rent videos geared to your interests and fitness needs (see "Selected resources"). Although there are some excellent tai chi books, it can be difficult to appreciate the flow of movements from still photos or illustrations.

Talk to the instructor. There's no standard training or licensing for tai chi instructors, so you'll need to rely on recommendations from friends or clinicians and, of course, your own judgment. Look for an experienced teacher who will accommodate individual health concerns or levels of coordination and fitness.

Dress comfortably. Choose loose-fitting clothes that don't restrict your range of motion. You can practice barefoot or in lightweight, comfortable, and flexible shoes. Tai chi shoes are available, but ones you find in your closet will probably work fine. You'll need shoes that won't slip and can provide enough support to help you balance, but have soles thin enough to allow you to feel the ground. Running shoes, designed to propel you forward, are usually unsuitable.

Gauge your progress. Most beginning programs and tai chi interventions tested in medical research last at least 12 weeks, with instruction once or twice a week and practice at home. By the end of that time, you should know whether you enjoy tai chi, and you may already notice positive physical and psychological changes.

No pain, big gains

Although tai chi is slow and gentle and doesn't leave you breathless, it addresses the key components of fitness — muscle strength, flexibility, balance, and, to a lesser degree, aerobic conditioning. Here's some of the evidence:

Muscle strength. In a 2006 study published in Alternative Therapies in Health and Medicine, Stanford University researchers reported benefits of tai chi in 39 women and men, average age 66, with below-average fitness and at least one cardiovascular risk factor. After taking 36 tai chi classes in 12 weeks, they showed improvement in both lower-body strength (measured by the number of times they could rise from a chair in 30 seconds) and upper-body strength (measured by their ability to do arm curls).

In a Japanese study using the same strength measures, 113 older adults were assigned to different 12-week exercise programs, including tai chi, brisk walking, and resistance training. People who did tai chi improved more than 30% in lower-body strength and 25% in arm strength — almost as much as those who participated in resistance training, and more than those assigned to brisk walking.

"Although you aren't working with weights or resistance bands, the unsupported arm exercise involved in tai chi strengthens your upper body," says internist Dr. Gloria Yeh, an assistant professor at Harvard Medical School. "Tai chi strengthens both the lower and upper extremities and also the core muscles of the back and abdomen."

Flexibility. Women in the 2006 Stanford study significantly boosted upper- and lower-body flexibility as well as strength.

Balance. Tai chi improves balance and, according to some studies, reduces falls. Proprioception — the ability to sense the position of one's body in space — declines with age. Tai chi helps train this sense, which is a function of sensory neurons in the inner ear and stretch receptors in the muscles and ligaments. Tai chi also improves muscle strength and flexibility, which makes it easier to recover from a stumble. Fear of falling can make you more likely to fall; some studies have found that tai chi training helps reduce that fear.

Aerobic conditioning. Depending on the speed and size of the movements, tai chi can provide some aerobic benefits. But in the Japanese study, only participants assigned to brisk walking gained much aerobic fitness. If your clinician advises a more intense cardio workout with a higher heart rate than tai chi can offer, you may need something more aerobic as well.

Selected resources

Tai Chi Health www.taichihealth.com
Tai Chi Productions www.taichiforhealth.com
Tree of Life Tai Chi Center www.treeoflifetaichi.com

Tai chi for medical conditions

When combined with standard treatment, tai chi appears to be helpful for several medical conditions. For example:

Arthritis. In a 40-person study at Tufts University, presented in October 2008 at a meeting of the American College of Rheumatology, an hour of tai chi twice a week for 12 weeks reduced pain and improved mood and physical functioning more than standard stretching exercises in people with severe knee osteoarthritis. According to a Korean study published in December 2008 in Evidence-based Complementary and Alternative Medicine, eight weeks of tai chi classes followed by eight weeks of home practice significantly improved flexibility and slowed the disease process in patients with ankylosing spondylitis, a painful and debilitating inflammatory form of arthritis that affects the spine.

Low bone density. A review of six controlled studies by Dr. Wayne and other Harvard researchers indicates that tai chi may be a safe and effective way to maintain bone density in postmenopausal women. A controlled study of tai chi in women with osteopenia (diminished bone density not as severe as osteoporosis) is under way at the Osher Research Center and Boston's Beth Israel Deaconess Medical Center.

Breast cancer. Tai chi has shown potential for improving quality of life and functional capacity (the physical ability to carry out normal daily activities, such as work or exercise) in women suffering from breast cancer or the side effects of breast cancer treatment. For example, a 2008 study at the University of Rochester, published in Medicine and Sport Science, found that quality of life and functional capacity (including aerobic capacity, muscular strength, and flexibility) improved in women with breast cancer who did 12 weeks of tai chi, while declining in a control group that received only supportive therapy.

Heart disease. A 53-person study at National Taiwan University found that a year of tai chi significantly boosted exercise capacity, lowered blood pressure, and improved levels of cholesterol, triglycerides, insulin, and C-reactive protein in people at high risk for heart disease. The study, which was published in the September 2008 Journal of Alternative and Complementary Medicine, found no improvement in a control group that did not practice tai chi.

Heart failure.  In a 30-person pilot study at Harvard Medical School, 12 weeks of tai chi improved participants' ability to walk and quality of life. It also reduced blood levels of B-type natriuretic protein, an indicator of heart failure. A 150-patient controlled trial is under way.

Hypertension.  In a review of 26 studies in English or Chinese published in Preventive Cardiology (Spring 2008), Dr. Yeh reported that in 85% of trials, tai chi lowered blood pressure — with improvements ranging from 3 to 32 mm Hg in systolic pressure and from 2 to 18 mm Hg in diastolic pressure.

Parkinson's disease.  A 33-person pilot study from Washington University School of Medicine in St. Louis, published in Gait and Posture (October 2008), found that people with mild to moderately severe Parkinson's disease showed improved balance, walking ability, and overall well-being after 20 tai chi sessions.

Sleep problems.  In a University of California, Los Angeles, study of 112 healthy older adults with moderate sleep complaints, 16 weeks of tai chi improved the quality and duration of sleep significantly more than standard sleep education. The study was published in the July 2008 issue of the journal Sleep.

Stroke.  In 136 patients who'd had a stroke at least six months earlier, 12 weeks of tai chi improved standing balance more than a general exercise program that entailed breathing, stretching, and mobilizing muscles and joints involved in sitting and walking. Findings were published in the January 2009 issue of Neurorehabilitation and Neural Repair.

Check out original article at http://www.health.harvard.edu/newsletters/Harvard_Womens_Health_Watch/2009/May/The-health-benefits-of-tai-chi

 

 

PRESCRIBING A NEW KIND OF CANCER REHAB FOR CANCER SURVIVORS

At the Cancer Support Community-Benjamin Center, we have over 20 mind-body classes per week to help people with cancer and their families regain strength, focus, balance and energy, as well as workshops relating to nutrition and complementary care.  Since 1982, CSC (formerly The Wellness Community) has stressed the importance of taking care of the whole person and the whole family through a program of psychosocial support, including exercise, stress relief classes and education. 


By LAURA LANDRO
A version of this article appeared January 29, 2013, on page D1 in the U.S. edition of The Wall Street Journal, with the headline: Prescribing a New Kind of Rehab for Cancer Survivors.

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A new push for cancer "rehab" is helping patients avoid long-term physical disability and complications after treatment ends. WSJ's Laura Landro and Julie Silver, Harvard Medical School assistant professor, discuss on Lunch Break. Photo: Getty Images.

 

Patients who undergo cardiac-bypass or joint-replacement surgery routinely are given specific guidance to the exercises and therapies they will need to return to their everyday activities and to prevent complications or relapse.

For cancer patients, the story is very different.

After undergoing often harsh and debilitating treatments, there is often little help for their return to normal life.

Now, an increasing number of hospitals are offering programs to provide cancer patients with comprehensive rehabilitation services, amid mounting evidence that these can help speed recovery, shorten hospital stays and improve quality of life.

Rehabilitation services are "an absolutely essential part of cancer care," says Dan McKellar, chairman of the Commission on Cancer. Last year the nonprofit standards-setting group, overseen by the American College of Surgeons, began requiring cancer programs to offer rehabilitation services to be eligible for accreditation. Major cancer centers are taking steps to better coordinate rehabilitation after treatment. And Medicare and most insurance companies are covering such services.

Doctors who specialize in rehabilitation medicine can evaluate patients for fatigue, pain, anemia and decreased endurance that result from chemotherapy, radiation and surgery. They can then prescribe physical and occupational therapy, as well as treatment for sleep problems, depression and cognitive impairment. Dietitians help with nutrition, as cancer can change the way the body uses food and patients often lose their appetite from treatment. Some institutions offer massage and yoga.
More than a third of the nation's 12.6 million cancer survivors had physical or mental health problems that put their overall health in jeopardy and had a negative impact on their quality of life, according to a recent study of federal health data funded by the National Cancer Institute. While patients may get emotional help from friends, family and support groups, physical problems may get scant attention once they are no longer in the care of oncologists and surgeons.

"When cancer patients are diagnosed, everyone sits down to look at the case, decide what to do and convey that plan to the patient, but the same sort of process doesn't happen for survivors of the treatment," says Kathryn Weaver, lead author of the study and an assistant professor at Wake Forest Baptist Medical Center in Winston-Salem, N.C. Patients, she adds, may feel their physical problems are "the new normal" and may not ask their doctors for help. And even though most hospitals have rehabilitation services, there may not be a formal program to identify cancer-patient needs or coordinate a care plan among different therapists.

One model being adopted by hospitals, including Johns Hopkins in Baltimore, M.D. and Bon Secours St. Francis Health System in Greenville, S.C., is called STAR, for Survivorship Training and Rehab. It uses specially trained teams of caregivers, coordinated by navigators such as nurses, to help patients with physical and emotional issues, as well as any other concerns that arise.

In 2011, Dan Yarborough, a 67-year-old attorney, had two stem cell transplants within months of each other and high-dose chemotherapy to treat multiple myeloma, a form of blood cancer, at Bon Secours. The treatments left him weak and fatigued, with pain and numbness in his feet that threw off his balance and left him unable to walk steadily and unable to stop himself from falling if he tripped. Golf and travel, favorite pastimes, were out of the question, and he was worried about being able to argue his cases standing in court.

While hospitalized for his second transplant, a nurse navigator from the hospital's STAR program set him up with regular physical therapy appointments and nutrition counseling. Staffers helped him establish goals such as improving his ability to get in and out of his SUV, and worked with his doctors to change medications that were linked to his foot problems.

The program was "incredibly valuable," Mr. Yarborough says, giving him back the stamina to return to work. He is following up with a recommended exercise program at a medical fitness facility owned by the hospital where his exercise plan is overseen by a STAR-certified physiologist for a $30-per-month fee.

The Bon Secours STAR team also deals with specific issues such as helping head and neck cancer patients restore normal functions of swallowing, speech and movement after treatment. "In a lot of hospitals you will see these patients fall through the cracks after surgery, so their cancer is gone but they can't turn their neck to drive a car," says Lori McKitrick, a speech therapist who oversees the program. "We are doing a great job saving people's lives but we have to help them live their lives too."

Julie Silver, an assistant professor at Harvard Medical School and expert in rehabilitation medicine, developed STAR after her own treatment for breast cancer, which she says left her too sick to care for her family or return to work. Her oncologist suggested she rest and try to heal on her own, but "it left me thinking there has to be a better way," Dr. Silver says. "Every cancer survivor should have the opportunity to heal as well as possible and function at optimal level whether their cancer is cured, in remission or they live with cancer as a chronic disease," Dr. Silver says.

She started a company, Oncology Rehab Partners, which helps health systems and hospitals create their own STAR programs for many types of cancer. STAR certification is used by insurance companies in reimbursement decisions. The program costs a typical hospital about $25,000 to launch with an annual fee of $10,000 for continuing education and recertification, Dr. Silver says.

Michelle Houle, 45, has been participating in the STAR program at Bon Secours since she was diagnosed with breast cancer in 2010. After chemotherapy, a bilateral mastectomy and radiation, Ms. Houle, on long-term disability from her job as a food company shelf manager, says she felt "about 90 years old." Nurse navigators at the hospital set her up with a specialist to help prevent lymphedema, a painful swelling of the lymph nodes and a common side effect of breast surgery, and she began a physical therapy regimen.

Ms. Houle suffered a recurrence in 2011 and is now on another chemotherapy regimen, but keeps up her exercises at the hospital's medical fitness facility. She is slowly returning to activities like gardening and housework. The rehabilitation program provides "a base to keep you going," she says, "and there is always someone to talk to if I'm feeling side effects."

Signature Healthcare in Brockton, Mass, which includes Brockton Hospital and 150 employed doctors, treats local cancer patients and those who have had treatment at major centers in Boston, then return home for follow-up with difficult physical aftereffects. Last week, it launched its own STAR program after 23 staffers went through six months of training and received STAR certification. "These needs have been unmet for such a long period of time, and they are very excited to be able to offer this enhanced level of service" says Linda McAlear, the program's coordinator.