Virtual Special Issue: Tai Chi

PMID: 36049742 DOI: 10.1123/japa.2022-0248

Tai Chi is an ancient Chinese form of exercise that has been practiced for at least hundreds of years. It is a slow, gentle, fluid form of exercise that is accessible for people of all ages and abilities. Further, it is a mind–body exercise, in that the physical movements of patterns with the arms and legs are accompanied by a form of “movement meditation.” That is, participants focus on the movements and the Tai Chi session and no longer think about other aspects before/after the session. This can result in a sensation of relaxation and calmness as well as gentle physical exertion. For these reasons, Tai Chi has grown in interest in the scientific community over the years and across the globe. It is therefore timely to have a virtual special issue on Tai Chi in Journal of Aging and Physical Activity (JAPA).

In this virtual special issue on Tai Chi, I have selected 16 papers published in JAPA from 1998 to present day. They include a mixture of study designs including reviews, quantitative, and qualitative studies. The virtual special issue begins with one of the very first papers on Tai Chi published by JAPA (Yan & Downing, 1998).1 It serves as useful starting point for readers to become familiar with Tai Chi and its origins. The paper ends with some useful suggestions for Tai Chi instruction with older adults. Thereafter, the papers have been ordered along the following themes that studies have contributed to the scientific literature: (a) the benefits of Tai Chi for older adults in the areas of cognition, balance and falls, cardiovascular system, arthritis, and psychological factors; (b) older adults’ adherence to Tai Chi interventions; and (c) implementation of Tai Chi interventions with older adults.

The first theme on the benefits of Tai Chi begins with a paper that reviews the potential for Tai Chi to improve cognition in older adults (Chang et al., 2010). While they show promise for Tai Chi to improve executive functioning, Chang et al. (2010) highlight methodological limitations of prior studies that provide useful considerations for researchers in this area. They also suggest potential mediators of the relationship between Tai Chi and cognition that can be tested in future studies. Another paper on cognition is by Li et al. (2007). They conducted a pilot study with older adults with Parkinson’s disease. They provide preliminary evidence of the suitability and acceptability of Tai Chi with this population and its potential to improve physical function.

Tai Chi has many potential physical benefits including preventing falls and improving balance. Nyman’s (2021) review paper found high-quality evidence for Tai Chi to be an effective intervention for preventing falls among community-dwelling older adults. Nyman also presented data to suggest that class-based adherence ranges 71%–81% in previous trials. Palermi et al. (2020) conducted a systematic review and meta-analysis. They found only four studies and three to include in their quantitative synthesis. Nonetheless, they found results that support the use of Tai Chi to improve balance in older adults with Type 2 diabetes.

In relation to the cardiovascular system, Wong et al. (2018) conducted a study with older women with fibromyalgia. Compared with a control group, they found the Tai Chi group to have improved in cardiac autonomic function and symptomatology. Zheng et al. (2019) conducted a similar study with older adults at risk of ischemic stroke. Relative to the control group, the Tai Chi group improved in cerebral hemodynamics and plasma risk factors.

In relation to arthritis, Callahan et al. (2016) randomized older adults with arthritis to either a Tai Chi or control group. Relative to the control group, improvements noticed at 8 weeks were still present after a year in relation to issues such as pain, fatigue, and role participation satisfaction even though only 30% were continuing Tai Chi practice at 1 year. Further, Duan et al.’s (2019) biomechanical study showed that Tai Chi is a suitable and promising form of exercise for older adults with hip osteoarthritis.

In relation to the benefits of Tai Chi, the final study is by Li et al. (2001) on a psychological variable of self-efficacy. Compared with those randomized to a control group, the Tai Chi group improved in their personal efficacy (or confidence) to perform physical movements, and this improvement was associated with higher class attendance.

The second theme that the Tai Chi studies addressed is adherence. Liang et al. (2022) assessed the feasibility and acceptability of remotely, home-based, short forms of exercise (snacking). Each form, including Tai Chi, had good adherence and led to increases in physical function at follow-up. Barrado-Martín et al. (2021) conducted a qualitative study with community-dwelling older people with dementia. They found that Tai Chi classes were enjoyed by people with dementia and their caregivers, which along with the socializing component, was a facilitator to class attendance. Unexpected health problems were the main barrier to class attendance. Gavin et al.’s (2003) study tracked participants in community programs for a year. They found that most older adults joined Tai Chi sessions for fitness and health, with 72% adherence to 8- to 12-week sessions.

The final theme that the Tai Chi studies addressed is implementation. Jones et al. (2022) conducted a study for older adults in hard-to-reach, medically underserved, rural communities. With the help of churches, they were able to achieve successes comparable with other reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) process evaluations, though attendance, completion, and continuation rates were lower. Siu et al. (2015) conducted a study with Latino older adults. They found improvements in functional status after a Tai Chi program, and that depression and social support were important moderators in the improvements observed in functioning. Finally, Li et al. (2003) presented an adapted eight-form Tai Chi program that can be implemented in research and practice. This includes a list of 10 essentials for Tai Chi practice to facilitate adoption.

The 16 papers selected for this virtual special issue on Tai Chi illustrate the breadth and depth of quality work on Tai Chi that has been published in JAPA over the past 24 years. This work has demonstrated the range of benefits of Tai Chi for older adults in the areas of cognition, balance and falls, cardiovascular system, arthritis, and psychological factors. It has also shed light on factors important for adherence and implementation of Tai Chi with older adults from various patient groups and communities. Looking forward, JAPA would welcome further novel and impactful contributions to the literature on Tai Chi with older adults. In particular, more qualitative studies that give voice to older adults and instructors, and more evaluations of implementing Tai Chi particularly with traditionally underserved groups. Also, longitudinal studies that speak to Tai Chi practice in the long-term and randomized trial designs and meta-analyses that further the evidence based on the benefits of Tai Chi with older adults. I hope that this virtual special issue encourages researchers to continue researching Tai Chi with older adults and to submit their quality work to JAPA.

Notes
1.
The JAPA papers cited in-text are included in the virtual special issue.