The Need to Redesign Health Care

The Veterans Health Administration Whole Health Model of Care: Early Implementation and Utilization at a Large Healthcare System. The U.S. Veterans Health Administration (VHA) is changing the way it provides healthcare to a model known as Whole Health (WH). The aim is to shift from a primarily medical/disease-oriented system to a model that focuses on health promotion and disease prevention; utilizes personalized, proactive, and patient-driven care; and emphasizes the use of complementary and integrative health. Implementation of the WH model of care has the potential to transform the way VHA delivers healthcare and improve the health and lives of veterans. [PMID: 32870303].

U.S. Department of Veterans Affairs

Evidence Map of Tai Chi. The VHA's Health Services Research & Development Service (HSR&D) Evidence-based Synthesis Program (ESP) was established to provide timely and accurate syntheses of targeted healthcare topics of particular importance to VA managers and policymakers, as they work to improve the health and healthcare of Veterans. The ESP disseminates these reports throughout VA. HSR&D provides funding for four ESP Centers and each Center has an active VA affiliation. The ESP Centers generate evidence syntheses on important clinical practice topics, and these reports help develop clinical policies informed by evidence, the implementation of effective services to improve patient outcomes and to support VA clinical practice guidelines and performance measures, and set the direction for future research to address gaps in clinical knowledge.The Evidence Map of Tai Chi provides an overview of Tai Chi research and describes its volume and focus. It combines a systematic review of systematic reviews with a scoping review for the Veterans Administration priority areas pain, posttraumatic stress disorder, and fall prevention. The evidence map summarizes patient outcomes reported in reviews of studies in patients practicing Tai Chi for health-related indications. Statistically significant effects across existing studies were reported for hypertension, falls outside of institutions, cognitive performance, osteoarthritis, chronic obstructive pulmonary disease, pain, balance confidence, depression, and muscle strength.

Whole Health Library. Tai Chi and Qigong. 

VA HealtheVet. Move Well with Tai Chi.

TAI CHI AND QI GONG (.PDF)

Meditation Practices for Health

State of Research

The Meditation Practices for Health Report was requested and funded by the National Center for Complementary and Integrative Medicine. It was created by the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.

Objective: To review and synthesize the state of research on a variety of meditation practices, including: the specific meditation practices examined; the research designs employed and the conditions and outcomes examined; the efficacy and effectiveness of different meditation practices for the three most studied conditions; the role of effect modifiers on outcomes; and the effects of meditation on physiological and neuropsychological outcomes.

Meditation Programs for Psychological Stress and Well-Being (.PDF). Comparative Effectiveness Review Number 124. Meditation programs, in particular mindfulness programs, reduce multiple negative dimensions of psychological stress. Stronger study designs are needed to determine the effects of meditation programs in improving the positive dimensions of mental health as well as stress- related behavioral outcomes.

Office of the Surgeon General

Bone Health and Osteoporosis: A Report of the Surgeon General Issued October 14, 2004. The Surgeon General recommends Tai Chi as a key part of a regular exercise program to improve balance, strength, and coordination to reduce the risk of falling.

U.S. Department of Health and Human Services Recommends Tai Chi

NIH review finds nondrug approaches effective for treatment of common pain conditions. U.S. study reviews trial results on complementary health approaches for pain relief; aims to assist with pain management.

Tai Chi is an effective nonpharmacologic therapy for low back pain. This review examines the evidence on the comparative benefits and harms of noninvasive treatments for low back pain as opposed to pharmacological therapies. This is an AHRQ Comparative Effectiveness Review funded by the U.S. Department of Health & Human Services. Comparative effectiveness research is designed to inform health-care decisions by providing evidence on the effectiveness, benefits, and harms of different treatment options. The evidence is generated from research studies that compare drugs, medical devices, tests, surgeries, or ways to deliver health care. The Effective Health Care Program funds individual researchers, research centers, and academic organizations to work together with the Agency for Healthcare Research and Quality (AHRQ) to produce effectiveness and comparative effectiveness research for clinicians, consumers, and policymakers. Comparative effectiveness reviews draw on completed scientific studies to make head-to-head comparisons of different health care interventions. They outline the effectiveness — or benefits and harms — of treatment options.

National Institutes of Health recommends Qigong for hypertension

In 1996 Dr. Ken Sancier, founder of the Qigong Institute, wrote a paper describing the benefits of Qigong for hypertension. It's nice to see that NIH has finally concurred. Sancier's paper: The Anti-Aging Benefits of Qigong.

National Center for Complemetary and Integrative Health 

Qigong Resources

Qigong: What You Need To Know

This document includes the paper Regulating the Teaching and Practice of Qigong and T'ai Chi by Tom Rogers (President) and Josie Weaver (Vicd-President) of the Qigong Institute.

Qigong—Systematic Reviews/Reviews/Meta-analyses (PubMed®)

Qigong—Randomized Controlled Trials (PubMed®)

Tai Chi: What You Need To Know

Tai Chi for Health Purposes 

NCCIH Clinical Digest: Mind and Body Approaches for Health Problems in Military Personnel and Veterans: What the Science Says. 

National Center for Complementary and Integrative Health

NCCIH's new Strategic Plan (Executive Summary) for Fiscal Years 2021–2025 expands the definition of integrative health to include whole person health, that is, empowering individuals, families, communities, and populations to improve their health in multiple interconnected domains: biological, behavioral, social, and environmental. The plan recognizes the need to expand the current model of biomedical research to include whole person health. Among other things, this requires multicomponent interventions that impact multiple systems of the body. The plan also notes that there continues to be a growing interest in the use of complementary and integrative health approaches for preventing the onset of mental, emotional, and behavioral disorders, promoting psychological and physical health and well-being, and enhancing cognitive, emotional, and behavioral resilience. Research has demonstrated the feasibility of conducting interventions that incorporate complementary and integrative health approaches, especially meditative approaches, for health promotion and disease prevention, particularly among adult populations. The plan specifically mentions Tai Chi and Qigong as psychological and physical approaches and meditative exercise interventions for health restoration, resilience, disease prevention, and health promotion across the lifespan (.PDF).

Mind and Body Practices for Fibromyalgia. Recent systematic reviews and randomized clinical trials provide encouraging evidence that practices such as tai chi, qi gong, yoga, massage therapy, acupuncture, and balneotherapy may help relieve some fibromyalgia symptoms.

Tai Chi Has Similar or Greater Benefits Than Aerobic Exercise for Fibromyalgia, Study Shows.

Tai chi, especially an enhanced version, may improve cognition in older adults with memory problems. An innovative form of tai chi that combines mental puzzles and challenges with the traditional physical movements improved cognition in older adults with mild cognitive impairment. The results of the NIA-funded study were published in Annals of Internal Medicine.

The NIH reporter website at https://reporter.nih.gov/ allows searching the database of all past and present NIH funded projects, which include Qigong and Tai Chi.

NIH Pragmatic Trials Collaboratory

The NIH has established the NIH Collaboratory to create a new infrastructure for gathering clinical evidence faster through cost-effective large-scale collaborative research studies with healthcare sytems partners.

"Pragmatic clinical trials present an opportunity to efficiently generate high-quality evidence to inform medical decision-making. However, these trials pose different challenges than traditional clinical trials. The Living Textbook reflects a collection of special considerations and best practices in the design, conduct, and reporting of pragmatic clinical trials."

One of these fast track projects is TAICHIKNEE. The TAICHIKNEE Demonstration Project will compare the effects of a 3-month, twice-weekly, remotely delivered, web-based tai chi intervention vs routine care in 20 to 25 clinics across 4 healthcare systems in 4 geographic regions. The study will enroll a diverse sample of 600 patients with a clinical diagnosis of knee osteoarthritis. Participants will be evaluated at baseline and 3 months, with additional follow-up at 6 and 12 months. The hypothesis of the study is that implementation of remotely delivered tai chi is feasible across 4 healthcare systems and that tai chi, compared with routine care, will improve physical health (including knee-related pain and function), mental health, and healthcare utilization. TAICHIKNEE will be the first rigorous multisite, embedded, pragmatic trial of a remote tai chi mind-body program in the outpatient practices of multiple healthcare systems and using web-based technology designed to improve patient-centered outcomes of knee osteoarthritis. The results will enable widespread adoption of mind-body approaches for knee osteoarthritis across healthcare systems and lay the groundwork for future trials comparing the effectiveness of different implementation strategies.

Tai chi as mind-body medicine? A UCLA Health psychiatrist aims to take the practice nationwide. After 15 years researching the benefits of tai chi, Dr. Helen Lavretsky is leading an initiative to integrate exercise into mainstream medical practice.

Administration for Community Living (ACL)

https://acl.gov/

Mission

Maximize the independence, well-being, and health of older adults, people with disabilities across the lifespan, and their families and caregivers.

Vision

For all people, regardless of age and disability, to live with dignity, make their own choices, and participate fully in society.

The Administration for Community Living was created around the fundamental principle that older adults and people of all ages with disabilities should be able to live where they choose, with the people they choose, and with the ability to participate fully in their communities.

By funding services and supports provided by networks of community-based organizations, and with investments in research, education, and innovation, ACL helps make this principle a reality for millions of Americans.

The Administration on Aging (AOA) is the principal agency of the U.S Department of Health and Human Services designated to carry out the provisions of the Older Americans Act of 1965 (OAA), as amended (42 U.S.C.A. § 3001 et seq.). The OAA promotes the well-being of older individuals by providing services and programs designed to help them live independently in their homes and communities. The Act also empowers the federal government to distribute funds to the states for supportive services for individuals over the age of 60.

The Administration on Aging (AOA) provides grants to States and Territories based on their share of the population aged 60 and over for education and implementation activities that support healthy lifestyles and promote healthy behaviors. Evidence-based health promotion programs reduce the need for more costly medical interventions.

A number of Tai Chi based programs have met varying degrees of criteria for inclusion in the AOA's list of effective evidence-based interventions for improving health and wellbeing or reducing disease, disability and/or injury among older adults; and being ready for translation, implementation and/or broad dissemination by community-based organizations using appropriately credentialed practitioners.

Tai Chi: Moving for Better Balance. Moving for Better Balance is designed to improve the strength, balance, and physical functioning of individuals with diminished physical abilities, including older adults and those with Parkinson’s disease. The focus of the program is Tai Chi, a nontraditional form of exercise, which is used to help participants improve postural stability, control of body positioning, gait initiation and locomotion, movement symmetry, and coordination; increase the range of motion around ankle joints; and build strength in lower extremities. Tai Chi also can be used to enhance mental health, improve sleep quality, and reduce blood pressure.

CIA

Experimental Research in the Application of Qigong (Deep Breathing) Exercises to Restore Intelligence for Mentally Handicapped Children. 2000 CIA report: "Practical results prove that Qigong intelligence recovery therapy can alter the state of low functional ability of the cerebral brain cells of mentally handicapped children. It only requires enough time for such Qigong intelligence restoration therapy, and the intelligence of feeble-minded children can be raised even to normal levels".

U.S. Veterans Administration and Department of Defense Recommend Tai Chi and Qigong

Complementary and Integrative Health Approaches Offered in the Veterans Health Administration: Results of a National Organizational Survey. Tai Chi and Qigong are included in many CIH programs. 

THE DIAGNOSIS AND TREATMENT OF LOW BACK PAIN: Synopsis of the 2021 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Qigong and Tai Chi are non-clinician directed physical activity whole person health interventions for low back pain. Tai Chi is also included under non-pharmacological and non-invasive therapies which are recommended as part of structured clinician-directed exercise programs. The Guideline defines Qigong as "An ancient Chinese healing art, older than, and similar to tai chi, with a focus on cultivating the body’s vital energy, or qi. It involves the coordination of the breath, posture, awareness, visualization, and focused movements. Qigong may be astationary or moving meditation." Tai Chi is defined as "A form of stylized, meditative exercise, characterized by methodically slow circular stretching movements and positions of bodily balance."

https://news.va.gov/?s=tai%20chi

https://news.va.gov/?s=qigong

#Live Whole Health #151: Tai Chi Moving Meditation. This moving meditation practice has been shown to help manage chronic pain and symptoms from rheumatoid arthritis. It has also shown to improve balance, stability, sleep, mood, quality of life and so much more! This centuries-old mind and body practice is accessible to people of all ages, fitness levels and abilities.

https://www.youtube.com/watch?v=Km_uiYtkfSk

Tai Chi in the VA. Vets find this ancient discipline to be relaxing therapy.

Military Researchers Collaborate With University on Opioid Crisis. "We now have good evidence for the use of non-pharmacologic, non-opioid treatments, such as yoga, guided imagery, medical massage, chiropractic, acupuncture, Tai Chi, as well as a closely related movement therapy called Qigong, and music therapy," he said. "We have pretty good research to endorse their use."

The U.S. Army enlists Tai Chi and Qigong in the fight against addiction. Lt. Gen. Schoomaker commented that “We now have good evidence for the use of non-pharmacologic, non-opioid treatments, such as yoga, guided imagery, medical massage, chiropractic, acupuncture, Tai Chi, as well as a closely related movement therapy called Qigong, and music therapy…We have pretty good research to endorse their use.”

Whole Health Qi Gong video

Veterans Health Administration: Veterans share Qi gong class impact on their lives.

Tai Chi Helps Manage Intrusive Thoughts in Veterans With PTSD

Veterans with symptoms of posttraumatic stress disorder (PTSD) who participated in in Tai Chi not only would recommend it to a friend, but also found the ancient Chinese tradition helped with their symptoms including managing intrusive thoughts, difficulties with concentration and physiological arousal. Read article.

U.S. Department of Veterans Affairs Recommends Mindfulness.

The VA's Health Services Research & Development Service (HSR&D) Evidence-based Synthesis Program (ESP) was established to provide timely and accurate syntheses of targeted healthcare topics of particular importance to VA managers and policymakers, as they work to improve the health and healthcare of Veterans. The ESP disseminates these reports (i.e. the Evidence Maps) throughout VA. HSR&D provides funding for four ESP Centers and each Center has an active VA affiliation. The ESP Centers generate evidence syntheses on important clinical practice topics, and these reports help develop clinical policies informed by evidence, the implementation of effective services to improve patient outcomes and to support VA clinical practice guidelines and performance measures, and set the direction for future research to address gaps in clinical knowledge. The Evidence Map of Mindfulness reports the most consistent effect for depression but published meta-analyses also indicated effects compared to passive control of MBSR on overall health, chronic illness, and psychological variables; MBCT for mental illness; and mindfulness interventions for somatization disorders. Limited evidence is also available for mindfulness interventions for pain, anxiety, and psychosis compared to passive control groups. More detail is provided for priority areas post-traumatic stress disorder, stress, depression, and wellness. The evidence map provides a broad overview (not detailed or definitive effectiveness evidence) over the existing research to help interpret the state of the evidence to inform policy and clinical decision making.

Efficacy and acceptability of mindfulness-based interventions for military veterans: A systematic review and meta-analysis. Interventions (such as Qigong) which incorporate mindfulness may improve psychological symptoms and quality of life / functioning in veterans. [PMID: 32906008].

Centers for Disease Control

Recommendations for an Effective Personal Falls Prevention Program

Exercise that can be offered through group classes or individually. Exercise programs can be offered in a community setting, at home with supervision, or in a program that combines group classes or one-on-one training with home-based exercise. Appropriate types of exercises that effectively reduce falls in older adults includes Tai Chi

Preventing Falls: How to Develop Community-based Fall Prevention Programs for Older Adults

The following publication has several articles recommending Tai Chi. CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults, 2nd Edition (website) 

Falls Compendium (.PDF 7.3MB, 159 Pages)

CDC STEADI Initiative offers a coordinated approach to implementing the American and British Geriatrics Societies’ Clinical Practice Guideline for Prevention of Falls in Older Persons, which includes a recommendation for Tai Chi: All multifactorial interventions for community-residing older people should have an exercise component. Exercise recommendations in the 2010 guidelines specify programs that include balance, gait, and strength training, such as tai chi or physical therapy, in group programs or as individual programs at home.

CDC:  Preventing Chronic Disease

Prevalence of Mindfulness Practices in the US Workforce: National Health Interview Survey. A typical mindfulness-based intervention (MBI) program incorporates a combination of mindfulness meditation and mindful movement including Tai Chi and Qigong. Growing evidence demonstrates the beneficial effects of mindfulness practices among workers, in terms of both physical symptoms (e.g. pain) and mental well-being. In health care providers, mindfulness training reduced burnout, mood disturbances, and stress. Mindfulness training also showed improvements in mood and sleep quality among teachers. Workplace stress is associated with many poor health outcomes, both mental and physical; workplace stress is linked with decreased productivity, increased occupational injury, and absenteeism, as well as with substantially higher medical expenditures among highly stressed employees. By helping employees manage stress better, mindfulness-based practices, whether formal or informal, can improve workers’ health, increase productivity, and reduce employers’ costs (17). [PMID: 28055821].