Authors

Betty Chewning, Ph.D., is director of the Sonderegger Research Center and is an associate professor, School of Pharmacy, University of Wisconsin-Madison. Her research addresses patients' health behaviors and decision-making related to prescribed regimens and self-care. She has practiced T'ai Chi for 25 years.

Tricia Yu, M.A., is director of the T'ai Chi Center in Madison, Wisconsin, one of the oldest and largest schools in the United States. She provides training nationwide on simplified versions of T'ai Chi for health professionals and fitness instructors. She has practiced T'ai Chi for 29 years and studies with Yang Style T'ai Chi masters Benjamin Pang Jeng Lo and William C.C. Chen. She is certified by Master Chen.

Jill Johnson, M.S., P.T., G.C.S., is a geriatric clinical specialist in physical therapy at the New England Center for Integrative Health. Jill has published numerous research articles on geriatric rehabilitation and has received a grant from the Physical Therapy Foundation to study falls in the elderly. She practices both yoga and T'ai Chi and leads T'ai Chi Fundamentals workshops nationwide.

This article is the first in a two-part series that introduces T'ai Chi to health and fitness instructors and program directors. It summarizes key elements in the practice of T'ai Chi and describes its basic movements and elements of mind/body integration. It includes descriptions of simplified version developed to make T'ai Chi more accessible, and provides resources for finding T'ai Chi classes, videos, and books.

What Is T'ai Chi?

T'ai Chi or T'ai Chi Ch'uan (also spelled T'aiji or T'aiji Quan) means "Supreme Ultimate Boxing." Developed more than 700 years ago by Chinese martial artists, this non-impact exercise form builds endurance and enhances flexibility, balance, and coordination. Unlike many exercise programs that focus on exertion and straining as a means to achieving increased strength and endurance, T'ai Chi movements are slow, relaxed and smooth. "In T'ai Chi, although one moves, there is also inner stillness. In practicing the form, slower is better. If it is slow and the inhalation is deep and long, the qi (life force) sinks to the tan tien (storehouse of energy located in the belly)"(1).

T'ai Chi is a choreography of movements that look like an effortless, slow motion dance. Although there are a variety of interpretations and styles, all authentic T'ai Chi is characterized by certain postures and patterns of movement (See figure 1). At first, it looks quite simple to do. After months of practice, many discover that, like any art, it has depth and subtlety that take years to explore. T'ai Chi is a daily exercise routine that can be practiced for a lifetime. Most forms take about 15 minutes to complete and can be practiced almost anywhere.

Instead of using television or loud music as distraction during exercise, T'ai Chi practice is mindful, with a focused awareness of the body and external environment. Ideally, the mind remains both alert and calm while in motion (See figure 2). T'ai Chi was developed as a means of integrating the mind, body, and spirit to function in harmony with the external world. "T'ai Chi uses mind, not force, it is continuous and not broken. Naturally there is no injurious practice" (1). This ancient art was developed to cultivate mental as well as physical strength and flexibility. The Chinese have practiced T'ai Chi for centuries, and its popularity in the United States is burgeoning.

Accessing T'ai Chi

Although there has been growing interest in T'ai Chi as a health exercise, the question has been: How can T'ai Chi become more accessible to individuals with a wide range of ages and conditions? Many beginners find it difficult to perform the movements and remember the sequence. After only a few classes they become discouraged and drop out. Originally developed by martial arts experts for advancing their skills, traditional T'ai Chi forms incorporate highly complex movement patterns throughout the entire sequence. T'ai Chi encompasses several styles or forms, each originating from three main branches named after their founders (Yang, Chen, and Wu). To add to the confusion, many interpretations of these styles have emerged throughout T'ai Chi's long history, resulting in numerous variations in forms. To help address this issue, a number of simplified versions of T'ai Chi have emerged during the past few decades, making it more accessible to the general public (see figure 4).

Simplified Versions of T'ai Chi

A group of martial arts experts in China created the 24 Forms, based on Yang Style T'ai Chi, the most popular style worldwide. The movements themselves have not been simplified, but the sequence includes fewer repetitions and takes less time to learn and practice than the traditional form. This shortened sequence has become a standard T'ai Chi form in China and there are videos available in the United States that teach 24 Forms.

At Emory University, Dr Wolf and colleagues developed a version of T'ai Chi to study as part of the Frailty and Injuries Cooperative Studies on Intervention Techniques (2). They identified several therapeutic elements of T'ai Chi including slow, continuous movement, weight shifting, postural alignment, and progressive knee flexion. These were incorporated into a 10-movement form (see Recommended Reading). Dr. Tingsen Xu, who taught this version of T'ai Chi to older adults in the study, created a video demonstrating these movements titled T'ai Chi: A Gift of Balance.

T'ai Chi instructor Tricia Yu, M.A., developed T'ai Chi Fundamentals , a simplified, systematic approach for mastering T'ai Chi basics that maintains the integrity of the traditional Yang Style form (3). She targeted critical elements from the traditional form that enhance balance, coordination, strength, and endurance and modified or eliminated consistent areas of difficulty that students encountered in learning T'ai Chi. The T'ai Chi Fundamentals form begins with simple, basic movements and progresses to complex patterns in later parts of the sequence. The program includes a series of warm-up exercises that reinforce the movement patterns repeated throughout T'ai Chi. Physical therapist Jill Johnson, M.S., P.T., G.C.S. analyzes the movements for their clinical applications and functional benefits. The program includes instructional videos, a manual and training workshops for therapists and instructors.

Exercise Programs Integrating T'ai Chi Principles
T'ai Chi instructor Justin Stone popularized a version of T'ai Chi Chih (T'ai Chi Ruler), an ancient Chinese health exercise (4). It involves rocking back and forth in a position similar to the basic T'ai Chi stance with the hands held about one foot apart (hence: Ruler). It provides practice in some of the mind/body integration elements found in T'ai Chi and is accessible to most ambulatory adults. The program includes videos, books and teacher training .

Occupational therapist Diane Harlowe, M.S., O.T.R., F.A.O.T.A., teamed up with T'ai Chi instructor Tricia Yu, M.A., to create the ROM Dance: Range of Motion Exercise and Relaxation Program (5). Developed for individuals with chronic pain and other limiting conditions, it blends medically recommended range-of-motion exercises with the mind/body integration principles of T'ai Chi. These principles include: attention to present, diaphragmatic breathing, postural alignment, slow movement, relaxed movement, and awareness of movement. The ROM Dance can be performed standing with or without support. There is also a version for wheelchair use. Grants from the Arthritis Foundation partially funded initial development, research, and creation of instructional media. This program, based in T'ai Chi principles, is now an established, reimbursable therapeutic intervention used in hospitals, clinical settings, home health care, and long-term-care facilities. Participants in these programs have a wide range of conditions, including arthritis, lupus, fibromyalgia, chronic pain, Parkinson's, mental illness, and stroke. Instructor training workshops, videos, audio tapes, and a manual for therapists are available on this innovative program.

Applications for Health Promotion

Health-care settings serving geriatric populations and individuals with chronic conditions increasingly are using T'ai Chi as a complementary therapy. In addition, a growing group of healthy individuals wish to learn T'ai Chi. Classes are popping up all over (See figure 3). For example, in the authors' city of Madison, WI, two hospital wellness programs, four health clubs, four senior centers, an assisted living facility, and a number of churches offer T'ai Chi classes. The city parks and recreation department, the YMCA, the University of Wisconsin Extension, and a national sports medicine center also sponsor classes. The university offers credit for T'ai Chi classes in its kinesiology department. For the past two summers, the Wisconsin Department of Health and Family Services has sponsored noontime T'ai Chi classes for state employees, which are also open to the general public, on the roof of the city convention center. And third-party payers reimburse classes at an established T'ai Chi Center as a health-promoting activity.
Given community interest, the challenge now is to provide an adequate number of well-trained instructors and to designate quiet space in exercise facilities to support T'ai chi practice. In addition to introductory classes, a few communities are fortunate to have an established T'ai Chi school. Learning T'ai Chi properly requires feedback from an experienced teacher. However, if no classes are available in a geographic area, T'ai Chi videos and books can offer information and some instruction (see figure 4).
Long accepted in China as an ideal exercise for lifelong well-being, the ancient art of T'ai Chi has potential for widespread use in fitness programs and therapies of the new millennium. Or, as one T'ai Chi master puts it, "It is no wonder that many thousands of people in the United States have found T'ai Chi Ch'uan a sound exercise for the body as well as an effective spiritual preparation for facing everyday problems "(6).

Link to Part 2 of this series

REFERENCES

1. Lo, B., Inn, M., Amacker, R., and Foe, S. The Essence of T'ai Chi Ch'uan. Richmond, CA: North Atlantic Books, 1979.

2. Wolf, S.L., Barnhart, H.X., Kutner, N.G., McNeely, E., Coogler, C., and Xu T. Reducing frailty and falls in older persons: an investigation of t'ai chi and computerized balance training. Atlanta FICSIT Group (Frailty and Injuries: Cooperative Studies of Intervention Techniques). Journal of the American Geriatrics Society 44: 489-497, 1996.

3. Yu, T., Johnson, J., T'ai Chi Fundamentals for Health Care Professionals and Instructors. Madison, WI: Uncharted Country Publishing, 1999.

4. Schaller, K., Tai chi chih: an exercise option for older adults. Journal of Gerentological Nursing Oct: 12-17, 1996

5 .Van Deusen, J., Harlowe, D., The efficacy of the ROM dance program for adults with rheumatoid arthritis. American Journal of Occupational Therapy 41:90-95, 1987

6. Chen, W., Body Mechanics of T'ai Chi Ch'uan. New York, NY: 2 Washington Square Village #10 J, 1989.

RECOMMENDED READING

Bottomley, Jennifer. T'ai-Chi: Choreography of Body and Mind.Complementary Therapies in Rehabilitation: Holistic Approaches for Prevention and Wellness. (C. Davis ed.) Thorofare, New York: Slack Inc.;1997.

Downs, Linda. T'ai-Chi. Modern Maturity.June-July: 61-64,1992.

Shine, Jerry. T'ai-Chi: A Kinder, Gentler Workout. Arthritis Today. Jan-Feb:31-33. 1993.

Wolf, S., Coogler., Xu, T., Exploring the basis for tai chi chuan as a theraputic exercise approach. Archives of Physical Medicine and Rehabilitation 78:886-92, 1997.

Figure One

Basic T'ai Chi Postures and Movements

Although there are many variations, most T'ai Chi forms include the following stances and movements that are repeated throughout the sequence:

The Horse Stance

This T'ai Chi stance emphasizes relaxed, natural body alignment. The head is "as if suspended from above" at the crown. Both feet are flat, parallel, hip-distance apart with knees slightly bent. Weight is evenly distributed between both feet.

The 70/30 Stance

The T'ai Chi Stance, or 70/30 Stance, provides a wide, stable base of support. When the weight is forward, more (70 percent) is on the front foot. When the weight is on the back foot, it supports up to 100 percent of the weight. During all weight shifts, the knees maintain a flexed position, and the feet remain flat with weight evenly distributed over the entire soles. The body stays upright throughout the movement. Moving forward and back in this stance strengthens the quads, lengthens the calf muscles, and promotes increased ankle range of motion.

Folding the "Kwa"

A key area of focus in T'ai Chi is the place where the hip joint forms a crease at the top of the femoral triangle. This area is called the "Kwa" in Chinese. As the weight shifts, the head, trunk, and pelvis move as a unit in the direction of the weighted foot. This creates a diagonal "fold" in loose clothing at the hip area. This is a powerful wind-up motion in many sports activities. Both feet remain flat throughout the movement, with knees bent and the body upright. The knee maintains alignment with the weighted foot. There is no twisting of the spine.

The 70/30 Stance with the Folding of the "Kwa"
This combines the wind-up with forward motion and demonstrates an important component of traditional T'ai Chi practice. Both feet remain flat and firmly rooted throughout the movement. While turning or "folding" at the Kwa or hip joint, the pelvis and trunk move as a unit. There is no twisting of the spine. The body remains in an upright position; shoulders maintain alignment over hips.

Single-limbed Stances

The kicks and knee strikes are executed while standing on one leg with the supporting foot at the diagonal and the body upright. There is a horizontal crease in the "Kwa" of the stable foot, with the tailbone maintaining alignment with the heel. This stance helps increase flexibility in the hip area and contributes to better balance.
Reprinted with permission from T'ai Chi for Health Care Professionals and Instructors.

Figure Two

Elements of Mind/Body Integration

T'ai Chi is based on the perspective that mind and body are not separate; rather, they are different expressions of qi: energy, or life force. The principles that facilitate health of body naturally are healthy for the mind, and vice versa. These same principles apply to all interactions.

Key to the practice of T'ai Chi is bringing focus into the present moment. This is done to integrate the mind with the body and to cue awareness of the environment. We are often absorbed by worries about the future, or events of the past -- sometimes to the extent that we are unaware of what is actually occurring in the present.

According to the principles of T'ai Chi, this depletes our qi. When we bring our attention to what is actually occurring, we gather our qi.. We are more alive to the present moment, aware of our body's signals, and more sensitive to others and to what is occurring.

"Centering" for Mind/Body Integration

T'ai Chi practice begins with a few moments of quiet while focusing on slow, natural breathing to help calm the mind, relax the body, and bring attention fully into the present moment. This process is called "centering." It is an essential component of all T'ai Chi practice that reinforces mind/body integration and includes the following elements:

Fostering the Flow of Qi

When the mind is calm and tuned to the body, there is increased awareness of the body's subtle energy. The dynamics for optimum flow of qi include the following:

figure three

Figure Three

Where to Find a T'ai Chi Class

T'ai Chi schools are usually under the following telephone listings:

Figure Four

Resources for T'ai Chi Videos and Books

Many T'ai Chi resources are not marketed nationally. If you cannot find a resource in your local bookstore, contact the distributors listed below who specialize in T'ai Chi videos and books. Direct contact information is provided if the resource is not available from a distributor.

Distributors
Wayfarer Publications
www.tai-chi.com
(323)665-7773, information
(800)888-9119, ordering

Uncharted Country Publishing
www.taichihealth.com
www.romdance.com
(608)280-9730, information
(800)488-4940, ordering

Dragon Door Publications
www.dragondoor.com
dragondoor@aol.com
(651)645-0517

Videos of Traditional Versions

Yang Style
Simplified Yang Style T'ai Chi. Benjamin Pang Jeng Lo
phone: (415) 221-0944.
Yang Long Form and Yang Short Form. William C.C. Chen
phone: (212) 675-2816

T'ai Chi: Exercise for Life Long Health and Well-Being. Tricia Yu
Yang Style T'ai Chi, China 's Living Treasures Vol. 22 and 23. Ye Xiao Long

Chen Style
Chen 19 Movement Form and Chen 38 Movement Form. Chen Xiao Wang
Web site: http://chentaijiquan.com
Chen Style T'ai Chi. Ren Guang Yi
phone: (718)358-5284

Wu Style
Traditional 100 Form Wu Style. Jiang Jian Ye
Wu Tai Chi Ch'uan. China's Living Treasures Vol. 28 and 29. Wang Han Da

Videos of Simplified Versions
Simplified 24-Movement Taiji and Applications. Liang Shou-Yu
T'ai Chi Fundamentals: Simplified Exercises for Beginners. Tricia Yu
T'ai Chi Fundamentals For Health Care Professionals and Instructors: Tricia Yu and Jill Johnson
Tai Chi: A Gift of Balance. Tingsen Xu

Videos That Teach T'ai Chi Principles
ROM Dance in Sunlight. (also Moonlight and Seated Versions). Diane Harlowe and Tricia Yu
Silk Reeling Exercises. Vol. 15 China's Living Treasures. Zhang Xue Xin
T'ai Chi Chih: A Gentle Approach to Health and Enlightenment. Justin Stone.
Web site: www.taichichih.org

Books