יתרונות צ'י גונג או טאי צ'י דלקת מפרקים או פיברומיאלגיה

סקירה מקיפה של היתרונות הבריאותיים של צ'י גונג או טאי צ'י

לפני הכול רק הסבר קצר:
הפיברומיאלגיה (FMS) היא תסמונת מתחום הראומטולוגיה, המורכבת מאוסף תסמינים הפוגעים באיכות החיים. ביניהם: כאבי שרירים מפושטים המערבים את השרירים ואת השלד המרכזי; חולשה כללית; עייפות; הפרעות שינה; כאבי ראש כרוניים; נמלול בגפיים; חרדה ודיכאון; כאבי בטן; תחושת תכיפות במתן שתן; קשיי ריכוז וזיכרון.
כאן אני מצרף מחקר רב שנים המתאר מחלות שונות ותסמינים רבים בהם תורת הצ'י גונג או הטאי צ'י עוזרים רבות…

המחקר בוחן את היתרונות הפסיכולוגיים והפיזיולוגיים של צ'י גונג או טאי צ'י גדל במהירות רבה. השיטות הרבות המתוארות בשם צ'י גונג או טאי צ'י הן בעלי מקורות דומים בדר"כ והתרגול המוצע מול ההצלחות והטבות התרגול רבים. מחקרים מצד אחד וביקורות מצד אחר דורשים להתייחס אליהם באופן זהיר ויש להתאימן לעוסקים ומתאמנים בשיטות השונות כמו גם למורים השונים שצריכים להיות מיומנים ומבוגלים לזהות תסמינים שונים אצל המבצע.
סקירה זו בוחנת את הראיות להשגת תוצאות ממבחנים מבוקרים אקראיים (RCTs) של הסוגים השונים אם כי ברור ללא ספק כי תורות אלו צ'י גונג או טאי צ'י עוזרות באופן ממשי ברמות שונות לטיפול עד לרמת שליטה במחלות הפרקים או הפיברומיאלגיה.

מילות המפתח טאי צ'י, טאי צ'י צ'ואן וצי גונג  נכנסו למנועי חיפוש אלקטרוניים עבור המדד המצטבר וסטטיסטיקות בנושאי סיעוד ובריאות  (CINAHL), בתחומי ספרות פסיכולוגית (PsycINFO), מאגרים שונים וגוגל כמובן לצורכי לימוד תוצאות מחקרים אינסופיים בתחום.

המחקר בוחן את היתרונות הפסיכולוגיים והפיזיולוגיים של צ'י גונג או טאי צ'י גדל במהירות רבה. השיטות הרבות המתוארות בשם צ'י גונג או טאי צ'י הן בעלי מקורות דומים בדר"כ והתרגול המוצע מול ההצלחות והטבות התרגול רבים. מחקרים מצד אחד וביקורות מצד אחר דורשים להתייחס אליהם באופן זהיר ויש להתאימן לעוסקים ומתאמנים בשיטות השונות כמו גם למורים השונים שצריכים להיות מיומנים ומבוגלים לזהות תסמינים שונים אצל המבצע.
סקירה זו בוחנת את הראיות להשגת תוצאות ממבחנים מבוקרים אקראיים (RCTs) של הסוגים השונים אם כי ברור ללא ספק כי תורות אלו צ'י גונג או טאי צ'י עוזרות באופן ממשי ברמות שונות לטיפול עד לרמת שליטה במחלות הפרקים או הפיברומיאלגיה.
מילות המפתח טאי צ'י, טאי צ'י צ'ואן וצי גונג  נכנסו למנועי חיפוש אלקטרוניים עבור המדד המצטבר וסטטיסטיקות בנושאי סיעוד ובריאות  (CINAHL), בתחומי ספרות פסיכולוגית (PsycINFO), מאגרים שונים וגוגל כמובן לצורכי לימוד תוצאות מחקרים אינסופיים בתחום.

RCTs מדווח על תוצאות הצלחות מימוש תהליכי צ'י גונג או טאי צ'י ופרסומם ביומנים שנסקרו על ידי עמיתים ושותפים לדרך מ-1993 ועד 2007. ועוד… התוצאות הקשורות לתרגול של צ'י גונג או טאי צ'י זוהו והוערכו, ראו מטה מאמר שלם באנגלית בנושא כאשר קיימת אפילו טבלאות הוכחה מדויקות לכל דבר שלא הובאו כאן מפאת גודלן.

.Results

Seventy-seven articles met the inclusion criteria. The nine outcome category groupings that emerged were bone density (n = 4), cardiopulmonary effects (n = 19), physical function (n = 16), falls and related risk factors (n = 23), quality of life (n = 17), self-efficacy (n = 8), patient-reported outcomes (n = 13), psychological symptoms (n = 27), and immune function (n = 6).

.Conclusions

Research has demonstrated consistent, significant results for a number of health benefits in RCTs, evidencing progress toward recognizing the similarity and equivalence of Qigong and Tai Chi.

A substantial body of published research has examined the health benefits of Tai Chi (also called Taiji) a traditional Chinese wellness practice. In addition, a strong body of research is also emerging for Qigong, an even more ancient traditional Chinese wellness practice that has similar characteristics to Tai Chi. Qigong and Tai Chi have been proposed, along with Yoga and Pranayama from India, to constitute a unique category or type of exercise referred to currently as meditative movement.1 These two forms of meditative movement, Qigong and Tai Chi, are close relatives having shared theoretical roots, common operational components, and similar links to the wellness and health promoting aspects of traditional Chinese medicine. They are nearly identical in practical application in the health enhancement context and share much overlap in what traditional Chinese medicine describes as the “three regulations”: body focus (posture and movement), breath focus, and mind focus (meditative components).12

Due to the similarity of Qigong and Tai Chi, this review of the state of the science for these forms of meditative movement will investigate the benefits of both forms together. In presenting evidence for a variety of health benefits, many of which are attributable to both practices, we will point to the magnitude of the combined literature and suggest under what circumstances Qigong and Tai Chi may be considered as potentially equivalent interventions, with recommendations for standards and further research to clarify this potential.

Objectives

Previously published reviews have reported on specific outcomes of either Tai Chi or Qigong, mostly addressing only one of these practices, and rarely taking into account the similarity of the two forms and their similar outcomes. These reviews have covered a wide variety of outcomes, with many focused on specific diseases or symptoms including: hypertension;3 cardiovascular disease;45 cancer;68 arthritic disease;9 stroke rehabilitation;10 aerobic capacity;11 falls and balance;1213 bone mineral density;14 and shingles-related immunity,15 with varying degrees of support noted for outcomes in response to Qigong or Tai Chi.

Other reviews have addressed a broad spectrum of outcomes to demonstrate how Qigong1619 or Tai Chi2026 have demonstrated improvements for participants with a variety of chronic health problems or with vulnerable older adults. While many of these reviews have utilized selection criteria which restrict their focus to rigorous empirical studies, others have used less stringent criteria. The purpose of this review is to evaluate the current evidence for a broad range of health benefits for both Qigong and Tai Chi using only randomized controlled trials (RCTs), and to evaluate the potential of treating these two forms of meditative movement as equivalent forms. A complete description of Qigong and Tai Chi is presented and the equivalence of their theoretical roots and their common elements of practice are established. Then, the body of evidence for outcomes in response to Qigong and Tai Chi is reviewed to examine the range of health benefits. Finally, to more critically evaluate similarities across studies of the two practices we discuss the potential of treating them as equivalent interventions in research and the interpretation of results across studies.

Research Question 1: What health benefits are evidenced from RCTs of Qigong and Tai Chi?

Research Question 2: In examining the Qigong and Tai Chi practices incorporated in research, and the evidence for health benefits commensurate with each, what claims can be made for equivalence of these two forms of practice/exercise that have typically been considered to be separate and different?

Overview of Qigong and Tai Chi

Qigong is, definitively, more ancient in origin than Tai Chi and it is the over-arching, more original discipline incorporating widely diverse practices designed to cultivate functional integrity and the enhancement of the life essence that the Chinese call Qi. Both Qigong and Tai Chi sessions incorporate a wide range of physical movements, including slow, meditative, flowing, dance-like motions. In addition, they both can include sitting or standing meditation postures as well as either gentle or vigorous body shaking. Most importantly, both incorporate the purposeful regulation of both breath and mind coordinated with the regulation of the body. Qigong and Tai Chi are both based on theoretical principles that are inherent to traditional Chinese medicine (TCM).1 In the ancient teachings of health-oriented Qigong and Tai Chi, the instructions for attaining the state of enhanced Qi capacity and function point to the purposeful coordination of body, breath and mind (paraphrased here): “Mind the body and the breath, and then clear the mind to distil the Heavenly elixir within.” This combination of self-awareness with self-correction of the posture and movement of the body, the flow of breath, and stilling of the mind, are thought to comprise a state which activates the natural self-regulatory (self-healing) capacity, stimulating the balanced release of endogenous neurohormones and a wide array of natural health recovery mechanisms which are evoked by the intentful integration of body and mind.
Despite variations among the myriad forms, we assert that health oriented Tai Chi and Qigong emphasize the same principles and practice elements. Given these similar foundations and the fashion in which Tai Chi has typically been modified for implementation in clinical research, we suggest that the research literature for these two forms of meditative movement should be considered as one body of evidence.

Qigong

Qigong translates from Chinese to mean, roughly, to cultivate or enhance the inherent functional (energetic) essence of the human being. It is considered to be the contemporary offspring of some of the most ancient (before recorded history) healing and medical practices of Asia. Earliest forms of Qigong make up one of the historic roots of contemporary Traditional Chinese Medicine (TCM) theory and practice.2 Many branches of Qigong have a health and medical focus and have been refined for well over 5000 years. Qigong purportedly allows individuals to cultivate the natural force or energy (“Qi”) in TCM that is associated with physiological and psychological functionality. Qi is the conceptual foundation of TCM in acupuncture, herbal medicine and Chinese physical therapy. It is considered to be a ubiquitous resource of nature that sustains human well-being and assists in healing disease as well as (according to TCM theory) having fundamental influence on all life and even the orderly function of celestial mechanics and the laws of physics. Qigong exercises consist of a series of orchestrated practices including body posture/movement, breath practice, and meditation, all designed to enhance Qi function (that is, drawing upon natural forces to optimize and balance energy within) through the attainment of deeply focused and relaxed states. From the perspective of Western thought and science, Qigong practices activate naturally occurring physiological and psychological mechanisms of self-repair and health recovery.
In addition, considered part of the overall domain of Qigong is “external Qigong” wherein a trained medical Qigong therapist diagnoses patients according to the principles of TCM and uses “emitted Qi” to foster healing. Both internal Qigong (personal practice) and external Qigong (clinician emitted Qi) are seen as affecting the balance and flow of energy and enhancing functionality in the body and the mind. For the purposes of our review, we are focused only on the individual, internal Qigong practice of exercises performed with the intent of cultivating enhanced function, inner Qi that is ample and unrestrained. This is the aspect of Qigong that parallels what is typically investigated in Tai Chi research.
There are thousands of forms of Qigong practice that have developed in different regions of China during various historic periods and that have been created by many specific teachers and schools. Some of these forms were designed for general health enhancement purposes and some for specific TCM diagnostic categories. Some were originally developed as rituals for spiritual practice, and others to empower greater skill in the martial arts. An overview of the research literature pertaining to internal Qigong yields more than a dozen forms that have been studied as they relate to health outcomes (e.g., Guo-lin, ChunDoSunBup, Vitality or Bu Zheng Qigong, Eight Brocade, Medical Qigong).
22729
The internal Qigong practices generally tested in health research (and that are addressed in this review), incorporate a range of simple movements (repeated and often flowing in nature), or postures (standing or sitting) and include a focused state of relaxed awareness and a variety of breathing techniques that accompany the movements or postures. A key underlying philosophy of the practice is that any form of Qigong has an effect on the cultivation of balance and harmony of Qi, positively influencing the human energy complex (Qi channels/pathways) which functions as a holistic, coherent and mutually interactive system.

Tai Chi

Tai Chi translates to mean, “Grand Ultimate”, and in the Chinese culture, it represents an expansive philosophical and theoretical notion that describes the natural world (i.e., the universe) in the spontaneous state of dynamic balance between mutually interactive phenomena including the balance of light and dark, movement and stillness, waves and particles. Tai Chi, the exercise, is named after this concept and was originally developed both as a martial art (Tai Chi Chuan or taijiquan) and as a form of meditative movement. The practice of Tai Chi as meditative movement is expected to elicit functional balance internally for healing, stress neutralization, longevity, and personal tranquility. This form of Tai Chi is the focus of this review.
For numerous, complex sociological and political reasons,2 Tai Chi has become one of the best known forms of exercise or practice for refining Qi and is purported to enhance physiological and psychological function. The one factor that appears to differentiate Tai Chi from Qigong is that traditional Tai Chi is typically performed as a highly choreographed, lengthy, and complex series of movements, while health enhancement Qigong is typically a simpler, easy to learn, more repetitive practice. However, even the longer forms of Tai Chi incorporate many movements that are similar to Qigong exercises. Usually, the more complex Tai Chi routines include Qigong exercises as a warm-up, and emphasize the same basic principles for practice, that is, the three regulations of body focus, breath focus and mind focus. Therefore, Qigong and Tai Chi, in the health promotion and wellness context, are operationally equivalent.

Tai Chi as Defined in the Research Literature

It is especially important to note that many of the RCTs investigating what is described as Tai Chi (for health enhancement), are actually not the traditional, lengthy, complex practices that match the formal definition of traditional Tai Chi. The Tai Chi used in research of both disease prevention and as a complement to medical intervention is often a “modified” Tai Chi (e.g., Tai Chi Easy, Tai Chi Chih, or “short forms” that greatly reduce the number of movements to be learned). The modifications generally simplify the practice, making the movements more like most health oriented Qigong exercises that are simple and repetitive, rather than a lengthy choreographed series of Tai Chi movements that take much longer to learn (and, for many participants, reportedly delay the experience of “settling” into the relaxation response). A partial list of examples of modified Tai Chi forms from the RCTs in the review are: balance exercises inspired by Tai Chi,30 Tai Chi for arthritis, 5 movements from Sun Tai Chi,31 Tai Chi Six Form,32 Yang Eight Form Easy,33,34 and Yang Five Core Movements.34
In 2003, a panel of Qigong and Tai Chi experts was convened by the University of Illinois and the Blueprint for Physical Activity to explore this very point.35 The expert panel agreed that it is appropriate to modify (simplify) Tai Chi to more efficiently disseminate the benefits to populations in need of cost effective, safe and gentle methods of physical activity and stress reduction. These simplified forms of Tai Chi are very similar to the forms of Qigong used in health research.
For this reason, it is not only reasonable, but a critical contribution to the emerging research dialogue to review the RCTs that explore the health benefits resulting from both of these practices together, as one comprehensive evidence base for the meditative movement practices originating from China.

Methods

Data Sources

The following data bases were used to conduct literature searches for potentially relevant articles: Cumulative Index for Allied Health and Nursing (CINAHL), Psychological Literature (PsychInfo), PubMed, Google Scholar, and the Cochrane database. The key words included Tai Chi, Taiji, Tai Chi Chuan, and Qigong combined with RCT or with clinical research terms. Additional hand searches (based on word-of-mouth recommendations) completed the search for articles.
Study Inclusion Criteria
Criteria for inclusion of articles included that they: a) were published in a peer-reviewed English-language journal between 1993 and December 2007; b) were cited in nursing, medical, or psychological literature; c) were designed to test the effects of Tai Chi or Qigong; and d) used a RCT research design. The literature search resulted in the identification of 576 articles to be considered for inclusion. The full texts of 158 articles appearing to meet initial criteria (a–d) were retrieved for further evaluation and to verify which ones were, in
fact, RCTs, resulting in a final set of 77 articles meeting all of our inclusion criteria

Data Abstraction

Articles were read and results were entered into a table according to criteria established by the authors for categorization and evaluation of the studies and outcomes. Included in Table One for review and discussion are: country of study; type and number of patients randomized; duration and type of intervention and control condition; measured outcomes; and results. As the information was entered into the table it became apparent that some of the authors reported results from the same study in more than one article. Thus, the 77 articles selected actually represented 67 unique studies, with 1 study reporting a range of outcomes across 4 articles, and 5 other studies’ results published in 2 articles each. An additional two articles were not entered into the table3637 as the same results were reported in newer articles. Other than these two dropped articles, multiple articles are entered into the table as representing one study
 (see 
Table One– not included) so that the full range of outcomes reported across the articles can be reported without inflating the number of studies.

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