Fuerst, Mark L.
If you have heart disease, you may want to find a physical activity that you can easily maintain. The slow-paced “meditation in motion” of Tai Chi may be just what the doctor ordered. Based on the existing evidence, Tai Chi is a promising addition to regular heart care.
Cardiac rehabilitation programs are, unfortunately, underused. “Tai Chi may be a good option for those unable or unwilling to engage in other forms of physical activity, or as a bridge to more rigorous exercise programs in frail patients,” says Peter Wayne, Ph.D., assistant professor of medicine at Harvard Medical School and the director of research for the Osher Center for Integrative Medicine, jointly based at Harvard Medical School and Brigham and Women's Hospital in Boston. “If your doctor says you have borderline high blood pressure and you are not certain you want to begin drug therapy, a non-pharmacological approach such as Tai Chi may be a way to keep your blood pressure in check. If you have established high blood pressure and find it difficult to engage in a regular exercise regimen, again, think about using Tai Chi to aid the treatment program your doctor has designed for you.”
Regular physical activity, including Tai Chi, has beneficial effects on many risk factors for heart disease, such as high blood pressure, high cholesterol levels and pre-diabetes, says Ruth E. Taylor-Piliae, Ph.D., R.N., associate professor and Robert Wood Johnson Foundation nurse faculty scholar alumna at the University of Arizona's College of Nursing in Phoenix, where she conducts Tai Chi research. “Regular physical activity promotes weight reduction, which can help reduce high blood pressure. Exercise can lower total LDL, or “bad”, cholesterol levels, as well as raise HDL, or “good”, cholesterol levels,” she says. “Among those with pre-diabetes, regular exercise can aid the body's ability to use insulin to control blood glucose levels.”
Importantly, all studies to date suggest that Tai Chi may be safe for heart patients. It may offer you additional options, whether in addition to a formal cardiac rehab program, as a part of maintenance therapy or as an exercise alternative.
TAI CHI EASES CONGESTIVE HEART FAILURE
Tai Chi may be one of the better ways to help you rehabilitate and manage the effects of conditions like congestive heart failure. “My doctor told me I was almost ready for a pacemaker. I was tired and couldn't endure much,” says Pat Finn, a 60-year-old marketing executive who has had congestive heart failure for more than a dozen years. Finn agreed to participate in a clinical study of Tai Chi and congestive heart failure at Harvard Medical School. During the study she learned Tai Chi breathing, strength and flexibility exercises, and a simplified Tai Chi protocol she could practice on her own.
After the study, Finn continued taking Tai Chi classes as well as doing an hour of aerobics twice a week. Three months later, Finn's doctor told her she didn't need a pacemaker after all. “My heart was more stable and I felt stronger,” she says. “I had more energy to run my business.”
To learn even more about Tai Chi, she began taking a class at a community Tai Chi center. “I always feel more energized after a Tai Chi class,” she says. “I have no problem doing two hours of Tai Chi whereas I'm counting the minutes during aerobic exercise. I can easily incorporate Tai Chi into my life. I take breaks at work to do Tai Chi and when I get stressed, I do some Tai Chi breathing to help calm me down.”
The research study at Harvard Medical School that Finn participated in, led by Wayne, found that after 12 weeks of Tai Chi, heart failure patients had a better quality of life, walked farther on a six-minute test and had greater decreases in blood levels of a marker for heart failure compared to a control group that had usual care. There were also trends toward improvement in aerobic capacity and more stable sleep in the Tai Chi group.
WHY TAI CHI IS GOOD FOR THE HEART
Tai Chi combines physical exercise, stress reduction, emotional regulation, improved breathing efficiency and social support. All of these target many modifiable heart disease risk factors, says Wayne. What's more, “the gentle, adaptable nature of Tai Chi makes it safe and accessible for people of all fitness and health levels, including those with existing heart disease,” he says. Here are a few more reasons why Tai Chi is good for your heart:
Tai Chi is a safe, adaptable form of aerobic exercise. If you watch people practice Tai Chi, it might not seem like they are getting any aerobic benefit. But they are. Numerous studies have shown Tai Chi is an aerobic activity of low-to-moderate intensity, depending on your training style, how deep you sink into the postures, how fast you move from one posture to the next and the duration of your practice. The physical activity of Tai Chi ranges between 1.6 and 4.6 metabolic equivalents (METS). To put this in perspective, your resting metabolic rate while sitting quietly is equal to 1 MET. The majority of studies report the intensity of Tai Chi at about 3.5 METS, which is about the same intensity as walking at a moderate pace (about three miles per hour) on level ground.
Tai Chi can get your heart rate up from 50 percent to 74 percent of maximum, depending on the type and intensity of Tai Chi and your age. “The ability to modify the intensity of Tai Chi makes it highly adaptable for people based on their level of physical fitness and cardiovascular impairment,” says Wayne.
Tai Chi can reduce stress and improve psychological well-being. It can help you manage and reduce stress and improve your mood. It may also help you soften unhealthy, overly aggressive behaviors by increasing your self-awareness and promoting a balanced lifestyle, says Wayne.
Tai Chi improves breathing efficiency. The slow, deep meditative breathing associated with Tai Chi has also been shown to reduce blood pressure, dilate blood vessels, improve circulation, calm the nervous system and improve mood by boosting mental focus and decreasing negative thoughts. The emphasis on breathing from the diaphragm can lessen the heart's work load, says Wayne. “Collectively, these potential benefits of Tai Chi breathing may underlie some of its clinical effects on heart disease.”
Tai Chi may improve your confidence to exercise and motivate healthy behavior. Another way Tai Chi enhances fitness and heart health is by giving you the confidence to exercise and motivating you to seek out other healthy behaviors, which translates into greater physical activity. “Tai Chi's meditative, self-reflective components, as well as its connection to Eastern philosophy that supports a balanced lifestyle, may foster your awareness of unhealthy behaviors and motivate you to make more healthy behavior changes,” says Wayne. “These changes may include an improved diet and overall lifestyle, which can only help your heart health.”
Tai Chi leads to social support. It's a social activity. “As a Tai Chi student, you interact with your instructors and other students,” says Wayne. “You may also feel you are broadly connected to a larger community of those who practice Tai Chi regularly.” Research suggests that this form of social support and a sense of connection can have a positive effect on your health, including prevention of and rehabilitation from heart attacks, stroke and other heart problems.
For a review of some recent studies of the heart-healthy effects of Tai Chi, read our online-only bonus article, “How Tai Chi impacts cardiovascular risk factors,” at www.heartinsight.com.
TAI CHI FOR EVERYONE
Tai Chi is a moderate-intensity activity that appeals to adults of all ages, including older adults with chronic illnesses. “If you have a chronic condition, talk to your healthcare provider before you begin a regular Tai Chi program,” suggests Taylor-Piliae. Look for a program that offers one of the shorter forms of Tai Chi, especially if you are just starting out. In his book The Harvard Medical School Guide to Tai Chi (Shambhala, 2013), Wayne offers a simplified Tai Chi program based on the protocol he uses in his clinical studies.
To make Tai Chi classes more accessible to heart patients, a variety of programs now add Tai Chi into existing cardiac and stroke rehab programs. Classes are also offered in community-based settings such as churches, libraries and senior centers, says Taylor-Piliae. To find Tai Chi classes, especially those teaching a simplified version, contact your local YMCA, Area Agency on Aging or Senior Community Center. Another option is to search for classes online at World Tai Chi Day ( worldtaichiday.org) or American Tai Chi ( americantaichi.net).
Wayne agrees that the first place to look for a Tai Chi teacher or program is on the Internet. “Just as it is when you search for a doctor, it's worth doing some research to find a Tai Chi teacher,” he says. “The Tai Chi school's website will give you some clues about the type of training, how long the teacher has trained and with whom.” Be aware that on the Internet, teachers can portray themselves in whatever way they want. “The best way to check out the teacher is to attend a class, where you can see the teacher's style and demeanor, and interact with and receive feedback from other students,” he says. “Finding a teacher is more about feel than an exact science.”
Look for an experienced teacher who has long-term students, good teaching skills, good people skills and someone who works in a comfortable environment in a practical location. Also, look for a class that is the right size for you, not too large or too small. Wayne suggests you visit a number of Tai Chi schools to get a sense of what size class you prefer.
Once you have a found a class, call the instructor and ask about his or her teaching experience. Has the instructor worked with older adults or those with chronic illness? “The Tai Chi instructor should be able to accommodate your individual health concerns and various levels of your prior exercise experience,” says Taylor-Piliae. “Ask about the instructor's teaching style. Does he or she teach a simplified version of Tai Chi? Does the instructor focus on the health benefits of Tai Chi or martial arts/fighting techniques?” Most people do Tai Chi for health reasons, but its origins are based in the martial arts, she notes.
Once you start attending a Tai Chi class regularly, you will begin to feel the beneficial effects. To gain all of the health benefits of Tai Chi, “you need to find your own optimal time and frequency to practice, the best times of day and the most convenient places to do Tai Chi, whether in a class, at home or in a park,” says Wayne. A good goal is to do two one-hour Tai Chi classes a week, plus at-home practice for at least 30 minutes, three times a week.
When you do Tai Chi, you feel healthier partly because you are participating in your own healthcare. “You are also more likely to become physically active and engage in other forms of exercise,” Wayne says. “Self-discovery is an appealing, lifelong learning skill. Tai Chi can be a lot more fun and meaningful than walking on a treadmill day after day, so you are more likely to stick with it.”