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Ai Chi improves movement efficiency in patients

This is an excerpt from Aquatic Exercise for Rehabilitation and Training by Lori Thein Brody & Paula Richley Geigle.

Ai Chi improves movement efficiency in patients

By Lori Thein Brody and Paula Richley Geigle

Ai Chi movements can be used to improve movement efficiency of clients who have chronic pain, arthritis, fibromyalgia, chronic obstructive pulmonary disease, balance deficits, diabetes, multiple sclerosis, or other neurological and orthopedic problems. Ai Chi can be used in groups or individually, requires no equipment, and allows the hair and face to stay dry. This head-out position is important for nonswimmers who would benefit from exercise in the water. Additionally, because the philosophy and breathing in Ai Chi are similar to those of land-based tai chi, many of the benefits seen in tai chi are applicable to Ai Chi.

Many of the benefits of Ai Chi come from breathing and relaxation. These benefits include those of exercise and the effects related to the relaxed contemplative state (Berger and Owen 1992; Taylor-Piliae and Froelicher 2004). The expanded range and cardiovascular benefits that arise from Ai Chi training have proved beneficial for patients with chronic pain, arthritis, chronic obstructive pulmonary disease, diabetes, and balance impairments. Ai Chi can also promote relaxation with clients who are coping with high stress levels (Courtney 2000; Jerath 2006; Vargas 2006).

Musculoskeletal and Chronic Pain

Practicing slow movement techniques and diaphragmatic breathing increases relaxation; decreases muscular tension; improves symptom management (Arpita 1982; Monroe, Ghosh and Kalish 1989; Koh 1982; Sancier 1996; Courtney 2000); and facilitates recovery from problems associated with low back pain (Bhatti 1998), scoliosis, carpal tunnel syndrome, musculoskeletal injury or surgery, and sports injuries. These techniques have also been used successfully to improve balance (Queiroz et al. 2007) and improve symptoms associated with chronic disorders such as rheumatologic diseases, fibromyalgia (Berman and Singh 1997), and arthritis. Tai chi has been show to improve osteoarthritis symptoms, self-efficacy, tension levels, and satisfaction with general health status (Hartman et al. 2000). Tai chi has also been shown to increase lower-extremity muscle strength and endurance (Lan 2000).

Tai chi and Ai Chi follow the same precepts of slow, fluid, rhythmic movement with controlled breathing that can positively affect postural stability and falls in the elderly. Several studies have examined the effects of tai chi on balance and on the risk of falls in older people. In one survey of people age 70 and older, those who participated in tai chi training reported improvements in their daily activities, whereas others who participated in balance training alone reported no such improvements (Natural Standard). A 2004 study clearly demonstrated that tai chi training could lead to statistically significant improvements in functional balance in older persons (Li 2004). In another study, researchers observed that tai chi practice is valuable for improving physical balance (Tsang and Hui-Chan 2005).

Long-term practice of tai chi can improve muscular strength in the lower body, particularly around the knees and ankles, as much as long-term jogging, according to another published study (Xu 2006). Another study found that tai chi participants had stronger feelings of self-efficacy and less fear of falling than did older adults who did not practice tai chi (Fuzhong et al. 2005). These findings are good news for older adults who are looking for gentle movement alternatives that provide powerful conditioning benefits.

Dynamic balance ability is an independent predictor of quality of life (Karinkanta et al. 2005), so if older-adult practitioners of tai chi are stronger, feel more confident, and experience less fear than their peers do, they are likely to experience a higher quality of life than those who do not have the same level of conditioning.

Ai Chi creates musculoskeletal benefits that are derived from the effects of buoyancy, gentle and controlled movement, and coordinated breathing. Clients who experience back, neck, or shoulder pain unresponsive to other interventions may find respiration to be the missing link. A key component of many head, neck, and shoulder pain syndromes may be secondary inspiratory muscle overuse (Gallagher 2005). Diaphragmatic breathing can cultivate relaxation, myofascial function, and lumbopelvic stabilization (Gallagher 2005). The stress response to pain traditionally increases muscle tension, which usually leads to more pain (Turner, Ersek, and Kemp 2005). Diaphragmatic breathing can decrease the stress response.

The Ai Chi coordination of breathing and movement allows muscles to produce graceful, flowing movements of the trunk and extremities. This activity can lead to development of core control and alignment for all movement, not only Ai Chi movements (Queiroz et al. 2007), if properly cued and trained (see figure 7.14). Alignment, balance, and stabilization skills can be improved with properly trained slow movement techniques (Tsang and Hui-Chan 2003, Yan 1998, Wolfson 1996, Wolf 1996). Balance learned in the water (an unstable medium) translates well to land.

Along with arthrokinematic effects, the active Ai Chi motions recruit specific muscle groups and preserve the contractile property of soft tissues. Relaxation done before range of motion will minimize or eliminate monosynaptic spinal reflex (Pal, Velkumary, and Madanmohan 2004). Submerging the joints lessens the joint compression and edema (Cole and Becker 2004). The properties of water combined with the Ai Chi movements can improve range of motion and overall mobility. From a musculoskeletal viewpoint, range of motion is an effective means of maintaining the integrity of connective and soft-tissue structures.

Cardiopulmonary, Vascular, and Metabolic

Positive cardiovascular effects have been found in studies of tai chi training (Lai et al. 1995). Studies of physiological measures during cycle ergometry have shown that oxygen uptake and work rate in the tai chi group were significantly higher than in the control group. Other studies have shown increased cardiorespiratory function, soft-tissue flexibility, and increased strength in community-dwelling older persons who participated in tai chi one to four times per week (Schneider and Leung 1991).

Practice of the slow movement techniques and diaphragmatic breathing has been shown to activate the parasympathetic inhibitory nervous system, decrease heart rate, decrease blood pressure, improve respiratory and cardiovascular function, decrease oxygen consumption (Lai et al. 1995; Jerath 2006; Bowler, Green, and Mitchell 1998; Fried 1993; Pal, Velkumary, and Madanmohan 2004), create a neutral respiratory quotient, and decrease blood lactate and blood lipid levels (Chopra 1989; LaForge 1997; Moyers 1993). Diaphragmatic breathing has been shown to decrease autonomic instability and improve heart rate variability (Pal, Velkumary, and Madanmohan 2004).

A stress response produces increased respiratory rate, decreased tidal volume, and a shift to thoracic breathing. Ai Chi breathing can inhibit neural responses (Gatti 2003). Eliciting a parasympathetic or inhibitory response will enhance vagal modulation, decrease heart rate, and improve respiratory synkinesis (Courtney 2000), thus improving breath function. Clients with respiratory impairments that affect their ventilation can benefit significantly from the synchronized Ai Chi breathing cycle (Vargas 2006). Research has shown that implementation of diaphragmatic breathing exercises decreased postoperative complications in patients who underwent cardiac or pulmonary surgery (Chumillas et al. 1998; Vraciu and Vraciu 1977).

Decreased blood pressure and anxiety are a result of the relaxation that accompanies diaphragmatic breathing (Cheung 2005; Gatti 2003). Essential hypertension (high blood pressure of unknown cause) is common in our society. The Ai Chi breathing mode of treatment is beneficial in decreasing essential hypertension. Research has shown that blood pressure decreases by 3 to 15 mm Hg in studies of regular diaphragmatic breathing exercises (Grossman et al. 2001; Schein et al. 2001). The breathing, however, must flow and be continuous. Breath holding creates detrimental effects on the heart and overall health, including elevated blood pressure and a decrease in blood oxygen levels.

Psychological, Neurobiological, and Cognitive

The practice of slow movement techniques with diaphragmatic breathing increases alpha electroencephalogram activity; produces right hemispheric activation; decreases sympathetic nervous system arousal and increases awareness; decreases hypothalamic–pituitary–adrenal activation (Martinsen 1993; Miller, Fletcher, and Kabat-Zinn 1995; Wang et al. 1993; Dychtwald 1986; Courtney 2000; Singh 1998; Ross 2001); and improves the psychological state associated with chronic diseases, anxiety and depressive disorders, anger management, and stress-related dysrhythmias. Stress can contribute to problems such as back pain, neck tension, headaches, fibrocystic nodules, muscle spasms, indigestion, heartburn, stomach ulcers, palpitations, shoulder and upper-chest pain, insomnia, disturbed sleep patterns, anxiety, depression, breathlessness, nausea, and fatigue (Rakel and Mercado 2007). Diaphragmatic breathing has been shown to decrease the stress response and alleviate depression, anxiety, and insomnia (Rakel and Mercado 2007; Tweddale, Rowbottom, and McHardy 1994; Cholz 1995). Stress increases muscular tension and vasoconstriction, thus decreasing blood flow throughout the body (Rakel and Mercado 2007). Tension in the neck causes muscular neck pain and headaches, tension in the stomach affects digestion, and tension in the body increases blood pressure. Relaxation through diaphragmatic breathing reduces blood pressure and the workload on the heart and decreases muscular tension.

Researchers attribute gains in brain function to the amount of oxygen that the brain receives during movement. The brain uses the glucose that it receives (delivered by the oxygen) as fuel for thought. Movement increases production of a brain chemical called brain-derived neurotrophic factor (BDNF), which stimulates the growth of nerve cells in the brain and curbs the development of Alzheimer’s disease as well as other age-related brain degeneration (Astin et al. 2003). Water, movement, and music are used to encourage a state of relaxed awareness. With increased awareness, the breathing and relaxation learned in Ai Chi can be transferred to other life situations. If the breathing and relaxation associated with Ai Chi can be used to aid healing when they are simply remembered, the actual Ai Chi session is doubly valuable.


Practicing slow movements with diaphragmatic breathing has been shown to decrease epinephrine, cortisol, serum growth hormone, thyroid-stimulating hormone, prolactin, adrenocorticotropic hormone, and beta-endorphin (Arpita 1982; Monroe, Ghosh, and Kalish 1989; Morales 1994; Keleman 1989; Gallagher 2005; Sancier 1996). An endogenous opioid is an endorphin that is a product of the endocrine system (Farrell 1986). It is a hormone that has a biochemical similarity to drugs like morphine. The endorphins are best known for their analgesic qualities and their assistance with mood control. Other effects that are more widespread include the regulation of appetite, temperature, and respiration (Hoffmann 1997; Rama 2007). Improvements in immune system functioning, weight maintenance, and overall disposition because of hormone regulation can be side benefits from the practice of Ai Chi.

This is an excerpt from Aquatic Exercise for Rehabilitation and Training.