Meditative Exercises

Meditative exercises described in this section were originally developed in Asia as a way to cultivate personal health and for defensive purposes; for practitioners, they were a way to improve their ability to treat patients. There are two essential forms of meditative exercise: external exercises, or the martial arts, and internal exercises. Martial art forms like Kung Fu and Wushu have long been a familiar practice in the United States. Internal exercises such as Tai Chi and Qigong (alternately referred to as Chi Kung) are comprised of slow, graceful movements and breathing techniques which aim to improve balance, strengthen the body and promote a general sense of well-being.

In this section, information relating to the prevalence, costs, scientific evaluation, adverse effects and mechanistic evaluation are available.

Tai Chi

Tai Chi, also referred to as Tai Chi Chuan and Taijiquan, has its roots in the martial arts; yet for centuries millions of Chinese have practiced Tai Chi's flowing, meditative movements to cultivate and maintain health and well being. Considered one of the treasures of Chinese medicine, Tai Chi is based on the same core principles that underlie acupuncture and Chinese herbal therapies. While acupuncture relies on needle insertion, and herbal medicine on phytochemical pharmacology, Tai Chi employs detailed regimens of physical movement, breathing techniques, and cognitive tools (both visualization and focused internal awareness) to strengthen the body, relax the mind, and "balance the flow of Qi" (life force).

For more general information on Tai Chi, see Wolf et al [1]. An extensive notebook of reference material on Tai Chi can be viewed at Lee Scheele's Online T'ai Chi Ch'uan Notebook

Tai Chi's reputed health benefits, apparent safety, low cost, and growing recognition have resulted in this exercise becoming more prominent as a preventative and rehabilitative therapeutic tool by the biomedical community. Recent studies have begun to address the safety and efficacy of Tai Chi as a therapeutic intervention for a variety of health concerns including: post-myocardial infarction [2], coronary artery bypass surgery cardiac rehabilitation [3], hypertension [4], general cardiorespiratory prophylaxis and functional improvement [5,6,7,8,9], multiple sclerosis [10], rheumatoid arthritis [11], osteoarthritis [12], microcirculation and endothelial function [13,14], immune function [15], dementia [16], and general stress management [17,18,19]. These and other Tai Chi uses have been reviewed in recent articles by Wolf et al [20], Sandlund and Norlander [21], Li et al. [22], Lan et al. [23], and Wu [24].

Qi Gong

Qigong, pronounced chee kung and loosely translated as the cultivation and regulation of Qi or internal energy, is a form of mind-body exercise originating in China more than 5000 years ago. Like other branches of traditional East Asian Medicine, Qigong practices have been developed to help maintain good health, to prevent and cure diseases, to provide martial arts prowess, to restore vitality, and to enhance the spirit of the patient or practitioner. It is estimated that over 10,000 styles/systems of Qigong have been developed, many of which are popularly practiced around the world today. [25], [26] Qigong systems vary with respect to their emphasis; some emphasize development of physical strength, conditioning and longevity while others emphasize more meditative or spiritual development. Examples of popular Qigong systems practiced in both China and the west today include

Despite the diversity of styles and emphases, most Qigong systems integrate a number of basic principles related to body movements or postures, breathing, and cognitive behaviors such as focused attention, visualization, and affirmation/intentions. In addition to self-healing and development, certain branches of Qigong also include training and techniques that enable skilled practitioners to transmit Qi to their students or patients in order to restore or balance the recipient's health. Expression of this energy is also a central component of internal Chinese martial arts such as Tai Chi.

Training, Licensure, and Regulation

Qigong training varies greatly across styles, as well as with the goals of the practitioner, but most systems encourage a regular practice (15-60 minutes) be integrated into one's daily routine. For those recovering from serious or chronic illnesses, training prescriptions can require a greater commitment. Numerous Qigong teacher training and certificate programs now exist in United States, however the content and rigor of these programs vary considerably, and there is no statewide or national oversight of the credentialing process. The National Qigong Association provides information on locating and evaluating Qigong practitioners in the US

Research

Scientific evaluation of the potential health benefits of Qigong is severely limited by a number of factors including the plurality and complexity of interventions included by the general category of Qigong; publication bias; serious limitations in the majority of experimental research including lack of appropriate controls, lack of blinding, poorly defined outcome measures, inadequate samples sizes, and lack of rigorous statistical considerations; and the difficulty of integrating issues specific to bioenergy healing that are not traditionally considered in biomedical research. [27], [28], [29] Nevertheless, a growing body of research based on case series, non-controlled clinical trials, and a few small randomized controlled trials purports that regular practice of Qigong can positively impact many aspects of health including cardiorespiratory function, [30], [31], [32] blood pressure regulation, [33] immune function, [34], [35] pain management [36] cancer, [37] diabetes, [38] drug addiction, [39] and psychological well-being. [40], [41]

In addition to evaluating the benefits of individuals practicing Qigong, a more limited body of research is beginning to evaluate the effects of Qigong therapies that involve the emission of Qi from a practitioner to a patient, [42] to laboratory animals, [43] or to experimental in vitro cultures. [44], [45]

Mechanisms of Qigong

Little is known about the specific physiological mechanism underlying observed responses to Qigong practice and treatments involving transmissions of energy. Because Qigong practice integrates many elements such as movement, breathing, visualization, and affirmations, it is likely that any health changes in response to Qigong result from the integrated responses of many physiological systems and biochemical pathways. Qigong systems also incorporate significant interpersonal, social and ritual elements, and thus psychosocial and placebogenic elements are also likely to play a mechanistic role. [46] Current research is actively attempting to objectively identify physiological and neurological characteristics of Qigong meditative states. One study that employed multifunctional physiological recorders observed increased alpha waves in the cerebrum, higher body temperatures in extremities, and increased skin conductance during Qigong practice. [47] Another brain function study reported changes in transcranial Doppler sonography and EEG during Qigong meditation. [48]

Safety of Qigong

When practiced with a qualified instructor, Qigong is believed to be safe with few health risks. There have been very few adverse effects reported in modern Qigong trials conducted in the west. However, recent systematic literature reviews of case studies from China suggest that when practiced inappropriately, in certain populations at risk for psychiatric conditions, Qigong may induce or precipitate mental disorders. [49], [50]