Qigong and Ageing

There are currently four classes designed for the over fifties in Wallingford, Henley, Charlbury, and Watlington, though all classes are suitable for everyone and age is not a barrier. The following is an article by Frances Watkins on the benefits of taiji and qigong practice for older students.

How the practice of Taiji and Qigong can lead to improved health and quality of life in elderly people

“In movement, seek stillness and rest; in rest, be mindful and attentive.” (from Cohen 1997).

Frances Watkins*

This article was written by Frances Watkins

Old age is generally associated with physical and mental deterioration, loneliness, and the loss of mobility, independence and confidence. This is the poor quality of life that many people seem to take for granted as they age. What starts as discomfort may turn into disease, which in turn accelerates the ageing process. Many older people experience falls, which may result in fractures and, in extreme cases, as people become bed‐ridden with secondary complications, this can become life‐threatening. In the UK, around 30 per cent of people over 65 and 50 per cent of over 80s will fall each year (Age UK: http://www.ageuk.org.uk).

Better public health has resulted in greater longevity worldwide: by 2030, those over 60 will outnumber those under 15, with the fastest growth in developing countries (http://www.helpage.org/resources/ageing‐data/). Non‐communicable diseases in older people, for example, cancer, diabetes, cardiovascular disease, hypertension, as well as dementias, are becoming a growing problem. Yet, even younger people can suddenly experience a rapid deterioration in their health: joints begin to show signs of damage; knees and hips need to be replaced by artificial ones. As many degenerative diseases are thought to be influenced by inactivity, it is becoming a serious challenge to health experts to deal with a growing population of elderly people and the problems that ageing brings.

According to Age UK, the charity that aims to “improve later life for everyone”, simple interventions, such as having an eye test, can reduce the risk of falls, as can taking part in regular strength and balance exercise. This is certainly a change in approach from the tradition in the West where the focus has tended to be on symptoms of disease and the use of drugs to treat them. The benefits gained by older adults taking part in physical activity have been shown to include not only improved physical functioning, but also improved mood, weight and cardiovascular risk factors (Rogers et al. 2009). In addition to conventional physical exercise, interest has grown in complementary forms of exercise, such as the Chinese practice of Qigong, which in some cases has been shown to be even more effective than regular exercise. With the integration of Western and Chinese medicine, cultures have begun not only to share information, so that medicine can evolve and it will be possible to provide more effective healthcare (Sancier 1999), but also to improve the lives of the growing population of elderly people worldwide without medical intervention.

* francesbwatkins@gmail.com

CIAA Six Harmonies Qigong Final Year course assignment (www.ciaa.org.uk) © Frances Watkins 2011

Chinese medical philosophy historically takes the stance that people should be responsible for their own health, using a medical expert’s wisdom as a guide. A person would be concerned with effective self‐maintenance and self‐healing techniques. This concept is one of the cornerstones of the classic text, The Yellow Emperor’s Classic of Medicine:

“Health and well‐being can be achieved only by remaining centred in spirit, guarding against the squandering of energy, promoting the constant flow of Qi and blood, maintaining harmonious balance of yin and yang, adapting to the changing seasonal and yearly macrocosmic influences, and nourishing one’s self preventively. This is the way to a long and happy life.”

Or, more simply, to quote the great physician Hua Tuo, of the second century AD, “the door hinge will rust if it is not used.” Qigong is a holistic system of self‐healing exercise and meditation; it is an ancient, evolving practice that involves postures, movement, self‐massage, breathing techniques and meditation (Cohen 1997). Unlike medication, it is not “prescribed” for a limited amount of time; rather, it is practiced daily. The state of disease is defined as an imbalance of Qi. Qi may be defined as life energy: the power that flows through all living things. In the Chinese tradition, the body is said to rely upon a smooth flow of Qi. Thus, disease is the result of poor Qi circulation. Balancing the flow of Qi allows the body to heal itself. Gong means work; so Qigong may be seen as the task of learning how to control the flow and distribution of Qi to improve the health and harmony of mind and body.

In traditional Chinese medicine, which includes acupuncture, herbalism and massage, a doctor may recommend Qigong as an adjunct to other necessary therapies, or as a way for a patient to maintain optimum health. As well as recovering more quickly, patients will gain the skills required to take charge of their own health. This medical Qigong generally consists of dynamic Qigong exercise, such as Baduan Jing (Baduanjin), or Taiji Quan (T’ai Chi Ch’uan), as opposed to passive—meditative— Qigong, in which the body is still, but the breath is moving. The Chinese martial arts community considers Qigong training as an important component in enhancing martial skill. Both Taoist and Buddhist traditions of the religious community practice meditative Qigong. There is also a form of Qigong practiced by Confucian scholars to improve their moral character.

In the 1940s and 1950s, attempts were made in the People’s Republic of China to standardize the old, traditional methods of Chinese medicine, and integrate these different approaches into one coherent system, with the intention of establishing a more scientific basis for the practice. Then, in 1966, at the start the Cultural Revolution (1966–1976), Qigong was officially prohibited, although it did continue to be practiced during these years. By the 1980s, however, scientific research into Qigong had resumed and the China Qigong Science Association was formed in 1985 (Cohen 1997). Of the hundreds of research studies that were performed by Chinese scientists, few were published, because suitable journals were unavailable. However, about 1400 reports were published as abstracts in the proceedings of conferences (Sancier and Holman 2004). China also hosted a number of international conferences on Qigong science, and, as Qigong gained international recognition, two of the early conferences were held in the USA (1990) and Canada (1995).

In a review of clinical studies presented at the first World Conference on Academic Exchange in Medical Qigong in 1988, Wang et al. described research over the previous 30 years. They reported that patients who practiced Qigong could reverse symptoms of ageing, had fewer strokes and lived longer. Two groups of hypertension patients (of comparable age, sex, occupation, duration and stage of disease, blood pressure and drug administration—half practicing Qigong as well as taking anti‐hypertension drugs, the other half just taking the drug therapy) were followed over 20 years, after which the Qigong group were found to have statistically significant improvements. For example, in the Qigong group, the cumulative mortality and stroke mortality rates were 17.3 and 11.5 per cent, respectively. The respective figures for the control group were 32.0 and 23.0 per cent. Likewise, blood pressure gradually rose in the control group, while it was relatively stable in the Qigong group. Patients who required drug therapy improved faster when they practiced Qigong. These and the results of EEG and physiological studies reported by Wang et al. (1988) showed Qigong to be an effective measure for preventing and treating geriatric diseases.

More recently, several randomized controlled trials have evaluated Taiji and Qigong interventions from a variety of perspectives, specifically targeting older adults. In a synthesis of 36 research reports with a total of just under 3800 participants, five categories of outcomes were identified, including falls and balance, physical function, cardiovascular disease, psychological and additional disease‐specific responses. It was concluded that interventions using Taiji and Qigong may help older adults improve physical function, and reduce blood pressure, fall risk, depression and anxiety (Rogers et al. 2009).

Because their life expectancy is greater than men’s, women comprise a significant majority of the older population. In Europe, for example, the number of women over 50 years of age is projected to increase by 30–40% between 1990 and 2025 (United Nations). According to reports cited by the World Health Organization (WHO 2003), the number of hip fractures worldwide is expected to reach almost 3 million by 2025 (from an estimated 1.3–1.7 million in 1990). Menopausal women are particularly affected owing to the development of osteoporosis. Osteoporosis is a skeletal disease characterized by low bone density and deterioration of the bone tissue so that bones become more fragile; it is three times more common in women than in men. Osteoporosis is not usually diagnosed early, so it becomes evident when fractures occur, generally as people age and bones lose density. One of the main causes of osteoporosis in middle‐aged women is oestrogen deficiency. As oestrogen naturally declines, its important function in preserving bone mass diminishes, resulting in bone loss. As life expectancy in many parts of the world increases, women now live more than one‐third of their lives after the menopause; therefore, the number of postmenopausal women is increasing. According to the WHO (2003), “osteoporosis affects more than 75 million people in Europe, Japan and the USA, and causes more than 2.3 million fractures annually in Europe and the USA alone.” It is estimated that the lifetime risk for hip, vertebral and wrist fractures is about 40 per cent, similar to that for coronary heart disease.

It is known that regular exercise can enhance bone mineral density, so it could be important in preventing bone loss due to menopause. In 2006, Chen et al. made a detailed study of the effects of a form of Qigong, Baduanjin, on the prevention of bone loss in middle‐aged women. They used medical indicators for oestrogen deficiency and bone mineral density and compared two [homogeneous] groups of women, one of which received a 12‐week Qigong training programme (3 days a week). The authors chose Baduanjin because many of the studies that had shown thebeneficial effects of Qigong on health maintenance up to then had focused on T’ai Chi. They felt that although the outcomes of these studies had been promising, T’ai Chi is difficult for a beginner to learn well in a short time. Instead Baduanjin is a simple sequence that involves movements and activation of every part of the body, including all the moveable joints and voluntary muscles. There was a significant difference in IL‐6 (interleukin‐6, the index for bone loss due to diminished oestrogen): the group receiving the Baduanjin training showed a decrease, and in those who did no Qigong, IL‐6 increased. Comparing the bone mineral density, this decreased in the group of women who did not perform Baduanjin, yet increased in those who did. Women can take effective action to prevent osteoporosis and delay the onset of bone loss by doing regular exercise such as Baduanjin. It is simple, easy to learn and easy to remember. It is not strenuous and does not require any equipment or large space to be performed, so it is ideally suited as exercise for middle‐aged women to maintain their health. Chen et al. found that the style of exercise practiced by the subjects in the Baduanjin programme gave different results from other studies, where exercise did not reduce the IL‐6 levels, and suggested that the soothing, relaxing form of exercise in Baduanjin could potentially explain the difference—when practicing, an individual has to relax the whole body, each movement being performed gently and slowly and with awareness focused on the movement of energy through the body.

It is interesting to note that, whilst a growing number of studies into Qigong and its effects are being done, some researchers are pointing out that the evidence is not complete. Many studies have focused on Taiji in particular, as it has been suggested that practising Taiji may improve the body balance of elderly people. Despite concerns about the methodology of previous studies and difficulties in explaining the cause‐and‐effect mechanism of Taiji on body balance, it is generally accepted that this form of physical activity is effective and thus it continues to be used. Maciaszkek and Osiński (2010) reviewed 19 studies published after 2000 that included a total of 750 people aged over 60 years. They concluded that more information is needed to determine the extent to which Taiji is more effective than other methods, especially different types of physical exercise. For example, it was not clear from the studies how much training was needed before decreases in falls occurred, nor was it clear whether different results may have been due to different “schools” of Taiji, or the training of the instructor. However, there was clear evidence from the studies reviewed by Maciaszkek and Osiński (2010) that participation in Taiji improves the body balance of elderly people. They concluded that this is probably due to the postural changes that involve various stabilizer muscles as a person’s body changes position from single‐leg to double‐leg stances, while constantly coordinating the arms and legs. Qigong styles tend to be more stationary, but it has similar movements to Taiji, making such exercise very attractive for elderly people.

One of the difficulties faced by health practitioners and those who deal with the elderly, such as in retirement homes, is to improve the levels of participation in physical activity, knowing that regular movement of any kind can provide innumerable benefits. Sedentary lifestyles are a major public health concern and the elderly are the least active of all age groups, so it is a critical health issue for effective forms of exercise to be researched and for participation, particularly among older people, to be encouraged. In a study that compared eight Qigong exercises, derived from Chinese medical Qigong, with a brisk walk, Kjos (2003) showed that a group of older adults of 55–79 years had similar changes in heart rate, breath frequency, and diastolic blood pressure, demonstrating that the two kinds of activity gave the participants similar work loads. The results of the investigation suggested that Qigong exercise provided the kind of moderate‐intensity level of activity of a brisk walk at 2.5 to 4 mph. Comparable psychological benefits in improved mood were also found. The importance of this finding is that Qigong is clearly highly suitable for elderly people, who might be unable to walk for a sustained length of time.

The spiritual exploration that occurs with meditative forms of physical activity is an important component of Qigong and may also contribute to successful ageing. Generally, medical studies have used quantitative and standardized psychological measures to evaluate psychological benefits. The significant positive effects of Taiji have included improved mood, reduction in perceived stress and pain, reduced fear of falls and increased balance confidence, as well as enhanced immune response (Yang et al. 2011). In a qualitative study carried out recently, Yang and colleagues in the USA interviewed eight people (aged between 70 and 82) who had continued practicing after an initial study on Taiji intervention. They were interested in the low drop‐out rate in people who were followed up after Taiji intervention (of 107 people who had enrolled in a beginning Taiji class and were tracked over a year, 67% planned to enrol in a subsequent class). It also seems that participants in Taiji, as opposed to balance training, reported effects in daily activities and overall life. Yang et al.’s subjects were given three one‐hour classes per week, consisting of two dynamic Qigong exercises (Heaven and Earth Open and Close and Lower the Qi and Cleanse Internally) and static sitting and standing Qigong meditation. The static practice was gradually increased until the study participants were completing one 10‐minute sitting and two 10‐minute standing meditations in each class. (The remainder of the sessions consisted of form work comprising seven movements taken from Chen Style 48‐Movement Form distilled by Grandmaster Feng Zhiqiang.) By means of a specially designed multi‐layered model, created to capture the results of the interviews, Yang et al. recorded not only the five simple dimensions of experience in their subjects—physical, mental, emotional, social and spiritual—but also multi‐dimensional experiences of two, three and more dimensions. Interviewees expressed the beginnings of improved mind–body connection and an increase in general self‐awareness at the simpler ‘two‐dimension’ level. Most felt more confident climbing stairs—balance and strength had improved. Complex statements found interviewees expressing their experience of Taiji and Qigong as “an opportunity and a tool to grow and nurture themselves” with “a sense of mind–body–spirit connection”. Here is one lady’s quote from Yang et al.’s study: I couldn’t believe it at first, I mean it looked like, “Why should we even do this?!” But I can see now after doing it that it is giving me strength. I mean it’s the ability to walk better, sit better, turn better . . . it isn’t just a forceful strength, it’s a strength within, it’s an inner . . . it has caused my body to follow through with my mind when it says to do something.

In reflecting on the complexity of the process, marvelling at how so simple a thing could be affecting everything, another expressed a strong sense of gratitude: Ithink that this is just grand! To learn something when you are in your late 70s that you can use for however long you happen to live—I mean what greater gift could you expect? You know you don’t think about 70‐year‐olds really learning new things that they can carry on . . . this is so unexpected.

The study suggests that older people who practise Taiji and Qigong may be motivated by a broad range of positive mind–body–spirit effects, the integrative nature of which is actually the attraction. There is a strong likelihood that the spiritual element of Qigong can go a long way toward counteracting the feeling many old people have that life is not worth living as they grow old. There is a sense that being old constitutes being a burden to one’s family when one can no longer cope with simple tasks and has to be cared for. In the words of Marie de Hennezel, “Giving up work, facing daily boredom and the feeling of no longer being useful, accelerates the process of growing old.” K

en Cohen describes Qigong as the ‘120‐year prescription’. However, he points out that “the first step to achieving longevity is making every attempt to eliminate the things that are shortening your life!” So, for Qigong to be effective, it helps not to be smoking, taking drugs, drinking excessively, eating too much, living in an ugly environment, staying in a destructive relationship, breathing polluted air, worrying, or being depressed, lonely or hostile, and not taking time for yourself. Whilst Qigong cannot miraculously change your chronological age, it can change your functional age (Cohen 1997). As described above, with prolonged, regular practice, Qigong can improve many of the physical indicators of ageing. De Hennezel writes, “...we may now have all the keys to growing old positively. Medicine and science will help us. We will take care of our health, taking part in sport and remaining useful to our society, and retaining links with other people. ...All of this will help, but the strength of our vitality and joie de vivre as we age will depend on how we have worked at growing old.” By combining the physical element of “taking part in sport ” with the awareness of one’s body and connection to the universe, Qigong can help develop the spiritual aspect of longevity to enable us to “reverse old age and return to youthfulness”—we do not age if the mind stays young.

These factors, plus its emphasis on prevention of disease, suggest that Qigong offers the possibility of greatly decreasing personal and national medical costs (Cohen 1997). Qigong teaches one to be self‐reliant and responsible, rather than shifting all decision‐making into the hands of the doctor. Because it is based on natural movements, it gives one a repertoire of movements for everyday life, as well as the confidence to deal with physical and emotional challenges. There are many thousands of styles of Qigong, but all are based on the common principles of balance, relaxation, correct breathing and good posture. Qigong techniques have stood the test of time and proven their efficacy in enhancing life and improving health. It is not necessary for a person to understand the system, nor make changes or additions to any belief system in order to benefit from its practice. Qigong is easy to learn, although it can take time and dedication to master it. As neither special equipment or clothing, nor invasive or costly medical procedures are needed, it is inexpensive, requiring only the use of one’s body and mind. It can even be practiced sitting down! There are no side effects, provided it is practiced correctly. Perhaps in years to come, we will see the same sight in our parks as can be seen anywhere in China: hundreds of people of all ages practising Qigong! A

new study providing evidence of Tai Chi’s anti-aging effects has now been published: see Tai Chi Intervention Increases Progenitor CD34+ ^Cells in Young Adults R

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