Public Health Report : Tai Chi for COPD
Author : Eric L. Zielinski
The NIH states that, “COPD is a major cause of disability, and it’s the third leading cause of death in the United States. Currently, millions of people are diagnosed with COPD. Many more people may have the disease and not even know it” because it develops slowly and people oftentimes mistake it for common annoyances like allergies or stress. Subsequently, American is in dire need of national awareness campaigns to educate people to the insidious harm these lung disorders have and the proven, alternative approaches like Tai Chi that can help.
Chronic obstructive pulmonary disease (COPD) refers to a group of diseases that makes it difficult to breathe and gets worse over time. Primarily consisting of people suffering from emphysema and chronic bronchitis, COPD oftentimes causes coughing that produces large amounts of mucus, wheezing, shortness of breath, chest tightness, and other symptoms. According to the National Institutes of Health (NIH), “Cigarette smoking is the leading cause of COPD. In fact, most people who have COPD smoke or used to smoke. Long-term exposure to other lung irritants—such as air pollution, chemical fumes, or dust—also may contribute to COPD.”
Due to the chronic obstruction, less air flows in and out of the lungs because of the following:
- The airways (bronchioles) and/or air sacs (alveoli) lose their elasticity.
- The walls separating the alveoli are destroyed.
- The walls between the bronchioles become thick and inflamed.
- Subsequently, the bronchioles make an excess of mucus and, thus, create obstruction.
According to the Mayo Clinic, complications to COPD include:
- Respiratory infections like the flu and pneumonia.
- High blood pressure leading to pulmonary hypertension.
- Heart problems like heart attacks and increase risk of heart disease.
- Lung cancer.
Medical Research and Management
According to the U.S. Department of Health and Human Services, “COPD has no cure yet, and doctors don’t know how to reverse the damage to the airways and lungs. However, treatments and lifestyle changes can help you feel better, stay more active, and slow the progress of the disease.”
Subsequently, it is recommended that people with COPD embrace the following lifestyle changes:
- Quit smoking and avoid common air-born irritants.
- Eat a diet high in necessary nutrients to combat infection and other issues related to chronic disease.
- Exercise in whatever capacity you are able to, although it may be difficult because of breathing difficulties.
In addition, common medications are recommended for people with COPD.
- Bronchodilators – utilized to help open the airways and relax related muscles in an attempt to help people breathe easier. As beta-2 agonists, common side effects include: nausea, nervousness, restlessness, trembling, muscle cramps, sleep problems, headaches, coughing, and more serious issues like rapid heart rate, dizziness and seizures.
- Inhaled glucocorticosteroids –used to reduce related inflammation, steroids are generally prescribed for 6-week to 3-month intervals as use has been proven to cause serious numerous toxicities, pneumonia, osteoporosis, glaucoma, skin fragility, acne amongst other issues.
- Flu shots and pneumococcal vaccine – believed to help prevent potentially pulmonary symptoms related to the flu and pneumonia. Side effects for vaccines are hotly debated whether or not they cause serious neurological disorders like autism or even death. However, even the Centers for Disease Control and Prevention (CDC) cautions that “life-threatening allergic reactions” are even possible.
Other medical therapies include:
- Pulmonary rehabilitation –including various exercise programs, disease management training, nutritional and psychological counseling.
- Oxygen (O2) therapy – in which oxygen is administered through tubes into the nose or through a mask and is known to be quite safe, yet comes with the annoyance of being tethered to an O2 tank. For serious COPD conditions, O2 therapy can be lifesaving.
Finally, generally regarded as the last resort, some surgeries are recommended for COPD patients:
- Bullectomy – a procedure that removes bullae (large air sacs) that are destroyed from the lungs to help open the airways.
- Lung volume reduction surgery – similar to bullectomies, this procedure removes damaged lung tissue from the lungs in an attempt to improve breathing.
- Lung transplants – reserved for the most severe conditions, healthy lung(s) donated by a deceased individual can improve lung function and improve quality of life.
As with all major surgeries, the above procedures come with the severe risk of fatal infection and death
Research showing Tai Chi’s ability to help improve COPD
Research from Thailand presented at the 2007 73rd annual meeting of the American College of Chest Physicians suggests that Tai Chi has “respiratory benefits in patients with COPD. The combination of graceful body movements and pursed-lip breathing was found to improve maximum and functional exercise capacities, and overall quality of life in patients with COPD. Modified Tai Chi exercises could offer an effective, inexpensive, and non-traumatic rehabilitation program for patients with COPD.”
It is important to note that this conference proceeding is not an anomaly. We are starting to see more studies in peer-reviewed literature about Tai Chi’s ability to help COPD sufferers not only manage the disease, but also reverse it!
• Quality of Life Research printed an article in 2010 highlighting the work researchers from The Chinese University of Hong Kong conducted as they evaluated the psychosocial functional health of COPD patients during a three-month Tai Chi program. Two hundred and six people participated and were assigned into one of three groups: Tai Chi, exercise, and a control group. The Tai Chi program consisted of two one-hour sessions per week for 12 weeks, people in the exercise group were taught breathing techniques and asked to walk as an exercise, and the control group was asked to maintain normal activities. By evaluating their health-related quality of life using the St. George Respiratory Questionnaire and their perceived social support using the Multidimensional Scale of Perceived Social Support, researchers observed that the Tai Chi group, “Showed greater improvements in the symptom and activity domains.” However, “No differences were detected in perceived social support among the three groups.” In other words, “Tai Chi Qigong promoted health outcomes with respect to clients’ perception of their respiratory symptoms. Moreover, [it] decreased disturbances to their physical activities.”
• Respiratory Care published an article in 2010 that highlights the work done by Harvard Medical School to determine how quality of life and exercise capacity would respond to Tai Chi in moderate to severe COPD patients. Being a pilot study, only 10 people were chosen and five participated in two one-hour Tai Chi sessions per week for 12 weeks plus usual medical care, and the control group only participated in usual medical care. According to the paper, after the 12-week intervention period, there were significant improvements seen in the Tai Chi in the following areas: Chronic Respiratory Questionnaire score, Center for Epidemiologic Studies Depression Scale University of California, San Diego Shortness of Breath score. Researchers recommended that a larger study be conducted to evaluate the widespread benefits Tai Chi has on COPD in more detail
• According to a 2011 article in Complementary Therapies in Medicine, researchers from The Chinese University of Hong Kong took 206 COPD patients from their five general outpatient clinics and randomly assigned them into one of three groups: Tai Chi, exercise, and a control group. The Tai Chi program consisted of two one-hour sessions per week for 12 weeks, people in the exercise group were taught breathing techniques and asked to walk as an exercise, and the control group was asked to maintain normal activities. Interestingly, no changes were observed in the exercise group and the lung functions of the control group even declined. Participants engaged in Tai Chi, however, showed improved respiratory function and activity tolerance levels as measured by increased walking distance, forced expiratory volume and forced vital capacity (indicators of lung function).
• Just this past April, PLoS One published an article in which Binzhou Medical University researchers conducted a meta-analysis of the effects Tai Chi has on COPD. Of the eight random controlled trials that met their specifications, 544 total people were evaluated in regards to the 6-minutes walking distance test and dyspnea (difficulty breathing). It was determined that Tai Chi, “Significantly improved the Chronic Respiratory Disease Questionnaire total score, and the St George’s Respiratory Questionnaire score.” Researchers were so impressed by the results that they concluded Tai Chi, “May provide an effective alternative means to achieve results similar to those reported following participation in pulmonary rehabilitation programs;” thereby stating that Tai Chi could possibly replace medical procedures to manage COPD.
Unlike many clinical trials, the Harvard Medical School study above highlighted qualitative analyses in which they conducted exit interviews with the participants to receive their input about their experience in the program. The quote below is taken from the article referenced above and exemplifies what many COPD patients experience after participating in similar Tai Chi programs.
“I think the thing that changed the most was understanding my breathing better— breathing patterns and breathing deep. I’m one who is used to shallow breaths rather than the whole thing, and now I try to be much more aware of that. And if I’m having a bad day, I try to give myself some time to rest and get my breathing back “in sync.” I like the idea, the pace of tai chi, and the gracefulness of it. I like the idea that it’s non-stressful. If you’re doing other forms of exercise, you often have more on your mind. If you’re on the treadmill or the bike, you’re watching to see how long you’re on, the speed you’re going at, and so forth, whereas with tai chi it’s nothing—it’s just you—and I like that idea.”
According to Gloria Y. Yea, MD – Assistant professor of medicine, Harvard Medical School and Osher Institute, Boston – “Tai Chi has been suggested as an appropriate, if not ideal, form of exercise for patients with chronic cardiopulmonary disease. Because it is a low-impact form of exercise that uses slow movements, it appears to be suitable for persons across a wide range of functional capacities, including those with severe deconditioning associated with CHF [congestive heart failure] or COPD.” As this may not surprise those of us in the alternative health care field, it is astounding to see the medical world embrace what millions have known for millennium. Hopefully, the research linking to Tai Chi and COPD will broadcast to every physician across the globe to change the standard of care to include fundamental breathing and mind-body arts like Tai Chi in their primary care plans.
Medical Studies and Resources
73rd annual meeting of the American College of Chest Physicians
Gloria Y. Yeh, MD Assistant professor of medicine, Harvard Medical School and Osher Institute
Quality of Life Research
Complementary Therapies in Medicine
Public Health Report : Tai Chi for Anxiety
Author : Eric L. Zielinski