Pearls of Wisdom

Exercise helps fight fear of falling

Rolf Krojanker was at The Monday Club in Webster Groves, Mo., on a Tuesday evening wearing two hearing aids and a T’ai Chi Ch’uan T-shirt. Those two details might seem unrelated, but they’re not. The American Geriatric Society recently added Tai Chi as a form of exercise to its list of recommendations for older people who run a high risk of falling. Checking for hearing loss has been on that list for awhile now. In its recent updates, the society recommends that physicians review medications that their elderly patients take, and reduce the use of those that increase the risk of falling, such as anti-depressants and sleeping aids. Previously, it suggested reviewing medications if a patient was taking four or more meds. The recommendations are for patients age 65 and older, which is considered geriatric, who run a high risk of falling.

According to the Centers for Disease Control and Prevention, falls are the leading cause of injury deaths among older adults in the United States, and the rate of those deaths has risen by more than 50 per cent over the past decade. In 2002, more than 12,800 people over age 65 died and 1.6 million were treated in emergency departments because of falls. In 2007, more than 18,000 people died after falls; in 2009, more than 2.2 million older people visited emergency departments for nonfatal falls. The CDC estimates that one out of 10 falls among older people results in serious injuries that require hospitalization and that many people spend a year or more recovering in long-term care facilities. Some never go home. Those numbers are expected to continue growing dramatically as baby boomers age.

Dr. Dulce Cruz-Oliver, assistant professor of the department of internal medicine and geriatrics at St. Louis University, said older people who have fallen in the past run a particularly high risk of falling again. “There are many factors that contribute to the increased risk, including changes in posture and gait, medical conditions such as dementia, Parkinson’s disease and stroke, poor eyesight and hearing,” Cruz-Oliver said. Your risk of falling increases when the number of these biological and environment factors increase, she said. Family doctors can determine whether you’re at risk. Cruz-Oliver said the best way to maintain a keen sense of balance is to exercise, and to start it in your 50s before you begin losing it. “If you don’t use it, you lose it,” she said. “Balance is something you should continually train and use.” T’ai Chi has been proved to decrease falls in the elderly. Gait-training, physical therapy and dancing help as well, though fewer studies exist on their effectiveness. “You need to do it one to three times a week for more than 12 weeks to really have an impact on decreasing falls,” she said.

Krojanker, 88, has been taking Tai Chi for 10 years. When asked if he’s ever fallen, he said: “Well, of course. When I took Jiu Jitsu.” That was several years ago, when he was in his 70s. But no, he said, he hasn’t fallen since. “How can people balance their bodies if they don’t know where their balance is?” Krojanker asked. “They need to become better aware of their bodies. In Tai Chi, the waist is the commander of balance, not the head.” Two instructors with the St. Louis T’ai Chi Ch’uan Association led a group of about 20 through the class at The Monday Club. At least half a dozen of the participants appeared to be over age 65. Mike David, one of the Tai Chi instructors, has noticed the number of older people coming to class increase significantly during the past decade. “Baby boomers are coming of age, so to speak, so that might have something to do with it,” said David, 63, of St. Louis. In addition to lowering blood pressure, helping with rheumatoid arthritis, increasing breath efficiency and reducing stress hormones, David said Tai Chi employs small muscles that aren’t often used but help with staying upright. “Also you try to keep your center of attention in your core area, which is where your energy should come from,” he said. Several years ago, David recalls, a woman who had two hip replacements and was walking with a four-prong cane began taking Tai Chi lessons with him. “When she came in I thought, ’Oh boy.’ She said she was really afraid of falling,” he said. “After one month, she threw her cane away. “A fear of falling changes not just the way you move but the way you live,” he said. “Then you gain more weight by being docile and there’s more stress every time you have to move and it multiplies from there.”

Reducing risks for falls

Recommendations by The American Geriatric Society and The British Geriatric Society to help reduce the risk of falling. Exercise: Take part in programs that help improve balance, gait and strength training, such as Tai Chi or physical therapy. Environment: Make changes to reduce your fall risk factors in the home and in daily activities, such as keeping high traffic areas clear of furniture or clutter. Vision: Undergo cataract surgery when needed, though not as an individual approach. Fewer meds: Reduce medications, regardless of the number prescribed, particularly those that affect the brain such as sleeping medications and antidepressants. In 2001 this was only recommended for elderly people who were on at least four medications. Blood pressure: Raise low blood pressure and manage heart rate and rhythm abnormalities. Consuming more salt and water and wearing compression stockings can raise low blood pressure. In extreme cases, doctors can prescribe fludrocortisone to control low blood pressure. Sometimes, doctors can control irregular heartbeats by altering medications.

Home safety

Home safety check list from the Centers for Disease Control and Prevention Avoid slipping: Remove rugs or use double-sided tape or a nonslip backing so to avoid slipping, or remove altogether and attach nonslip rubber treads. Put a nonslip rubber mat or self-stick strips on the floor of bath tub or shower. Tidy up: Always keep objects off the floor and stairs. Cords: Coil or tape cords and wires next to the wall to avoid tripping. Too loose?: Fix loose or uneven steps. If handrails are loose, maybe it’s time to install new ones. Make sure they’re on both sides of the stairs and are as long as the stairs. Lighting: Install an overhead light and light switch at the top and bottom of the stairs. Place a lamp close to the bed so that it’s easy to reach. Consider using a night-light so you can see when you’re walking to the bathroom in the dark. Some night lights go on automatically when it’s dark. Sightlines: Paint a contrasting color on the top edge of all steps so you can see them better. Stepping up: If you must use a step stool, get one with a bar to hold on to. Never use a chair. Getting up: Install grab bars inside the tub and next to the toilet if you need help getting up or out of them.

By Cynthia Billhartz Gregorian, St. Louis Post-Dispatch Read the original here.

Tweet

By JANE E. BRODY
New York Times
September 27, 2010

The graceful, dancelike progression of meditative poses called tai chi originated in ancient China as a martial art, but the exercise is best known in modern times as a route to reduced stress and enhanced health. After reviewing existing scientific evidence for its potential health benefits, I’ve concluded that the proper question to ask yourself may not be why you should practice tai chi, but why not.

Tai Chi is a low-impact activity suitable for people of all ages and most states of health, even those who “hate” exercise or have long been sedentary. It is a gentle, calming exercise — some call it meditation in motion — that involves deep breathing but no sweat or breathlessness.

It places minimal stress on joints and muscles and thus is far less likely than other forms of exercise to cause muscle soreness or injury. It requires no special equipment or clothing and can be practiced almost anywhere at any time, alone or with others.

Once the proper technique is learned from a qualified instructor, continuing to practice it need not cost another cent.

The many small studies of tai chi have found health benefits ranging from better balance and prevention of falls to reduced blood pressure, relief of pain and improved immunity.

The latest and perhaps best designed study was conducted among patients with debilitating fibromyalgia, a complex and poorly understood pain syndrome.

Dr. Chenchen Wang and colleagues at Tufts Medical Center in Boston reported in August in The New England Journal of Medicine that tai chi reduced pain and fatigue and improved the patients’ ability to move, function physically and sleep. The benefits persisted long after the 12 weeks of tai chi sessions ended.

The study was financed primarily by the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health. To be sure, documenting tai chi’s purported health benefits is a challenge. As an editorial in the journal noted, it is virtually impossible to design an ideal study of tai chi. There is no “fake” version that could serve as a proper control to be tested against the real thing. Thus, researchers have to rely on less-than-perfect comparison groups. In the fibromyalgia study, for example, the control group was given stretching exercises and wellness education.

And unlike evaluations of drugs, tai chi studies cannot be double-blinded such that neither patients nor researchers know which group is receiving which treatment. Those guided by a tai chi master would undoubtedly know who they are and could be influenced by the teacher’s enthusiasm for the practice.

Still, scientists have come to better understand and appreciate the mind-body connection, which for too long was dismissed as nothing more than a placebo effect, and most doctors are now more willing to accept the possibility that stress-reducing activities can have a profound effect on health.

A Stress Reducer

There is no question that tai chi can reduce stress. As the study authors described it, tai chi “combines meditation with slow, gentle, graceful movements, as well as deep breathing and relaxation to move vital energy (called qi by the Chinese) throughout the body.”

If nothing else, this kind of relaxing activity can lower blood pressure and heart rate, improve cardiovascular fitness and enhance mood. For example, a review in 2008 found that tai chi lowered blood pressure in 22 of 26 published studies.

Thus, it can be a useful aid in treating heart disease, high blood pressure and depression, conditions common among older people who may be unable to benefit from more physically demanding exercise.

Regular practitioners of tai chi report that they sleep better, feel healthier and experience less pain and stiffness, though it cannot be said for certain that tai chi alone is responsible for such benefits.

Yet as Dr. Wang and co-authors noted in an earlier report that analyzed the literature on tai chi and health, a majority of studies have been small and poorly controlled, if they were controlled at all. Therefore, the tai chi practitioners could have been healthier to begin with or could have practiced other health-enhancing habits.

Perhaps the best-documented benefit of tai chi, and one that is easiest to appreciate, is its ability to improve balance and reduce the risk of falls, even in people in their 80s and 90s. The moves are done in a smooth, continuous fashion, as weight is shifted from one leg to the other and arms are moved rhythmically. This can improve muscle strength and flexibility, and enable the muscles in the legs and hips to function in a more coordinated and balanced manner. Thus, practitioners become more stable and sure-footed.

Another benefit, again especially important to older adults, is the apparent ability of tai chi to improve immune function. In a 2007 study also financed by the Complementary and Alternative Medicine center, those who practiced tai chi had a better response to the varicella zoster vaccine that can help prevent shingles.

Talk to a Doctor First

Tai chi is not a substitute for professional medical care, but rather an adjunct to such care and a way to keep debility at bay. As with other forms of alternative medicine, it is best to consult your physician before signing up for instruction.

This is especially important if you are a pregnant woman or have serious physical limitations, joint problems, back pain or advanced osteoporosis. While such conditions do not preclude practicing tai chi, you may have to modify or avoid certain positions.

Although tai chi is a gentle exercise, one can get carried away. Overdoing any activity, including tai chi, can result in sore or sprained muscles. On its Web site, the Complementary and Alternative Medicine center notes that “tai chi instructors often recommend that you do not practice tai chi right after a meal, or when you are very tired, or if you have an active infection.”

Also important is assurance that your instructor is well qualified. Instructors do not have to be licensed, and the practice is not regulated by any governmental authority. There are many styles of tai chi — the yang style is most commonly practiced in Western countries — and there are no established training standards.

Traditionally, would-be instructors learn from a master teacher. Before choosing an instructor, you’d be wise to inquire about the person’s training and experience.

Learning tai chi from a qualified instructor is critical. The Complementary and Alternative Medicine center cautions that trying to learn it from a book or video is no guarantee that you will be able to perform the moves safely and correctly. Reliable sources of instructors include Y.M.C.A.’s and Y.W.C.A.’s, and well-run commercial gyms.

Finally, attending a few sessions or even a 12-week course in Tai Chi is not enough to guarantee lasting health benefits. As with any other form of exercise, tai chi must be practiced regularly and indefinitely to maintain its value.

Read the original New York Times article about Tai Chi here.

Training for Life September 1988

By Grandmaster Doc Fai Wong

It’s long, straight, sharp on both sides, and exclusively Chinese. You won’t find any other country’s martial art using a straight bladed sword that draws its energy primarily from wrist action and flexibility.

Chinese call it “Gim” in Cantonese and “Jian” in Mandarin. It’s a far different weapon than the more popular broadsword. Unlike the brute force broadsword, fighting Gim techniques are practically unknown today. Most people learn only fancy performing techniques that turn the weapon into a blur of flashy figure-eight circles and ground-hugging stationary postures. However, in traditional Chinese martial arts the Gim was an advanced weapon that required top-notch teachers and years of correct practice before it became an effective fighting tool.

In the days when combat with a straight sword was practiced, most students had over ten years of martial art training before they were exposed to the Gim. The average student learned only broadsword and staff techniques. Those two, one long and the other short, were Chinese martial art’s major weapons. Occasionally, different implements found their way into a fighter’s arsenal because they were more convenient than swords or staffs. Horse bench, fan, smoking pipe, and hoe were all routinely pressed into service as kung fu weapons, using basic techniques from those popular long and short weapons - the staff and the broadsword.

Even in those times, those who routinely carried straight swords were high-ranking military officials who used the weapon for punctuating command or military ceremonies and Confucian scholars, who practiced intricate sword forms for daily exercise. During the height of Chinese Confucianism, all Confucian scholars wore Gims as decorations and signs of their scholarly office, not for self defense. Those scholars and officers gave rise to the Gim being strictly a gentleman’s weapon. The real swordsmen of ancient China were Taoist Priests of Wu-Dang Mountain. They practiced straight sword-fighting techniques as part of their daily martial art training.

A famous Taoist priest-fighter named Lu Dong Bin made the sword popular among other Taoist martial artist. His trademark was the way he carried the weapon – on his back over his right shoulder, where it was easy to pull from its scabbard. He was so famous that all later-day Taoist Priests wore their swords the same way.

Buddhist monks favored the Chinese broadsword, calling it the “precept knife”. They made personal vows that if they broke any Buddhist Priest or vows, they would cut off a limb with their broadsword. Shaolin monks practiced broadsword form for exercise. Their daily broadsword practice made them experts with the broadsword.

What were the Gim techniques that distinguished the difference between combat and dance?

First, understand that the Chinese straight sword was fragile, lightweight weapon. It isn’t strong enough for contact against the much sturdier broad sword. However, the Gim has two cutting edges, one on each side of the blade. Those two cutting surfaces give it the versatility of slicing left and right, as well as poking straight.

Fighting Gim experts took advantage of the two-edge blade by using only three-to-four inches near the tip for cutting. That’s the only truly sharp area, besides the tip itself, of an authentic Gim. The rest of the blade was kept dull and slightly thicker for any emergency blocking techniques. I say “emergency”, because sword technicians did not want to use their weapon for blocking. The sword is thin and long and not very strong. Speedy dodging actions and small circles angular cuts aimed at the enemy’s wrist better suited its size and shape.

Wu-Dang sword experts taught special basic training techniques that trained Gim students to put their force out into the last three inches of the blade. These were waist and wrist loosing exercises, similar to Western fencing. Some, still taught today, include a variety of movements. The tip of the sword is circled clockwise or counter-clockwise. The blade’s tip is snapped up and down. The cutting section slices from side to side. These basics are done thousands of times in front of a knowledgeable teacher who will direct the student along the right path. Of course they also had a special way to hold the sword. It wasn’t a five-finger grab.

True Wu-Dang swordsman used only three fingers, the thumb and two center fingers. The three-finger grip gave them more wrist and hand flexibility for the small slices and pokes that characterize straight-sword techniques. The index finger was pointed forward, guiding the blade along its path to the target.

The unused hand was called the “sword finger” hand. Its first two fingers formed a miniature sword, which was used to help balance the uneven weight of the other hand. Pressure point strikes also were made with the free hand.

Among China’s best-known teachers in recent history are General Lee Jing-Lin and Guo Chi-Feng, both members of the fabled seven swordsmen of China. Of the seven, they are the only ones known to have living students. The famous seven were trained by a Taoist priest called Fung Tao-Zi, who was said to have been 100 years old when he taught the techniques.

My own teacher, Woo Van-Cheuk, now 84 years old, was a disciple of both General Lee and Guo. To the best of my knowledge, Woo Van-Cheuk is the lone remaining student outside China.

What the Science Says (cont. from Part 1)

Several studies have shown that regular tai chi practice has benefits: It can reduce falls in the elderly or those with balance disorders — sometimes dramatically. In one 1996 Atlanta study, elderly people who practiced tai chi for 15 weeks reduced their risk of multiple falls by 47.5 percent. Falls are a particular danger for elders and others with brittle bones, or osteoporosis. For such people, falls frequently result in broken bones.

Research has shown tai chi has other benefits, too. Participants in the Atlanta study also had lower blood pressure at the end of the study; and a 1999 study that looked at people with multiple sclerosis who practiced tai chi found that it contributed to an overall improvement in quality of life for people with chronic, disabling conditions.

While there are no good, controlled studies that prove tai chi specifically benefits people with arthritis by reducing pain or inflammation, there is a study from 1991 that evaluates its safety for rheumatoid arthritis patients. It concluded that 10 weeks of tai chi classes did not make joint problems worse, and says the weight-bearing aspects of this exercise has the potential to stimulate bone growth and strengthen connective tissue.

And a recent University of Arizona opinion paper on mind-body alternatives, such as tai chi and meditation, for rheumatic diseases concluded that stress and pain are closely related, and therapies that focus on psychological as well as physical function could be beneficial, when used along with conventional medications.

But doctors don’t need proof to approve an exercise as safe and soothing as tai chi — even for themselves. Dr. Lam, who is 52, developed osteoarthritis in his neck, back and hands when he was in his 20s, and began practicing and then teaching tai chi to keep his own arthritis under control.

“Given its low impact and evidence that it tends to increase muscle strength and balance and give general pain relief, we think it’s a worthwhile option for arthritis patients,” says William L. Haskell, PhD, deputy director of the Stanford [University] Center for Research in Disease Prevention in California.

Stanford has offered tai chi classes for years, and is launching a major National Institute on Aging study to assess benefits of various types of exercise on healthy aging. A year-long study of tai chi for those 60 and older is part of the project. While this study won’t look at arthritis specifically, the data is expected to provide evidence of tai chi’s general benefits.

Suitable Styles
Tai chi classes are usually small, with fewer than 20 people of diverse ages. It’s common to see people in their 80s alongside students in their 20s and every age in between.

There are five distinct styles of tai chi and many variations within each style. Most gentle and, therefore, suitable for people with arthritis, says Dr. Lam, are the Yang, Sun, Wu and Hao styles. Dr. Lam’s program for arthritis is based on the Sun style, which is performed without deep knee bending. He says beginners should avoid the Chen style, a more brisk and active style not recommended for most people with arthritis.

You may encounter a tai chi class that teaches a variation on a style or one that combines several styles. The “right” version for you is one that you can do easily, without making hard or forceful movements and without stressing your joints or muscles.

Tai chi classes usually last about one hour, and may be held once or twice a week. They begin with a gentle warm-up and breathing exercises or a meditation to quiet the mind.

The teacher demonstrates individual poses and then leads the class through the sequences, step by step, gradually linking the movements together in longer sequences. The sequences can be done slowly, or with more speed and energy. But movements are always soft and graceful, with careful attention to breathing and posture.

Classes end with cooling down exercises and, sometimes, a short meditation. At the end of class, you should feel relaxed. If you have pain that lasts more than a few hours after class, talk to the instructor about how to change the movements to work within your limits.

Good Advice
Before you begin any exercise program, be sure to ask your doctor’s advice about specific movements to avoid.

• Don’t try to learn tai chi from a video or book: It’s best to learn from a teacher who can make sure you are doing the movements correctly. As you learn the basics, you can practice on your own or with a video.
• Choose your teacher carefully. Make sure the instructor has experience teaching people with arthritis and can guide you to the safest movements.
• Warm up before class and cool down afterward. Tai chi may not seem strenuous, but it does work joints and muscles.
• Modify the movements if necessary. For example, many tai chi postures are done with bent knees. If you have knee involvement, you may need to adapt those movements to be safe and comfortable.
• Be cautious when you have a flare or sore joint. Many experts say you can still exercise, but carefully. Check with your doctor if you aren’t sure, and stop if it makes you hurt more or if you feel pain two hours after the class.
• Never push or exert yourself. Most teachers believe the meditative effects of Qi are as important as the physical exercise.
• Practice daily. The practice can take as few as five minutes or can last as long as an hour per session.
• Remember that while tai chi is a good adjunct exercise, it doesn’t provide much in aerobic or weight-bearing benefits.

Judith Horstman is a contributing editor to Arthritis Today and author of The Arthritis Foundation’s Guide to Alternative Therapies.

For more information about Tai Chi at White Dragon Schools log onto whitedragonmartialarts.com