Study: Tai Chi good for people with type II diabetes

[bodhitree]

http://news.bbc.co.uk/2/hi/health/7322665.stm

here it is.

[GLW]

Granted, I practice Taijiquan and have for a long time. I like it a lot...

But, studies like these are flawed. They do not mention an obvious control group...that is, where is the group that did low impact aerobics or some other type of exercise the same way?

They mention in one study doing 60 to 90 minutes of Taijiquan 3 times a week and having a video to refer to when at home. They should also do this with something like Yoga, Pilates, NIA, even, god forbid, Jazzercise.

From what they published, you can't tell if Taijiquan did any better than any other form of exercise in helping the people with Type II Diabetes. You also can't tell if it did any worse, if Qi Gong by itself would have had an impact, and so on.

They do mention – just in passing sort of – the benefits of stress reduction on their Diabetes. However, again, the approach as described really doesn’t make much distinction between Taijiquan practice and other exercise/stress reduction approaches.

It has long been known that one of the things that will help Type II Diabetes is exercise. So, no big surprise that Taijiquan is a form of exercise. What I would like to see is if there is any BETTER benefit over plain exercise.

[GeneChing]

there's some more specifics in this report
Tai Chi Helps Improve Type 2 Diabetes (http://www.newsmax.com/health/Tai_chil_helps_diabetes/2008/04/01/84553.html)
Tuesday, April 1, 2008 8:25 AM

Tai Chi exercises can improve the control of type 2 diabetes, suggests a small study, published ahead of print in the British Journal of Sports Medicine.

Tai Chi Chuan is a traditional Chinese martial art, which combines deep diaphragmatic breathing and relaxation with gentle movement.

The research team assessed the impact of a 12 week programme of Tai Chi exercises on the T helper cell activity of 30 patients with type 2 diabetes and 30 healthy people of the same age.

T cells are a key component of the body’s immune system, producing powerful chemicals, including interleukins, which alter the immune response.

Type 2 diabetes is associated with chronic inflammation, caused by excessive glucose in the blood (hyperglycaemia).

After the 12 week programme glycated haemoglobin (when excess blood sugar combines with the oxygen transporter in red blood cells) levels fell significantly from 7.59% to 7.16 in the diabetic patients.

And levels of interleukin-12, which boosts the immune response, doubled. Levels of interleukin-4, which suppresses the immune response, fell.

T cell activity also significantly increased.

Strenuous physical activity depresses the immune system response, but moderate exercise seems to have the opposite effect, say the authors. Tai Chi is classified as moderate exercise.

Previous research has shown that it boosts cardiovascular and respiratory function, as well as improving flexibility and relieving stress, they add.

Tai Chi may prompt a fall in blood glucose levels, or improve blood glucose metabolism, sparking a drop in the inflammatory response.

Alternatively, the exercise may boost fitness levels and the feeling of wellbeing, which may then boost the health of the immune system, they suggest.

In a separate study, also published ahead of print, a 12 week programme of Tai Chi and Qigong (another Chinese exercise) prompted a significant fall in blood glucose levels and significant improvements in other indicators of the metabolic syndrome in 11 middle aged to older adults.

The metabolic syndrome is a cluster of symptoms, including high blood pressure and high blood glucose that is associated with increased risks of cardiovascular disease and diabetes.

The 13 participants exercised for up to 1.5 hours, up to three times a week, and were also encouraged to practice the exercises at home.

At the end of the 12 weeks, they had lost an average of 3 kg in weight and their waist size had dropped by an average of almost 3 cm.

Their blood pressure also fell significantly, and by more than would have been expected from the weight loss alone, say the authors.

Three people no longer met the criteria for metabolic syndrome.

Participants said they slept better, had more energy, felt less pain and had fewer food cravings while on the programme.

[cjurakpt]

it's nice to see - but again, as GLW pointed out, is there anything particularly "special" about taiji that makes it a better choice of exercise than, say, taking a brisk walk, or doing any sort of moderate exercise program consistently? there would need to be comparative groups run to see if taiji conferred anything beyond something like Pilates, etc. (personally, I think the results would be about the same);

what might, in fact, make it "better", are things not directly related to the actual movements, but rather factors that contribute to the psychological state of participants: for example, it's exotic, as compared to something like aerobics, and as the saying goes "the local ginger never tastes as good..."; also, taiji is usually done in a group setting and in a manner that allows for frequent interaction (e.g. - push hands), so there is a definite social aspect (which in and of itself has physiological "de-stressing" benefits); finally, it's perceived as open-ended: meaning that, as opposed to an aerobic program which is somewhat of a finite skill set, taiji is portrayed as being an endless journey, meaning that there is always the possibility finding something new in it - and we as humans thrive on novelty, that could help keep people interested over time; actually, you could make the argument that these factors alone might have caused the measured changes in blood values, based on the fact that stress levels are higher in lonely, bored people

of course, it's good that this sort of research is done, because it at least shows that taiji in and of itself "works" in a way that you can substantiate it within the healthcare field, and even to third party payers...

[GLW]

Exactly what I was getting at. I have yet to see a study that had one group do nothing, one do a good program of Taijiquan or Qi Gong, and then another group do something that would sort of simulate the external obvious aspects of Taijiquan.

For example, in this case, they mention the stress reduction aspect as well as the exercise aspect. So, for the third group, you could do something like have a group of people that did 60 to 90 minutes of walking at the same heart rate as the Taijiquan group to this the right aerobic level...and add in with the walking relaxation techniques such as creative visualization....but deliberately exclude any form of breathing that would accidentally make this something closer to Qi Gong.

What I would hope to see is that the third group did better than the group that did nothing and the Taijiquan group did better than the third group.

A well constructed study like this would generate a much larger interest and be harder to refute than most studies I have seen.

[Xiao3 Meng4]

Exactly what I was getting at. I have yet to see a study that had one group do nothing, one do a good program of Taijiquan or Qi Gong, and then another group do something that would sort of simulate the external obvious aspects of Taijiquan.


These results aren't all that surprising, are they?

Instead of comparing a group doing nothing to a group doing Tai Ji, I'd rather see a study comparing a group doing nothing to a group doing Zhan Zhuang. Not that the results should be any more unpredictable...

CSP

[GLW]

Actually, the way the study is reported, you can't discern if the benefit is due to Taijiquan or simply due to doing some form of exercise that also has a component of stress reduction mixed with the low impact low level aerobic activity,

However, in these cases, either the person running the study already has an idea of what they want to show or they do not know how to set up the control groups to measure what they want to measure.

With this study, you can say that Taijiquan benefits a Type II Diabetic...but you can't say it benefits them any more or any less than other forms of activity that may be studied.

Nowhere close to definitive.

[GeneChing]

...as is the fact that they are getting exposure. Now two media sources have latched on to the story and reported it to the general public. That's interesting to me. As a reporter of martial arts, I'm always intrigued to see which stories get reported outside of the martial arts circles. That's why I post so many news article clippings (if that term could be used for the web) here on the forum. It's very important to see how the public perceives us.

[Eric Olson]

But, studies like these are flawed. They do not mention an obvious control group...that is, where is the group that did low impact aerobics or some other type of exercise the same way?

One thing I wonder too is how can you do a controlled, randomized, DOUBLE-BLINDED study for exercise. Is it even possible?

The researchers could be blinded but there's no way to blind the person doing the exercise. There is no "placebo" exercise that you could do.

How might this bias the results of exercise studies?

EO

[GLW]

The medical advice for Type II Diabetics and pre-Diabetics has consistently been to maintain a good weight, eat the correct diet - low fat, lo carb, high protein and fiber, and do aerobic exercise.

So, unless this advice is totally off base, what i REALLY want to know from a study is if Taijiquan, Qi Gong, or a combination of both is any better than any other form of exercise program at helping to control a person's Diabetes.

To this end, you really would not have to include the non-exercise group unless you wanted to lay a baseline of "See, exercise in and of itself does a lot of good..." This would then get you out of the ethical problem os "withholding treatment" even though a large number of people with Type II Diabetes or pre-Diabetes are already couch potatoes.

Now, maybe I am just sensitized...living in Houston with a couple of very large medical schools and a large well known medical center... Quoting a study like this in justifying why to take up Taijiquan over some other program will basically get your lunch eaten.

[cjurakpt]

One thing I wonder too is how can you do a controlled, randomized, DOUBLE-BLINDED study for exercise. Is it even possible?

The researchers could be blinded but there's no way to blind the person doing the exercise. There is no "placebo" exercise that you could do.

How might this bias the results of exercise studies?

EO
well, of course, you can't placebo movement per se - either people are engaged in kinetic activity, or they are not; I think what would differentiate qigong from aerobic exercise is the specifics of the movements and also how they are coordinated by with the breath; for example, some of the qigong I do utilizes end range breathing a great deal, meaning that one maintains an inhale or exhale to the point where the impetus to reverse it becomes physiological as opposed to voluntary (ok, not to be done by just anyone, I agree, especially not someone at risk for aortic aneurism, LOL); that is something that could not be replicated via placebo, if people in a "walking" group just walk without specific instruction regarding breathing in time with their stepping, for example; the idea is that, coordinated breathing practice could have some impact on ANS, the lymphatics, etc., so you could conjecture a differential there...


The medical advice for Type II Diabetics and pre-Diabetics has consistently been to maintain a good weight, eat the correct diet - low fat, lo carb, high protein and fiber, and do aerobic exercise.

So, unless this advice is totally off base, what i REALLY want to know from a study is if Taijiquan, Qi Gong, or a combination of both is any better than any other form of exercise program at helping to control a person's Diabetes.

To this end, you really would not have to include the non-exercise group unless you wanted to lay a baseline of "See, exercise in and of itself does a lot of good..." This would then get you out of the ethical problem os "withholding treatment" even though a large number of people with Type II Diabetes or pre-Diabetes are already couch potatoes.

Now, maybe I am just sensitized...living in Houston with a couple of very large medical schools and a large well known medical center... Quoting a study like this in justifying why to take up Taijiquan over some other program will basically get your lunch eaten.
again, same idea - it's not so much what you do, but how you do it: if I teach taiji movements and don't talk about details like coordination of breathing with movement, coordination of eye movements with body movements, specific kinesthetic awareness of weight transfer etc., then I am not teaching taiji, i'm just having people move around slowly - what a good research study would do would be to articulate these specific parameters in terms of physiologically / biomechanically what is going on, and project their possible impact based on analysis of how they might reasonably interact with autonomics, lymphatics, etc.; this of course means that you have to leave behind all the mumbo about "qi" and whatnot, and simply analyze the parameters of what is going on in as relatively objective a manner as possible - so for instance we can talk about coordinating eye and body movement in terms of the occulo gyro cephallic reflex, which is the phenomenon of muscles priming to activate to move the body in the direction that the eyes are looking, ostensibly leading to more appropriate agonist / antagonist relationships in the muscular system, and possibly leading to more appropriate postural tone overall in a group that practiced this way as opposed to one who didn't bother to coordinate where they were going with where they were looking (a not uncommon phenomenon, LOL);
so again, we need to identify specific parameters of an activity in order to differentiate
it from something that resembles it in another capacity; only then can you determine if the intrinsic properties of something like qigong or taiji are inherently more "health producing" than something else that does not contain those things; of course, if that is the case, then one might suggest that these parameters could conceivably be practiced in and of themselves in an alternative superstructure of movement, meaning that they do not require the architecture per se of taiji in order to be effective, LOL...

[cjurakpt]

...as is the fact that they are getting exposure. Now two media sources have latched on to the story and reported it to the general public. That's interesting to me. As a reporter of martial arts, I'm always intrigued to see which stories get reported outside of the martial arts circles. That's why I post so many news article clippings (if that term could be used for the web) here on the forum. It's very important to see how the public perceives us.

absolutely; it really exists on two layers at the same time: layperson perspective and "expert" (?) perspective; each sub-set will have their own requirements and will vet each example differently; what it indicates sociologically is that the interest is there, to examine something exo-cultural utilizing the endo-cultural apparatus of objective quantification; since most people are not trained researchers, they will simply cut to the chase and look to see if anything changed, and not be so concerned with why or how it happened; on the one hand, this means that something like taiji can enter into a comfort zone for more people to try; on the other, it can give a false sense of cause / effect; and, as Gene points out, it is fascinating to observe the process by which specialized esoterica becomes part of the popular cultural consciousness - kinda like watching galaxies collide...

[Eric Olson]

...as is the fact that they are getting exposure. Now two media sources have latched on to the story and reported it to the general public. That's interesting to me. As a reporter of martial arts, I'm always intrigued to see which stories get reported outside of the martial arts circles. That's why I post so many news article clippings (if that term could be used for the web) here on the forum. It's very important to see how the public perceives us. a

I'd say anything related to health is probably a big factor, its got wide appeal. Also, if you look at the way a lot of Sifu's promote their schools its usually got the term "health" in their somewhere.

EO