Ai Chi: Safety and Effectiveness (Part 2 of 2)

Does a slow, quiet water exercise actually change anything you can measure? For Ai Chi, the honest answer is: often yes, in small studies.

Part 2 walks through those studies, condition by condition, and says what each one found.

Want to go deeper? Explore the Aquatic Therapy for Balance Disorders & Fall Risk course →

Osteopenia / Osteoporosis: Devereux et al ¹⁴ studied the effect of water-based program combined with self-management program on elderly women diagnosed with osteopenia / osteoporosis. Fifty individuals, between ages of 65–83 years, living in a community-setting were enrolled in the study. They were randomly selected to participate either in the intervention or the control group. The intervention group received aquatic therapy for 1 hour, twice a week, for a total period of 10 weeks. The aquatic therapy incorporated Tai Chi movements. In addition, to the aquatic therapy, individuals in this group also received a self-management program. The control group did not receive any interventions during this time. Upon completion of the study, the intervention group showed improvements in their balance abilities as measured using the Step test. A questionnaire was developed to evaluate changes in the quality of life of these individuals. The test showed that the intervention group had improvements in physical function, vitality, social function and mental health. However, there was no difference between the two groups on the fear of falling.

The authors make recommendations for similar studies in the future. A comparison of water-based and land-based exercises may be performed with a similar patient population. A longer follow-up could be implemented to study optimal therapy times for adequate improvements. It is known that Modified Falls Efficacy Scale (MFES) scores reach a ceiling effect for high-functioning individuals. Therefore, studies can be designed to incorporate subjects with varying MFES scores to evaluate the effect of water-based therapy on the fear of falling.

Teixeira et al ¹⁵ studied the effect of Ai Chi on balance and the fear of falling in elderly individuals. Thirty adults, between the ages 77-88 years, were enrolled for a study spanning 6-weeks. They were randomly placed in two groups—experimental and control. All individuals displayed a high or a medium risk of falling, as measured by the Tinetti Performance-Oriented Mobility Assessment (POMA) scores. The experimental group received 16 Ai Chi sessions based on the sequence suggestions by Sova and Konno. ¹⁶ The control group did not receive any interventions. According to the study’s findings, the experimental group had a significant improvement in balance (as measured by POMA) following the intervention. Fear of falling (Falls Efficacy Scale [FES]) stayed about the same in the experimental group; the change was not statistically significant. The control group did not show any improvement in balance during the same time period; in addition the fear of falling increased in this group.

Parkinson’s disease: Pérez de la Cruz ¹⁷ randomized 30 people with Parkinson’s disease (Hoehn and Yahr stages 1 to 3) to aquatic Ai Chi or to therapy on dry land, twice a week for 10 weeks. At the one-month follow-up the Ai Chi group had improved more on pain and on the Tinetti balance test. The land group improved only on pain, and by less. It is a small, single-blind trial.

Stroke survivors: Noh et al ¹⁸ evaluated the effect of Halliwick-concept and Ai Chi swimming programs on stroke survivors. Twenty five stroke survivors were selected, and randomly divided into two groups. One group (13 individuals) was involved in aquatic programs (Halliwick and Ai Chi), while the other group (12 individuals) received land-based gym therapy. The total period of therapy was 8 weeks, with 3 sessions every week, for 1 hour each. According to this study, the aquatic therapy group demonstrated significant improvements in Berg Balance Scale scores, forward and backward weight-bearing abilities of the affected limbs and knee flexor strength, as compared with the conventional therapy group. There were no significant changes in the other measures between the two groups.

Multiple Sclerosis: Castro-Sanchez et al ¹⁹ evaluated the effect of Ai Chi on multiple sclerosis patients. Seventy three patients were randomly placed in two groups—experimental and control. The experimental group received 40 sessions of Ai Chi, while the control group received 40 sessions of land-based abdominal breathing and contraction-relaxation exercises. The total study period was 20-weeks long, with 2 sessions/week. This study found a significant decrease in pain intensity over baseline in the experimental group. This decrease in pain was maintained up to 10 weeks following the last session. The experimental group also had significant improvements in spasm, fatigue, disability and autonomy.

In this study, pain was measured using VAS, the Pain Rating Index (PRI) and the Present Pain Intensity (PPI) from the McGill Pain Questionnaire (MPQ). Stability and disability were measured using the Roland Morris Disability Questionnaire (RMDQ). The secondary measurements were spasm VAS score, Multiple Sclerosis Impact Scale-29, Modified Fatigue Impact Scale, Fatigue Severity Scale, Becks Depression Inventory and Barthel Index. The authors noted that Ai Chi exercises offer neural and musculoskeletal benefits that are not possible by passive water immersion techniques, such as balneotherapy. Since exercise-based therapies alleviate the symptoms of multiple sclerosis, clinicians may use aquatic programs to encourage a more active lifestyle. In addition, this study incorporated ambient music together with the Ai Chi sessions, which might have enhanced the patient’s positive experience. In future, individualized Ai Chi sessions, wherein the participant can choose their own music, may be explored.

In another study, Bayraktar et al ²⁰ evaluated the effect of Ai Chi on Multiple Sclerosis patients. Twenty three patients were randomly divided into two groups—experimental (n=15) and control (n=8). The experimental group performed Ai Chi sessions, while the control group performed home-based active arm and leg exercises along with abdominal breathing. The study found improvements in static standing balance (as measured by the duration of one-leg stance), functional mobility (as measured by Timed-up-and-Go and 6-minute walk tests), upper and lower extremity muscle strengths (as measured by hand-held dynamometer) and fatigue (as measured by Fatigue Severity Scale). No improvements were observed in the control group in these selected outcome measures.

Rheumatoid Arthritis: Lambeck and Bommer ⁷ [Expert opinion] describe the effect of Ai Chi on a 59-year old woman with rheumatoid arthritis. This individual had secondary osteoarthritis of knees, ankles and hip. A 5-week Clinical Ai Chi regimen was selected for her, based on the American College of Sports Medicine (ACSM) guidelines for arthritic patients. Her low-level workout sessions comprised of 20-minute of workout at 40% VO 2 max, or RPE 11/20. The program was designed to present a high number of repetitions with a low external load in order to build muscle endurance. The slow movements of Ai Chi were incorporated to reduce connective tissue stiffness. The individual’s balance training was facilitated by selecting Ai Chi movements with frequent changes in center of gravity. Stabilization of postures, without the use of hands and with narrow support bases, was encouraged. Upon completion of the program, the woman showed improvements in the range of motion of hip, knees and ankles. Her MRC muscle strength (as measured by MRC scores) and functional balance (as measured by Timed Up and Go test) had improved. In addition, the woman reported to be able to better handle the activities of daily living. This is a single case described in a textbook chapter, not a trial.

Fibromyalgia: Calandre et al ²¹ evaluated the effect of pool-based Ai Chi in fibromyalgia patients. Eighty one patients, in their 40s and 50s, were randomly placed in two groups—one receiving Ai Chi (n=42) and the other group receiving stretching exercises (n=39). All interventions were carried out in a heated water environment. A total of 18 sessions were implemented for each group, which spanned a total period of 6 weeks (3 sessions/week). The study found significant improvements in fibromyalgia symptoms (as measured by Fibromyalgia Impact Questionnaire [FIQ]) and sleep quality (as measured by the Pittsburgh Sleep Quality Index [PSQI] in the Ai Chi group, which was not observed in the stretching group. This study’s unique strength was that the sustained benefits on fibromyalgia symptoms and sleep were even observable 3 months post-study. The study also found decreased Trait-anxiety scores for both the groups. The stretching group also showed reduced Beck Depression Inventory (BDI) scores and increased Short Form-12 Health Inventory (SF-12) scores; however, a similar trend was not observed in the Ai Chi group.

Kelley and Loy ²² evaluated the effect of Ai Chi on salivary cortisol levels in fibromyalgia patients. Increased cortisol levels are associated with stress conditions. A total of three patients were enrolled for the study, which implemented a single-patient alternating treatment design. Walking on a treadmill was compared with Ai Chi (aquatic exercise) in this study. The study spanned a total period of 7 weeks. According to the study findings, both aquatic and land-based exercises reduced salivary cortisol levels in these fibromyalgia patients; most noticeable benefits were observed during moderate-pace walking on treadmill. The authors suggest that the positive effect on cortisol levels of treadmill-walking could be partly due to the social interactions during these exercise sessions. The participants could talk to one another while walking on a treadmill, as opposed to concentrating on deep breathing during Ai Chi sessions. This social interaction could have helped lower cortisol levels in these patients.

For fibromyalgia patients, continued adherence to an exercise regimen is a critical factor to consider, especially because these individuals tend to easily discontinue. Future studies may be designed to evaluate the favorability of adherence to an Ai Chi program in this patient population.

Conclusion

In conclusion, the studies detailed above provide encouraging evidence for the health benefits of Ai Chi on several patient populations.

For education only; not a substitute for individual clinical judgment.