So many conditions that can come with age challenge mainstream prescriptions for health. Parkinson’s, like Alzheimer’s and fibromyalgia, of uncertain origins, has no “cure”; as certain types of neurons in the brain die, a person loses fine control of their body, which manifests as tremors, postural instability, difficulty walking, and frequent falls.
Medication for Parkinson’s reduces tremors but doesn’t do much for postural stability, an urgent problem because of the danger of falls to the elderly, and because postural stability is an essential component of countless basic everyday activities such as standing up and reaching for something on a shelf.
Exercise is already an important part of managing Parkinson’s because it slows the deterioration of motor functions in general. And resistance-training does increase balance and strength in Parkinson’s patients. However, resistance training requires equipment and safety monitoring and there hasn’t been much research on more convenient, or more effective alternatives. One of the most advanced studies ever done on alternative exercises for Parkinson’s tested an interesting hypothesis: that Tai Chi, previously shown to improve strength, balance, and functioning in older adults, would perform better than resistance training, or mindful stretching, as a therapy for Parkinson’s symptoms.
In fact, in the study, tai chi brought more benefits to subjects than either resistance training or mindful stretching, including benefits not fully understood by the study authors. The study, by a large international team of researchers, and published in the New England Journal of Medicine, stands out in several ways. It is one of very few randomized clinical trials comparing the effects of an alternative exercise like Tai Chi to both resistance training and stretching, and measuring the maintenance of benefits after six months, and for an unusual variety of primary and secondary outcomes (see below).
It is also very unusual in using a tai chi form purposely designed for its purposes, one which emphasized rhythmic weight-shifting, symmetric stepping, and controlled movements near the limits of stability. As a tai chi instructor, I was curious to see the description of this form, which is available as an appendix to the study, and it struck me as very well designed for these purposes. The researchers also mention the constant axial rotation of the body and the way the hips and ankles “sway” to maintain balance as components of tai chi that they expected to benefit the Parkinson’s patients.
The resistance training employed weighted vests and ankle weights, during side-steps, squats, lunges, and ankle and toe raises. The stretching involved a wide variety of exercises covering the whole body and lower limbs especially, with deep abdominal breathing.
Defining Tai Chi
Tai chi (for those who come late to my discussion of it in these pages) is a “soft-style” Chinese martial-art which combines kung-fu with qi gong, a 1000s years-old family of mind-body exercises based on the principles of Taoist philosophy, emphasizing the unity of mind, body, and breath, and gentle natural movements. Qi gong and tai chi are traditionally believed to increase all kinds of physical functionality and to balance the body’s “internal energies”—circulation, digestion, immunity, and nerve activity, for example. Qi gong has demonstrated a hodge-podge of surprising benefits in peer-reviewed studies, such as reducing inflammation and blood-pressure and eliminating allergies and migraines. Tai chi has performed very well at the limited tasks set it by peer-reviewed research such as reducing falls in the elderly. The study we’re looking at today stands out for measuring a greater variety of outcomes.
Postural stability in the study was measured in terms of how far and how accurately subjects could shift or lean in any direction without losing balance. They also evaluated the subjects’ gaits’ in terms of stride-length and speed, the strength and flexibility of knees during movement, their functional reach from a fixed position, and the time it took them to stand up, walk 10 feet, return, and sit down. Their Parkinson’s motor symptoms were also scored on the 14 item “Unified Parkinson’s Disease Rating Scale” (UPDRS III).
Tai Chi Benefits Parkinson's Sufferers
After six months, the tai chi group performed significantly better than either of the other groups at the postural stability tests. Tai chi also did better than the stretching for all of the other outcomes—gait, knee strength, functional reach, timed get-up-and-go—and UPDRS III scores. The resistance-trained group did about the same as tai chi at for improving strength and speed, however tai chi did more for stride-length and functional reach. Tai chi also did better than either other group at reducing falls during the six months of follow-up.
The authors speculate that the superiority of tai chi at improving these functions has to do with several of its prominent characteristics as an exercise—the constant switching between narrow and wide stances, careful weight shifting, heel-to-toe forward and toe-heel backward stepping, and the constant rotation of the trunk in coordination with the stepping and hip movements. All these training features would seem to support postural stability and walking ability.
The superiority of tai chi at improving motor control in general (the UPDRS score) seemed somewhat mysterious to the study authors—I presume because there is no direct link between the movements of tai chi and the functionality of the nervous system. However, such an effect is hardly surprising. Any kind of mindful movement practice increases the mind / brain’s ability to control fine movements. Tai chi seems likely to do this better than just any form of mindful movement because of its emphasis on whole body awareness and coordination, especially with different limbs, joints, or sides of the body moving in different but coordinated directions, and while maintaining an unshakeable base. It should be no surprise that tai chi has powerful potential as a form of neuromuscular rehabilitation, and it does, as the study authors put it, “warrant further exploration.” - Aaron Nitzkin, Ph.D.
