What you should know about HIV and Tai Chi

by Mary Lou Galantino, PHD, PD

There is an exercise technique that may not be completely familiar to you. It can improve physical and emotional measures for almost any populationespecially for those people along the spectrum of HIV disease. What is this mystery workout? It's Tai Chi, a Chinese martial art form, over 300-years-old, that is rapidly gaining popularity in the U.S. as an easy and beneficial workout.

The philosophy behind Tai Chi, which means "Supreme Ultimate," assumes that the body's flow of energy, or Tao, contains negative and positive forces. An imbalance of these forces, known as Yin and Yang, creates physical dysfunction. Tai Chi is designed to promote a smooth and balanced flow of energy throughout the body through a series of poses involving slow, rhythmic movement.

Clinical studies and demonstration project results are measuring the value of this ancient technique. One study performed on an elderly population showed that after one year of Tai Chi training, 83.2% of study enrollees could perform "house chores" that they could not do before beginning a Tai Chi regimen. Further, a National Institute on Aging research demonstration project studying frailty and injuries in elderly patients found that those patients who undertook a six-month regimen of weekly one-hour Tai Chi sessions achieved scores typical of people three to ten years younger.

And while the technique doesn't outwardly look intense enough to increase heart rate, it does, in fact, have a significant impact on the cardiovascular system. One study comparing 33 Tai Chi practitioners to 33 beginners (aged 16 to 75) showed the Tai Chi group had increased heart rate, increased noradrenaline excretion in urine and decreased salivary cortisol concentration. Tai Chi has also been shown to improve balance and posture.

I perform Tai Chi myself, and I find that it gives me a wonderful centeredness, providing focus at the beginning of the day and a heightened awareness of my body and how it moves. With this in mind, I conducted a study in 1997 which provided further evidence of the health benefits of Tai Chi for people with HIV. The technique is especially beneficial for people with HIV and neuropathy, as well as for those with HIV and CNS opportunistic infections such as toxoplasmosis or CNF lymphoma. One reason: Tai Chi can help solve physical imbalance problems brought on by these conditions. In fact, I'd recommend it even for people with HIV who are asymptomatic.

The 1997 study I conducted compared the effects of a Tai Chi exercise regimen, an aerobic exercise regimen and a control group that did not exercise. Both of the exercise groups participated in two weekly classes, one hour each, for eight weeks. I wanted to study the two modalities, but with each of the regimens similarly structured. Although it wasn't funded, I was fortunate enough to have both a Tai Chi master and a physical therapist volunteer their time for the study.

The exercise group (EX) began each session with a five-minute discussion of terminology, followed by 10 minutes of warm-up and flexibility exercises, 15 minutes of low-impact aerobics, 10 minutes of progressive resistance exercise using Therabands, a 10-minute cool-down and, finally, a 10-minute closing circle of discussion and affirmation.

The Tai Chi group began with a five-minute discussion of terminology, a 10-minute seated meditation, 25 minutes of various Chi movements and postures, followed by a 10-minute "healing chi circle" (seated chi movement) and 10 minutes of discussion and affirmation.

Outcomes were measured on the Medical Outcomes Short Form and the Spirituality Well-Being Scale. Functional measures included tests of functional reach, sit-up and sit-and-reach. The Physical Performance Test was used for general function.

There were significant differences in functional measures among participants. The Tai Chi group outperformed the control group in the sit-up test (43.9, vs. 29.1), sit-and-reach (12.4, vs. 9.9) and in the stairclimbing subset of the physical performance test (28.8, vs. 24.7). The exercise group scored only slightly better than the Tai Chi group in sit-and-reach (13.5, vs. 12.4) and stairclimbing (34.8, vs. 28.8) tests.

Still, functional measures are not the only relevant factors in determining the success of an exercise regimen, particularly among an HIV-positive population.

Collecting data from participants' qualitative journals and through focus groups, I found that patients from the Tai Chi group had three common responses to the technique: they felt it improved their social interaction, enhanced their psychological coping with HIV/AIDS and resulted in positive physical changes.

Some comments from patients included: "I'm sleeping better, resting better"; "I found Tai Chi less regimentedthere's a freeing of mind and body"; "I feel less depressed and tired"; and, "Before this group, I didn't know anyone else with HIV disease."

In a testament to the success of the Tai Chi regimen, the participants did not want to end their sessions when the eight-week study was concluded. In fact, the 13 participants decided to fight for funding to continue their class, and they got it. The 13 members of the aerobic group also enjoyed the group dynamics of the study and continued their sessions as well, with two study participants leading the class.

I believe these developments speak to the desirability of group interactions for HIV patients, regardless of the exercise regimen selected. The study didn't turn out to be a "thanks for the data" experience that ended at eight weeks. My goal was for the groups to continue, and they did.

I also asked participants to complete a spirituality well-being scale, with 10 questions on religiosity and 10 on existential matters. Many participants didn't like the questionnaire, but they didn't mind being interviewed about how the group affected their spiritual health. Many said they felt a sense of increased spiritual connectedness as a result of their participation in the study.

A word of advice about Tai Chi: It is difficult to perform with only text instructions. Taking a Tai Chi class or watching a video cassette makes the process much easier. A video by instructor David Carradine shows a simple progression of Tai Chi, from beginner to advanced levels.

Another option, and one which I strongly recommend, is to join a Tai Chi group. Not only will this allow someone to reap the positive rewards of social interaction, but members can get feedback on the way they performed (and a Tai Chi master can see the person's form and correct it ). A group setting is an extra bonus when participants are from a like population with common interests. This is an important element in enhancing skill levels, and it allows members to share information on treatment and other alternatives, pass on success stories and offer psychological support.