Health Benefits of Taiji Based on Modern Scientific Investigations*

This article provides a summary of the health benefits of Taiji as shown by modern scientific research investigations during the last 25 years.

Taiji (also spelled Tai Chi, and also known as Taijiquan, or the fist of Taiji) is an ancient Chinese art that has existed for at least several hundred years. To the Chinese, it is known as both a martial art that is good for self defense and is a set of exercises that is good for health. Millions of Chinese for several hundred years have practiced it as a martial art and as a health exercise.

Taiji became known in the West starting in the 20th century, especially in the second half of the 20th century. An important question is whether the above perception of Taiji as a good exercise for health is more than just a folklore, or can it actually be supported by medical (or scientific) investigations. This article provides a summary of such investigations.

The answer from these medical investigations during the last quarter of a century is that there are many indications that Taiji is a good exercise for health.

We first provide a brief definition of Taiji. Then we summarize the medical research findings. This is followed with an explanation why Taiji can give rise to such health benefits. Then we illustrate the above explanation with an example.

What is Taiji?

Taiji is a set of soft and slow exercises that can be performed by males and females, by people of all ages, including children and senior citizens. It can be performed by people who are not necessarily in good health. A subset of the exercises can even be performed by people with certain handicaps, e.g., with mobility handicaps, memory handicaps.

Taiji exercises are usually also integrated with breathing and relaxation. Deep and slow breathing provides more oxygen to revitalize the body. Relaxation relieves the stress in the body and mind. However, the mind is not empty. As a matter of fact, the meditative mind is very much involved and directs the exercises, e.g., by visualizing the movements that are being performed.

This combination of stretching, breathing, and meditation is also known as Qigong. With Gong meaning exercise and Qi meaning the life force in a human body, Qigong thus means exercising the body’s life force. Qigong exercises are often part of the exercises in a Taiji class, e.g., as part of the warm-up exercises at the beginning of the class. Taiji is combining the stretching, breathing, and meditation of Qigong with the movements of a Taiji form set. That is why Taiji is often known as meditation in motion. [1]

Summary of Medical Investigations of Taiji

Because Taiji is an exercise that can be performed by all kinds of people, and it has a reputation that it is a good exercise for health, it is very important to assess the health benefits of Taiji based on modern medical investigations.

During the last 25 years, many medical investigations on the health benefits of Taiji has been carried out. The usual method is to randomly assigned a large group of participants to two groups, one group doing Taiji exercises under a Taiji instructor, and another group under another instructor doing something else, such as another type of exercises or some educational program about the health issue in question. The number of participants is usually several dozens, sometimes more and sometimes less. The program usually meets two-to-three, and sometimes even four, times a week, for about an hour for each meeting, and the duration of the program is usually three to six months.

Most of the studies have been done in the U.S., but a few have been done outside of the U.S. The results of all the studies have been presented in scientific conferences or published in peer-review scientific journals.

We have grouped the health benefits into the following seven categories:

· Lowers blood pressure

· Reduces body pains

· Increases immunity

· Improves physical functions

· Provides positive psychological impacts

· Helps with Parkinson disease and Alzheimer’s disease

· Improves general health

1. Lowers Blood Pressure: One of the first medical investigations was one performed by the Johns Hopkins University’s School of Medicine in 1998 on the effect of Taiji on lowering blood pressure. This study involved 62 sedentary adults 60 years old and over, with half the group doing moderate aerobic exercise consisting of brisk walking and low-impact aerobics, and the other half doing Taiji. The participants met four times per week for 12 weeks. The study found that the systolic blood pressure of the aerobic exercise group had fallen by 8.4 mm of mercury (Hg). But to their surprise, they also found that the systolic blood pressure of the Taiji group had also fallen significantly, an average of 7 mm of Hg. The results were first presented at the American Heart Association’s Epidemiology and Prevention Conference in March 1998, and widely reported. [2]

2. Reduces Body Pains: An important health problem is finding ways to relieve various kinds of pain in the body, e.g., back pain, neck pain, knee pain, and in more serious cases of fibromyalgia with pains all over the body and often accompanied by other symptoms such as fatigues, headaches, and depressions. We now discuss several types of body pains.

Back Pain: The most common pain is back pain, which according to the National Institute of Health about 80% of adults have experienced low back pain at some point in their lifetimes, and it is the most common cause of job-related disability and a leading contributor to missed work days. [3]

What do we know about the effect of Taiji on back pain? A new Consumer Reports survey of more than 3,500 adults who’ve had back pain in the last three years confirms that Taiji helps provide relief. Nearly 90% of respondents who used Taiji (or yoga) for back pain found it helpful. In comparison, only 64% of people thought that the advice and treatment they got from a primary-care physician or orthopedic surgeon gave them relief. [4]

Neck Pain: What about other types of pain? First, let’s discuss neck pain. It has been estimated that seven out of 10 people will be troubled by neck pain at some point in their lives. A medical research study was done in Germany in 2014–2015 and found that Taiji can be as beneficial in treating neck pain as treatment by conventional neck exercise therapy. [5]

Knee Osteoarthritis. Commonly known as wear-and-tear arthritis of the knee, knee osteoarthritis is a condition in which the natural cushioning between joints in the knee — cartilage — wears away. When this happens, the bones of the knee joints rub more closely against one another with less of the shock-absorbing benefits of cartilage, resulting in pain, swelling, stiffness, and decreased ability to move. More than 27 million people in the U.S. have osteoarthritis, with the knee being one of the most commonly affected areas.

A study was done in 2016 by the Tuft Medical Center in Boston on the effect of doing Taiji or physical therapy exercises in the treatment of knee osteoarthritis. [6] The study found that there are significant improvements for both methods, but doing Taiji exercises has a positive impact in terms of depression that may result from knee osteoarthritis, whereas doing physical therapy exercises does not seem to help with depression that may result from knee osteoarthritis.

Fibromyalgia: A more serious pain is fibromyalgia [7], which is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Fibromyalgia should be treated by a doctor or team of healthcare professionals called rheumatologists who specialize in the treatment of fibromyalgia and other types of arthritis. Fibromyalgia is usually treated with medication (pain relievers and anti-depression medicines), aerobic exercises, and often with addition of stress management techniques (such as meditation, yoga, massage, and better sleeping habits), and behavior therapy to treat any underlying depression.

A recently published research investigation 2018 (also by the Tufts Medical Center in Boston) compares Taiji exercise with aerobic exercise for the treatment of fibromyalgia. This research concluded that participants of either exercise routine show improvements after practicing twice a week for 24 weeks, and furthermore, participants of the Taiji exercise routine show more improvements than participants of the aerobic exercise routine. [8]

Traditionally, medication and aerobic exercise are often combined as the main treatment method for people inflicted with fibromyalgia. However, since medicines such as pain relievers and anti-depression medicines may have potential serious side effects such as addiction and adverse mood changes, many fibromyalgia patients may choose aerobic exercise as their sole treatment. The fact that Taiji is shown to be as effective, and perhaps even more effective, than aerobic exercise is an important finding.

The trial also showed that the Taiji participants as a whole attended 62% of possible classes, while the aerobic exercise participants as a whole attended only 40% of possible classes. This suggests that a Taiji program may be able to retain more of the fibromyalgia patients than an aerobic exercise program.

3. Increases Immunity: An early study on Taiji and boosting of immunity to shingles was done at the University of California at Los Angeles. [9] Shingles is caused by reactivation of the chickenpox virus (varicella-zoster virus or VZV). The research was first done in 2003 and confirmed in 2007 with a larger study. The 2007 study involved 112 healthy adults age 59 to 86 (average age of 70) over a 16-week program (but monitored for 25 weeks) of either Taiji or a health education program that provided 120 minutes of instruction weekly. The health education (control) group participated in classes learning about a variety of health-related topics.

There is a vaccination VARIVAX that can increase a person’s immunity to shingles. The study found that the Taiji group’s immunity to VZV was increased by as much as the vaccine VARIVAX typically produces. Furthermore, when the participants are people who have already received the VARIVAX vaccine, the Taiji group still produced a significantly higher level of immunity than the health education group, about 40% higher. The Taiji group’s rate of increase in immunity over the course of the 25-week study was double that of the health education group. Therefore, practicing Taiji increased the immunity to VZV with or without the VARIVAX vaccine.

There are other studies that showed Taiji can increase other immunities. See, e.g. [10].

4. Improves Physical Functions: An important component of health is the ability to do certain basic physical activities that are required in everyday life, e.g., sit down, stand up, lie down, bend down to tie shoelaces, walk, including up and down stairs, lift light objects, etc. These are usually called self-efficacy activities. Having such capabilities is almost a prerequisite to be able to enjoy life and to minimize disasters like falling down resulting in broken hips.

Several studies have shown that Taiji can give rise to positive improvements in such self-efficacy activities. For example, a study in 2001 showed that there was a significant improvement in the self-efficacy functions of the Taiji participants during the course of the program. [11]

Another study done in 2010 showed that Western exercise and Taiji showed comparable improvements in many self-efficacy activities, but Western exercises had greater improvements in upper body flexibility, and Taiji had greater improvements in balance and some measure of cognitive function (i.e., mental process). [12]

5. Provides Positive Psychological Impacts: Besides physical health, psychological health is just as important for a person’s overall well being. In 2012 an important paper was published that surveyed several health journal electronic databases on research papers that measured the effects of Taiji on psychological and mental health. Forty-three articles were found, with eight of them being review articles. [13] Here are some key findings from this study.

Based on analyses of 3072 healthy patients and 745 patients with chronic pathologies such as anxiety, sleep disorders, osteoarthritis, diabetes, AIDS, cancer, balance problems, ADHD (Attention Deficit Hyperactivity Disorder), heart problems: Taiji contributes significant improvements to emotional well being with regard to mood, depression, anger and tension, anxiety, stress, self-efficacy, sleep disorders, fear of falling, emotional disorders, and self-esteem.

For elderly people there were also significant improvements with respect to sleep problems, which could result in decreased anxiety and depression and increased quality of life in the elderly (and decreased hyperactivity in children although these studies were not with children).

Several studies showed that there is significant increase in the feeling of vitality which is an important component of good psychological health.

For the one study that focused on young people with ADHD, it found that there were significant improvements with respect to anxiety and sleep disorders.

There were also two interesting findings from this study:

• The slower the Taiji movements were carried out, the better the effects of the exercise. We will come back to this point later in this article.
• The lower the stance the better the effects of the exercise. Again, we will come back to this point later in this article.

6. Helps with Parkinson’s Disease and Alzheimer’s Disease:

Parkinson’s Disease: Parkinson’s disease is a degenerative disorder of the central nervous system. It belongs to a group of conditions called motor system disorders, which are the result of the loss of dopamine-producing brain cells. Dopamine is a chemical released by nerve cells to send signals to other nerve cells. The four primary symptoms of Parkinson’s disease are (1) tremor, or trembling in hands, arms, legs, jaw, and face; (2) rigidity, or stiffness of the limbs and trunk; (3) bradykinesia, or slowness of movement; and (4) postural instability, or impaired balance and coordination. As these symptoms become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks. At advanced stages, cognitive and behavioral problems and dementia may arise.

A 2012 research in Oregon studied 195 patients with stage 1 to 4 affliction with Parkinson’s disease. [13] The study randomly assigned the patients to three groups: Taiji, resistance training, or stretching. At the end of the 24-week program, they were given several Parkinson’s disease-related standardized tests to measure various parameters related to strength, movement control, balance, stride length and reach, and number of falls.

The Taiji group performed consistently better than the other two groups in all the above tests, except that the resistance-training group’s performance in the number of falls was comparable to that of the Taiji group.

Furthermore, the benefits of Taiji training were maintained when the group was tested again three months after the 6-month study, and no serious adverse effects were observed.

Alzheimer’s Disease: A 2012 research involving three institutions (University of South Florida, Fudan University in Shanghai, and the University of California at Davis) conducted a 40-week randomized controlled trial of 120 non-demented, senior (60–79) Chinese citizens from Shanghai. [15,16] The 120 people were divided into four groups: Taiji Group, Walking Group, Social Interaction Group, and No Interaction Group. Each of the first three groups met three times per week, for one hour each. The No Interaction Group got phone calls four times during the program from a study coordinator.

Two MRIs were obtained for each participant, one before the study and one after the 40-week study. A neuropsychological battery of tests was administered at the start of the study, at 20 weeks, and at 40 weeks.

This study showed that practicing Taiji can increase the brain size and results in improvements in several cognitive tests (discussed below) that may suggest reducing the probability of getting Alzheimer Disease or delaying its onset.

· Brain size: No Interaction Group’s brain size shrank. Walking Group’s brain size shrank as well, but not as much. Social Interaction Group brain size grew, but the growth was not as much as the Taiji Group’s growth.

· Mattis Dementia Rating Scale (which is designed to measure and track mental status in adults with cognitive health): No Intervention Group and the Walking Group had no change in this scale. The Social Interaction Group had some improvement, and the Taiji Group had a significant improvement.

· Trail-making tests (neuropsychological tests of visual attention and task switching, which can provide information about the speeds of visual search, scanning and processing, mental flexibility, as well as executive functioning. It is used to detect several cognitive impairments such as Alzheimer’s Disease and Dementia): No Interaction Group took more time to complete the task. Both Social Interaction Group and Walking Group had no change in time. The Taij Group became “sharper” and used less time.

The above results show that the Taiji Group had the best results in all three tests. The brain size grew the most; the Mattis Dementia Rating Scale improved the most, and the Trail-making tests showed a faster response time. Actually, these results are not surprising because of the commonly accepted axiom “if you don’t use it, you will lose it.” We will also come back to this issue in the discussion why Taiji can be beneficial to health.

7. Improves General Health:

Improves general health or overall quality of life is really just a combination of all of the above categories of health improvement. Of course, one needs the basic self-efficacy physical functions, but one also needs good blood pressure, lack of pains in various parts of the body, the ability of the body to be immune to infections, and at older age to be free of Parkinson’s disease and Alzheimer disease. Besides good physical health, one also needs good psychological health.

As we have discussed above, various research studies have shown that Taiji can make significant improvements in all these categories of good health. Therefore, practicing Taiji can improve general health.

There are also some research studies that focus on Taiji and overall quality of life. For example, a study in 2009 of nursing home residents in Hong Kong showed that there was significant improvement in the Health-Related Quality of Life (HRQOL) metrics (both physical and mental) for residents after they have gone through a Taiji program. [17]

How Does Taiji Give Rise to These Health Benefits?

There are several fundamental principles of Taiji:

1. Keep good posture when doing the forms, e.g., keep your upper body straight and separate your two feet with a shoulder-width separation in the direction transverse to your direction of motion.
2. Move your body strategically, e.g., rotate your waist, and step down on the heel first followed by stepping down on the toes (sometimes known as “cat-step”).
3. Don’t oppose an opponent’s force head on, but deflect, supplement, and constantly change direction.
4. Integrate movement with slow and deep breathing, especially using Lower Abdominal Breathing.
5. Make slow and soft movements.
6. Relax body and mind, but mind is not empty.

Keeping the upper body straight as in Principle 1 means that the weight of the whole back is firmly supported by the pelvic structure and the legs, and avoids putting any unnecessary stress on any part of the upper body. This is similar to the usual suggestion that when we sit, we should sit upright. Separating your two feet also as in Principle 1 provides a firmer foundation because as long as your center of gravity is between your two lines of feet support, you will not fall. Good posture also means to keep a low stance, because that strengthens your leg muscles. That is why to a certain extent, the lower the stance, the more health benefit the Taiji exercise will bring.

Rotate your waist as much as possible as in Principle 2 means that you are constantly exercising and strengthening your muscles on both sides of your spine. Doing the cat step as also in Principle 2 means that you have firmer support since the heel provides much stronger support than the toes. This also maximizes the force of your hand strike because when you are stepping down on your toes, your foot and body also move forward as your hand strikes your opponent.

When your opponent tries to punch you, you don’t resist that force head on; otherwise, the stronger person will win. Instead as in Principle 3 you deflect that force with a small force perpendicular to the incoming force and also supplementing with a force along the direction of the incoming force. This uses the principle of “four ounces can deflect a thousand pounds.” This could cause the opponent to lose balance, and the opponent will pull back. Then you also reverse direction and apply a strong force in the new direction. This means that you are constantly changing directions and changing between defending and attacking, as in the Taiji symbol.

An integral component of Taiji exercise is slow deep breathing as in Principle 4. This not only provides you with more oxygen, but together with using Lower Abdominal Breathing when the diaphragm moves up and down and your abdominal cavity expands and contracts (both front and back), that brings in even more oxygen and the movement of the abdominal cavity is like massaging the internal organs inside the abdominal cavity, thus strengthening those internal organs.

Make slow and soft movements as in Principle 5 synchronizes with the slow and deep breathing of Principle 4. Both the slow movements and the deep breathing bring in more oxygen into the body. Therefore, to a certain extent, the slower the Taiji movements, the more health benefits it will result. The slow and soft movements also allow all kinds of people, including young and old, or people not necessarily in good health or with some handicaps, to practice Taiji, making it an exercise that can appeal to all people. It is also one of the reasons that Taiji does not lead to any adverse side effects.

Principle 6 to relax body and mind is probably the most important fundamental principle of Taiji. This reduces stress, which we know from modern medical science can lead to all kinds of health problems. But the mind is not empty. This means that one should get rid of extraneous thoughts in the mind, but the mind focuses only on the task at hand. As a matter of fact, the mind leads the forms, e.g., by visualizing the forms one is performing. The fact that the mind is integrally involved is probably the major reason why Taiji may delay Alzheimer’s disease.

This collection of fundamental principles of Taiji is what makes Taiji to be able to give rise to all kinds of health benefits. In the next section, we will illustrate some of these principles to apply to “Taiji and back pain.”

As we mentioned at the beginning of this article, Taiji is both a good martial art and a good exercise for health. Before we end this section, we want to mention that what are good from a health perspective are usually also good from a martial arts perspective, and conversely, what are good from a martial arts perspective are usually also good from a health perspective

Illustration with An Example of “Taiji and Back Pain”

We now apply the above Taiji principles to the example of “Taiji and Back Pain.”

Taiji is effective for low back pain because it gives rise to better posture and balance, it strengthens back muscles and stretches the spinal column structure, and it benefits from associated meditation aspects (relaxation and deep breathing).

Gives Rise to Better Posture and Balance: One of the fundamental principles of Taiji is to keep the upper back of the body straight or almost straight. This means that the weight of the whole back is firmly supported by the pelvic structure and the legs, and it avoids putting any unnecessary stress on any part of the upper body. This is similar to the usual suggestion that when we sit, we should sit upright.

Another fundamental principle of Taiji is that we should have close to one-shoulder-width separation between the left foot and the right foot in the transverse direction (i.e., direction perpendicular to direction of motion). Then the center of gravity of your body will be between the two lines of support from your two feet. This gives rise to a very firm stance and better balance, and again avoids putting any unnecessary stress on your body. This is also why practicing Taiji can significantly reduce the probability of falling.

Strengthens Back Muscles and Stretches Spinal Column Structure: Many Taiji movements involve waist rotation. When you rotate the waist, you are strengthening the muscles surrounding your lower back spinal column. This means that when you are involved in doing various daily activities, such as turning your body, lifting an object, or bending down, your strengthened back muscles will result in less stress on your lower back spinal column. This minimizes the probability of causing a vertebra disk to protrude and touching a nerve which will cause pain.

Waist rotation is integral to Taiji. You will find it in numerous forms, e.g., in Wild Horse Shakes Its Mane. Brush Knee and Step Forward, Grasp the Sparrow’s Tail, Single Whip, Wave Hands Like Cloud, Fair Lady Works the Shuttles.

By the way, waist rotation is also very important from a martial arts perspective. When you punch with your arm or kick with your foot, rotating the waist adds more power to your punch or kick. The power from your punch or kick no longer just comes from your arm or leg, because the rotational power will be added to the power of your punch or kick. This illustrates that what are good from a health perspective are usually also good from a martial arts perspective. Conversely, what are good from a martial arts perspective are usually also good from a health perspective.

Besides doing various Taiji forms, there are also many stretching or Qigong exercises that one also practices in a Taiji class. Some of these exercises stretch the spinal vertebra column. This gives rise to more space for the disk between vertebrae, and thus avoids disk rupture or herniated disk. An example is Item #3 “Separating Heaven and Earth” in the Eight Silk Brocade Qigong exercise of Ref 19.

Benefits from Associated Meditation Aspects (Relaxation and Deep Breathing) of Taiji: Taiji is also known as Meditation in Motion. There are two components to meditation: Relaxation and deep breathing. Relaxation is for both the body and mind. You relax your whole body. That is why the Taiji movements (especially for the Yang Style) are essentially all slow and soft. The mind is also relaxed, in the sense that your mind is focused only on the current exercise, and gets rid of all extraneous thoughts from your mind.

Deep breathing refers to long, slow breatihng and to Lower Abdominal Breathing (also called Dantian Breathing). When you use Lower Abdominal Breathing, your diaphragm moves up and down, and your abdomen (both front and back) moves outward and inward. Lower Abdominal Breathing allows you to take longer breaths and take in more oxygen. Because of the movement of the diaphragm and the expansion and contraction of your lower abdomen, Lower Abdominal Breathing provides some massaging of the organs inside your abdomen. Massaging is like doing exercises with your internal organs, thus strengthening them.

Relaxation and deep breathing can get rid of stress on your body and mind. The combination also allows the blood, oxygen, and Qi (life force in traditional Chinese medicine) to circulate more freely in your blood vessels, energy meridians, muscles, and organs, thus invigorating your body. Deep breathing also can get rid of more of the toxins that are inside your blood, resulting in healthier organs. Thus the meditation aspects of Taiji can result in a healthier body, including your lower back.

Relaxation not only is good for your health, it is also good from a martial arts perspective. When you are relaxed, you can better sense your opponent’s motion and intent. At the same time, it will be more difficult for your opponent to sense your motion and intent. This provides an advantage in combat. This also provides another illustration of the earlier statement that what are good for your health are usually also good for martial arts, and what are good for martial arts are usually also good for your health.

Summary

Taiji is an ancient Chinese art that is known as both a martial art that is good for self defense and is a set of exercises that is good for health. Modern medical research, especially during the past quarter of a century, has provided many confirmations that Taiji is a good exercise for health. Its contributions to good health ranges from reducing blood pressure, reducing body pains, increasing immunity, improving physical functions, providing positive psychological impacts, helping with Parkinson disease and Alzheimer disease, and improving general health.

One of the important findings is that Taiji can sometimes give rise to positive results that in Western medical treatment requires a combination of physical therapy exercises and Western medicine, as in the treatment of psychological problems and fibromyalgia. Since some of the medicines in treating these problems have adverse side effects, it makes even more important to determine the benefits and the extent of the benefits of Taiji.

Another interesting finding is that the participants are more likely to continue participating in the Taiji program than in other alternative exercise programs. No matter how good a program is, it doesn’t do any good if people don’t continue to practice it. Coupling this with the fact that Taiji is a program that can be practiced by all types of people and there are no adverse side effects to practicing Taiji makes Taiji an even more appealing exercise program.

Since most of the medical studies to date have small sample sizes, usually involving dozens of people, more studies need to be conducted with larger sample sizes. More studies also need to be conducted in different research facilities, different localities, and involving different nationalities.

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* This article with the title “Health Benefits of Taiji” was published in “Qi: The Journal of Traditional Eastern Health & Fitness,” Volume 29, №. 3, Autumn 2019, pages 20–28.

[1] There are many articles and books explaining Taiji. Here is an article by the author providing a short introduction to Taiji, as well as to a related subject Qigong: “Taijiquan: An Introductory Overview,” D. M. Tow, 2008, February: . http://www.dontow.com/2008/02/taijiquan-an-introductory-oveview/.

[2] “Tai chi Lowers Blood Pressure for Older Adults,” Science Daily, March 20, 1998: https://www.sciencedaily.com/releases/1998/03/980320075947.htm.

[3] “Lower Back Pain Fact Sheet,” National Institute of Neurological Disorders and Stroke (NINDS): https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet.

[4] “Consider Tai Chi for Back Pain,” Teresa Carr, Consumer Reports, March 12, 2017: https://www.consumerreports.org/back-pain/tai-chi-for-back-pain/.

[5] “The Effects of Tai Chi and Neck Exercises in the Treatment of Chronic Nonspecific Neck Pain: A Randomized Controlled Trial,” R. Lauche, et. al., The Journal of Pain, Vol. 17, No 9 (September), 2016; pp1013–1027.

[6] “Comparative Effectiveness of Tai Chi Versus Physical Therapy for Knee Osteoarthritis: A Randomized Trial,” C. Wang, et. al., Annals of Internal Medicine, 2016; 165(2):77–86.

[7] “Fibromyalgia,” Center for Disease Control and Prevention, 2017 October: https://www.cdc.gov/arthritis/basics/fibromyalgia.htm.

[8] “Effects of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial,” C. Wang, et. al., March 21, 2018, BMJ journal: https://doi.org/101136/bmj.k851. BMJ used to stand for British Medical Journal, but now only the acronym is used. The pdf file for this article can be downloaded at: https://www.researchgate.net/publication/323938961_Effect_of_tai_chi_versus_aerobic_exercise_for_fibromyalgia_Comparative_effectiveness.

[9] “Effects of a behavioral intervention, tai chi chih, on varicella-zoster virus specific immunity and health functioning in older adults,” M. R. Irwin, J. L. Pike, J. C. Cole, and M. N. Osman, Psychosomatic Medicine. 2003;65:824–30.

[10] “A Comprehensive Review of Health Benefits of Qigong and Tai Chi,” R. Jahnke, et. al., Am J Health Promotion,. 2010 JUL-AUG; 24(6): e1–e25.

[11] “Tai Chi, Self-Efficacy, and Physical Function in the Elderly,” F. Li, et. al., Prevention Science, 2001 December, Volume 2, Issue 4, pp 229–239: https://doi.org/10.1023/A:1013614200329.

[12] “Effects of Tai Chi and Western Exercise on Physical and Cognitive Functioning in Healthy Community-Dwelling Older Adults,” R. E. Taylor-Piliae, et. al., J. Aging and Physical Activity, 2010 Jul, 18(3), pp 261–279.

[13] “Psychological Effects of Tai Chi Chuan,” P. J. Jimenez, A. Melendez, and U. Albers, Archives of Gerontology and Geriatrics 55 (2012) 460–467.

[14] “Tai Chi and Postural Stabiilty in Patients with Parkinson’s Disease,” F. Li, et. al., N Engl J Med 2012; 366:511–519.

[15] “Changes in Brain Volume and Cognition in a Randomized Trial of Exercise and Social Interaction in a Community-Based Sample of Non-Demented Chinese Elders, J. A. Mortimer, et. al., Journal of Alzheimer’s Disease 2012; 30 (4), published by IOS Press: http://www.j-alz.com/press/2012/20120619.html.

[16] “Tai Chi increases brain size and potentially delays the onset of the Alzheimer,” August 16, 2012:, V. Li http://www.violetlitaichi.com/wp-content/uploads/2016/07/Tai-Chi-increases-brain-size-and-potentially-delays-the-onset-of-the-Alzheimer-Examiner.com_.pdf.

[17] “Tai Chi and health-related quality of life in nursing home residents,” L. Y. Lee, D. T. Lee, and J. Woo, Journal of Nursing Scholarship, 2009 Mar; 41(1):35–43: https://www.ncbi.nlm.nih.gov/pubmed/19335676. See also Ref. [18].

[18] “Tai Chi May Improve Balance and Quality of Life,” Keneda, Brain and Life, 2019 April/May: https://www.brainandlife.org/articles/tai-chi-may-improve-balance-and-quality-of-life/.

[19] “A Set of Simple Time-Tested Health Exercises: The Eight Silk Brocade (八段錦)”: http://www.dontow.com/2018/12/a-set-of-simple-time-tested-health-exercises-the-eight-silk-brocade-%e5%85%ab%e6%ae%b5%e9%8c%a6/.