Tai Chi for Stroke
Sep 21, 2020
Public Health Report by: Eric L. Zielinski
As the working environments trend indoors, more people than ever remain sedentary throughout the day. This leaves people disconnected with healthy lifestyle choices like proper diet, exercise and stress management techniques. Subsequently, the world has experienced steady, unprecedented rises in chronic diseases like stroke. Lacking the necessary time in their day to maintain a robust health profile, the world is in desperate need of proven, broad spectrum interventions that help mitigate the risk of this silent killer. Tai Chi, for instance, has received much interest in research circles as a potential answer to the world’s chronic health problems. Not only proven to be able to reduce the risks associated with strokes, it has been shown to be effective in helping stroke survivors recover quicker. It is, therefore, one of the few all-encompassing activities that may be able to help reverse the stroke epidemic that is overtaking the world.
Strokes are medical emergencies mainly caused by a blockage that prevents blood from flowing to the brain. It is believed that the most common reason for this is fatty deposit accumulation within the inner walls of the blood vessels that supply the heart or brain. Thus, destroying brain cells. Bleeding from a blood vessel in the brain can also cause strokes. Transient ischemic attacks (TIAs), or “mini-strokes,” occurs when blood is only temporarily prevented from flowing into the brain. TIAs are especially dangerous because they are oftentimes ignored and can lead to a major stroke event.
According to the World Health Organization (WHO) stroke is the number two cause of death in the world, second only to ischemic heart disease. It was responsible for the death of 6.2 million people in 2011, up from 5.9 million in 2000.
The National Stroke Association differentiates between two types of risk factors associated with stroke: controllable and uncontrollable risk factors.
Controllable Risk Factors:
- Alcohol use
- Atrial fibrillation
- Circulation problems
- High blood pressure
- High cholesterol
- Physical inactivity
- Smoking and tobacco use
Uncontrollable Risk Factors:
- Family history
- Patent foramen ovale (congenital hole in the heart)
- Previous stroke
According to the National Institute of Health (NIH), the following is a list of stroke symptoms:
- Sudden numbness or weakness of the face, arm or leg (especially on one side of the body).
- Sudden confusion, trouble speaking or understanding speech.
- Sudden trouble seeing in one or both eyes.
- Sudden trouble walking, dizziness, loss of balance or coordination.
- Sudden severe headache with no known cause.
Medical Research and Management
Overall, medical prevention of strokes includes avoiding the controllable risk factors above. The Mayo Clinic provides the following examples:
- Avoiding salty and fried foods.
- Controlling diabetes.
- Controlling high blood pressure and cholesterol through lifestyle changes and medications if necessary.
- Controlling sleep apnea (if present).
- Eating a well-balanced diet high in fruits, vegetables, and whole grains.
- Exercising regularly.
- Maintaining a healthy weight.
- Quitting tobacco use.
Being medical emergencies, most strokes are treated in hospitals and in ambulances. Various methods are employed to keep the brain alive and to inhibit blood clots from developing, thereby preventing further damage to the brain. Following emergency procedures, the focus of stroke management centers on regaining strength to help victims live independently again. Rehabilitation programs such as speech therapy, physical therapy and occupational therapy are oftentimes utilized as every aspect of someone’s health can be affected by a stroke.
For people who have suffered from a stroke, physicians will often prescribe preventative medications such as anti-platelet drugs such as aspirin to prevent blood clots. Also, anticoagulants such as Coumadin may be employed for the same reason.
In addition to bleeding disorders, the risks of anti-blood clotting drugs including:
- Blood in the urine.
- Easy bruising.
- Pale skin.
- Sudden headaches.
- Sudden dizziness, feeling light-headed, shortness of breath, and rapid heart rate.
- Overall muscle weakness or numbness.
- Infrequent urination or not urinating at all.
- Various illnesses associated with body aches, chills, and fever or flu symptoms.
Research showing Tai Chi’s ability to help prevent strokes and to speed recovery
In regards to stroke, Tai Chi is beneficial in two ways. First, by directly affecting the primary risk factors – diabetes, high blood pressure, high cholesterol, physical inactivity, obesity and stress – Tai Chi can help prevent strokes from occurring. Secondly, by addressing typical disabilities following strokes – poor balance, irregular neuromuscular control, and mood disorders such as depression – Tai Chi is highly effective in rehabilitation assistance for stroke survivors.
The literature below, therefore, not only addresses studies concentrating on Tai Chi’s relationship with strokes directly, it also covers those relating Tai Chi and stroke risk and rehabilitation factors.
Tai Chi and Stroke Prevention
- In 2006, the British Journal of Sports Medicine published a study in which researchers from Taiwan investigated the effects a 12-week program of regular Tai Chi had on key risk factors associated with type 2 diabetes; functional mobility, beliefs about benefits of exercise on physical and psychological health, and immune regulation in middle aged volunteers. Recruiting 14 men and 23 women who were considered of normal health, it was shown that “regular [Tai Chi] exercise had a highly significant positive effect on functional mobility, and beliefs about the health benefits of exercise, in the 37 participants. Total white blood cell and red blood cell count did not change significantly, but a highly significant decrease in monocyte count occurred. A significant increase in the ratio of T helper to suppressor cells was found, along with a significant increase in CD4CD25 regulatory T cells. Production of the regulatory T cell mediators transforming growth factor ß and interleukin 10 under specific antigen stimulation (varicella zoster virus) was also significantly increased after this exercise program.” The researchers concluded that “a 12 week program of regular [Tai Chi] exercise enhances functional mobility, personal health expectations, and regulatory T cell function” – were thus able to prove that Tai Chi can play a significant role in addressing key risk factors related to type 2 diabetes and thus stroke.
- One year later, the same researchers published a paper in which they measured fasting blood glucose, A1C (three month blood glucose) levels, complete blood counts, and T-lymphocyte subsets in blood before and three days after a similar 12-week Tai Chi program. The article – published in Diabetes Care – reported that, “After the 12-week [Tai Chi] exercise, the A1C levels revealed a significant decrease, but were not clinically normalized…Analysis of lymphocyte subpopulations showed that percentages of both CD4 and CD8 lymphocyte subpopulations significantly decreased after the [Tai Chi] exercise.” Although, “The effect of [Tai Chi] exercise on the increase in regulatory T-cells may indirectly be due to better cardiopulmonary fitness after exercise,” researchers proposed that, “Another possibility is that a regular [Tai Chi] exercise can improve glucose metabolism, resulting in less glycosylated proteins, which benefit immune regulatory function in type 2 diabetic patients.” Since it is well-known that glycosylated modulation of leukocyte surface receptors and soluble cytokines significantly change immune functions, the researchers conclude that, “Studies are needed to explore the glycosylated proteins other than A1C in type 2 diabetic patients that are involved in the improvement of immune functions after [Tai Chi] exercise. Moreover, an appropriate combination of the [Tai Chi] exercise program with diabetic medications may improve both glucose metabolism and immunity of type 2 diabetic patients.”
- Also in 2013, The Journal of Nursing reviewed the effects Tai Chi has on blood pressure, blood sugar and blood lipid control for patients with chronic diseases. By reviewing six electronic databases for related articles published between 1990 and 2011, Chang Gung University of Science and Technology researchers were able to collect from seven studies in which 947 people participated in clinical trials. They concluded that risk factors leading to stroke were minimized by Tai Chi. “Systematic review results indicate that Tai Chi interventions have a significant and positive effect on blood pressure and lipid levels” and thus put people at less risk of stroke and cardiac events.
- A 2009 pilot study was printed in the Clinic Journal of Sport Medicine reporting the effects a 10-week multidisciplinary Tai Chi intervention had on 21 sedentary obese women. To date, this was the first study evaluating these factors as most research designs have concentrated on diet and conventional exercise programs; thereby, neglecting the mind-body aspect that so commonly affects weight gain. The research design determined that these women add Tai Chi to their regular care plan including a low calorie diet, weekly physician/psychologist/dietician group sessions, and a generic exercise program. Changes in weight, body composition, heart rate, blood pressure, mobility scores, mood, Three Factor Eating Questionnaire scores, and general self-efficacy were looked at carefully to determine the outcomes. The Tai Group “improved in resting systolic blood pressure, chair rise test, mood, and reduced percent of fat at week 10 and at 6 months follow-up. General self-efficacy was enhanced in both groups and maintained at 30 weeks.” It cannot be over-emphasized that Tai Chi has an incredible ability to produce long-standing benefits even after discontinuing the exercise. For these women to sustain reduction in obesity and stroke-related risk factors 20 weeks after their 10-week Tai Chi program is profound and researchers need to conduct follow up studies to determine the far-reaching effects the ancient mind-body healing art can have on people.
- In 2013, the American Journal of Health Promotion set out to determine the associations between Tai Chi, anxiety, and cardiovascular disease risk factors. In a community from Taipei City, Taiwan 133 adults aged 55 years and older volunteered to be part of the study. Sixty-four participated were chosen to be part of a 60-minute Tai Chi exercise routine three times per week for 12 weeks, and 69 volunteers were chosen to as a control group and did not participate in Tai Chi activities. Not only did the Tai Chi group show a greater drop in anxiety levels and diastolic blood pressure at the 12-week follow-up than did the control group, systolic diastolic blood pressure significantly decreased in the 6-week follow-up and 12-week follow-up tests. Furthermore, the Tai Chi cohort achieved a greater drop in body mass index at the 6-week and 12-week follow-up visits than the controls. The researchers thus concluded, “The results highlight the long-term benefits of a [Tai Chi] program in facilitating health promotion by reducing anxiety and risk factors for cardiovascular diseases” like heart failure and stroke.
Tai Chi and Stroke Rehabilitation
- Ever since a 1989 study published in the Journal of Psychosomatic Research, the psychological benefits of those practicing Tai Chi has been extensively researched. In this now classic text, La Trobe University researchers assessed 33 Tai Chi novices and 33 regular practitioners. It was observed in both groups that, “Tai Chi raised heart rate, increased noradrenaline excretion in urine, and decreased salivary cortisol concentration. Relative to baseline levels, subjects reported less tension, depression, anger, fatigue, confusion and state-anxiety, they felt more vigorous, and in general they had less total mood disturbance.” In addition to the subjective benefits experienced by the participants, the significance of this study is that Tai Chi’s ability to decrease salivary cortisol levels equates it directly with its capacity to decrease stress in someone’s life. As cortisol levels are a well-known stress marker, this study convincing proves that Tai Chi is an effective stress management tool and, therefore, greatly aids in stroke rehabilitation.
- To determine the effect on balance and strength, University of Connecticut School of Medicine recruited 110 participants to engage in three months of intensive balance and/or weight training followed by six months of low-intensity Tai Chi training for maintenance of gains. Participants were healthy and an average age of 80 years. They were free of dementia, neurological disease, and serious cardiovascular or musculoskeletal conditions. Short-term training lasting three months occurred three times per week. Balance training included equilibrium control exercises on firm and foam surfaces and center-of-pressure biofeedback. Strength training consisted of generic lower extremity weight lifting exercises. All subjects then received long-term group Tai Chi instruction for six months; one hour per session, one time per week. Balance training meaningfully improved all balance measures by restoring performance to a level analogous to an individual 3 to 10 years younger. Strengthening also increased torque of eight lower extremity movements. Of particular interest is that “gains persisted after 6 months of Tai Chi” suggesting that Tai Chi contributes not only to improved balance, but also strength conditioning well after discontinuing use. This is paramount for stroke rehabilitation as many stroke survivors struggle to regain and maintain strength levels after an attack.
- Neurorehabilitation Neural Repair printed a study in 2009 in which investigators researched the ability of a four-week intensive Tai Chi program to improve balance in chronic stroke patients. One hundred thirty-six volunteers were randomly assigned to a control group (62 people) practicing general exercises or a Tai Chi group (74 people). During the one-month study period, one hour of group practice was supplemented by three hours of self-practice each week. Researchers used a short-form of Tai Chi consisting of 12 positions that required whole-body movements to be performed in a continuous sequence and demanded concentration. According to the paper, “When compared with the controls, the Tai Chi group showed greater COG [center of gravity] excursion amplitude in leaning forward, backward, and toward the affected and nonaffected sides, as well as faster reaction time in moving the COG toward the nonaffected side in the end-program and follow-up assessments. The Tai Chi group also demonstrated better reliance on vestibular integration for balance control at end-program.” Ultimately, the 12-week Tai Chi program greatly improved balance in chronic stroke patients that outlasted training for six weeks. This highlights the long-term potential benefits Tai Chi holds for stroke patients struggling to maintain proper balance and its ability to assist in fall-prevention.
- Not only a complication of stroke, it has been shown that mental disorders can cause falls. Thus, excessive fear of falling – also associated with depression – greatly increases one’s likelihood to be injured. According to University of Toronto researchers, “Both depression and fear of falling are associated with impairment of gait and balance, an association that is mediated through cognitive, sensory, and motor pathways.” To complicate matters, anti-depressant medications can increase the risk of falls thereby putting an elderly individual battling depression between a rock and a hard place. University of Toronto researchers address this challenging interplay in an article they published in 2013 in the American Journal of Geriatric Psychiatry and thus recommend that,” Based on the current state of knowledge, exercise (particularly Tai Chi) and cognitive-behavioral therapy should be considered for the first-line treatment of mild depression in older fallers.” By addressing two common concerns related to stroke rehabilitation – depression and falls – the benefits of Tai Chi are widespread and are only recently being explored to its fullest capacity.
- The 1989 study mentioned above from in the Journal of Psychosomatic Research also showed the benefits that Tai Chi has concerning mental disorders commonly associated with stroke rehabilitation. Relative to baseline levels, subjects reported less tension, depression, anger, fatigue, confusion and state-anxiety, they felt more vigorous, and in general they had less total mood disturbance.” This study has laid the groundwork for hundreds of researchers to follow suit and tell the world confidently that Tai Chi is a fantastic tool to employ against chronic diseases like stroke-related depression.
Of all the complications related to stroke, it is easy to overlook the mental challenges associated with falling; particularly because stroke survivors experience seven times as many falls as same-aged populations who have never experienced a stroke. Preventing falls is especially important as they often cause hip or other fractures, loss of mobility, and increased fear of falling resulting in social isolation and/or dependence. Thankfully, in addition to the wide variety of benefits associated with practicing Tai Chi, it has been clinically proven to reduce the number of falls that stroke survivors experience.
In spite of the billions of dollars spent on medical methods worldwide, more people are dying from strokes than ever before. Furthermore, few interventions can positively affect the various factors relating to strokes as Tai Chi can. As clinical research suggests, it is vital for people of all ages to implement effective mind-body techniques like Tai Chi to not only reduce their risk of getting a stroke, but also to help them in the rehabilitation process should they experience one.
Medical Studies and Resources
Topics in Stroke Rehabilitation
Neurorehabilitation Neural Repair
British Journal of Sports Medicine
Clinic Journal of Sport Medicine
The Journal of Nursing
American Journal of Health Promotion
American Journal of Health Promotion
University of Toronto
American Journal of Geriatric Psychiatry
University of Connecticut School of Medicine
The Journal of Psychosomatic Research
Journal of Psychosomatic Research