Nursing, Healthcare of Chronic Illness The benefits of tai chi as a self management strategy to
improve health in people with chronic conditions.

Aim
To provide health professionals with information regarding the phenomenon of tai chi, which has now become a world-wide activity with the potential to im­prove health and well-being in a broad range of chronic illnesses. Background. Mind-body approaches to health, such as tai chi, are gaining in popularity. No funding or competing interests to declare particularly amongst people with chronic illness who are seeking self management health strategies that have the capacity to address multiple health needs across both physical and psychological spectrums.
Method.
This article has been informed by a broad computerized systematic liter­ ature search.
Conclusions.
An ever increasing body of research indicates that tai chi has beneficial effects in people with a range of medical conditions in varying populations. Its potential benefits include enhancing cardio-respiratory fitness, reducing blood pressure, improving glucose control in diabetic patients, increasing immune re­sponse, alleviating pain, assisting in the rehabilitation of people experiencing chronic health conditions, and promoting psychological well-being. Tai chi’s wide range of reported benefits makes it an ideal self management strategy, for both the elderly and people with chronic conditions, to improve their psychological and physical well-being in a community setting.
Relevance to clinical practice. Knowledge regarding indications for, and effects of, this popular self management intervention will enable health professionals to pro­ vide up to date information and advice to patients on the appropriateness of including tai chi in their self management health plans.
CM Fetherston and L Wei

Introduction
Chronic illnesses pose one of the most significant challenges facing health care systems worldwide. The increasing prev­alence of conditions such as metabolic syndrome, asthma, arthritis, diabetes, cardiovascular disease (CVD) and depres sion is expected to consume 80% of Australia’s healthcare expenditure by 2020 (National Health Priority Action Council 2006) and is the leading cause of death and disability in the USA, accounting for 70% of all deaths (Kung et al. 2008). The increasing economic burden resulting from this world-wide problem has been compounded by ageing populations, which in the author’s home country, Australia, is expected to see a doubling of people aged 65 years and older by the year 2036 [Australia Institute of Health and Welfare (AIHW) 2008]. As a result, effective public health strategies directed at early intervention in, and prevention of, chronic illnesses are now a major health priority.

One of the key intervention strategies outlined by the World Health Organization’s (WHO) Innovative Care for Chronic Conditions (ICCC) report (WHO 2001) is to educate and support patients to find strategies that enable them to manage their own conditions as much as possible. This has led to the development of specific programs that guide health professionals in how to encourage self management strategies. Examples of these include the Chronic Disease Self Management Program (Lorig et al. 1999) developed at Stanford
University in the USA and the Flinders Program of Chronic Condition Self Management, which was formerly known as The Flinders Model from Flinders University in Australia (Flinders Human Behaviour & Health Research Unit 2010). Integral to programs such as these are health promotion strategies that assist patients with chronic illness to adopt lifestyles and engage in activities that protect and promote their health. Initiatives such as the Flinders Program are supported by Government and have resulted in a strong level of interest, from both health professionals and the popular media, in behaviours that assist in promoting and-maintaining optimal health. However, health promotion is not only about persuading people to make healthy behavioural and lifestyle changes, but also extends to helping them either access or rearrange circumstances in their physical environments (Egger et al. 2005., p. 14). Clearly, programs offered at the community or neighbourhood level have enormous potential to help people manage chronic conditions and prevent ill health throughout the ageing process.

Neighbourhood and community-based programs range from local council sponsored aerobic exercise and weight loss training, at one end of the continuum, to psychological approaches such as meditation, support groups and psychotherapy at the other. The availability and promotion of these type of programs has encouraged many people to seek out a health pursuit which they view will assist them to achieve their personal health management goals. Often such programs also have the added benefit of providing an opportunity for people with chronic conditions to be part of a supportive environment where they can increase their self-efficacy by develop­ing personal skills that assist them to better manage their health. The combination of social opportunities and physical activity also helps people remain socially connected, which in itself, has health benefits. There are a number of interventions that do this by focusing on both the physical and psychological components of health in what is termed the ‘mind-body’ approach.

The mind-body approaches to health are gaining in popularity, particularly amongst people seeking self management health strategies that have the potential to address multiple health needs across both physical and psychological spectrums (Larkey et al. 2009). One of the most popular of these approaches is tai chi, which is estimated to have approximately 5 million practitioners in the US alone (Wayne & Kaptchuk 2008a) with one particular volunteer based tai chi group that originated in Canada, the International Taoist Tai Chi Society ·(2010) having around 40 000 members in approximately 500 branches throughout more than 25 countries.