Medical research




Nursing, Healthcare of Chronic Illness            

REVIEW - Continued           
Benefits of tai chi for chronic illness
(Wong 1991, p. I).
Although the philosophical origins of tai chi lie with Taoism, the art of tai chi unites three Chinese philosophical traditions: Confucianism, Taoism and Buddhism, and  also reflects the ethics and aesthetics that link it with Chinese traditional medicine and cultural history (Alperson 2008).
Tai chi appeared in China during the 11th and 12th centuries, although its exact origins are unclear. The com­ monly accepted belief is that it originated from the Wu-Tang Mountain where a Shaolin monk, called Zhang San-Feng, left his Buddhist monastery to learn from Taoist hermits. This resulted in the Wudonshan sect of Taoism and the emergence of a martial art that 'used softness and internal power to overcome brute force' (Kurland 1998, p. 106). The alterna­ tive belief maintains that the first practice and teaching of tai chi appeared in the Chen village family, where Chen Wang­ Ting, a ninth generation family member founded tai chi, basing it on a combination of his experiences as a soldier and knowledge from the Chinese classical texts on boxing (Tang & Gu 1963). During the subsequent period, tai chi instruction was exclusively the domain of either Buddhist or Taoist monks, until the 17th and 18th centuries when China was conquered by the invading Manchu. The reigning Manchu then passed laws preventing the ownership of weapons which, in turn, prompted the transfer of knowledge, from the monasteries to the people, of a modified form of self defence that did not require weaponry and was based on the strengthening of the body systems (tai chi). Following this, during the late 18th century, various family schools or styles of tai chi emerged. These were the Chen, Yang, Wu and Sun styles (\Vong 1991). Each style has a characteristic technique which differs in the posture, form, order, pace and level of difficulty but all styles emphasise movement coordination, relaxation and mindfulness.

Although the original Taoist forms of tai chi, as taught in monasteries, incorporated body and mind discipline, scriptures, divination, metallurgic sciences and medicine, the focus changed over time. Subsequently various styles of tai chi evolved due to the needs of the people, focusing predomi­ nately on self defence and physical fitness. Tai chi is now practiced widely as a form of exercise in China and plays a significant role in public health following the introduction by the Chinese Government, in 1956, of a simplified 24 movement tai chi form (Tang & Gu 1963). The current popularity of tai chi in China is illustrated by the event of the first National Fitness Day celebrated in Beijing in August 2009, where 3 million people practised tai chi together (Chang 2009).

Tai chi is now becoming increasingly popular m many other countries outside of China due to its perceived health related benefits (Yan & Downing 1998, Klein  &  Adams 2004) and the styles of tai chi practice are subsequently evolving to meet the needs of the new and varying environments. Hence, there are now many different derivations as individual masters of tai chi change the form to adapt to different cultures and the varying needs of either health or defence and the restraints of time and space.  Adaptation of the form to meet the changing needs of the people is considered part of the Taoist way.

The role of nurses in providing care to people with chronic conditions continues to enlarge exponentially as the world's populations age {Forbes & While 2009). In recognition of their expanding role, this article seeks to provide nurses and other health professionals with information on the history of  tai chi and its emergence as a world-wide activity with the potential to improve health and well-being for people with a broad range of chronic illnesses. As the phenomenon  of tai chi has grown in popularity there has been a simultaneous burgeoning of research into its health effects. The  various areas of research are discussed to provide an overview of the current state of evidence for the use of tai chi by people with chronic illnesses. Knowledge regarding indications for, and effects of, this popular self management intervention will enable nurses and health professionals to provide up to date information and advice regarding its use to  patients  under their care.

A broad computerized systematic literature search was conducted to provide information for this overview. Data bases included CINAHL, MEDLINE, Proquest, Pub.Med, SCOPUS (Elsevier), Academic OneFile (Gale), APATT/APAIS (Informit), Health Collection, EBSCOhost, PsyclNFO and Chinese databases [China National Knowledge Infrastructure (CNKI) and Wanfangdata]. The search terms used were limited by the key words: Tai chi, T'ai Chi, Tai chi chuan, Taiji or Taijiquan.

There was no restriction on population characteristics but, for feasibility reasons, the publications chosen had to be written in English or Chinese and related to issues associated with chronic illness. The initial search revealed 686 publications for the period encompassing 1976- 2010. Of these papers all relevant meta-analyses and synthe­ ses, systematic reviews, randomized controlled trials (RCTs) and qualitative papers which  were  published  in  the  last 10 years, were selected to provide information for the following overview. If any paper published prior to 2000 was deemed by the authors to be important to conrributing to the discussion in a specific area of chronic illness, this was also included.


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