In 2002, according to the NHIS survey, there were 2.8 million individuals who practiced TCQ for health.1
TCQ users relative to nonusers were more likely to be Asian, educated, and live in the West or Northeast; however, TCQ use spanned all ages and genders. Musculoskeletal conditions, severe sprains, and asthma were associated with TCQ use, but it is unknown whether these conditions led to TCQ use or were a result of TCQ use. Despite a large percentage of respondents reporting the importance of TCQ practice for health maintenance, only a quarter disclosed their practice to their medical professional.
As mind–body practices have grown in popularity in the United States, there has been a concurrent increase in evidence-based clinical research for TCQ.4–6
These findings suggest the potential need to investigate TCQ practice among individuals who have musculoskeletal conditions and asthma. Existing research suggests positive benefits of t'ai chi
for balance and postural control,8–11
However, there are limited data on the use of t'ai chi
for pulmonary conditions including asthma.15
TCQ has also been examined for various other medical conditions or applications including the following: stress management,16,17
general mental health,18–20
immune system modulation,23–25
and cardiovascular applications such as cardiorespiratory fitness,26,27
There is also suggestive, but limited, data for qigong
Yoga, a mind–body exercise from India, may be considered a parallel practice to TCQ. In a recent analysis, yoga users were characterized from NHIS,7
who differ from TCQ users with regard to specific sociodemographic factors. TCQ users were evenly distributed from young adult to the elderly. In contrast, yoga users tended to be younger. This may represent a broader appeal of TCQ to the elderly and that many popular types of yoga in the United States often cater toward a younger, more physically able population. As the elderly population grows in the United States, TCQ may increase in prevalence. In addition, TCQ appeared to be gender neutral, while yoga users were more likely to be women. Historically in India, yoga was practiced almost exclusively by men, while in the United States yoga has been feminized within contemporary popular culture.33,34 T'ai chi
is perhaps perceived as more masculine, given its origin in martial arts. Asians were also more likely to practice TCQ for health, which was not observed among yoga users. Other socioeconomic patterns such as associations with region, educational level, and health status were similar to those of yoga users.
Generally, TCQ are considered safe practices, and there have been few published adverse events. However, there have been no systematic reviews on the risks of t'ai chi.
Reviews of qigong
have reported the potential negative psychiatric effects.35,36
While data on the safety profile of yoga are also lacking, there have been more published reports of adverse events,37–40
which may simply reflect the higher overall prevalence of yoga use. Of TCQ users, the results indicate that 1 of 2 users also practiced yoga. Therefore, the associations identified between t'ai chi
use may also be partially explained by concurrent yoga use. For example, TCQ users were identified as having more severe sprains than non-TCQ users did. The same association was found with severe sprains among yoga users compared to non-yoga users. It is unclear whether the severe sprains seen among the t'ai chi
users are related to yoga use or vice versa. There may be an underestimation of the potential risks of practice, reflecting underreporting of adverse events in studies and medical practice.
There are limitations to this study. Data were collected via questionnaires, and are therefore subject to recall bias. Given the cross-sectional nature of NHIS, causal relationships cannot be determined. For example, the increased association of TCQ use with asthma does not mean that TCQ use causes asthma. NHIS did not capture details of the TCQ practice such as frequency, duration, style, school, or teacher. Variations in practice may play an important role in potential health benefits. Also, the analysis is based on data from 2002, which may not reflect current trends. Regardless of these limitations, this represents the first report and most current information available on the characteristics of TCQ users based on a national survey.
TCQ use for health in the United States is being practiced by a broad group of individuals. As research agendas for the clinical application of mind–body techniques are developed, patterns of TCQ use should inform future studies. The practice of TCQ for musculoskeletal and pulmonary conditions, as well as for preventive health and health maintenance, should be explored. TCQ, like other mind–body practices, are complex interventions with multiple components.2
Research designs need to be sensitive to this complexity employing a variety of methodologies.41
The therapeutic role of TCQ will only be defined by thoughtful and rigorous research evaluating the feasibility, efficacy, cost, and safety of these practices.