In answering Research Question 1, we have identified 9 categories of health benefits related to Tai Chi and Qigong interventions, with varying levels of support. Six domains of health-related benefits have dominated the research with sixteen or more RCTs published for each of these outcomes: psychological effects (27), falls/balance (23), cardiopulmonary fitness (19), QOL (17), PROs (18), and physical function (16). These areas represent most of the RCTs reviewed, with many of the studies including multiple measured outcomes spanning across several categories (n=42). Substantially fewer RCTs have been completed in the other three categories, including bone density (4), self-efficacy (8), and studies examining markers of immune function or inflammation (6).
The preponderance of studies showed significant, positive results on the tested health outcomes, especially when comparisons were made with minimally active or inactive controls (n=52). For some of the outcomes addressed in this review, there were studies that did not demonstrate significant improvements for the Tai Chi or Qigong intervention as compared to the control condition. For the most part, however, these non-significant findings occurred in studies in which the control design was actually a treatment type of control expected to produce similar benefits, such as an educational control group intervention producing similar outcomes as Tai Chi for self-esteem,99
aerobic exercise showing similar results to Qigong in reducing depression,28, 57
an acupressure group successfully maintaining weight loss compared to no intervention effect for Qigong,60
or resistance training producing similar (nonsignificant) effects as Tai Chi for muscle strength, balance, and falls.43, 66
It is important to note that although the Tai Chi and Qigong interventions did not produce larger benefits than these active treatment controls, in most cases substantial improvements in the outcome were observed for both treatment groups.
Other studies in which the improvements did not significantly differ between the treatment group and the control group suffered from: (a) study designs of shorter duration (4 to 8 weeks, rather than the usual 12 or more weeks)51, 98
although there were some exceptional studies with significant results after only 8 weeks;44, 83, 103
(b) selection of very health-compromised participants or individuals with conditions that do not generally respond to other conventional treatments or medicines such as muscular dystrophy,58
or (c) the outcome measured was not noted as particularly problematic nor set as an eligibility criteria for poor starting levels at baseline (n=5).28, 96
On the other hand, in the areas of research that address outcomes typically associated with physical exercise, such as cardiopulmonary health or physical function, results are fairly consistent in showing that positive, significantly larger effects are observed for both Tai Chi and Qigong when compared to no-exercise control groups and similar health outcomes are found when compared to exercise controls. Even with the very wide range of study design types, strength of control interventions, and the entry level of the health status of study participants, there remain a number of remarkable and persistent findings of health benefits in response to both Qigong and Tai Chi.
In response to Research Question 2, we have noted in earlier sections the ways in which Qigong and Tai Chi are considered equivalent, and now address how studies identifying similar outcomes in response to these practices may provide additional evidence for equivalence. On the surface, research that examines the effects of Qigong on health outcomes appears to be of lesser magnitude than the research on what is typically called Tai Chi. For each category of outcomes described above, we noted how many RCTs had been conducted for each, Tai Chi and Qigong, and for the most part, there were many fewer reports on Qigong than for what is named Tai Chi for any given outcome examined. Nevertheless, across the outcomes examined in RCTs, the findings are often similar, with no particular trends indicating that one has different effects than the other.
As noted earlier, however, it is not unusual for the intervention used in a study or trial to be named Tai Chi, but to actually apply a set of activities which is more a form of Qigong, that is, easy-to-learn movements that are simple and repeatable rather than the long complex sequences of traditional Tai Chi movements that can take a long time to learn. For example, a large number of studies examining Tai Chi effects on balance use a modified, repetitive form of Tai Chi which is more like Qigong. Thus, while it appears that fewer studies have been conducted to test what is called Qigong, it is also clear that when a practice called Tai Chi is modified to focus, especially on balance enhancement, for example, it actually may be Tai Chi in name only.
Given the apparent similarity of practice forms utilized in research, the discussion of equivalence of Tai Chi and Qigong extends beyond the earlier observation that they are similar in practice and philosophy. Since research designs often incorporate blended aspects of both Qigong and Tai Chi, it is unreasonable to claim that the evidence is lacking for one or the other and it becomes inappropriate not to claim their equivalence. We suggest that the combined current research provides a wider base of growing evidence indicating that these two forms produce a wide range of health-related benefits.
The problem with claiming equivalence, then, does not lie within the smaller number of studies using a form called Qigong, but rather in the lack of detail reported across the studies regarding whether or not the interventions contain the key elements philosophically and operationally thought to define meditative movement practices such as Tai Chi and Qigong. In previous publications, and in this review, we note that the roots of both of these TCM-based wellness practices require that the key elements of meditative movement be implemented: focus on regulating the body (movement/posture); focus on regulating the breath; and focus on regulating the mind (consciousness) to achieve a meditative state. Given the equivalence noted in foundational principles and practice, the differences among interventions and resultant effects on outcomes would perhaps more purposefully be assessed for intervention fidelity (i.e., adherence to the criteria of meditative movement).
Beyond the meditative movement factors that tie the practices and expected outcomes together, other, more conventional factors would be important to assess, each potentially contributing to variations in outcomes achieved. For example, dosing (i.e., frequency, duration and level of intensity, including estimate of aerobic level or metabolic equivalents) may be important in whether or not benefits accrue. Or, a focus on particular muscle groups may be critical to understanding changes relative to certain goals (e.g., how many of the exercises chosen for a study protocol develop quadricep strength likely to produce results for specific physical function tests?). Beyond the important similarities of movement and a focus on breath and mind to achieve meditative states, there are other aspects that vary greatly within the wide variety of both Tai Chi and Qigong exercises, including speed of execution, muscle groups used and range of motion, all of which may provide differences in the physiologically-oriented outcomes (similar to the differences that could be noted in the wide variety of exercises considered under the aerobic “umbrella”).
The question of the equivalence Tai Chi and Qigong, then, may be helpful if the focus is on similarity in philosophy and practice. With consistent reporting on adherence to the above mentioned aspects of practice, not only could a level of standardization be implemented, but also measures that control for variation of interventions could be used to better understand differences and similarities in effects.1