COULD IT BE THAT SIMPLE?

Gary Shapiro

While I was reading an internet thread concerning Tai Chi and stroke rehabilitation, I came across a link to an article in a prominent physiology journal. It dealt with the effects of bed rest (6 weeks) on lower limb muscle function. The first sentence of the article reads, "The gravity dependent load of the human body, acting on the lower limbs in the upright position, seems fundamental to maintenance of lower limb muscle function". In other words, standing is good for you. You donÕt have to be the proverbial "rocket scientist" to conclude that the study volunteers experienced loss of strength and muscle girth. The researchers however, found that they could not attribute the entire strength loss to the diminished muscle mass. They concluded that decreased "neural drive" was partly responsible.

Muscles require nerve impulses from the brain not only to function, but to function efficiently. When I attempt to bend my elbow the biceps muscle must contract, while the opposing triceps have to relax. Timing is crucial. The brain must send the appropriate signals to these muscles in order to coordinate the movement. Prolonged bed rest is a form of sensory deprivation that blurs communication between brain and muscle. When a conductor has difficulty working with his/her orchestra, the quality of the resulting music will be compromised, regardless of the talent of the individual musicians.

The article brought to mind the "A Taste of China" workshop that I attended two months earlier. It was advertised as a Tai Chi instructors meeting. The theme dealt with learning how to communicate with the medical community. Tai ChiÕs many documented health benefits have made it a "hot" topic for research. Therefore, instructors are in demand, and it is imperative that they have an understanding of medical/scientific jargon. For instance, "dan tien" becomes the center of gravity and absolutely no references to "chi"or "energy". I didnÕt need the communication skills because I am a member of the medical community. The attraction was the presenter, Yang Yang, a famous Chen stylist, and author of the ground breaking book, Taijiquan: The Art of NurturingÑThe Science of Power.

YangÕs credentials are impressive. He earned degrees in engineering and law in his native China, and recently successfully defended his PhD dissertation in kinesiology at the University of Illinois. Part of our workshop was devoted to reviewing his dissertation study. He measured the effects of a six month program of Chi Kung and Tai Chi on a group of healthy seniors. The training had three components: Chi Kung (mindful sitting and standing), form training, and push hands. Two standing postures were used-- Santi, and "Holding the Balloon". The form was a Chen style derivative. Its was approximately 4 minutes in length, consisting of expansive movements, but relatively high stances in deference to age and arthritic joints.

At the 2 month juncture, the changes were very impressive. The measures that I was most interested in were lower extremity strength and balance. Yang had a unique way of gauging progress. Instead of speaking of percentage gain, he measured changes in terms of years gained. At the 2 month mark, the average participant gained 8 years in standing balance and 15 years in lower extremity strength. In other words, a 70 yr old now had the balance of someone 62 , and the lower limb strength of a 55 year old.

Surprisingly however, the gains made during the remaining four months were minimal. Yang conceded that they were barely above maintenance level. He proceeded to explain what actually transpired during the study. At two months, the seniors had only "scratched the surface" of the form, so to speak. As expected, with aging, mental concentration declines. Yang told us that a "Step back and repulse the monkey" sequence took nearly 2 months to master. We spent part of the work shop learning portions of the form. With all due respect to Yang, speaking as someone who works with seniors on a daily basis, I believe that the form was too complex for this age group. The push hands training didnÕt fare too well, because many of the participants were uncomfortable with the physical contact.

There was considerable enthusiasm shown for the Chi Kung portion-- sitting and standing training. They found it deeply relaxing and best of all, there was no detailed memorization involved. I had the temerity to suggest that this part of the training, especially the standing may have been largely responsible for the impressive two month gains, and that perhaps form training may not have been necessary. This was not favorably greeted by the group (of instructors). Yang felt that based on the study design , he could not to validate my suggestion, but he was definitely willing to entertain the possibility. He believed that if what I said was true, the Chi Kung fostered positive central nervous system changes. This could be another way of saying that it enhanced neural drive, the same neural drive that was diminished with prolonged bed rest.

I wonder if it really could be that simple-- to help seniors improve their leg strength and balance without having to resort to form training. A chi kung program such as the one above would certainly be easier to digest. I do realize that you canÕt go to the local Y and offer a six week course for seniors consisting only of sitting and standing. I can imagine the drop out rate! I know that many tai chi instructors include chi kung in their classes, but itÕs often used as a filler to consume time. Perhaps chi kung should be the core practice, with form training being secondary.

I have started to integrate chi kung into my homecare practice. I have to write it up in my visit notes as "static unsupported standing". It seems perfectly logical for someone just returning home from a hospitalization where they have spent considerable time in bed. Believe it or not many in my field would consider this approach somewhat "out of the box". After all, a physical therapist is supposed have you "exercise".

I can envision the following scene:
   Visiting Nurse: Well Mr. Smith, you certainly are doing better. Your walking has really improved, youÕre so much steadier on your feet!
   Mr. Smith: Yes, I know.
   Visiting Nurse: I bet that the physical therapist has really been putting you through your paces.
   Mr. Smith: Nah---He comes here and we just stand around.

ThatÕs all I need!