World T'ai Chi & Qigong Day

-- Medical Research

In addition to the below, be sure to visit our Medical Research Library,
in the menu to the right, for much more valuable information.



Bone Mass, Bone Loss, Osteoperosis, Menopause & Tai Chi


BRITTLE BONES/BONE LOSS IN WOMEN.

Research from the National Institute of Mental Health reports that the stress hormones found in depressed women caused bone loss that gave them bones of women nearly twice their age. T’ai Chi and QiGong are known to reduce depression and anxiety and provide weight-bearing exercises to encourage building bone mass and connective tissue. http://www.worldtaichiday.org/WOMENandTAICHI.html



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Tai Chi May Relieve Anxiety and Depression – Prevention.com

The healing power of this martial art may lie in combining movement, meditation and breathing exercises. by Jan Eickmeier

Jan Eickmeier is an information analyst in the area of health for the Rodale library.

http://www.prevention.com/article/0,5778,s1-1-65-150-5184-1,00.html

While there are few studies on the effects of tai chi (t'ai chi ch'uan) on reducing anxiety and depression, those there are suggest that it [tai chi] could be beneficial, especially among the elderly.

What evidence there is suggests that the benefits of tai chi extend beyond those of simply exercising. The combination of exercise, meditation, and breathing all may help relieve anxiety and depression, according to this

Donal P. O'Mathuna, Ph.D., a lecturer in Health Care Ethics at the School of Nursing in Dublin City University, Ireland.





Tai chi - From MayoClinic.com - Special to CNN.com

http://www.cnn.com/HEALTH/library/SA/00087.html

Although the practice of tai chi is very old, it hasn't been studied scientifically until recently. Preliminary research shows that practicing tai chi regularly may also:

§ Increase bone mineral density after menopause

§ Improve physical functioning in older adults, from more ease in dressing to increased comfort in climbing stairs

§ Improve blood circulation in the legs

§ Reduce anxiety and depression





Depression, anger, fatigue, anxiety – Natural Standard and the Faculty of Harvard Medical School

http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/34968/358867.html?d=dmtContent

Preliminary scientific study reports that tai chi may help to alleviate depression, anxiety, confusion, anger, fatigue, mood disturbances and pain perception. Additional research is necessary before a clear conclusion can be reached.





TAI CHI REDUCES STRESS HORMONES – SeniorNet.org

http://www.seniornet.org/php/default.php?PageID=6055

La Trobe University in Australia found that Tai Chi reduced levels of stress hormones more effectively than some other forms of activity.

 Tai Chi

 Meditate while moving. The Australian study mentioned [above] earlier showed that tai chi is as effective in relieving stress as meditation. Another study by the same researcher showed why: Tai chi reduces levels of the stress hormone, cortisol.[13] Except for the fact that you meditate sitting down and do tai chi exercises standing, the two are quite similar, which is why tai chi is often described as a “moving meditation.”

Qigong

 Sample this simple stress reliever. Qigong is reputed to be the ancient forerunner of tai chi and all the martial arts.[14] Qigong exercises are more subtle than tai chi, and involve less motion, but a recent study by researchers at the Wonkwang University School of Medicine in South Korea shows that they significantly increase levels of beta-endorphin, the body’s own mood-elevating, stress-relieving compound.[15]



Whole Health MD.com

http://www.wholehealthmd.com/refshelf/substances_view/1,1525,737,00.html

Stress. Although the evidence is limited, some studies have shown that tai chi is as effective as meditation and walking for reducing the amount of stress hormones in the body.





Depression Linked to Bone Loss

http://www.nih.gov/news/pr/oct96/nimh-16.htm

NATIONAL INSTITUTES OF HEALTH - National Institute of Mental Health

EMBARGOED FOR RELEASE

Wednesday, Oct. 16, 1996

6:30 PM Eastern Time

Jules Asher

Elaine Baldwin

(301) 443-4536

Depression Linked to Bone Loss

Depression may increase a woman's risk for broken bones, suggests a study by scientists at the National Institute of Mental Health (NIMH). The hip bone mineral density of women with a history of major depression was found to be 10 to 15 percent lower than normal for their age -- so low that their risk of hip fracture increased by 40 percent over 10 years.

"Although further research is required to determine the underlying mechanisms, our findings underscore the fact that depression is not only a psychological problem, but also a biological syndrome," said NIMH researcher David Michelson, M.D., first author of the study, published in the Oct. 17th issue of The New England Journal of Medicine. "Bone mineral density, once lost, is not easily regained. Thus, losses that may occur during recurrent episodes of depression could be additive."

"Since depression affects 5 to 9 percent of women, providing early treatment could have significant public health implications by reducing the risk of fracture," added Philip Gold, M.D., chief of the NIMH Clinical Neuroendocrinology Branch, where the research was conducted. "The affected women in this study, average age 41, had bone loss equivalent to that of 70-year-old women. More than a third faced a markedly increased risk of fracture."

The researchers measured bone mineral density in the spine, hip and radius (forearm) of 24 women with past or current major depression and also 24 control subjects, matched for age, body mass and menstrual status. They also measured indicators of bone metabolism and stress hormones.

Compared to established norms for their age, women who had experienced depression, as a group, showed bone density reductions of 6.5 percent at the spine, and 10 to 15 percent in the upper leg and hip. They also showed moderately reduced bone metabolism and moderate increases in the stress hormone cortisol.

Excess cortisol secretion, a common feature of some forms of depression, is known to cause bone loss and could account for some of the observed deficits, say the researchers. They saw little relationship with other possible factors, such as antidepressant medications, physical activity levels and appetite.

Other NIMH researchers participating in the study were: Lauren Hill and Elise Galliven. Also participating were: James Reynold, M.D., NIH Clinical Center, and Constantine Stratakis, M.D., Ph.D., and George Chrousos, M.D., National Institute of Child Health and Human Development.

The National Institute of Mental Health is a component of the NIH, an agency of the U.S. Public Health Service, part of the U.S. Department of Health and Human Services.

Premenopausal women who have experienced recurrent episodes of depression are needed for further NIMH studies to explore the mechanisms responsible for bone loss and determine effective treatments. For more information, call Denise Sehiulo at (301) 496-1891.



NATIONAL INSTITUTES OF HEALTH National Institute of Mental Health

FOR IMMEDIATE RELEASEFriday, June 29, 2001 Contact:Constance Burr(301) 443-4536

Depression, Bone Mass, and Osteoporosis

The National Institute of Mental Health (NIMH) has launched a new study of women ages 21 to 45 who are suffering from major depression to find out whether low bone mass is related to depression or stress hormones, such as cortisol. During a 12-month period, researchers will monitor bone loss and the effects of depression and stress on physical health. The trial involves 6 visits to NIMH, where participants will receive a psychological evaluation, a bone mineral density test, and measurements of stress hormones.

In a review of published research, NIMH-funded scientists report a strong association between depression and osteoporosis. The literature suggests that depression may be a significant risk factor for osteoporosis, a progressive decrease in bone density that makes bones fragile and more likely to break. Low bone mineral density (BMD), a major risk factor for fracture, is more common in depressed people than in the general population.

"Using different data, all of the studies point to the same conclusion," said NIMH researcher and first author Giovanni Cizza, M.D., Ph.D. "Depression is not only a disease of the brain, but it also has long-term consequences for other medical conditions, such as osteoporosis." Dr. Cizza and Philip Gold, M.D., NIMH, George Chrousos, M.D., National Institute of Child Health and Human Development, and Pernille Ravn, M.D, Center for Clinical and Basic Research, Ballerup, Denmark, present a summary of the findings in the July issue of Trends in Endocrinology & Metabolism.

Both the clinical trial and research review underscore the seriousness of depression, a treatable illness that affects 5 to 9 percent of women and 1 to 2 percent of men. Depression symptoms include loss of interest or pleasure in activities that were once enjoyed, including sex; fatigue, decreased energy; difficulty concentrating, remembering, making decisions; insomnia, early-morning awakening, or oversleeping; appetite and weight loss or overeating and weight gain; thoughts of death or suicide; suicide attempts; restlessness, irritability; and persistent symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain.

Although its causes are unclear, major depression is associated with hormonal abnormalities that can lead to changes in tissue, such as bone. Research suggests that higher cortisol levels, often found in depressed patients, may contribute to bone loss and changes in body composition. Fragile bones and increased risk of fracture are signs of osteoporosis. When one or more risk factors occur, such as low BMD, family history, previous fracture, thinness, or smoking, a clinical evaluation for osteoporosis is recommended. Identifying depression as a risk factor would improve patient diagnosis and treatment.

In one study, evidence revealed that bone density at the lumbar spine was 15% lower in 80 men and women older than 40 with major depression compared to 57 men and women who were not depressed. Factors such as smoking, a history of excessive or inadequate exercise, or estrogen treatment did not affect the study, implying that depression per se had an effect on bone mass.

Another study measured bone mineral density at the spine, hip, and radius in 22 pre-and 2 postmenopausal women with previous or current major depression. The 24 controls were matched by age, menopausal status, race, and body mass index. BMD was 6% lower at the spine and 14% lower at the hip in the depressed women. No premenopausal women in the control group had such a deficit.

The association between depression, BMD, falls, and risk of fracture was examined in a study of 7,414 elderly women. Depression prevalence was 6%. Depressed women were more likely to fall (70% versus 59%) and had more vertebral (11% versus 5%) and non-vertebral (28% versus 21%) fractures compared with controls. This research underlines depression as a risk factor for osteoporotic fractures.

The relationship between osteoporosis and mental health was evaluated in a sample of 102 middle-aged Portuguese women. Osteoporosis had a 47% prevalence, and depression was significantly more common in women with osteoporosis than in women without it (77% versus 54%). Women with the disorder had depressive scores 25-35% higher than those with normal bone mass. This study did not find a link between depressive symptoms and low BMD, suggesting that only fully developed depression is a risk factor for osteoporosis.

In their summary, the researchers show a consistent association between depression and osteoporosis, suggesting that depression is a substantial risk factor. Some bone-loss studies combined actively depressed subjects with those who had a previous diagnosis, so it is unknown whether current depression and past diagnoses affect bone loss equally. With major depression as the threshold, most studies revealed a clear association between depression and osteoporosis.

Cizza and colleagues concluded that a clinical evaluation of subjects with unexplained bone loss, especially premenopausal women and young or middle-aged men, should include an assessment of depression. Conversely, non-traumatic fractures in a depressed patient should alert the physician to the possibility of osteoporosis.

The current NIMH study will determine whether women with major depression and normal BMD lose bone mass faster than women without depression and if the drug alendronate (Fosamax) can maintain or increase bone mass in premenopausal women with major depression and low bone mass. It is open to women 21 to 45 years old in treatment for major depression within the year and no history of schizophrenia, bipolar or eating disorders, or suicide risk and to healthy control women with no history of major depression or major organ disease.

The trial will be conducted at the National Institute of Mental Health, 9000 Rockville Pike, Bethesda, Maryland, 20892. For more information about the study on women, depression, and osteoporosis, call 1-800-411-1222 or 301-496-5645, e-mail prpl@mail.cc.nih.gov. or write to Dr. Giovanni Cizza, Principle Investigator, NIH, Building 10, Room 2D 47, 10 Center Drive, Bethesda, MD 20892.

The National Institute of Mental Health (NIMH) is part of the National Institutes of Health (NIH), the Federal Government's primary agency for biomedical and behavioral research. NIH is a component of the U.S. Department of Health and Human Services. For more information about NIMH and its research programs, visit the NIMH Web site http://www.nimh.nih.gov.





Tai Chi Decreases Bone Loss

Early postmenopausal women can benefit from this ancient Chinese form of exercise. by Jan Eickmeier - Jan Eickmeier is an information analyst in the area of health for the Rodale library.

A Chinese study reported in the December 2004 Physician and Sportsmedicine found that tai chi could retard bone loss among postmenopausal women.

The average age of the 132 women in the study was 54, and all the women were within 10 years of the start of menopause. They were randomly assigned to a control group or to do tai chi for 45 minutes a day, 5 days a week, for 12 months. Bone mineral density was measured before and after the study period.

During the yearlong study, both groups experienced general bone loss, but the rate of bone loss was less in the tai chi group; compared to women in the control group, there was a significant 2.6 to 3.6-fold retardation in bone loss among women who did tai chi.

Regular Tai Chi Chuan exercise may retard bone loss in postmenopausal women: A case-control study.

Qin L, Au S, Choy W, Leung P, Neff M, Lee K, Lau M, Woo J, Chan K

Arch Phys Med Rehabil - Oct 2002 (Vol. 83, Issue 10, Pages 1355-9)

Abstract

OBJECTIVE: To evaluate the potential benefits of regular Tai Chi Chuan exercise on the weight-bearing bones of postmenopausal women. DESIGN: Case-control study. SETTING: University medical school in Hong Kong. PARTICIPANTS: Postmenopausal women (age range, 50-59y), including 17 self-selected regular Tai Chi Chuan exercisers (TCE) with over 4 years of regular exercise, and 17 age- and gender-matched nonexercising controls (CON). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Bone mineral density (BMD) in the lumbar spine and proximal femur was measured at baseline and at follow-up 12 months later by using dual-energy x-ray absorptiometry (DXA) and in the distal tibia using multislice peripheral quantitative computed tomography (pQCT). RESULTS: Baseline results showed that the TCE group had significantly higher BMD (10.1%-14.8%, all P<.05) than the CON group in the lumbar spine, proximal femur, and the ultradistal tibia. The follow-up measurements showed generalized bone loss in both groups. Although both DXA and pQCT measurements revealed decelerated rates of bone loss in the TCE group, only the more sensitive pQCT showed significantly reduced rate of bone loss in trabecular BMD of the ultradistal tibia (TCE vs CON: -1.10%+/-1.26% vs -2.18%+/-1.60%, P<.05) and of cortical BMD of the distal tibial diaphysis (TCE vs CON: -0.90%+/-1.36% vs -1.86%+/-0.93%, P<.05). CONCLUSION: This is the first case-control study to show that regular Tai Chi Chuan exercise may help retard bone loss in the weight-bearing bones of postmenopausal women.

MeSH

Bone Density; Case-Control Studies; Female; Humans; Middle Aged; Osteoporosis, Postmenopausal; Tai Ji

Author Address

Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong. lingqin@cuhk.edu.hk





UNIVERSITY OF MARYLAND MEDICAL CENTER

http://www.umm.edu/altmed/ConsModalities/TaiChicm.html

How does tai chi work?

Tai chi improves balance, agility, strength, flexibility, stamina, muscle tone, and coordination. This low-impact, weight-bearing exercise strengthens bones and can slow bone loss, thus preventing the development of osteoporosis.





NEW YORK STATE NURSES ASSOCIATION

http://www.nysna.org/departments/communications/publications/report/2005/mar/research.htm -- REPORT: March 2005

Effects of Tai Chi Exercise on Bone Mineral Density in Early Postmenopausal Women - by Priscilla Sandford Worral, PhD, RN, Coordinator for Nursing Research, University Hospital, SUNY Upstate Medical University, Syracuse, New York; Member, Council on Nursing Research

Tai Chi is a low-impact; weight-bearing exercise using slow and smooth movements to change poses. Those who have followed this column over the past few years may remember Mary Beth Holz’s article on use of Tai Chi in the elderly (Holz, 2002). As described by Holz and many other researchers, Tai Chi has been found to be effective for improving balance and general cardiovascular function in the elderly. The gentle movements of Tai Chi seem far removed from the high-impact strengthening exercises generally considered necessary for maintaining or improving bone density.

Many women in their late 40s and 50s are either unwilling or unable to participate in regular high-impact exercise. They are in a fast bone-loss phase of their lives, however, when efforts to slow bone loss are important. A study by Chan and colleagues (2004) focused on postmenopausal women in this age range to test the potential benefits of regular Tai Chi exercise on weight-bearing bones.

Method

This age-matched, prospective study included 132 healthy postmenopausal women (mean age, 54.0 ± 3.5 yrs) who were randomly assigned into either the Tai Chi exercise group or the sedentary control group. Women were not on hormone replacement therapy or other drug treatment known to affect bone metabolism or cause spontaneous bone loss. Supervised Tai Chi exercise was performed for 45 minutes a day, 5 days a week, for 12 months. Women in the sedentary group were encouraged to maintain their routine activities. Bone mineral density (BMD) was measured in the lumbar spine and proximal femur by using dual-energy x-ray absorptiometry (DEXA), and in the distal tibia by using quantitative computed tomography (pQCT). All BMD measurements were repeated after 12 months in both groups. The fracture rate was also recorded. All fractures were confirmed by radiography.

Results

Baseline measurements showed no difference between groups in age, height, weight, body mass index, or menstrual history. Women who completed the entire study included 81.6% in the exercise group and 83.1% in the control group. Average attendance at the exercise sessions for women in the exercise group was 4.2 ± 0.9 days/week. Women in both groups were found to have a general bone loss at all measured skeletal sites; however, the rate of loss was slower in the exercise group. Bone loss was 2.6 to 3.6 times slower (p<.01) in the distal tibia in the [Tai Chi] exercise group compared with bone loss in the control group. Three women in the control group and one woman in the exercise group had a fracture.

Translation into Practice

This study was conducted in Hong Kong with a convenience sample of Chinese women who met the eligibility criteria. What this means is that if you or your patients are not Chinese women living in Hong Kong who are similar in age, height, weight, and routine activities as the women in this study, you cannot be guaranteed that study results will be applicable to you or to your patients.

This does not mean that the results should be discounted, however. Many times experimental studies (often called randomized clinical trials or RCTs) use very specific criteria for patient selection because researchers are focused on demonstrating that the study intervention does cause the patient outcome. Once they demonstrate cause and effect with one sample of patients, they replicate the study repeatedly with different patient samples.

Yes, we do need to replicate the study by Chan and colleagues here to strengthen our faith in the findings. In the meantime, however, you can consider the option of Tai Chi as a regular exercise for your postmenopausal patients who are unlikely or unable to participate in regular strength training or high-impact exercise. Remember that they will need to be committed to a frequent regular exercise program; the study women exercised for 45 minutes, 5 days per week for a full year. The broader lessen here is that exercise is helpful not only for improved functioning and a general sense of well being, but perhaps to slow bone loss as well.

References

Chan, K., Qin, L., Lau, M., Woo, J., Au, S., Choy, W., Lee, K., & Lee, S. (2004). A randomized, prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women. “Archives of Physical Medicine & Rehabilitation”, 85, 717-722.

Holz, Mary Beth. (2002). Considerations for health maintenance using T’ai Chi in elderly populations. “NYSNA Report”, x(9), 7.


Osteoporosis: current modes of prevention and treatment

Lane JM, Nydick M

J Am Acad Orthop Surg 1999; 7:19-31.

Abstract

The most common metabolic bone disorder is osteoporosis, which affects 25 million Americans, of whom 80% are women. Bone loss in women occurs most commonly after menopause, when the rate of loss may be as high as 2% per year. Bone mass can be determined with dual-energy x-ray absorptiometry. The rate of active loss can be assayed by the detection of bone collagen breakdown products (e.g., N-telopeptide, pyridinoline) in the urine. Although it has been suggested that white women are most commonly affected, Hispanic and Asian women are also affected. Strategies for the prevention and treatment of osteoporosis are directed at maximizing peak bone mass by optimizing physiologic intake of calcium, vitamin D therapy, exercise, and maintenance of normal menstrual cycles from youth through adulthood. Coupled with drug therapy should be a comprehensive approach to exercise and fall prevention. Stretching, strengthening, impact, and balance exercises are effective. Of the balance exercises, tai chi chuan has proved to be the most successful in decreasing falls. Prevention of bone loss is obviously preferable to any remedial measures, but new therapeutic strategies provide a means of restoring deficient bone.

MeSH

Adult; Aged; Amino Acids; Asian Continental Ancestry Group; Biological Markers; Bone Density; Calcium; Collagen; Densitometry, X-Ray; European Continental Ancestry Group; Exercise Therapy; Female; Hispanic Americans; Humans; Male; Menstrual Cycle; Middle Aged; Osteoporosis, Postmenopausal; Peptides; Vitamin D

CAS Registry Number (Substance Name)

0 (Amino Acids) , 0 (Biological Markers) , 0 (Peptides) , 0 (collagen type I trimeric cross-linked peptide) , 1406-16-2 (Vitamin D) , 63800-01-1 (pyridinoline) , 7440-70-2 (Calcium) , 9007-34-5 (Collagen)

Author Address

Weill Medical College of Cornell University, Metabolic Bone Disease Unit, Hospital for Special Surgery, New York, NY 10021, USA.




Hot Flashes / Menopause


Sex Hormone Levels . . . Improvement in sex hormone levels

http://www.healthy.net/scr/article.asp?id=382

One consequence of aging is that the levels of sex hormones change in unfavorable directions. For example, female sex hormone (estrogen) levels tend to increase in men and decrease in women. Three studies indicate that qigong exercise can reverse this trend. The effect of qigong exercise on plasma sex hormone levels was determine for hypertensive men and women. The sex hormones levels were measured before and after qigong practice for one year.

For women (ages 51 to 67, the number in the group is not available), the aging process was associated with failure of ovarian function manifested by decreased E2 and increased T levels. Qigong practiced one year resulted in an increase of E2 from 40.9±.3.5 to 51.6±3.5 pg/ml, a value about equal to that of normal menopausal controls without hypertension or cardiovascular, pulmonary, hepatic, renal, or endocrine diseases. The value of T was also increased by qigong from 25.5±2.2 to 37.2±2.2 ng/dl.

The favorable changes in estradiol levels, E2, brought about by qigong are summarized in Fig. 3 for both men and women.

[Figure 3 shows that high estrodiol levels in men lowered to near normal, and low estrodial levels in women raised to near normal after qigong practice.]

http://www.healthy.net/scr/article.asp?id=382





Menopause

Medline Plus – a Service of the National Institutes of Health

Update Date: 3/3/2004 - Updated by: Jacqueline A. Hart, M.D., Department of Internal Medicine, Newton-Wellesley Hospital, Boston, Ma.

http://www.nlm.nih.gov/medlineplus/ency/article/000894.htm

HORMONE REPLACEMENT THERAPY

For years, hormone replacement therapy (HRT) was the main treatment for menopause symptoms. Many physicians believed that HRT was not only good for reducing menopausal symptoms, but also reduced the risk of heart disease and bone fractures from osteoporosis. However, the results of a major study -- called the Women's Health Initiative -- has led physicians to revise their recommendations.

In fact, this important study was stopped early because the health risks outweighed the health benefits. Women taking the hormones did see some benefits. But they greatly increased their risk for breast cancer, heart attacks, strokes, and blood clots.


ALTERNATIVES TO Hormone Replacement Therapy (HRT)

The good news is that you can take many steps to reduce your symptoms without taking hormones:

Dress lightly and in layers.

Avoid caffeine, alcohol, and spicy foods.

Practice slow, deep breathing whenever a hot flash starts to come on. (Try taking 6 breaths per minute.)

See an acupuncturist.

Use relaxation techniques like yoga, tai chi, or meditation.





The Mysterious 'Medication' of Meditation

http://my.webmd.com/content/article/25/1728_57992.htm

By Jeanie Lerche Davis, WebMD Medical News

Meditation-type exercises are "virtually curative of tension-related pain like tension headache. It's vitally important in PMS, infertility, hot flashes, insomnia," Benson says.

. . . Benson says yoga, tai chi, Lamaze breathing, and repetitive prayer such as the rosary can do the same. "They all share this common physiology," he says. "Repetition is key to creating the response. ? So it could be a mantra; it could be a prayer; it could be a repetitive muscular activity. The other feature is, when other thoughts come to mind when you do a repetition, simply let them go and come back to the repetition.






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