MEDITATIVE MOVEMENT, ENERGETIC, AND PHYSICAL ANALYSES OF THREE QIGONG EXERCISES: UNIFICATION OF EASTERN AND WESTERN MECHANISTIC EXERCISE THEORY.

        Qigong is the meditative movement and therapeutic exercise of Eastern medicine. A growing body of evidence is validating its health benefits leading to mechanistic questions of how it works. The purpose of this article is to explore mechanisms of action related to Qigong, with the intent of unifying Eastern and Western exercise theory and to present a model for Qigong exercise analysis. Three exercises from a standardized Qigong form: 'Plucking the Stars', 'Lotus Leaves Rustle in the Wind', and 'Pacing Forwards and Backwards' were selected for meditative, energetic, and physical analyses. Meditative aspects include relaxation response, interoception and exteroception. Energetic aspects include stimulation of meridians through mental intent, acupressure, and self-massage. Physical aspects include flexibility, strength, articular stimulation, neuro-integration, respiratory effect, fascial stretch, visceral massage, balance challenge Craniosacral pump, lymphatic and venous return and glandular stimulation, and physiologic response to relaxation. Knowledge of mechanisms of action for specific Qigong exercises can guide operational definition of Qigong, selection of outcomes assessment in future research, inform prescriptive practice addressing clinical health issues, and advance adoption of Qigong practice within integrative health care. The model of analysis demonstrated in this discussion may assist in these endeavors.


QIGONG IN CANCER CARE: THEORY, EVIDENCE-BASE, AND PRACTICE.

        The purpose of this discussion is to explore the theory, evidence base, and practice of Qigong for individuals with cancer. Questions addressed are: What is qigong? How does it work? What evidence exists supporting its practice in integrative oncology? What barriers to wide-spread programming access exist?

METHODS: Sources for this discussion include a review of scholarly texts, the Internet, PubMed, field observations, and expert opinion.

RESULTS: Qigong is a gentle, mind/body exercise integral within Chinese medicine. Theoretical foundations include Chinese medicine energy theory, psychoneuroimmunology, the relaxation response, the meditation effect, and epigenetics. Research supports positive effects on quality of life (QOL), fatigue, immune function and cortisol levels, and cognition for individuals with cancer. There is indirect, scientific evidence suggesting that qigong practice may positively influence cancer prevention and survival. No one Qigong exercise regimen has been established as superior. Effective protocols do have common elements: slow mindful exercise, easy to learn, breath regulation, meditation, emphasis on relaxation, and energy cultivation including mental intent and self-massage.

CONCLUSION: Regular practice of Qigong exercise therapy has the potential to improve cancer-related QOL and is indirectly linked to cancer prevention and survival. Wide-spread access to quality Qigong in cancer care programming may be challenged by the availability of existing programming and work force capacity.


RASCH ANALYSIS OF THE FULLERTON ADVANCED BALANCE (FAB) SCALE.

PURPOSE: This cross-sectional study explores the psychometric properties and dimensionality of the Fullerton Advanced Balance (FAB) Scale, a multi-item balance test for higher-functioning older adults.

METHODS: Participants (n=480) were community-dwelling adults able to ambulate independently. Data gathering consisted of survey and balance performance assessment. Psychometric properties were assessed using Rasch analysis.

RESULTS: Mean age of participants was 76.4 (SD=7.1) years. Mean FAB Scale scores were 24.7/40 (SD=7.5). Analyses for scale dimensionality showed that 9 of the 10 items fit a unidimensional measure of balance. Item 10 (Reactive Postural Control) did not fit the model. The reliability of the scale to separate persons was 0.81 out of 1.00; the reliability of the scale to separate items in terms of their difficulty was 0.99 out of 1.00. Cronbach's alpha for a 10-item model was 0.805. Items of differing difficulties formed a useful ordinal hierarchy for scaling patterns of expected balance ability scoring for a normative population.

CONCLUSION: The FAB Scale appears to be a reliable and valid tool to assess balance function in higher-functioning older adults. The test was found to discriminate among participants of varying balance abilities. Further exploration of concurrent validity of Rasch-generated expected item scoring patterns should be undertaken to determine the test's diagnostic and prescriptive utility.


PHYSICAL ACTIVITY BENEFITS AND NEEDS IN ADULTS WITH INTELLECTUAL DISABILITIES: SYSTEMATIC REVIEW OF THE LITERATURE.

        Regular physical activity is vital for adult individuals with intellectual disabilities. The purpose of this review was to assess critically the evidence on effectiveness of physical activity interventions for adults with intellectual disability. An electronic database search was conducted. Research was then assessed for methodological rigor, and strength of the evidence was determined. Eleven clinical studies met inclusion criteria. Interventions studied included a variety of physical activity modes. Critical review revealed moderate to strong evidence that physical activity positively affected balance, muscle strength, and quality of life in individuals with intellectual disability. The authors also found that the research in this area needs to be translated into practice, specifically the development of physical activity programs that are adaptable to the needs of individuals with intellectual disability.


TAI CHI CHUAN IN THE MANAGEMENT OF PARKINSON'S DISEASE AND ALZHEIMER'S DISEASE.

BACKGROUND: Parkinson's disease (PD) and Alzheimer's disease (ALZ) represent later-life onset neurodegenerative disorders that gradually rob those afflicted of their quality of life.

PURPOSE: This chapter offers practice-based recommendations on how instruction and practice of Tai Chi Chuan (TCC) can be adapted for individuals with PD and those with ALZ. RESEARCH EVIDENCE: Practice of TCC is widely advocated as an exercise option in PD; however, little validating research exists. Even less is known about feasibility of applications of TCC for individuals with ALZ. CLINICAL IMPRESSIONS: The slow, rhythmic pace of functionally based exercises, internal organ stimulation, flexibility maintenance, balance-training effects, and general health benefits of TCC and Tai Chi-like exercise practice have clinical relevance for both conditions. Falls prevention, tremor reduction and motor control may be of most importance in management of PD. Behavioral and general health benefits as well as slowing of functional and cognitive decline are considerations with ALZ.

RECOMMENDATIONS: Strategies of exercise adaptation include use of Tai Chi-like exercise for individuals with ALZ and those in middle or late stages of PD as well as providing instructional resources and training for caregivers and exercise aides to facilitate practice as a part of daily life.


Taiji for individuals with Parkinson disease and their support partners: a program evaluation.

BACKGROUND AND PURPOSE: Exercise is advocated in the management of Parkinson disease (PD), however, little is known regarding the potential benefits of complementary mind/body exercise for this clinical population. The purpose of this pilot program evaluation was to gain insight into participant and instructor perceptions of the perceived benefits and potential utility of a taiji exercise program.

PROGRAM EVALUATION: Program participants (N=15) included 8 individuals with PD and 7 support partners with no history of PD. Group taiji instruction was offered in 45-minute weekly sessions, for 12 weeks at a community facility. Post-program evaluation included administration of a survey questionnaire, thematic analysis of a focus group discussion, instructor reflections, and review of attendance records.

RESULTS: Benefits were perceived by participants in physical, psychological, and social domains. Thirteen of the survey respondents, including 6 of the 8 respondents with PD reported perceiving a physical benefit attributed to taiji practice. Improved balance was reported most frequently. Instructor observations and participant testimony suggest movement capability for individuals with Parkinsons may also be improved by performing taiji.

CONCLUSION: This preliminary research provides support for further Taiji Buddy program examination and application.


COMPREHENSIVE THERAPEUTIC BENEFITS OF TAIJI: A CRITICAL REVIEW.­­­­­

        This literature review offers physical rehabilitation professionals an update on the current breadth and strength of research evidence regarding comprehensive therapeutic benefits of Taiji practice. A critical analysis distinguishes between what is known from controlled clinical research and what is suggested in preliminary research. Of >200 published reports examined, 17 controlled clinical trials were judged to meet a high standard of methodological rigor. Controlled research evidence was found to confirm therapeutic benefits of Taiji practice with regard to improving quality of life, physical function including activity tolerance and cardiovascular function, pain management, balance and risk of falls reduction, enhancing immune response, and improving flexibility, strength, and kinesthetic sense. Preliminary research on implementation feasibility of Taiji programming exists for a variety of clinical populations. Further controlled clinical study is justified for a wide variety of clinical contexts.