Skip to main content
SpringerLink
Log in

Research on Tai Chi as a sport in health care

The challenge of complex interventions

Forschung über Tai Chi im Gesundheitssport

Die Herausforderung komplexer Interventionen

  • Main articles
  • Published:
Sportwissenschaft Aims and scope Submit manuscript

Abstract

This article examines the content and methodology of studies on Tai Chi as a sport in health care. We investigate the concept behind the rather simple name “Tai Chi,” concluding that this concept is manifold and highly variable. How did researchers deal with this variability when studying the effects of Tai Chi as a health-care intervention? We then explore how scientific research on Tai Chi has been conducted to date and draw the interim conclusion that the variability was barely taken into consideration. Our analysis of seven Tai Chi interventions reveals that two interventions referred to as Tai Chi may differ considerably in their content. The variability poses difficulty in repeating the intervention and drawing causal inferences. This problem is discussed in the current literature under the term “complexity in health-care interventions.” On the basis of a summary of this debate, we discuss the challenge of researching Tai Chi from a complex perspective—with the aim of achieving solid results that can be repeated.

Zusammenfassung

Was bedeutet es inhaltlich und methodologisch, Tai Chi als Intervention im Gesundheitssport zu erforschen? Wir untersuchen das Konzept, das sich hinter dem Begriff Tai Chi verbirgt und stellen fest, dass dieses Konzept höchst variabel und vielfältig ist. Auf welche Weise findet diese Variabilität in der Erforschung von Tai Chi als Intervention im Gesundheitssport Berücksichtigung? Wir untersuchen daraufhin, wie Tai Chi bisher wissenschaftlich erforscht wurde und ziehen die Zwischenbilanz, dass die Variabilität der Interventionen kaum Berücksichtigung fand. Unsere beispielhafte Analyse von sieben Interventionen lässt erkennen, dass zwei Interventionen, die beide als Tai Chi bezeichnet werden, inhaltlich sehr unterschiedlich sein können. Die Variabilität stellt uns vor die Schwierigkeit, die Intervention zu wiederholen und kausale Zusammenhänge abzuleiten. Dieses Problem wird aktuell unter dem Begriff Komplexität in der Gesundheitsforschung diskutiert. Auf Basis einer Zusammenfassung dieser Debatte diskutieren wir die Herausforderung, Tai Chi aus einer komplexen Perspektive zu erforschen – mit dem Ziel, zu belastbaren Ergebnissen zu kommen, die replizierbar sind.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Notes

  1. We did not include the two reviews on methodology in Tai Chi research. Both articles delineated the challenge of complexity within Tai Chi and are referred to in our discussion on this topic in Sect. 5.

  2. Here, the goal of the Tai Chi intervention itself is meant (as opposed to the aim of the study that was addressed above). Reporting of this criterion may help to distinguish between a Tai Chi intervention as a means to achieving a particular goal (such as balance improvement) versus a Tai Chi intervention aimed at practicing principles of Tai Chi.

  3. A review on the variability within Tai Chi practice could investigate the hypothesis of the study, styles, and forms researched, the intensity of the program, the methodology of teaching, or the reaction of the participants, for example.

  4. Pragmatic trials aim to better reflect clinical practice in real life than standardized explanatory trials are able to and they allow for individualized treatment approaches.

  5. The goal of the summary was to clarify the problems that are addressed with the term complex intervention. Since the limitations of RCTs are tightly connected to the discussion on complexity within healthcare interventions, they form a major part of this summary. As our overview is oriented toward the challenges of complexity, we refrained from summarizing the importance of RCTs for inferential conclusions. We affirm that this section is not intended to question the legitimation and importance of RCTs in general.

  6. The article “Tai chi and postural stability in patients with Parkinson’s disease” by Li, Harmer and Fitzgerald (2012) may serve as guidance for thorough planning and reporting.

References

  • Allen, J., & Meires, J. (2011). How to prescribe Tai Chi therapy. Journal of Transcultural Nursing: Official Journal of the Transcultural Nursing Society/Transcultural Nursing Society, 22(2), 201–204.

    Article  Google Scholar 

  • Anders, F., Brauner, V., & Zock, A. (2009). Taiji, Atemenergetik und Biomechanik. Der Weg zur inneren und äußeren Technik; [mit DVD] (1. Aufl.). Bern: Huber.

  • Bar-Yam, Y. (2003). Dynamics of complex systems. http://necsi.edu/publications/dcs/DCSchapter0.pdf. Zugegriffen: 20. Jun. 2012.

  • Bird, L., Arthur, A., & Cox, K. (2011). “Did the trial kill the intervention?” experiences from the development, implementation and evaluation of a complex intervention. BMC Medical Research Methodology, 11, 1–8.

    Article  CAS  Google Scholar 

  • Blackwood, B. (2006). Methodological issues in evaluating complex healthcare interventions. Journal of Advanced Nursing, 54(5), 612–622.

    Article  PubMed  Google Scholar 

  • Boon, H., MacPherson, H., Fleishman, S., Grimsgaard, S., Koithan, M., Norheim, A. J., & Walach, H. (2007). Evaluating complex healthcare systems: A critique of four approaches. Evidence Based Complementary and Alternative Medicine eCAM, 4(3), 279–285.

    Article  PubMed  Google Scholar 

  • Bu, B., Haijun, H., Yong, L., Chaohui, Z., Xiaoyuan, Y., & Singh, M. F. (2010). Effects of martial arts on health status: A systematic review. Journal of Evidence-Based Medicine, 3(4), 205–219.

    Article  PubMed  Google Scholar 

  • Burke, D. T., Al-Adawi, S., Lee, Y. T., & Audette, J. (2007). Martial arts as sport and therapy. The Journal of Sports Medicine and Physical Fitness, 47(1), 96–102.

    PubMed  CAS  Google Scholar 

  • Buss, M. (2007). Transfer des Taijiquan vom Osten in den Westen. Untersuchung zur Übertragbarkeit eines chinesischen Bewegungskonzeptes. Magisterarbeit, Georg-August-Universität Göttingen.

  • Campbell, M., Fitzpatrick, R., Haines, A., Kinmonth, A. L., Sandercock, P., Spiegelhalter, D., & Tyrer, P. (2000). Framework for design and evaluation of complex interventions to improve health. BMJ (Clinical Research Ed.), 321(7262), 694–696.

    Article  CAS  Google Scholar 

  • Carter, B. (2003). Methodological issues and complementary therapies: researching intangibles? Complementary Therapies in Nursing & Midwifery, 9(3), 133–139.

    Article  Google Scholar 

  • Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., & Petticrew, M. (2008). Developing and evaluating complex interventions: New Guidance. www.mrc.ac.uk/complexinterventionsguidance. Accessed: 20. Jun. 2012.

  • Elder, C., Aickin, M., Bell, I. R., Fønnebø, V., Lewith, G. T., Ritenbaugh, C., & Verhoef, M. (2006). Methodological challenges in whole systems research. Journal of Alternative and Complementary Medicine (New York, N.Y.), 12(9), 843–850.

    Article  Google Scholar 

  • Emsley, R., Dunn, G., & White, I. R. (2010). Mediation and moderation of treatment effects in randomized controlled trials of complex interventions. Statistical Methods in Medical Research, 19(3), 237–270.

    Article  PubMed  Google Scholar 

  • High Level Pharmaceutical Forum, E. U. (2008). Core principles on relative effectiveness. http://ec.europa.eu/pharmaforum/docs/rea_principles_en.pdf. Accessed: 02. Apr. 2012.

  • Field, T. (2011). Tai Chi research review. Complementary Therapies in Clinical Practice, 17(3), 141–146.

    Article  PubMed  Google Scholar 

  • Filipiak, K. (2001). Die chinesische Kampfkunst. Spiegel und Element traditioneller chinesischer Kultur. Leipzig: Leipziger Univ-Verl.

    Google Scholar 

  • Glouberman, S., & Zimmerman, B. (2002). Complicated and complex systems. What would successful reform of medicare look like? http://www.plexusinstitute.org/resource/collection/6528ED29-9907-4BC7-8D00-8DC907679FED/ComplicatedAndComplexSystems-ZimmermanReport_Medicare_reform.pdf. Accessed: 20. Jun. 2012.

  • Heng, H. H. Q. (2008). The conflict between complex systems and reductionism. JAMA: the Journal of the American Medical Association, 300(13), 1580–1581.

    Article  CAS  Google Scholar 

  • Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) (2011). Allgemeine Methoden. Version 4.0. https://www.iqwig.de/download/IQWiG_Methoden_Version_4_0.pdf. Accessed: 11. Apr. 2012.

  • Jahnke, R., Larkey, L., Rogers, C., Etnier, J., & Lin, F. (2010). A comprehensive review of health benefits of Qigong and Tai Chi. American Journal of Health Promotion: AJHP, 24(6), e1–e25.

    Article  PubMed  Google Scholar 

  • Kang, J. (2011). Master vs. Sifu: Titles in Chinese Martial Arts. http://imos-journal.net/?p=3318. Accessed: 03. May. 2012.

  • King, M., Nazareth, I., Lampe, F., Bower, P., Chandler, M., Morou, M., Sibbald, B., & Lai, R. (2005). Conceptual framework and systematic review of the effects of participants’ and professionals’ preferences in randomized controlled trials. Health Technology Assessment (Winchester, England), 9(35), 1–186, iii–iv.

    Google Scholar 

  • Klein, P. J., & Adams, W. D. (2004). Comprehensive therapeutic benefits of Taiji: A critical review. American Journal of Physical Medicine & Rehabilitation/Association of Academic Physiatrists, 83(9), 735–745.

    Article  Google Scholar 

  • Kuramoto, A. M. (2006). Therapeutic benefits of Tai Chi exercise: Research review. WMJ: Official Publication of the State Medical Society of Wisconsin, 105(7), 42–46.

    Google Scholar 

  • Landmann, R. (2005). Taijiquan. Konzepte und Prinzipien einer Bewegungskunst; Analyse anhand der frühen Schriften (3. unveränderte Auflage). Hamburg: Inst. für Bewegungswiss. Anthropologie.

    Google Scholar 

  • Li, F., Harmer, P., Fisher, K. J., McAuley, E., Chaumeton, N., Eckstrom, E., & Wilson, N. L. (2005). Tai Chi and fall reductions in older adults: A randomized controlled trial. The Journals of Gerontology. Series A, Biological sciences and medical sciences, 60(2), 187–194.

    Article  PubMed  Google Scholar 

  • Li, J. Y., Zhang, Y. F., Smith, G. S., Xue, C. J., Luo, Y. N., Chen, W. H., Skinner, C. J., & Finkelstein, J. (2011). Quality of reporting of randomized clinical trials in Tai Chi interventions—A systematic review. Evidence based complementary and alternative medicine: eCAM. http://downloads.hindawi.com/journals/ecam/2011/383245.pdf. Accessed: 20. Jun. 2012.

  • Li, F., Harmer, P., Fitzgerald, K., Eckstrom, E., Stock, R., Galver, J., Maddalozzo, G., & Batya, S. S. (2012). Tai Chi and postural stability in patients with Parkinson’s disease. The New England Journal of Medicine, 366(6), 511–519.

    Article  PubMed  CAS  Google Scholar 

  • McQuay, H. (2011). Evidence-based medicine: What is the evidence that it has made a difference? Palliative medicine, 25(5), 394–397.

    Article  PubMed  Google Scholar 

  • Medical Research Council (2000). A Framework for development and evaluation of RCTs for Complex Interventions to Improve Health. http://www.mrc.ac.uk/consumption/idcplg?IdcService=GET_FILE&dID=9025&dDocName=MRC003372&allowInterrupt=1. Accessed: 03. Oct. 2011.

  • Mühlhauser, I., Lenz, M., & Meyer, G. (2011). Entwicklung, Bewertung und Synthese von komplexen Interventionen—eine methodische Herausforderung. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 105(10), 751–761.

    Article  PubMed  Google Scholar 

  • Paterson, C., Baarts, C., Launsø, L., & Verhoef, M. J. (2009). Evaluating complex health interventions: A critical analysis of the † outcomes’ concept. BMC Complementary and Alternative Medicine, 9, 1–11.

    Article  Google Scholar 

  • Patsopoulos, N. (2011). A pragmatic view on pragmatic trials. Dialogues in Clinical Neuroscience, 13(2), 217–224.

    PubMed  Google Scholar 

  • Petticrew, M. (2011). When are complex interventions ‘complex’? When are simple interventions ‘simple’? The European Journal of Public Health, 21(4), 397–398.

    Article  Google Scholar 

  • Rickles, D. (2009). Causality in complex interventions. Medicine, Health Care, and Philosophy, 12(1), 77–90.

    Article  PubMed  Google Scholar 

  • Rickles, D., Hawe, P., & Shiell, A. (2007). A simple guide to chaos and complexity. Journal of Epidemiology and Community Health, 61(11), 933–937.

    Article  PubMed  Google Scholar 

  • Ritenbaugh, C., Aickin, M., Bradley, R., Caspi, O., Grimsgaard, S., & Musial, F. (2010). Whole systems research becomes real: New results and next steps. Journal of Alternative and Complementary Medicine (New York, N.Y.), 16(1), 131–137.

    Article  Google Scholar 

  • Shiell, A., Hawe, P., & Gold, L. (2008). Complex interventions or complex systems? Implications for health economic evaluation. BMJ, 336(7656), 1281–1283.

    Article  PubMed  Google Scholar 

  • Song, Z. J., & Bohn, H. G. (1991). Tài-chi chüàn. Die Grundlagen: Geschichte und Traditionen, Philosophie des I Ging, physiologische Wirkungen. München: Piper.

    Google Scholar 

  • Taylor-Piliae, R., & Coull, B. (2012). Community-based Yang-style Tai Chi is safe and feasible in chronic stroke: A pilot study. Clinical Rehabilitation, 26(2), 121–131.

    Article  PubMed  Google Scholar 

  • Taylor-Piliae, R. E., Newell, K. A., Cherin, R., Lee, M. J., King, A. C., & Haskell, W. L. (2010). Effects of Tai Chi and Western exercise on physical and cognitive functioning in healthy community-dwelling older adults. Journal of Aging and Physical Activity, 18(3), 261–279.

    PubMed  Google Scholar 

  • Verhoef, M., Lewith, G., Ritenbaugh, C., Boon, H., Fleishman, S., & Leis, A. (2005). Complementary and alternative medicine whole systems research: Beyond identification of inadequacies of the RCT. Complementary Therapies in Medicine, 13(3), 206–212.

    Article  PubMed  Google Scholar 

  • Walach, H., Falkenberg, T., Fønnebø, V., Lewith, G., & Jonas, W. B. (2006). Circular instead of hierarchical: Methodological principles for the evaluation of complex interventions. BMC Medical Research Methodology, 6, 2–9.

    Article  Google Scholar 

  • Wang, C., Schmid, C., Rones, R., Kalish, R., Yinh, J., Goldenberg, D., Lee, Y., & McAlindon, T. (2010). A randomized trial of Tai Chi for fibromyalgia. The New England Journal of Medicine, 363(8), 743–754.

    Article  PubMed  CAS  Google Scholar 

  • Wayne, P. M., & Kaptchuk, T. J. (2008a). Challenges inherent to Tài Chi research: Part I–Tài Chi as a complex multicomponent intervention. Journal of Alternative and Complementary Medicine (New York, N.Y.), 14(1), 95–102.

    Article  Google Scholar 

  • Wayne, P. M., & Kaptchuk, T. J. (2008b). Challenges inherent to Tài Chi research: Part II-defining the intervention and optimal study design. Journal of Alternative and Complementary Medicine (New York, N.Y.), 14(2), 191–197.

    Article  Google Scholar 

  • Wayne, P. M., Buring, J. E., Davis, R. B., Connors, E. M., Bonato, P., Patritti, B., Fischer, M., Yeh, G. Y., Cohen, C. J., Carroll, D., & Kiel, D. P. (2010). Tai Chi for osteopenic women: Design and rationale of a pragmatic randomized controlled trial. BMC Musculoskeletal Disorders, 11, 40.

    Article  PubMed  Google Scholar 

  • Wayne, P. M., Kiel, D. P., Buring, J. E., Connors, E. M., Bonato, P., Yeh, G. Y., Cohen, C. J., Mancinelli, C., & Davis, R. B. (2012). Impact of Tai Chi exercise on multiple fracture-related risk factors in post-menopausal osteopenic women: A pilot pragmatic, randomized trial. BMC Complementary and Alternative Medicine, 12(1), 7.

    Google Scholar 

  • Yang, Y., Verkuilen, J. V., Rosengren, K. S., Grubisich, S. A., Reed, M. R., & Hsiao-Wecksler, E. T. (2007). Effect of combined Taiji and Qigong training on balance mechanisms: A randomized controlled trial of older adults. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 13(8), CR339–CR48.

    Google Scholar 

  • Zhu, W., Guan, S., & Yang, Y. (2010). Clinical implications of Tai Chi interventions: A review. American Journal of Lifestyle Medicine, 5(4), 418–432.

    Google Scholar 

Download references

Conflicts of interest.

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Institut für Sportwissenschaft, Universität Bayreuth, Universitätsstraße 30, 95447, Bayreuth, Deutschland

    Janina Burschka &  Peter Kuhn PD

  2. Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte, Neurologische Klinik, Hohe Warte 8, 95445, Bayreuth, Deutschland

    Janina Burschka,  Uwe Menge &  Patrick Oschmann

Authors
  1. Janina Burschka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Kuhn PD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Uwe Menge
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Patrick Oschmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Janina Burschka.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Cite this article

Burschka, J., Kuhn, P., Menge, U. et al. Research on Tai Chi as a sport in health care. Sportwiss 43, 181–196 (2013). https://doi.org/10.1007/s12662-013-0300-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12662-013-0300-1

Schlüsselwörter

Keywords

Search

Navigation