2. Ask Dr Lam

From Dr Lam: I love answering your tai chi questions and hearing your feedback, email me at service@tchi.org. I will try to answer the best I can. Below is the list of videos available.DSC00425

Ask Dr Lam series:

Producing a video take considerable time and cost, you will receive notification as soon as they are posted by subscribing my YouTube channel, Newsletter, or like my FaceBook page. More importantly you would be helping to spread tai chi to more people. My clips, mostly the free tai chi lessons, received 7,130,505 hits by Sept 15, 2016.TempDTCD2

My intention is to produce work that are useful to you and I don’t allow advertisement on them.

Related links:

The list of Dr Paul Lam’s Youtube videos

1. Dr Lam’s YouTube Videos

Dr Lam offering the gift of tai chi for health

Dr Lam offering the gift of tai chi for health

From Dr Lam: I have published over 100 YouTube clips, from free tai chi lessons, answer enquiries and medical studies to tai chi and life style topics. I intended to post useful information to you without any pay advertisement. My clips have 7,683,531 hits so far. They are:

For more videos please go to YouTube or Google and search for Dr Paul Lam and your topic. Feel free to contact me at service@tchi.org. 

1. Published Studies of Dr Lam’s Tai Chi for Health Programs

For a pdf version of this list, please visit this link

1.     Lam P. New horizons…developing tai chi for health care. Journal of Australian Family Physician. 1998 Jan-Feb;27(1-2):100-1.

2.     Lam, P. (2004). “Tai Chi for ageing and its associated chronic conditions.” Journal of Aging and Physical Activity 12(3): 347-347.

3.     Song, Lee E, Lam P, Bae S. Effects of Tai Chi exercise on pain, balance, muscle strength, and physical functioning in older women with osteoarthritis: A randomized clinical trial. Journal of Rheumatology. Sept 2003. 30:9 page 2039-2044.

4.     Lam P and Stephenson A. Tai Chi for Back Pain: Rationale and Available Evidence Supporting Tai Chi as a Complementary Treatment. Journal Medical Paradigm. August 2004 page 5-12 (journal no longer in publication)

5.     CHOI J .H. , MOON J . S. & SONG R. Effects of Sun-style Tai Chi exercise on physical fitness and fall prevention in fall prone older adults. Journal of Advanced Nursing 2005, 51(2),150–157

6.     Orr R, Tsang T, Lam P, Comino E, Fiatarone M. Mobility Impairment in Type 2 Diabetes. Diabetes Care. Volume 29, Number 9, Sept 2006. page 2120-2122

7.     Fransen M, Nairn L, Winstanley J, Lam P,  Edmonds J.  A Randomized Control Trial Of 200 Subjects Comparing Tai Chi, Hydrotherapy And Control, To Measure Improvement In Pain, Physical Function, Muscular Strength And Walking Capacity. Arthritis Care and Research.. Vol.57, No.3, April 15, 2007, pp407-414.

8.     Alexander Voukelatos, MA (Psychol), Robert G. Cumming, PhD, Stephen R. Lord, DSc,and Chris Rissel, PhD. A Randomized, Controlled Trial of tai chi for the Prevention of Falls: The Central Sydney tai chi Trial. JAGS 55:1185–1191, 2007

9.     Tsang T, Orr R, Lam P, Comino E, Fiatarone M. Health benefits of Tai Chi for older patients with Type 2 diabetes: The “Move It for Diabetes Study” – A randomized controlled trial. Clinical Interventions in Aging 2007:2(3) 429-439

10.  Paul Lam, Sarah M Dennis, Terry H Diamond, Nicholas Zwar. Improving Glycaemic and BP control in type 2 diabetes The effectiveness of Tai Chi. Australian Family Physician Vol. 37, No. 10, October 2008 P884-887

11.  Lam P Tai Chi for fall prevention.  NZ Family Physician Journal.  June 2006 volume 33 number 3 page 202

12.  Song, R., Lee, E. O., Lam, P., & Bae. S. C. (2007). Effects of a Sun-style Tai Chi exercise on arthritic symptoms, motivation and the performance of health behaviors in women with osteoarthritis. Journal of Korean Academy of Nursing (English), 37(2), 249-256.

13.  Song, R. Lee, E. O., Bae, S. C., Ahn, Y. H., Paul Lam, Lee, I. O. (2007). Effects of Tai Chi Self-help program on glucose control, cardiovascular risks, and quality of life in type II diabetic patients. Journal of Muscle and Joint Health, 14(1), 13-25.

14.  E Lee, Aeyong Eom, Rhayun Song, Young Ran Chae. Factors Influencing Quality of Life in Patients with Gastrointestinal Neoplasms. Journal of Korean Academy of Nursing. 2008 ISSN 1598-2874 Vol(Ed.) 38(5)

15.  M Lee, Paul Lam, E Ernst. Effectiveness of tai chi for Parkinson’s disease: A critical review. Parkinsonism and Related Disorders, Pages 589-594, ISSN 1353-8020, Vol(Ed.) 14(8, 2008)

16.  Ching-Huey Chen, Miaofen Yen, Susan Fetzer, Li-Hua Lo, Paul Lam. The Effects of Tai Chi Exercise on Elders with Osteoarthritis: A Longitudinal Study, Asian Nursing Research December 2008 Vol 2 No 4

17.  Stephanie S. Y. Au-Yeung, PhD, Christina W. Y. Hui-Chan, PhD, and Jervis C. S. Tang, MSW. Short-form Tai Chi Improves Standing Balance of People With Chronic Stroke. Neurorehabil Neural Repair Online First, published on January 7, 2009

18.  Song, R., Lee, E. O., Lam, P., Bae, S. C. (2009). Effects of Tai Chi or Self-help Program on Balance, Flexibility, Oxygen Consumption, and Muscle Strength in Women with Osteoarthritis. Journal of Korean Academy of Fundamental Nursing, 16(1), 30-38.

19.  Song, R., Eom, A., Lee, E. O., Lam, P․ & Bae, S-C. (2009).  Effects of Tai Chi combined with Self-help Program on Arthritic Symptoms and Fear of Falling in Women with Osteoarthritis.  Journal of Muscle and Joint Health, 16(1), 46-54.

20.  Amanda M Hall, Chris G Maher, Jane Latimer, Manuela L Ferreira and Paul Lam. A randomized controlled trial of tai chi for long-term low back pain (TAI CHI): Study rationale, design, and methods. BMC Musculoskeletal Disorders 2009, 10:55 (28 May 2009).

21.  Rhayun Song, Sukhee Ahn, Beverly L Roberts, Eun Ok Lee, and You Hern Ahn. Adhering to a Tai Chi program to improve glucose control and quality of life for individuals with type 2 diabetes. Journal of Alternative and Complementary Medicine, 15(6), 2009, 627-632.

22.  Eun Ok Lee, Young Ran Chae, Rhayun Song, Aeyong Eom, Paul Lam, and Margaret Heitkemper. Feasibility and Effects of a Tai Chi Self-Help Education Program for Korean Gastric Cancer Survivors, Oncology Nursing Forum • Vol. 37, No. 1, January 2010

23.  Rhayun Song, Beverly L. Roberts, Eun-Ok Lee, Paul Lam, Sang-Cheol Bae. A Randomized Study of the Effects of T’ai Chi on Muscle Strength, Bone Mineral Density, and Fear of Falling in Women with Osteoarthritis. The Journal of Alternative and Complementary Medicine, Volume 16, Number 2, 2010, pp. 1–7

24.  Michelle DiGiacomo, Paul Lam, Beverly L. Roberts, Tang Ching Lau, Rhayun Song, Patricia M. Davidson. Exploring the Reasons for Adherence to T’ai Chi Practice. The Journal of Alternative and Complementary Medicine. December 2010, 16(12): 1245-1246.

25.  Amanda M. Hall, Chris G. Maher, Paul Lam, Manuela Ferreira, Jane Latimer. Tai Chi Exercise for Treatment of Pain and Disability in People With Persistent Low Back Pain: A Randomized Controlled Trial. Arthritis Care & Research. Vol. 63, No. 11, November 2011, pp 1576–1583

26.  Hyung Kyoung Oh, Sukhee Ahn, Rhayun Song. Comparing effects of Tai Chi exercise on pain, activities of daily living, and fear of falling in women with Osteoarthritis and Rheumatoid arthritis. Journal of Muscle and Joint Health, 18(2), 2011, 137-146.

27.  Hua Ren,Veronica Collins, Sandy J. Clarke, Jin-Song Han, Paul Lam, Fiona Clay, Lara M.Williamson, K. H. Andy Choo. Epigenetic Changes in Response to Tai Chi Practice: A Pilot Investigation of DNA Methylation Marks. Evidence-Based Complementary and Alternative Medicine, Volume March 2012, Article ID 841810, 9 pages.

28.  Sukhee Ahn, Rhayun Song. Effects of Tai Chi exercise on glucose control, neuropathy scores, balance, and quality of life in patients with Type 2 diabetes and Neuropathy. Journal of Alternative and Complementary Medicine, 18(12), 2012, 1172-1178.

29.  Rhayun Song, Moonkyoung Park, Jin Ok Chung, Jae Hyung Park, In Whan Sung. Effects of Tai chi exercises on Cardiovascular Risks, Recurrence Risk, and Quality of life in Patients with coronary artery disease. Korean Journal of Adult Nursing, 25(5), 2013, 516-527.

30.  Pao-Feng Tsai, RN, PhD, Jason Y. Chang, PhD, Cornelia Beck, RN, PhD, FAAN,Yong-Fang Kuo, PhD, and Francis J. Keefe, PhD. A Pilot Cluster-Randomized Trial of a 20-Week Tai Chi Program in Elders With Cognitive Impairment and osteoarthritic Knee: Effects on Pain and Other Health Outcomes. Journal of Pain and Symptom Management Vol. 45 No. 4 April 2013

31.  Moonkyoung Park, Rhayun Song. Effects of Tai Chi on fall risk factors: a Meta analysis. Journal of Korean Academic Nursing, 43(3), 2013, 341-351.

32.  Regina Wai Man Leung, Zoe J. McKeough, Matthew J. Peters and Jennifer A. Alison. Short-form Sun-style t’ai chi as an exercise training modality in people with COPD. Eur Respir J 2013; 41: 1051–1057

33.  Beverly Roberts, Rhayun Song, Sukhee Ahn, Paul Lam. Research Metholodogies for Tai Chi research. Edited by mark langweiler, Research methodology for Complementary and alternative therapy. 2015.

34.  Rhayun Song, Sukhee Ahn, Heeyoung So, Eun-hyun Lee, Younghae Chung, Moonkyoung Park. Effects of Tai Chi on balance: A population based meta analysis, The Journal of Alternative and Complementary Medicine 21(3) 2015, 141-151.

35.  Leigh F. Callahan, Rebecca J. Cleveland, Mary Altpeter, and Betsy Hackney. Evaluation of Tai Chi Program Effectiveness for People with Arthritis in the Community: A Randomized Controlled Trial. Journal of Aging and Physical Activity, 2016, 24, 101 -110

Tai Chi for Arthritis Helps CVA

Dr Paul Lam

Published in Neurorehabilitation and Neuro Repair, Volume 20, Number 10, January 7 2009
Authors Stephanie S. Y. Au-Yeung, PhD, Christina W. Y. Hui-Chan, PhD, and Jervis C. S. Tang, MSWtai chi for people with chronic conditions in New Zealand 2008
All subjects were six months or more post-stroke.  Over a twelve week period a control group of 62 subjects performed general exercise, and a further 74 subjects received training in Tai Chi for Arthritis.  The subjects were tested for improved balance and reaction after six weeks, twelve weeks (conclusion of training) and eighteen weeks (six weeks post study).
Results showed that the tai chi group improved their reaction times on the non-affected side, and this was still noticeable six weeks after the study concluded.
This result supports the idea that regular practice of short-form Tai Chi for 6 to 12 weeks improves standing balance in people with chronic stroke. With its lasting effect beyond the training period, such short-form Tai Chi might be applied in community rehabilitation programs for patients who have adequate sensorimotor function and learning ability to safely participate.
Related Articles

Reference of the study: Fransen M, Nairn L, Winstanley J, Lam P, Edmonds J : Physical activity for osteoarthritis management: a randomized controlled clinical trial evaluating hydrotherapy or Tai chi classes Arthritis & Rheumatism (Arthritis Care & Research) April 2007, 57:3 pp 407-414.

Tai Chi for Diabetes Study by Dr Paul Lam Et Al

A Tai Chi for Diabetes Study 2008
 “Improving Glycaemic and BP control in type 2 diabetes –  The effectiveness of Tai Chi”
Published in the Australian Family Physician, Vol 37, Number 10, October 2008 p884-887
Authors: Lam, P., Dennis, S., Diamond, T., & Zwar, N.


This community based, randomised control trial assessed the effects of a modified Tai Chi program for people with poorly controlled type II diabetes. It found improvements in HbA1c (an important indicator of blood glucose level); six-meter walk test and total cholesterol in both the control and Tai Chi group. Improvements in physical and social functioning were found in the Tai Chi group. 

Fifty-three people who fulfilled the study criteria were randomly divided into a Tai Chi (28) and control group (25). The Tai Chi group were taught the specially designed Tai Chi for Diabetes program twice per week for six months. The control group were given ten weeks of free lessons after the study. At six months, improvements in HbA1c, six-meter walk test and total cholesterol were not statistically significant between the groups. However, improvements were observed in physical and social functioning in the Tai Chi group from baseline to follow up. Many people joined Tai Chi classes after the study.

The researchers believe that Tai Chi with its relatively low cost, easy accessibility and high adherence rate may be a useful part of the treatment of type II diabetes in the community. Tai Chi for Diabetes may be a useful introduction to greater physical activity. However, longer duration or increased number of Tai Chi sessions per week may be required to demonstrate statistically significant reductions in metabolic or cardiovascular parameters.

The authors gratefully acknowledge the RACGP Cardiovascular Research Grant that supported this project.

What Can Tai Chi Do for You?

By Dr Paul Lam © Tai Chi Productions. All rights reserved. You can copy this article for educational purpose but not for any commercial gain. For example you can give a copy of this article for your fee paying students and conference attendees provided you do not charge a fee for it. 
Just what is Tai Chi?
Originating in ancient China, tai chi is an effective exercise for health of mind and body. Although an art with great depth of knowledge and skill, it can be easy to learn and soon delivers its health benefits. For many, it continues as a lifetime journey. There are many styles and forms of tai chi, the major ones being Chen, Yang, Wu, another Wu (actually two different words in Chinese) and Sun. Each style has its own unique features, although most styles share similar essential principles. 
These essential principles include the mind being integrated with the body; fluidity of movement; control of breathing; and mental concentration. The central focus is to enable the qi or life force to flow smoothly and powerfully throughout the body. Total harmony of the inner and outer self comes from the integration of mind and body, achieved through the ongoing practice of tai chi.
Here’s to your healthdtca chicago faculty
Medical and fitness authorities stress that effective exercise for health should include three components: cardio-vascular fitness or stamina, muscular strength, and flexibility.
Cardio-vascular fitness
Cardio-vascular fitness means better heart-lung capacity. A good supply of blood and oxygen is essential for maintaining your health and for healing any disease.

In 1996, a study was carried out involving 126 post-heart attack patients. They were randomly assigned to participate in a tai chi class, an aerobic exercise class or a non-exercise support group. The patients from the tai chi group came out with better cardiovascular fitness and lower blood pressure than patients from the non-exercise group. To top it off, 80 percent of the people in the tai chi group kept up the practice of tai chi while the non-exercise support group retained only 10 percent of its original membership. The aerobic group retained less of its members than the tai chi group and their diastolic blood pressure did not improve. 

Since then many other studies have confirmed the efficacy of tai chi for cardio-vascular fitness.

StrengtheningWelcome to the annual workshops
By strengthening our muscles, we keep our joints stable and protected. Of course, we need our muscles to move and when we move, the muscles pump fluid and blood throughout the body, improving the functions not only of the organs and joints but also the entire body.

Many well-known sports heroes suffer from osteoarthritis resulting from injuries. Yet, they are able to perform at their peak level because their strong muscles protect their joints and reduce the pain of osteoarthritis. After they retire from active sports, however, and their training lapses, their muscles weaken. Arthritis flares up. Perhaps we can conclude that had they taken up tai chi upon retirement they would have stayed in shape and enjoyed a healthier, happier retirement.

Flexibility improves our range of motion, making us more functional. Being flexible keeps our joints, muscles – our entire body – healthy and allows us to be more active. Jim, a 56-year-old retired fireman, is a good example of how tai chi can improve flexibility. Because of an on-the-job injury, Jim couldn’t lift his arms any higher than his shoulders. Otherwise healthy, he experienced ongoing frustration. He couldn’t reach up to cupboards; he couldn’t paint his house; he couldn’t even reach a book on a shelf above his head. Jim had given up hope of ever returning to normal. Then, simply to get exercise, he took up tai chi. Within six months, normal flexibility had returned to his shoulder joints. His life changed. He could reach.
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Let’s get it straight
In addition to these three main components of healthy exercise, tai chi also improves posture, an important component of health. Developing correct posture will result in less wear and tear of the joint muscles. When your posture is upright, the lung space is larger. Try taking a deep breath and expanding your chest. You’ll notice that there’s more space in the chest. Now try to hunch. The space in your chest diminishes, doesn’t it? As you can see, the body works better in an upright posture.
Shirley suffered from lower back pain and sciatica problems for some time before she started doing tai chi. Tai chi really helped her. “I think part of the reason I got better was that tai chi strengthened my back muscles and made me conscious of keeping good posture throughout the day,” she says. “I don’t slouch any more. It has really made a difference.”
Good posture in turn promotes better balance, thus preventing falls and the resulting injuries. Shirley goes on to say, “Tai chi has also strengthened my ankles. I was twisting and spraining them once or twice a year. Now, between my stronger ankles and better posture, I enjoy better balance, and as I get older, I’ll be less likely to fall.”
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It’s all in your head
The mind is the most important aspect of health. It’s a universally accepted fact that the mind controls the body. Surely you’ve heard of people overcoming disabilities because of their positive attitudes and strong minds? And tai chi, as one of the most powerful mind-body exercises, teaches the student to be aware of the intrinsic energy from which he or she can perceive greater self-control and empowerment.
Almost everyone who practises tai chi recognizes its powerful effect on relaxation and concentration. Take Joanne, for example. About 10 years ago while driving, she was clipped by a van running a red light. She suffered seven pinched nerves between her skull and her coccyx. Her frequent business travel didn’t help. For years she lived in pain.
Finally, a chiropractor suggested she try tai chi. “A six-week introductory course was enough to get me hooked,” says Joanne. “I found that, even in that short time, what we were doing was enough to help me start to relax, and that meant my back was finally getting a chance to heal.”
You don’t have to have sustained an injury to benefit from tai chi-produced relaxation. Tai chi simply offers a tool to help you cope with busy, modern-day life by appreciating the tranquillity and the nature around you.

Going hand-in-hand with relaxation is the alleviation of stress. As a high-energy businessperson, Joanne has truly benefited from her eight years of tai chi. “Physically, I can handle stress a lot better than I used to. I’m now aware much earlier when I’m responding to stress and can react appropriately. That means I don’t end up with tight shoulders and headaches.

“Mentally, I find that overall I handle people and stressful situations differently. I’m more inclined to sit back, listen, and evaluate a situation than I used to be,” she continues. “I make much more use of energy and try to be sensitive to other people’s energy to assess their state of mind and body. That’s tremendously helpful in dealing with difficult people and situations.”

Spirit DTCA Ashville 2

In this context, the term “spirit” refers to simply feeling good and positive rather than “spirit” in the sense of religious or occult. For instance, “Hey, today I’m in good spirits.” Or, “Today I’m happy.” It’s usually not easy to control your mood or your spirit with your conscious mind. If it were easy, depression wouldn’t be so common, nor would it be so hard for doctors to treat. The spirit and mood is largely controlled by the subconscious mind, which has an immense power to control us. For instance, you know you’re depressed, and although you dislike the condition, you can’t seem to get out of this mental state.
The daily stress, negativity and destructive emotion accumulate to dampen our spirit, whereas when we’re close to nature, for example, or involved in a cultural activity, our psychic energy gets in balance. All too often, fast-paced Western society tips the balance to the negative side. In fact, in Western society more than 50 percent of diseases presented to doctors are caused by mind-related problems, such as stress.
The spirit is also often meant a form of community spirit that one sees something more important than the self.

Tai chi can help. The ancient Chinese were aware of the immense power of the mind/spirit. Tai chi aims to achieve harmony with nature and the balance of mental serenity and physical strength. Having better balance calms the unconscious mind.

Enhancing the qi-vital life energy-during tai chi practice is the path to uplifting the spirit. The qi is simply a life energy within all living beings. For humans, our minds can learn to enhance qi, which in turn, connects with the unconscious mind to enhance our mental attitude. Qi grows when the person is well balanced and in harmony. Once your body is relaxed and calm, and your mind receptive, your qi will begin to circulate. And that will start your spirits soaring.
Related articles:
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Extract from: “Tai Chi for Beginners and the 24 Forms” by Dr Paul Lam and Nancy Kayne, Limelight Publishing 2006 with updates.Tai Chi for Beginners cover220

1. Tai Chi for Fall Prevention

By Dr Paul Lam, Dr Pamela Kircher and Maureen MillerDSC04312

© Copyright 2013 Dr Paul Lam. All rights reserved, except copy for non-profit making educational purpose. For example, you may forward to your friends or make copies for your fee-paying students as long as no fee is charged for this material.


Treatment of injuries, due to falls, is one of the most expensive health conditions. Evidence has shown tai chi being one of the two effective exercises to prevent falls. Dr Paul Lam’s “Tai Chi for Arthritis” program is proven by the world largest study on older adults for fall prevention, and also to improve health and the quality of life.

Update – CDC Recommends Tai Chi for Arthritis for fall prevention.PC20131

NB: CDC recommends the Tai Chi for Arthritis program which is exactly the same as Tai Chi for Arthritis and Fall Prevention except the later has additional emphasis on fall prevention. Both programs are evidenced based to effective at preventing falls. 

U.S. Administration for Community Living Falls Prevention Grantee Tai Chi for Arthritis Information and Guidance.

Falls and Tai Chi
According to the US Centers for Disease Control and Prevention (CDC), one in three adults over the age of 65 fall each year. Treatment of injuries due to falls is the most expensive health cost, estimated 2015 by CDC to be 31 billion dollars per year in USA.
There are many studies on measures to prevent falls. A recent review of 111 randomised trials involving over 55,000 subjects singled out tai chi and individually prescribed exercise programs to be effective. There remain skeptics who see tai chi as too gentle an exercise to have such significant effects. True, tai chi movements appear to be gentle and graceful, but like the force beneath a seemingly calmly flowing river, tai chi movements contain much power and internal strength. What is fascinating is that the fear of falling often results in more falls; hence, confidence in “not falling” will help to reduce falls. With regular practice, tai chi improves balance by strengthening muscles and co-ordination; at the same time, it strengthens the mind, thereby improving calmness and confidence in not falling. Thus, both physically and mentally, tai chi is an extremely effective exercise for fall prevention. A great bonus, at the same time, tai chi also improves almost all aspects of health!DSC04414
An Evidence Based Approach
In addition to established manuals and consistent instructor training world-wide, the Tai Chi for Arthritis program is evidence based. The following are several examples.
Similar to other western countries, the New South Wales Health Department of Australia experiences high costs related to injuries due to falls—far higher than from injuries of any other source including road trauma.iv In 2001, the Department funded the world’s largest fall prevention study in a community setting. The majority of participants were taught the Tai Chi for Arthritis program. vi This study found that recurring falls were reduced by nearly 70%. It also found that building confidence—a fundamental component of the Tai Chi for Arthritis program—correlates closely to the reduced rate of falling. This study was one of the two listed on the CDC official site as evidence of tai chi preventing falls.

Since then, and based on the evidence of the study, the New South Wales Health Department has funded many tai chi for faDSC04240ll prevention programs using Tai Chi for Arthritis. One of these was conducted in the town of Ford. For two years, approximately 20% of the population participated in tai chi classes. An evaluation by the Health Department, taken of the 576 persons age 65 or over, sampled 31 participants. It was found that 99% of the participants had improved balance and flexibility and 100% improved strength.

In addition to the New South Wales Health Department, the Aged Care Department in Victoria, the South Australia Health Department, and Sport and Creation Department, among others around the world, have funded training for Tai Chi for Arthritis programs.
A Greater South Health Area Service (GSHAS) program was studied by the Australian National University. The GSHAS, which covers a total population of 452,643 distributed over an area of 166,000 square kilometers, has implemented and provides ongoing support for the Tai Chi for Arthritis program on a not-for-profit basis for eight years. A research team from the Australian National University studied the recent three years (Feb 2007 to June 2010) during which the Tai Chi for Arthritis program was followed by 1.7% of the target population. There were 119 classes in 49 locations at a cost estimated to be 76 AU$ per person per year. The outcome shows significant improvement in fall rate and general well being. Interestingly, falls and fear of falling are a relatively minor factor in participants’ motivation to join the tai chi classes. Instead, people keep coming to tai chi classes because they experience a range of physical, social and cognitive benefits which they find overwhelmingly positive. These benefits include improvements in physical function, psychological health and well-being, and social vigour—all relatively evenly distributed among the participant body. Such benefits address a range of issues which pose challenges for the elderly and ageing population in rural communities.DSC04357

In 2000, the Accident Compensation Corporation (ACC) in New Zealand, a national government body that has a no-fault policy and compensates all accidents and injuries in the country, realised that prevention is often much cheaper than treatment. Their medical experts recommended using tai chi, among other exercises, to prevent falls. Being new to tai chi, the ACC’s initial foray into contracting for tai chi instruction was met with several challenges. For example, instructors taught different styles of tai chi, making it difficult to assess outcome and enforce safety standards; one major provider, who franchised instructors nationally, based the teaching on Chen style, which was too complex and martial. Additionally the teaching methodologies were not geared to learning styles of older adults and did not focus on safety. However, once the ACC adapted the less complex and easier to learn Tai Chi for Arthritis program, more positive results were obtained.dsc00855

As the ACC discovered, tai chi encompasses a vast number of styles and forms; plus there are a myriad ways of teaching tai chi. In translating medical evidence to benefit a community, not only is content important, but equally so is the teaching method. The ACC worked with Dr Lam to install a training program that included safety and quality control. Within a year, instructors were trained and excellent quality was maintained with minimal cost. By 2009, approximately 80% of the ACC’s 700 trained instructors were using the Tai Chi for Arthritis program, delivering Tai Chi to over 35,000 people.

How Tai Chi Works
No matter what forms of tai chi, if specific tai chi principles are incorporated into tai chi practice, the result will be better balance and reduced falls. The principles are:TCworkshop_2015_100
1. Movement control
Tai chi movements are slow, smooth and continuous, helping to strengthen internal muscles, like the deep stabilisers that support and strengthen the spine. Additionally, tai chi practitioners move against a gentle resistance to build full
muscular strength. Slow and smooth movements calm the mind, helping to reduce falls resulting from sudden movements that lead to significant blood pressure drop, especially in elder people taking medication that can cause
change of blood pressure.
2. Weight transference
Tai chi practitioners are mindful of transferring weight with each step, helping to improve mobility, coordination and balance. This, in addition to emphasis on upright and supple posture, further strengthens muscles.
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3. Integration of mind and body
Tai chi is an internal art, which stresses the integration—and balance—of mind and body. Tai chi practitioners focus, calm their minds, and loosen and relax their joints and ligaments. A number of studies indicate that being confident results in less falls, since the fear of falls increases the risk of falling. Practicing a mindbody exercise, such as tai chi, builds confidence, thus alleviating the fear of falling. 
Why Tai Chi for Arthritis for Fall Prevention Workshome2
Factors that make the Tai Chi for Arthritis program so effective include a high standard and consistent training of instructors throughout the world—one of the reasons CDC has listed this program and is promoting it for fall prevention.
Tai Chi for Arthritis incorporates a progressive stepwise teaching method that simplifies and enhances the student’s ability to learn. The teaching method also encourages students through specific positive feedback and minimal corrections, thereby enhancing their enjoyment of learning and creating a sense of achievement. Instructor training also includes understanding the principles listed above and working with students to incorporate them into real life situations. Because of the allure of the Tai Chi for Arthritis form itself and the standardised teaching method, students tend to adhere to this tai chi program much more than in a regular exercise program.DTCA Ashville 2
Extra Benefit: Reduction of the Burden of Chronic Diseases.
Investing in tai chi programs can have cost savings in other areas. As the practice of tai chi improves many aspects of health, it can also be an ideal preventive intervention. The U.S. National Institute of Health’s National Center for Complementary and Alternative Medicine suggests that people practice tai chi for a variety of health-related purposes, such as
• for benefits associated with low-impact, weight-bearing, aerobic exercise;
• to improve physical condition, muscle strength, coordination, and flexibility;
• to improve balance and decrease the risk for falls, especially in elderly people;
• to ease pain and stiffness—for example, from osteoarthritis;
• to improve sleep;home3
• for overall wellness.
The largest study about the practice of tai chi by people with arthritis, published in the Arthritis Care and Research Journal, found that the Tai Chi for Arthritis program not only reduced pain, but also improved the quality of life. It has also been found to improve standing balance for people with strokes as well as six out of eight measurements of quality of life for older adults. A study, published in the Journal of Alternative and Complementary Medicine, followed 82 older women divided into tai chi and control groups. After six months, those practicing tai chi significantly increased knee extensor endurance and bone mineral density and had less fear of falling than the control group.
most exciting study has shown regular tai chi practice improves genetic components that are associated with health and wellness at the molecular level, e.g. tai chi practitioners have improved chromosomal markers relating to health and significant slowing (by 5–70%) of the age-related methylation losses.Dr Lam, Linda from MN and Linda from UK at Alaska Tai Chi for Diabetes workshop
The May 2009 issue of the Harvard Health Newsletter suggests that while tai chi is often described as “meditation in motion”, it could well be called “medication in motion”. For, in addition to preventing falls, tai chi programs have been shown to be helpful for a number of medical conditions including: arthritis, lower back pain, low bone density, breast cancer and its side effects, heart disease and heart failure, hypertension, Parkinson’s disease, sleep problems, and stroke.
“A growing body of carefully conducted research is building a compelling case for tai chi as an adjunct to standard medical treatment for the prevention and rehabilitation of many conditions commonly associated with age,” says Peter M. Wayne, assistant professor of medicine at Harvard Medical School and director of the Tai Chi and Mind-Body Research Program at Harvard Medical School’s Osher Research Center.
Tai Chi Has an Important Role in the Future of Health Management.
Research has demonstrated that the practice of tai chi improves many components of health. Tai Chi for Arthritis, in particular, has been shown to help prevent falls and improve health and the quality of life. Additionally, it may prevent and/or improve the management of chronic diseases, particularly for our ageing population, and thus be an effective measure to save significant health care costs. The Milken Institute reports that the annual economic impact on the U.S. economy of the most common chronic diseases is calculated to be more than one trillion dollars. However, if the
impact of seven chronic diseases—diabetes, pulmonary conditions, hypertension, mental disorders, heart disease, cancers and stroke—could be prevented, by midcentury the annual GDP could be reduced by six trillion dollars a year. Tai chi has a important role to play in preventing these chronic conditions and improving health and wellness.


Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and nonfatal falls among older adults. Injury Prevention 2006;12:290–5.

ii Englander F, Hodson TJ, Terregrossa RA. Economic dimensions of slip and fall injuries. Journal of  Forensic Science 1996;41(5):733–46.

iii Gillespie L D, Robertson M C, Gillespie W J, Lamb S E, Gates S, Cumming R G, Rowe B H; Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2009, Apr 15;(2): CD007146. http://www.ncbi.nlm.nih.gov/pubmed/19370674

iv Policy Directive, Fall Injury Among Older People – Management Policy to Reduce in NSW  health, http://www.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_353.pdf

v Alexander Voukelatos, MA (Psychol); Robert G. Cumming, PhD; Stephen R. Lord, DSc; Chris Rissel, PhD. A Randomised, Controlled Trial of Tai Chi for the Prevention of Falls: The Central Sydney Tai Chi Trial. Journal of American Geriatrics Society, August 2007, Vol. 55, No. 8

vi Quote from Dr Lam’s correspondence with the chief author, Dr Alex Voukelatos: ’”Of the 76 Tai Chi programs taught by 22 instructors, 58 (76%) were Tai Chi for Arthritis (TCA) based on Sun style tai chi. They were taught by instructors certified in TCA by Dr. Paul Lam’s Tai Chi for Health.”

vii  Hall SJ, Phillips CB, Dubois L, Follett N & Pancaningtyas N. Preventing Falls, Promoting Health, Engaging Community: Evaluation Report of the Greater Southern Area Health Service Physical Activity Leaders Network Tai Chi Program. Canberra: ANU Medical School. 2010.

viii  Presentation at the ACC annual conference 2010 by Rose Ann, Programme Manager, Accident Compensation Corporation, Wellington, New Zealand

ix  http://nccam.nih.gov/health/taichi/

 Fransen M, Nairn L, Winstanley J, Lam P, Edmonds J. A Randomised Control Trial Of 200 Subjects Comparing Tai Chi, Hydrotherapy And Control, To Measure Improvement In Pain, Physical Function, Muscular Strength And Walking Capacity. Arthritis Care and Research. Vol. 57, No.3, April 15, 2007, pp

xi  Stephanie S. Y. Au-Yeung, PhD, Christina W. Y. Hui-Chan, PhD, and Jervis C. S. Tang, MSW; Neurorehabilitation and Neuro Repair, Volume 20, Number 10, January 7 2009,

xii  Ching-Huey Chen, Miaofen Yen, Susan Fetzer, Li-Hua Lo, Paul Lam; The Effects of Tai Chi Exercise on Elders with Osteoarthritis: A Longitudinal Study. Asian Nursing Research. December 2008 Vol. 2 No4.

xiii  Rhayun Song, Beverly L. Roberts, Eun-Ok Lee, Paul Lam, Sang-Cheol Bae. A Randomized Study of the Effects of T’ai Chi on Muscle Strength, Bone Mineral Density, and Fear of Falling in Women with Osteoarthritis. The Journal of Alternative and Complementary Medicine, Volume 16, Number 2, 2010,
pp. 1–7

xiv  Hua Ren,Veronica Collins, Sandy J. Clarke, Jin-Song Han, Paul Lam, Fiona Clay, Lara M.Williamson,K. H. Andy Choo. Epigenetic Changes in Response to Tai Chi Practice: A Pilot Investigation of DNA Methylation Marks. Evidence-Based Complementary and Alternative Medicine, Volume March 2012,Article ID 841810, 9 pages.

xv  “The health benefits of tai chi”, Harvard Health Publications. May, 2009. https://www.health.harvard.edu/newsletters/Harvard_Womens_Health_Watch/2009/May/The-health-benefitsof-tai-chi

xvi http://www.milkeninstitute.org/publications/publications.taf?function=detail&ID=38801154&cat=Arts 

How Does Tai Chi for Arthritis Work?

By: Dr Paul Lam

© Copyrights Tai Chi Productions 2007. All rights reserved, no part of this article may be reproduced in any forms or by any means, without permission in writing, except for non-profit educational purpose. For example: you can photocopy this article for a paying student or participant as long as this article is not included as part of your charge.

NB: The Tai Chi for Arthritis Program is the same as the Tai Chi for Arthritis for Fall Prevention Program which was recommended by the Centers for Disease Control and Prevention (CDC) at 2013 in America and evidenced based. Both programs have exactly the same movements and incorporated tai chi principles for improving health and wellness, as well as proven effective for fall prevention. The former has slightly more emphasis on arthritis while the later on fall prevention.

Tai Chi for Arthritis workshop Brisbane Australia 2006Synopsis
Since the inception of Tai Chi for Arthritis in 1997, over five million people around the world have enjoyed using the program and gained health benefits. Studies have shown its effect in relieving pain, improving physical ability and balance. Arthritis Foundations around the world support the program and instructors trained by the creator, Dr Paul Lam and his authorised master trainers.
Exercise Helps Arthritis
Exercise or being active is essential for good health, it is even more important for people with arthritis. Pain and stiffness of the joints tend to discourage and even limit people from exercising. However, without exercise, joints become stiffer and muscles weaker which will lead to further pain and stiffness. In another word, without exercise arthritis gets worse in the long term. Exercise keeps bones, muscles, and joints healthy, thus improving flexibility and muscular strength. Exercise improves the circulation of blood and body fluids through muscles, tendons and joints. Better circulation will aid the healing process.
Tai Chi for Arthritis workshop in Sydney 2005
What Kind of Exercise?
Not all exercises are suitable for people with arthritis. An effective exercise program should have low risk of injury and fulfil three objectives: increase flexibility, strengthen muscles, and improve cardiorespiratory fitness. Tai Chi for Arthritis can accomplish these and more.
The Tai Chi for Arthritis Program
In 1997, Dr Paul Lam’s team of Tai Chi and medical experts designed the program Tai Chi for Arthritis especially for people with arthritis. This program is based on Sun style Tai Chi for its unique Qigong component which has a powerful healing ability. It contains all the essential principles of Tai Chi and the movements are safe. It is short and easy-to-learn. Tai Chi for Arthritis helps arthritis by improving muscular strength, flexibility and fitness. Studies have shown the program to be effective and safe (referencesand 2). Arthritis Foundations of Australia, America, Arthritis Care UK and many others support this program because its efficacy and safe features.
1. Improved Flexibility
Improved flexibility will reduce stiffness and help keep joints mobile. Stiffness causes pain; increase flexibility will relieve pain.  Tai Chi for Arthritis gently moves all joints, muscles and tendons throughout the body. Scientific studies have shown Tai Chi can significantly increase flexibility (references 34 and 5).     
The Atlanta FICSIT Group (reference 6) conducted a prospective, randomised, controlled clinical trial. The study divided 200 participants into three groups: Tai Chi, computerised balance training and control. The results indicated that Tai Chi significantly improved flexibility, strength and cardiovascular endurance, as well as decreased the occurrence of falls by a massive 47.5%.Tai Chi for children with and without arthritis 2008
Tai Chi for Arthritis contains all the essential principles of Tai Chi that support the improvement of flexibility. It has shown to relieve arthritic pain, helping people with arthritis to stretch more thus further improve their flexibility. What is more, it prevents recurrent falls by an amazing 70% (reference 7).
2. Improved Muscular Strength
Improved muscular strength will help keep joints stable, thereby protecting the joints. This minimises the likelihood of injury and reduces pain. Increased muscular strength enables a person to be more active, which in turn improves blood and body fluid circulation.
Many top level athletes and sportsmen have suffered from osteoarthritis as a result of injuries. Yet they are able to perform at peak levels because their strong muscles protecting their joints. Frequently, after retirement from active sports, their level of activity diminishes and their muscles become weak, causing their arthritis to flare up.
Studies have shown Tai Chi to be effective in strengthening muscles by 15 to 20 % (references 891011 and 12). Tai Chi for Arthritis helps to relieve pain, enable people with arthritis to exercise their muscles to improve its strength.  The Song study showed an improvement of learners’ physical function and balance by 30% after only three months of learning Tai Chi for Arthritis  (reference 1).
Tai Chi for Arthritis workshop in USA 2005
3. Improved Fitness
Improving cardiorespiratory fitness helps strengthen the heart and lungs and increases stamina. Arthritic joints and tissues need a good supply of blood and oxygen for healing. Better circulation of blood, fluid and oxygen also helps keep joints flexible and muscles strong. Tai Chi for Arthritis is designed to gradually increase the level of fitness. Study has shown Tai Chi to be effective in improving fitness level  (reference13).
The Power of the Mind
It is well known that a positive frame of mind aids healing. There is ample evidence showing the powerful effect of mind over body. Tai Chi integrates both the body and mind. When practicing Tai Chi, one focuses on clarity of the mind, the movements and the coordination of the body. This training improves relaxation and uplifts a person’s mood. A recent review of complementary and alternative treatments completed by doctors from Stanford University (reference 14) concludes that mind-body techniques are efficacious primarily as a complementary treatment, but sometimes as a stand-alone, alternative treatment.
Being more relaxed and more positive improves the perception of pain. As one of the most powerful mind-body exercises, Tai Chi for Arthritis teaches students to be mindful of the intrinsic energy from this derives a greater sense of self-control and empowerment.
The Power of Qigong
The concept of Qi has been a fundamental belief in most eastern cultures for thousands of years. Qi is the inner energy of a person. Chinese medicine has based their central theory on this concept. The word, “Gong” means exercise that requires regular practice to become proficient. Qigong is the practice of cultivating better Qi. It is a breathing exercise sometimes helped by certain body movements and meditation. When Qi flows through the body smoothly and powerfully, it enhances healing and brings better health and vitality. According to Chinese medicine, arthritis is caused by weak and sluggish flow of Qi. For centuries, doctors of Chinese medicine have recommended Tai Chi for people with arthritis.Dr Lam at a Tai Chi for Arthritis workshop in USA 2006
Tai Chi for Arthritis incorporates the Sun style’s unique Qigong in all its movements. The gentle and slow movements open up one’s energy channels, keeping them strong and supple. The rhythmic movements of the muscle, spine and joints pump energy throughout the whole body.
The Practical Advantages
Tai Chi for Arthritis is affordable for most people. It does not require expensive equipments, special clothing or much space. It is not weather-dependent and can be a nice social event.
Tai Chi is a progressive exercise in the sense that no matter at what age you start, you can develop your skill. As one progresses, the more fascinating it becomes. Tai Chi for Arthritis has great depth. As you progress to a higher level your mind becomes more serene, body becomes stronger and your understanding of Tai Chi principles deepens. This deeper understanding will, in turn, enable you to reach an even higher level. Akin to looking at a very high mountain, it is impossible to see the top from ground level. You will see more of the view when you make the effort to climb higher up. At the higher level, the view becomes more fascinating and the air fresher. At a higher level Tai Chi, you will discover more enjoyment, health benefits and personal fulfilment.
Exercise will benefit people only when they do it. Naturally, people are more likely to do the exercise they enjoy. Tai Chi for Arthritis is intrinsically enjoyable exercises that can help people adhere to them. Thousands of Tai Chi for Arthritis instructors around the world will attest to their students’ enjoyment because they keep returning year after year.Tai Chi for arthritis workshop in Sydney 2007
Improve Balance and Fall Prevention
Injury from falls by older people is a serious health problem, it is even more so for people with arthritis as pain and weakened muscle compromise their abilities to balance.
Tai Chi for Arthritis has been shown to improve balance and prevent falls by several studies i  . The Sydney Central Area Health Promotion study is community based and the world’s largest fall prevention study with 700 subjects. After 16 weeks of Tai Chi (80% doing Tai Chi for Arthritis), the incident of multiple falls was reduced by an incredible 70% (reference 7).
How to Learn Tai Chi for Arthritis
Contact your local arthritis foundation, or use this website to find classes by trained instructors. You can also use the instructional DVD, the book Overcoming Arthritis and other teaching material available from our store to learn the program.
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1.  Song, Lee E, Lam P, Bae S. Effects of Tai Chi exercise on pain, balance, muscle strength, and physical functioning in older women with osteoarthritis: A randomized clinical trial. Journal of Rheumatology. Sept 2003. 30:9 page 2039-2044.

2.  Fransen M, Nairn L, Winstanley J, Lam P,  Edmonds J.  A Randomized Control Trial Of 200 Subjects Comparing Tai Chi, Hydrotherapy And Control, To Measure Improvement In Pain, Physical Function, Muscular Strength And Walking Capacity. Arthritis Care and Research.. Vol.57, No.3, April 15, 2007, pp407-414.

3.  Lan-C; Lai-JS; Wong-MK; Yu-ML:Cardiorespiratory function, flexibility, and body composition among geriatric Tai Chi Chuan practitioners. Arch-Phys-Med-Rehabil. 1996 Jun; 77(6): 612-6.

4.  Lan-C; Lai-JS; Wong-MK; Yu-ML: 12-month Tai Chi training in the elderly: its effect on health fitness. Med-Sci-Sports-Exerc. 1998 Mar; 30(3): 345-51.

5.  Chen,-W.-William; Sun,-Wei-Yue: Tai Chi Chuan, an alternative form of exercise for health promotion and disease prevention for older adults in the community. International-Quarterly-of-Community-Health-Education. 1997; Vol 16(4): 333-339.

6.  Atlanta FICSIT Group: Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. J-Am-Geriatr-Soc. 1996 May; 44(5): 489-97.

7.  Alexander Voukelatos et all, Journal American Geriatrics Society, AUGUST 2007–VOL. 55, NO. 8, A Randomized, Controlled Trial of tai chi for the Prevention of Falls: The Central Sydney tai chi Trial. (NB: 80% of subjects were taught Tai Chi for Arthritis)

8.  Wolfson-L; Whipple-R; Derby-C; Judge-J; King-M; Amerman-P; Schmidt-J; Smyers-D: Balance and strength training in older adults: intervention gains and Tai Chi maintenance. J-Am-Geriatr-Soc. 1996 May; 44(5): 498-506.

9.  La-Forge-R: Mind-body fitness: encouraging prospects for primary and secondary prevention. J-Cardiovasc-Nurs. 1997 Apr; 11(3): 53-65.

10.  Jacobson-BH; Chen-HC; Cashel-C; Guerrero-L: The effect of T’ai Chi Chuan training on balance, kinesthetic sense, and strength. Percept-Mot-Skills. 1997 Feb; 84(1): 27-33.

11.  Judge-JO; Lindsey-C; Underwood-M; Winsemius-D: Balance improvements in older women: effects of exercise training. Phys-Ther. 1993 Apr; 73(4): 254-62; discussion 263-5.

12.  Wolfson-L; Whipple-R; Judge-J; Amerman-P; Derby-C; King-M: Training balance and strength in the elderly to improve function. J-Am-Geriatr-Soc. 1993 Mar; 41(3): 341-3.

13.  Channer-KS; Barrow-D; Barrow-R; Osborne-M; Ives-G: Changes in haemodynamic parameters following Tai Chi Chuan and aerobic exercise in patients recovering from acute myocardial infarction. Postgrad-Med-J. 1996 Jun; 72(848): 349-51.

14.  Luskin-FM; Newell-KA; Griffith-M; Holmes-M; Telles-S; Marvasti-FF; Pelletier-KR; Haskell-WL: A review of mind-body therapies in the treatment of cardiovascular disease. Part 1: Implications for the elderly. Altern-Ther-Health-Med. 1998 May; 4(3): 46-61.

15.  Choi J.H., Moon J.S. and Song R, The Effects of Sun-Style Tai Chi Exercise on Physical Fitness and Fall Prevention in Fall-Prone Adults. The journal of Advanced Nursing 51(2), 150-157, 2005

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Tai Chi for Arthritis – Fact Sheet for Health Care Professionals

Tai Chi for Arthritis – Fact Sheet for Health Care Professionals
By: Arthritis Foundation of Australia

� Copyright Dr Paul Lam. Reproduction for nonprofit educational purposes is permitted.

If your patient would like to enroll in a Tai Chi for Arthritis class, this is information about tai chi in general, and the special benefits of the Tai Chi for Arthritis program.
What is Tai Chi?
  • Tai Chi is a slow moving meditative exercise that began in ancient China, around 500 years ago.
  • Tai Chi combines stress reduction with movement to improve health.
  • Dr. Paul Lam, from Sydney, Australia is family practice doctor who developed Tai Chi for Arthritis for people with arthritis and elderly people with balance problems. Dr Lam developed the form with input from rheumatologists and physical therapists.
What are the benefits of Tai Chi for Arthritis?
  • Increases strength and flexibility
  • Decreases pain in joints
  • Decreases stress
  • Helps reduce high blood pressure
  • Increases sense of well-being.
  • Improves balance

What is some of the research behind Tai Chi? 

Who practices Tai Chi for Arthritis?

  • Tai Chi for Arthritis has been officially adapted as the tai chi form used by the Arthritis Foundation of America; supported by Arthritis Foundation of Australia and Arthritis Care of UK.
  • Thousands of people practice Tai Chi for Arthritis in the U.S. and internationally. 


How can you encourage your patient to benefit from Tai Chi for Arthritis?

  • Complete the Participant Enrollment Form for your patient (download from Arthritis Foundation Australia's website).
  • Ask them about their tai chi practice when they come in for regular visits.
  • Monitor the effect of tai chi on their report of pain, flexibility, and balance.

Tai Chi for Chronic Fatigue Syndrome

By: Dr Paul Lam
Copyright Dr Paul Lam 2005. Copying for non profit educational purpose is permitted. For Example; you can give your fee paying students this article but not sell to them.

Disclaimer: All persons involved in the writing of this article will not be held responsible in any way whatsoever for any injury or consequence that may arise as a result of following the instructions given in this article. Readers are advised to work with their health professionals before commencing these activities. Readers engaged in activities described in this article do so at their own risk.

Note: This guide is complementary to the program Tai Chi for Back Pain, Wheelchair Bound and Other Chronic Conditions. It is intended to help you to use the program effectively and safely. Dr Paul Lam is the producer of the commercially available instructional DVD of the program.

This article contains a step-by-step guide on how to best use the program for people with chronic fatigue syndrome.

From Clinical Practice Guidelines – 2002 for people with Chronic Fatigue Syndrome (CFS): Produced by a Working Group convened under the auspices of the Royal Australian College of Physicians published by Medical Journal of Australia

“On Physical activity
In general, people with CFS should be encouraged to undertake physical and intellectual tasks, starting at a level that is tolerated without significant exacerbation of symptoms. This should initially be in divided sessions of a relatively short duration. As exercise tolerance improves, duration and intensity of activity can be gradually increased. Graded exercise programs have been shown to be beneficial for some people with CFS, and can improve functional status.
It is important to discuss with the patient the vicious circle whereby initial avoidance of physical activity may lead to longer-term avoidance of all activity. In the early stages of the illness, many people with CFS put off chores or social engagements until they feel better, then push themselves excessively on “good days” to make up for lost time. The subsequent worsening of symptoms and delayed recovery can establish a cyclic pattern of illness and disability.
An individualized management program should be carefully negotiated between the patient and doctor, with particular attention to:
” starting at a level of activity that can be achieved without exacerbation of symptoms – abrupt resumption of strenuous activity after prolonged periods of inactivity should be discouraged;
” undertaking activity on a regular basis, with sessions of limited duration; and
” planning for regular reviews to achieve feasible increases in activity over a realistic time-frame (e.g. several months).
In formulating a management plan, it is important to be aware that in many people with CFS the degree of fatigue can fluctuate unpredictably from day to day and week to week. Flexibility in the level of physical and mental activity undertaken to allow for such fluctuations (“pacing”) should be explicitly discussed.”

There are different levels of severity with CFS, please adjust your level accordingly; if in doubt, discuss with your health professionals.

The advantage of tai chi is that you can use visualization to practice so that in a bad period of your condition you can keep up with your progression without aggravating it.

You can also adjust your level of exertion with regard to how deep is your knees are bent, and how much internal force you are using, as well as the length of time for practice.

Using both the Tai Chi for Back Pain DVD and the Tai Chi for Arthritis handbook (as the Tai Chi for Back Pain is based on the same set of tai chi forms as Tai Chi for Arthritis) can help you learn the program easier, although if possible an instructor who is familiar with your condition is the ideal way to learn.

Work out what is a realistic time to practice daily with your health professional. A rough guide would be how much time you can walk comfortably. If you are a person who is severely affected, you should do minimum physical work possible for you but still do at least 5-10 minutes practice daily using the visualization method.

Adhere to a routine unless there is a medical reason not to. Whenever you feel you could be over-exerting yourself, use visualization to replace physical practice and check with your health professional at any time. Follow the instructions on the DVD, only do what you can within your comfort zone and visualize anything you cannot do.

Let us start:tai chi for back pain workshop in Florida USA 2004

Let us start. Please note: I am using the timing system with the DVD in a (…minutes) to help you locate the specific segment.

1. Starting with the introduction (0 – 11minutes), it contains information of what is back pain, what is tai chi and general precautions for all viewers and specifically for people with back pain. Take care to follow the precautions. Ignore the back pain discussion if you don’t have that problem, however most contents regarding back pain are also helpful for health improvement and back pain prevention. The program is effective for general health improvement especially for people with most chronic conditions.

You don’t need to have back pain to do this program. To find out how it works to improve your health, please read “How Tai Chi Helps Arthritis” in the handbook (p 9), as well as the article “What Can Tai Chi Do for You“.

Also read “Tai Chi Practice” on page 11 of the handbook.

2. Now that you are prepared and understand how to take care of easing into the exercise, let us go to lesson one. Learn the Deep Stabilisers muscle exercises. Be aware that you can do it sitting, lying or standing and with visualization. Try to think about it, contracting the pelvic muscles gently any time during your daily activities. If you don’t have the strength to sit or stand straight, do what is comfortable and visualize sitting straight.

Depending on the level of your condition, spend 1 to 10 days on this before moving on.

More written instructions for the exercises are included at the end of the article. These exercises will enhance your life energy (Qi – see page 47 handbook) therefore enhancing health in general, and improving your level of tai chi. Try to incorporate them slowly into all your tai chi movements.

3. Contents of lesson one (11-40 minutes):

  • Warm up, stretching and cooling down exercises
  • Qigong exercises:

    1. The Posture of Infinity
    2. The Posture of Tai Chi
    3. The Posture of Opening and Closing

  • Movement 1. Commencement

A session of half an hour will be used from now on. The number of session (s) recommended is a guide only, use more session if required. Avoid going faster than recommended unless you and your health professional are sure that you can do it. Patience is part of tai chi philosophy.

If you feel that is too long and ten minutes is the best for you, simply divide it into three sessions to cover the same content. Tai chi is not about how many forms you can learn, and how fast you are learning. Rather it is more about how well you understand the principles and integrates them into your practice. Practicing with visualization can be just as effective.

Use one to three sessions to learn the warm up and cooling down exercises. Practice another one to three sessions until you are comfortable at doing them before moving on.

4. Use one to three sessions to learn the three Qigong exercises. Practice several sessions until you are ready before moving on. Always do warm up before starting and cool down when finishing for your future tai chi exercises. The Qigong exercises can be brought up anytime, for example when you are sitting down waiting for your doctor, you can physically or mentally adjust your posture, be aware of the dan tian and breathe gently using abdominal muscles.

5. Having done your warm up exercises, revise the previous contents before starting the new movements. There is no hurry, pacing yourself is part of tai chi philosophy; tai chi is a way of life to many of us – the way of life is nature. Nature moves when it is ready, no one needs to hurry nature and it would not work if you tried.

Movement 1 can be learned any time you are ready using one to three sessions. Practice a similar number of sessions for each new exercise you learn; only move on when it feels comfortable to do so.

6. Contents of lesson two (40- 47 minutes).

  • Qigong exercises:

    4. The Posture of Yin Yang Harmony

  • Movement 2 – Opening and Closing Hands
  • Movement 3 – Single Whip


Remember in tai chi, it is important to control your movements so that they are slow, even and continuous rather than moving fast and getting over as many movements as possible. Tai chi is different from the fast paced world we are now a part of. Tai chi philosophy is that moving slower may get you closer to nature and health faster, and moving in curves can be more effective than a straight line.

You can learn the 4th Qigong (pronounce as chee gong) exercise in one or two sessions. Practice all four Qigong exercises together once you remember them.

Movement 2 should take one to two sessions; remember to practice before moving on.

Movement 3 should take one to four sessions, and same sessions for practice.

If you encounter any discomfort or problems, discuss with your health professionals or instructor. It is a good idea to check with your health professional every now and report how you are getting along.

Link everything you have learned and practice in a sequence. For example, once you have learned movement 1 and 2, practice them together, and then when you have learned movement 3, continue to practice 1,2 and 3 together in a sequence.

7. Lesson 3 (47-59 minutes) begins to put everything together; the natural flow of tai chi is beginning to show.

The contents are:

  • Movement 4 – Waving Hands in the Cloud.
  • Movement 5 – Opening and Closing Hands
  • Movement 6 – Closing
  • Both sides of the six movements


As a general rule, I recommend two to four sessions per movement and a similar numbers of sessions for practice. By now you should have a rough idea of what you can do; if you are not sure, go for the conservative approach. Movement 4 is more difficult, you may need more time, whereas movement 5 and 6 are repetitions which do not require much time to pick up.

You may need to give yourself more time to learn and practice the Basic Six set to the other side.

8. Depending on how well you have done the previous lessons, you can adjust your speed accordingly.

Now you should read “Six Tai Chi Principles for Beginners” at page 53 of the handbook, as listed below.


Tai chi contains essential principles, all of which are fundamental and similar in the different styles. When you concentrate on the essential, you speed up your progression, and you improve, no matter what style you do. Don’t worry about the minor details. Focus your practise on these principles.

In my workshops and videos, I mention these essential principles. Here, I’ve converted them into simple, easy to understand terms. They are classified into: Movement; body and internal.

1. Make your movements slow, even and continuous, maintaining the same speed throughout. In other words, control your movements.

2. Move as though there is a gentle resistance. Imagine that the air around you is dense and you have to move against this dense air. This will help you cultivate your inner force.

3. Be aware of your weight transference. First, centre yourself, then control your balance, keeping your body alignments, and when you move backwards, forwards or sideways, touch down first, then gradually and consciously transfer your weight forward or backward.

4. Body Alignments. Be sure you keep your body in an upright position.

5. Loosening the joints. It is important to do the Tai Chi movements in a relaxed manner but relaxation here does not mean that all your muscles go floppy. You should be stretching, loosening. Try consciously and gently stretch every joint from within, almost like an internal expansion of the joints.

6. Mental Focus. Be sure not to let your mind distract what you are doing and focus on your movement so that your internal and external are well integrated.

Try to work on one principle at a time, for several sessions, until you feel proficient with it, then pick up another principle to practice with the Basic set you have done so far. Keep practicing with all principles before moving on to the next lesson.

These are the contents of the remainder of the lessons:

Lesson 4 – moving (59 minutes -1 hour 30 minutes)

  • Warm up, stretching and cooling exercises
  • Qigong exercises
  • Both sides of the six movements


Lesson 5 – moving (- 1 hour 38 minutes)

  • Advanced movement 1 – Brush Knee
  • Advanced movement 2 – Playing the Lute


Lesson 6 – moving (- 1 HOUR 44 minutes)

  • Advanced movement 3 – Parry and Punch


Lesson 7 – moving (- 1 hour 47 minutes)

  • Advanced movement 4 – Apparent close up
  • Advanced movement 5 – Pushing the Mountain
  • Advanced movement 6 – Opening and Closing


Lesson 8 – moving ( – 1 hour 50 minutes)

  • Both sides of the advanced 6 movements


A Few points to consider:

Use the recommended general rule of learning a movement in two to five sessions. If standing and moving around takes too much energy, you should sit down most of the time and slowly add a small portion of moving practice. Progressively increase your exertion level according to your condition, be conservative but consistent.

After lesson 4 you should practice for a period of one to four months before moving on. Many people gain significant benefits from practicing these initial movements. You should continue to practice these until you notice your fitness and health has improved, and you are confident with your forms before moving on.

Go back to the tai chi principles regularly, as you progress further in tai chi, they will take a some what different meaning to you. Tai chi’s immense depth comes from its essential principles.

After lesson 8 and practice for a suitable period of time, and having done the six principles several times, you can move on the Ten Essential Principles on page 54 of the handbook. You will find the fundamental principles in tai chi are similar and can appear simple, to appreciate their depth you need to practice. Through practice you can learn and enjoy the different layers of tai chi inner meanings. By now you might need a suitable instructor to progress further and to help interpret these principles. Read my book “Overcoming Arthritis” published by DK on how to find a good tai chi teacher, or the article of this topic on my website in the article section.

If you are unable to find a suitable instructor and if your progression is going to be very different from the other people, consider having private lessons. You are welcome to write to me for any advice or information. The best way to contact me is online via email to service@taichiproductions.com . Or write to: C/O Dr Paul Lam, Tai Chi Productions, 6 Fisher Place, Narwee, NSW 2209, Australia.

Best wishes for a healthier and better quality of life, and enjoy the journey.