A rheumatology nurse has set up low cost tai chi classes for people with long term health issues in the Nottingham area. This initiative won the HRH The Prince of Wales Integrated Approaches to Care Nursing Times Award in 2017
After regaining health following a serious illness with tai chi, a rheumatology nurse decided to set up tai chi classes for people with chronic inflammatory and autoimmune diseases in the Nottingham area. Trained as an instructor, she arouses interest, obtains free venues, initiates the first classes, and then convinces the participants to become instructors themselves. People with various long term health conditions can now access low cost tai chi classes with physical, psychological and social benefits.
Quote: Muir A (2018) Tai Chi Classes to Help People Cope with Long-Term Health Problems. Breastfeeding time [online]; 114: 2, 32-33.
Author: Alice Muir is a Rheumatology Nurse at Circle Nottingham NHS Treatment Center.
Patients with long-term rheumatologic disorders find it difficult to manage conventional exercise, but exercise has significant health benefits. Tai chi is a holistic form of exercise that most people can handle, although some of its more martial forms are not suitable for people with health concerns.
Benefits of tai chi
There are five traditional styles of tai chi and many different forms. Some are more martial than others and require greater endurance and dexterity, but most involve conscious, gentle, slow, and fluid movements and diaphragmatic breathing.
Tai chi can be used to help people maintain and improve their health, restore health after acute illness, injury, or surgery, and manage problems resulting from long-term health problems. Gentle exercise helps maintain musculoskeletal health and function while the meditative aspect is relaxing and reduces stress. Learning tai chi can help people regain a sense of control and empowerment, while attending a class has psychological and social benefits.
Research has highlighted health benefits of tai chi, especially for rheumatoid arthritis (Han et al, 2004), chronic obstructive pulmonary disease (Ngai et al, 2016), cardiovascular disease (Hartley et al, 2014) and fall prevention (Gillespie et al, 2012) . It can also help the elderly reduce stress, improve posture, balance and mobility, and increase muscle strength in the legs.
Discovering tai chi
The patients I care for suffer from a variety of chronic autoimmune and rheumatic diseases that cause debilitating symptoms such as pain, stiffness, extreme fatigue, depression, and anxiety, and can lead to isolation and loneliness. I have spent many years looking for solutions to help them cope with long term health issues such as various forms of arthritis.
In 2009, I was sick myself and needed something to help me get healthy. I have attended tai chi classes and have found them useful. When I returned to work, I decided to create tai chi classes for people living with long-term rheumatological disorders. It seemed like a positive thing to do.
In 2010, I began training with master trainer Linda Arksey of the Tai Chi for Health Institute, founded in Australia by Dr Paul Lam, who trains people to teach specialized programs developed by tai chi experts and medical. I was impressed by the programs and training, but also by the ethics, the educational materials and the emphasis on safe teaching (Lam, 2006). I have since qualified to teach eight of the institute’s programs.
Setting up classes
The next step was to convince patients, professionals and organizations of the benefits of tai chi. Between 2010 and 2014, I contacted various patient groups and rheumatology professionals and organized a conference and tasting session for each of them, as well as for my fellow rheumatologists at Circle Nottingham.
Rushcliffe Country Park, a 210 acre open space south of Nottingham, is my local park and was my sanctuary when I was sick. After my training, I approached park warden Zoe Fordham with the idea of ââhaving classes there. Tasting sessions were organized and the first course at the park took place in March 2012. Classes at Circle Nottingham followed in May 2014.
In December 2014, I conducted a small survey of 22 participants of regular classes, which showed that tai chi helped reduce stress (77%), muscle tension (68%), pain (68% ), stiffness (55%) and fatigue (55%); 68% of participants reported improvements in mobility, 91% in posture, 86% in balance, 77% in coordination, 77% in general fitness, 91% in well-being, 82% in concentration, 55% of memory and 68% of confidence. Box 1 shows some comments from participants.
Box 1. Comments from participants
Participants said that tai chi classes allow them to:
- Learn something new
- Get symptom relief
- Meet other patients
- To feel better
- Feel less alone
One of my goals was to ensure sustainability, the idea being that the classes would continue to run without my input. To achieve this, I encouraged the people who came to the classes to learn to teach the programs themselves. To date, six participants teach in my absence, which allows us to run classes throughout the year.
âAn original, non-biomedical, self-sufficient and reproducible interventionâ (Feedback from the judges)
Today we run two classes at Rushcliffe Country Park and two at Circle Nottingham, teaching all programs on a rotational basis (each lasting eight to 10 weeks). Classes last one hour, followed by discussion and refreshments. They are advertised through posters and word of mouth. People register themselves and there are no admission criteria. Participants can bring friends and relatives – everyone is welcome. Each class attracts between 10 and 25 participants.
Keep costs low
Another goal was to run the project on a low budget. It is self-funded and managed on a voluntary basis. Initial training costs Â£ 170-195 per program and the training update, required every two years, costs Â£ 30. Insurance costs around Â£ 80 per year. Most of the time, we pay for them ourselves.
The Rushcliffe Country Park offers a room and facilities for free refreshments. We charge Â£ 3 per person per class and the money is used for park development projects, such as planting an orchard. So far, the courses have generated over Â£ 13,000 for the park. At Circle Nottingham the room is also free, the classes are free for the participants and I am supported to facilitate them as part of my job.
The courses themselves cost very little. There is a small one-time expense for the purchase of a CD player (Â£ 100) and music (Â£ 10-15 per CD). Participants do not need any special clothing or equipment, and they bring food and drinks for tea breaks.
Although it does not create the conditions for rigorous scientific study, the project does offer a form of hands-on inquiry into the benefits of tai chi. We now have links with the University of Nottingham University Rheumatology Department and hope to contribute to the knowledge base on tai chi as a therapeutic intervention. If further research is to be conducted, a prospective, qualitative and phenomenological approach integrated into clinical practice may be more fruitful than a randomized control study.
However, what interests me now is not how to prove the benefits of tai chi – which to me are obvious – but how to tailor classes for people with disabilities and different abilities, how to increase interest and retention. , how to integrate new people into established classes, how to encourage participants to train as instructors and how to make future classes affordable and sustainable.
Born from my critical illness experience combined with my nursing experience and professional training, the project is carried out in collaboration with Circle Nottingham, Rushcliffe Borough Council and the Tai Chi for Health Institute, as well as in partnership with the participants. One of our instructors has now set up a community course for people with multiple sclerosis, and another has set up two courses at a local complementary therapy center.
From the initial idea of ââhelping people with autoimmune and rheumatic diseases, the project has grown into something bigger and classes are now attended by members of the general public, many of whom have health issues such as heart and respiratory disease, diabetes, Parkinson’s disease, stroke and multiple sclerosis. We plan to encourage more participants to train as instructors, to advertise more widely and to set up additional courses. We would like tai chi to be offered more widely across health services and hope that our experience will encourage others to take similar initiatives.
- Tai chi is a holistic form of exercise involving gentle, slow and fluid movements
- Tai chi can be used as a therapeutic intervention for people with long term health problems
- Tai Chi for Health Institute programs are suitable for people who have difficulty with conventional exercise
- Setting up tai chi classes requires thinking about funding, training, safety, sustainability and inclusiveness
- Tai chi lessons can be implemented at low cost by using existing resources and involving participants
- Thanks – The author would like to thank the following people, who all contributed to the project and continue to do so:
- Sue Morgan, Head Nurse, Department of Rheumatology, Circle Nottingham NHS Treatment Center
- Keith Laing, park manager, and Zoe Fordham, park warden (and volunteer tai chi instructor) at Rushcliffe Country Park
- Linda Arksey, Master Trainer, and Chris Coates, Instructor and Administrator, Tai Chi for Health Institute
- Carol Tarlton Weatherall, Rodger Canning, Claire Cross, Judy Hasson and Tina Morris, volunteer Tai Chi instructors
- Beverley Perkins, professional photographer
- Jenny Rogers and Peter Lanyon for their encouragement, support and advice
- All the participants, who make the lessons fun and dynamic and inspire us to continue
Han A et al (2004) Tai chi for the treatment of rheumatoid arthritis. Cochrane Database of Systematic Reviews; 3: CD004849.
Hartley L et al (2014) Tai chi for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews; 4: CD010366.
Lamp (2006) Teach Tai Chi Effectively. Narwee, Australia: Tai Chi Productions.
Ngai SP et al (2016) Tai chi for chronic obstructive pulmonary disease (COPD). Cochrane Database of Systematic Reviews; 6: CD009953.