Training Effects of Water Tai Chi on Health Indicators among Chinese Older Females in Hong Kong

Abstract

The present study aimed to examine the effects of water Tai Chi on health indicators, namely blood pressure, body composition, and lipid profile among Chinese older females in Hong Kong. A group of apparently healthy older females aged 65 to 80 years old was recruited from local community senior centers. They were randomly assigned into three groups, namely water Tai Chi group (WTC), land Tai Chi group (LTC), and sedentary control group (CON). Participants in WTC and LTC groups have received 8-week Tai Chi training with three sessions per week and 60 minutes per session. The participants in WTC performed their Tai Chi in a swimming pool with water in depth of 1.0m. The results found that there was no significant group difference after the 8-week Tai Chi training, which indicated that WTC and LTC have similar training effects on the health indicators after the 8-week training. However, trends for means of SBP in WTC and %BF in LTC showed significant decreases from pre-tests to post-tests (p < .05) respectively, which suggested a longer training period is necessary for confirming these trends in future studies.

Full text

~ 20 ~
International Journal of Physical Education, Sports and Health
2014; 1(2):
20
-
24
P-ISSN: 2394-1685
E-ISSN: 2394-1693
IJPESH 2014; 1(2): 20-24
© 2014 IJPESH
www.kheljournal .com
Received: 17-09-2014
Accepted: 07-10-2014
Pak Kwong Chung
Department of Physical
Education, Hong Kong Baptist
University, Hong Kong, China.
Rosetta MUI
Department of Physical
Education, Hong Kong Baptist
University, Hong Kong, China
Ya Nan ZHAO
Department of Physical
Education, Hong Kong Baptist
University, Hong Kong, China
Jing Dong LIU
Department of Physical
Education, Hong Kong Baptist
University, Hong Kong, China
Correspondence
Pak Kwong CHUNG
Department of Physical
Education, Hong Kong Baptist
University, Hong Kong, China
Training Effects of Water Tai Chi on Health Indicators
among Chinese Older Females in Hong Kong
Pak Kwong Chung, Rosetta Mui, Ya Nan Zhao, Jing Dong Liu
Abstract
The present study aimed to examine the effects of water Tai Chi on health indicators, namely blood
pressure, body composition, and lipid profile among Chinese older females in Hong Kong. A group of
apparently healthy older females aged 65 to 80 years old was recruited from local community senior
centers. They were randomly assigned into three groups, namely water Tai Chi group (WTC), land Tai
Chi group (LTC), and sedentary control group (CON). Participants in WTC and LTC groups have
received 8-week Tai Chi training with three sessions per week and 60 minutes per session. The
participants in WTC performed their Tai Chi in a swimming pool with water in depth of 1.0m. The
results found that there was no significant group difference after the 8-week Tai Chi training, which
indicated that WTC and LTC have similar training effects on the health indicators after the 8-week
training. However, trends for means of SBP in WTC and %BF in LTC showed significant decreases from
pre-tests to post-tests (p < .05) respectively, which suggested a longer training period is necessary for
confirming these trends in future studies.
Keywords: Tai Chi, Water Exercise, Older Adult, Health indicators
1. Introduction
In Hong Kong, the proportion of people aged 65 and over is 12.6%, which is projected to be
increased to 24.2% in 2029 [1]. It is expected this enlarging proportion of older adults will
create a huge burden to Hong Kong in ageing-associated mortality, morbidity and costs. In
addition, ageing and deconditioning usually cause changes in blood pressure, body
composition, and lipid profile, which would result in functional independence of ageing people
[2]. Based on numerous evidences of ageing and physical activity, health benefits from a
regular physical activity provided a powerful basis for health promotion at both individual and
community levels [3]. Tai Chi, as a traditional Chinese aerobic exercise, has claimed to be one
of the most suitable exercises for older adults, especially for those with chronic illnesses, such
as arthritis and other chronic conditions [4], pain and disabilities [5]. In addition, this low-impact
and mind-body exercise has been shown to benefit one’s health not only in physical aspects
(e.g., flexibility, balance, muscular strength and endurance) [6], but also in psychological
aspects (e.g., mood states, depression, and general self-efficacy) [7, 8, 9].Water is a supportive,
low-risk exercise environment that may reduce the likelihood of acute injury while improving
participation and adherence [10, 11]. Because of the reduced pressure and increased resistance,
water exercise has allowed people to exercise longer time than on land with less demand on
joints [12]. Related evidences have proved the health benefits of water exercise for people,
especially for older adults with weaker lower limbs or patients with lower limb problems. The
benefits include improving flexibility, strength and aerobic fitness in osteoarthritis patients [13],
enhancing neuromuscular and functional fitness performance in healthy older females [14, 15]. In
addition, one of the few studies that compared water-based activities to land-based activities
showed greater improvement in functional reach in the aquatic environment [16]; and this
improvement may be the result of increased confidence and reduced fear of falling that
participants perceived when doing exercise in water. To gain maximum benefit from Tai Chi
and water-based exercise, Argo (1998) first introduced Water Tai Chi (WTC) [17]. WTC is a
combination of the principles of aquatic fitness and the graceful flowing movements of Tai
Chi. It is performed upright in chest depth water in swimming pool. Its movements can be
incorporated into warm-up, conditioning and cool-down phases of an aquatic class.

~ 21 ~
International Journal of Phys
ical Education, Sports and Health
In considering WTC is a body-mind harmony exercise, the
water provides an ideal environment for slow, rounded,
flowing movements and helps use i magery-based commands
when leading Tai Chi in the water. The water also provides
about 12 times the resistance of air that may have better
training effects when comparing with the effects from Tai Chi
training on land [17]. Given the different environmental
conditions for Tai Chi practice, health benefits from WTC and
LTC were hypothesized to be different. The purpose of this
study was to investigate the training effects between WTC and
LTC on the selected health indicators namely blood pressures
(BP), body composition [including body mass index (BMI)
and percent body fat (%BF)], blood lipid profile [high-density
lipoproteins (HDL-C), low-density lipoproteins (LDL-C), and
triglycerides (TG)].
2. Methods
2.1 Participants
A total of 66 healthy older adults aged from 65 to 80 were
recruited from the selected community senior centers in Hong
Kong, of which 48 participants fulfilled all inclusion criteria
and were randomly assigned into one of the three groups:
Water Tai Chi-WTC (n = 16), Land Tai Chi-LTC (n = 16) and
Control Groups-COT (n = 16). All participants were informed
of the experimental procedures and asked to give their written
consent for participating in this research as approved by
Committee on the Use of Human & Animal Subjects in
Teaching and Research of Hong Kong Baptist University. All
participants were healthy and without any diseases that might
negatively impact on their performances. None of them have
experience in practicing Tai Chi or other similar martial arts.
2.2 Procedures
Participants were screened by using the standard PAR-Q form
for ensuring that they were healthy for exercise. Participants in
WTC and LTC underwent the 24-Forms Tai Chi training for 8
weeks, with three sessions per week and 60 minutes per
session. Participants in the CON group received no Tai Chi
training. They were asked to continue their usual life-styles
during the intervention period. The training of WTC and LTC
were conducted in Sport Centre with a swimming pool in a
university in Hong Kong.
2.3 Intervention groups
WTC Group the Basic movements of the 24-Forms Tai Chi
were taught and practiced, with the philosophy and principles
of Tai Chi motions and the breathing techniques. The 24-
Forms Tai Chi is one of the most popular forms of Tai Chi
practiced in public [18, 19]. Each practice session consists of 10
minutes of breathing and stretching exercises on land followed
by 50 minutes of Tai Chi practice in water (WTC). The
program was conducted in the shallow end of swimming pool,
with water depth of 1.0 m. The water temperature was 32 °C in
average. LTC Group the LTC group received the same format
of training as the WTC group but on land. The training
sessions were carried out in an air-conditioning indoor activity
room, with a constant room temperature of 23-25°C and
humidity of 75-85%. The same Tai Chi instructor was
appointed for both the LTC and WTC groups. Control Group
The control group received no exercise training of any kind
during the 8-week period.
2.4 Tests and Measurement
All participants received the following measurements and tests
prior to and after the 8-week intervention: Blood pressure (BP)
BP was the first indicator to be measured. It was tested
manually by the mercury sphygmomanometer. Participants
were required to sit near a table and rest at least 10 minutes
before testing. For participants who reported being influenced
by the “white coat effect”, they were excluded from this test.
Body composition BMI and % body fat were measured using
Tanita, TBF-410 (Tanita Corp., Tokyo, Japan). All participants
were asked to be bare-footed in these tests. Blood lipid profile
three indicators for cholesterol were tested using Reflotron®
system (Boehringer Mannheim, Germany) in terms of low-
density lipoprotein cholesterol (LDL-C), high-density
lipoprotein cholesterol (HDL-C), triglycerides (TG).
2.5 Statistical Analysis
All the data was presented as mean ± SD. The two
independent variables (IVs) were Group (i.e., WTC, LTC, and
COT) and Time (i.e., pre-test and post-test). Dependent
variables were systolic blood pressures (SBP), diastolic blood
pressure (DBP), Body Mass Index (BMI), percent body fat (%
BF), LDL-C, HDL-C, and TG. All the data was analyzed using
a modified “intent-to-treat” methods (i.e., data from people
who dropped out at the beginning of the study was not
analyzed for results). Missing values were dealt by list-wise
deletion. All tests for statistical significance are standardized at
an alpha level of p < .05, unless other specified. A one-way
between-groups ANOVA was conducted to find the group
differences on the demographic and clinical data before the
following analysis. To explore the overall changes of testing
parameters among the three groups across the two-time tests, a
two-way mixed ANOVA, Groups (3) x Time (2), was
performed. Post hoc analysis with Bonfferoni correction was
carried out to explore the difference between groups. In the
case there was significant main effect for Time, the paired t-
test was analyzed in each group to find the changes before and
after intervention. All the data were analyzed using Statistical
Package for Social Science (SPSS) version 21.0 (IBM,
Chicago, IL).
3. Results
Due to the inconvenient training time and body discomfort,
four participants dropped out at the beginning of intervention
period, and the final study group has included 44 participants
(WTC = 15, LTC = 16, and CON = 13). Although we have
intended to recruit both male and female participants for this
study, only six males were involved in this study. To eliminate
any potential bias, only results from female participants were
analyzed. The final number of participants was therefore
adjusted to 38 (WTC = 13, LTC = 15, and CON = 10). The
average attendance rate is 90% for each group. There was no
harm/hurt reported during and after the intervention periods,
indicating that both WTC and LTC are suitable and safe for
the older adults to practice. The detailed information of
participant attrition was described in Figure 1.

~ 22 ~
International Journal of Phys
ical Education, Sports and Health
Fig 1: Flow of participants.
Demographic and clinical characteristics of participants for each group were presented in Table 1. Results from one-way ANOVA
at the pre-test found no significant difference on these baseline parameters among the three groups (p > .05).
Table 1: Demographic and clinical characteristics for each group
WTC (n = 13) LTC (n = 15) CON (n = 10)
Age (years) 69.4 ± 7.19 71.2 ± 6.05 74.6 ± 6.52
Height (cm) 152.9 ± 6.00 151.3 ± 5.20 149.1 ± 8.93
Weight (kg) 58.6 ± 9.70 50.8 ± 8.21 52.6 ± 12.9
Note. Mean ± SD; WTC = Water Tai Chi group, LTC = Land Tai Chi group, CON = Control group.
Given the analysis was based on a “modified intention-to-
treat” method, a baseline difference was checked using one-
way ANOVA and results showed no si gnificant difference in
all the testing parameters among the three groups (p > .05).
Results from two-way mixed ANOVA found no significant
interaction effect of Group x Time on any of the testing
parameters and no main effect for Groups as well. All these
indicated that WTC did not improve in the testing parameters
Assessed for eligibility (n = 66)
Excluded (n = 18)
♦ Not meeting inclusion criteria (n = 6)
♦ Declined to participate (n = 4)
♦
Other reasons (n
=
8
)
Analyzed (n = 13)
Allocated to WTC (n = 16)
♦ Received WTC (n = 15)
♦ Did not receive WTC (n = 1)
Reason: time conflicts
Analyzed (n = 15)
Randomized (n = 48)
Allocated to LTC (n = 16)
♦ Received LTC (n = 16)
♦ Did not receive LTC (n = 0)
Allocated to CON (n = 16)
♦ Received intervention (n= 13)
♦ Did not receive intervention (n= 3)
Reason: time conflicts and body pains
Analyzed (n = 10)

~ 23 ~
International Journal of Phys
ical Education, Sports and Health
within the eight-week training period, and the training effect
from WTC did not differ from that of LTC. There were main
effects for Time on SBP, F (1, 35) = 4.84, p = .034, partial η2
= .12, and %BF, F (1, 35) = 5.28, p = .028,
partial η2 = .13. Results from paired-t test found there were
statistically significant decreases on the SBP in WTC, t (12) =
2.93, p = .013, and %BF in LTC, t (14) = 2.62, p = .020,
respectively. The magnitudes of the decreases were quite large
in SBP (d = .51) and small in %BF (d = .12). Although there
was no statistically significant difference on other parameters
before and after intervention, the trend of mean values suggest
a longer training period is necessary for further confirmation
of this trend in future related studies. Detailed values were
presented in Table 3.
Table 2. Testing para meters in WTC, LTC and COT Groups before and a fter intervention
Physical para meters WTC (n = 13) LTC (n = 15) COT (n = 10)
Before intervention After intervention Before intervention After i ntervention Before intervention After intervention
SBP
(mmHg)
14
5.4
± 1
2.5
1
39.2
±
11.
5*
135.3
±
15.7
128.1
±
19.4
137.7
±
22.1
134.1
±
19.9
DBP (mmHg) 80.1 ± 10.7 75.9 ± 8.90 72.5 ± 8.03 71.5 ± 10.6 74.0 ± 17.2 73.7 ± 12.6
BMI
25.0
±
3.68
24.9
±
3.52
22.2
±
3.62
22.0
±
3.41
23.3
±
3.80
23.1
±
3.85
% Body fat 31.7 ± 5.84 31.5 ± 6.70 27.6 ± 6.01 26.8 ± 5.38* 30.4 ± 6.64 29.5 ± 6.75
HDL (mmol/L) 1.36 ± .210 1.16 ± .323 1.20 ± .353 1.20 ± .368 1.17 ± .552 1.18 ± .480
LDL (mmol/L) 4. 95 ± .885 5. 02 ± .812 5. 20 ± .925 4.90 ± 1.04 4.83 ± 1.51 5.07 ± 1.25
TG (mmol/L) 1. 43 ± .432 1. 38 ± .272 1.54 ± .727 1.64 ± .952 1.88 ± 1.16 1.70 ± .934
Note. Mean ± SD; WTC = Water Tai Chi group, LTC = Land Tai Chi group, CON = Control group; *Significant di fferences between pre-test and post-tests.
4. Discussions
The present study investigated the training effects of an eight-
week water-based and land-based Tai Chi programs on blood
pressure, body composition, and lipid profile among a group
of Chinese older females. Results showed no significant
interaction effect of Groups x Time on all testing parameters,
indicating that the three groups did not differ from each other.
However, significant improvements on SBP in WTC group
and %BF in LTC group were evidenced. All these suggest that
longer training period is necessary for confirming these
improvements in future related studies. There are increasing
evidences showing that exercise has a positive effect on blood
pressure [20]. Mechanism for the changes in blood pressure, as
identified in a prior systematic review, is the decrease in the
activities of the autonomic nervous system resulted from
exercise training [21]. Tai Chi is an aerobic exercise with slow
and controlled movements. It emphasizes not only on the
external postures of the forms, but also includes many internal
practices like breathing and meditation. All the practicing
process is assumed to be relaxed. In considering the buoyancy
and temperature in a water environment that can stimulate the
response from blood pressure, WTC thus has more possibility
to induce a positive effect on blood pressure. Our findings are
in agreement with the results of some past related studies.
Among which, Farahani and colleagues have proven that a 10-
week aquatic aerobic exercise (including swimming) can
substantially reduce the systolic blood pressure after
intervention [22]. In the land-based TC group, there was a
significant difference in percent of body fat before and after
intervention but no significant group difference at posttest.
Apart from the relatively shorter-term intervention period,
exercise intensity and duration may play a significant role.
Training-induced decrease of body fat from vigorous, long
duration aerobic exercise has been well-reported in past
studies. [23] However, Tai Chi is usually regarded as the
moderate-intensity exercise and thus may not be able to make
a significant effect on body fat [24]. If possible, a repeat study is
recommended to be conducted, and exercise intensity and
energy consumption should be monitored so as to differentiate
the effect of WTC and LTC on % body fat. The preponderance
of female participants is a limitation of our study and is a
common problem among geriatric studies. In Hong Kong, it is
the fact that female takes up the majority of participants in
community senior centers. Future studies are recommended to
recruit participants based on gender stratification to
compensate any gender effect on outcome parameters, if any.
Furthermore, since most related researches looking into the
training effect of water exercise adopted a longer training
period [13 , 15, 2 5], and non-significant interaction results were
showed in the present study, future investigation is suggested
to adopt a longer training duration in the intervention
programs.
5. Conclusions
The 8-week water-based and land-based Tai Chi training
programs have similar training effects on blood pressure, body
composition and lipid profile. Although no significant
between-groups difference was found, trends for means of
SBP in WTC and %BF in LTC have showed substantial
decreases from pre-test to post-test (p < .05), suggesting a
longer training period is necessary for confirming these trends
in future studies.
6. Acknowledgements
This work would not be succeeded without the assistances of
Prof Mee-Lee, Leung 1, Dr. Kwok-Keung, Tong1, Dr. Yu
Zhang 2, Ms. Linxuan Gou 1, Mr. Binh Quach1, Mr. Shing Wu
1, and the funding support by the Hong Kong Baptist
University as well as logistic support by the Hong Kong
Christian Service. 1 Department of Physical Education, Hong
Kong Baptist University, Hong Kong, China 2 Beijing Sports
University, Beijing, China.
7. References
1. Hong Kong Census and Statistics Department. Available
from Hong Kong Census and Statistics Department Web
site, http://sc.info.gov.hk. 2008.
2. Spirduso WW, Francis KL, MacRae PG. Physical
dimensions of aging. Edn 2, Human Kinetics, Francis,
2005.
3. Yau MKS, Packer TL. Health and well-being through Tai
Chi: perceptions of older adults in Hong Kong. Leisure
Studies 2002; 21:163-178.
4. Fontana JA, Colella C, Wilson BR, Baas L. The energy
costs of a modified form of T'ai Chi exercise. Nursing
Research 2000; 49:91-96.
5. Taggart HM, Arslanian CL, Bae S, Singh K. Effects of
T'ai Chi Exercise on Fibromyalgia Symptoms and Health-
Related Quality of Life. Orthopaedic Nursing 2003;
22:353.

~ 24 ~
International Journal of Phys
ical Education, Sports and Health
6. Song R, Lee EO, Lam P, Bae SC. Effects of Tai Chi
exercise on pain, balance, muscle strength, and perceived
difficulties in physical functioning in older women with
osteoarthritis: a randomized clinical trial. The Journal of
Rheumatology 2003; 30:2039-2044.
7. Dechamps A, Gatta B, Bourdel-Marchasson I, Tabarin A,
Roger P. Pilot study of a 10-week multidisciplinary Tai
Chi intervention in sedentary obese women. Clinical
Journal of Sport Medicine: Official Journal of the
Canadian Academy of Sport Medicine 2009; 19:49-53.
8. Rogers CE, Larkey LK, Keller CA. Review of clinical
trials of Tai Chi and qigong in older adults. Western
Journal of Nursing Research 2009; 31:245-279.
9. Liu Y, Mimura K, Wang L, Ikuta K. Psychological and
physiological effects of 24-style taijiquan.
Neuropsychobiology 2005; 52(4):212-218.
10. Hauer K, Specht N, Schuler M, Bartsch P, Oster P.
Intensive physical training in geriatric patients after severe
falls and hip surgery. Age and Aging 2002; 31:49–57.
11. Skelton D, Dinan SM. Exercise for falls management:
Rationale for an exercise programme aimed at reducing
postural instability. Physiotherapy Theory and Practice
1999; 15:105–120.
12. Bartels EM, Lund H, Hagen KB, Dagfinrud H,
Christensen R, Danneskiold-Samsøe B. Aquatic exercise
for the treatment of knee and hip osteoarthritis. Cochrane
Database Syst Rev 2007: 4.
13. Wang TJ, Belza B, Thompson FE, Whitney JD, Bennett
K. Effects of aquatic exercise on flexibility, strength and
aerobic fitness in adults with osteoarthritis of the hip and
knee. Journal of Advance nursing 2007; 57(2):141-152.
14. Namjoshi MA, Buesching DP. A review of the health-
related quality of life literature in bipolar disorder. Quality
of Life Research 2001; 10:105-115.
15. Tsourlou T, Benik A, Dipla K, Zafeirids A, Kellis S. The
effects of a twenty-four--week aquatic training program
on muscular strength performance in healthy elderly
women. The Journal of Strength & Conditioning Research
2006; 20(4):811-818.
16. Simmons V, Hansen P. Effectiveness of water exercise on
postural mobility in the well elderly: an experimental
study on balance enhancement. J Gerontol. 1996;
51:M233-238.
17. Argo C, Water Tai Chi. American Fitness 1998; 16:52.
18. Lan C, Lai JS, Chen SY. Tai chi chuan - An ancient
wisdom on exercise and health promotion. Sports
Medicine 2002; 32:217-224.
19. Wang Y, Taylor L, Pearl M, Chang LS. Effects of Tai Chi
exercise on physical and mental health of college students.
American Journal of Chinese Medicine 2004; 32:453-459.
20. Cornelissen VA, Fagard RH. Effects of endurance training
on blood pressure, blood pressure–regulating mechanisms,
and cardiovascular risk factors. Hypertension 2005;
46(4):667-675.
21. Fagard RH, Cornelissen VA. Effect of exercise on blood
pressure control in hypertensive patients. European
Journal of Cardiovascular Prevention & Rehabilitation
2007; 14(1):12-17.
22. Farahani AV, Mansournia MA, Asheri H, Fotouhi A,
Yunesian M, Jamali M et al. The effects of a 10-week
water aerobic exercise on the resting blood pressure in
patients with essential hypertension. Asian journal of
sports medicine 2010; 1(3):159.
23. Hagberg JM, Montain SJ, Martin III WH, Ehsani AA.
Effect of exercise training in 60-to 69-year-old persons
with essential hypertension. The American journal of
cardiology 1989; 64(5):348-353.
24. Yu T, Pei Y, Lau Y, Chen C, Hsu H, Wong AM.
Comparison of the effects of swimming and Tai Chi
Chuan on body fat composition in elderly people. Chang
Gung medical journal 2007; 30(2):128.
25. Taylor-Piliae RE, Newell KA, Cherin R, Lee MJ, King
AC, Haskell WL. Effects of Tai Chi and Western Exercise
on Physical Cognitive Functioning in Healthy
Community-Dwelling Older Adults. Journal of Ageing
and Physical Activity 2010; 18:261-279.