T’ai Chi and Qigong for Health:
Patterns of Use in the United States
Gurjeet S. Birdee, M.D., M.P.H.,1Peter M. Wayne, Ph.D.,1Roger B. Davis, Sc.D.,2
Russell S. Phillips, M.D.,2and Gloria Y. Yeh, M.D., M.P.H.1
Background: Little is known in the United States about those who practice t’ai chi and qigong, two mind–body
techniques that originated in Asia.
Objective: The objective of this study is to characterize use of t’ai chi and qigong for health with regard to
sociodemographics, health status, medical conditions, perceptions of helpfulness, and disclosure of use to
Methods: We analyzed associations of t’ai chi and qigong use for health using cross-sectional data from the 2002
National Health Interview Survey (NHIS) Alternative Medicine Supplement (n¼31,044). The 2002 NHIS esti-
mated the number of t’ai chi and qigong users for health to be 2.5 and 0.5 million persons, respectively. We
collapsed t’ai chi and qigong use into a single category (TCQ) for analysis, representing 2.8 million individuals.
Results: We found that neither age nor sex was associated with TCQ use. TCQ users were more likely than
nonusers to be Asian than white (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.30–3.15), college educated
(OR 2.44, 95% CI 1.97–3.03), and less likely to live in the Midwest (OR 0.64, 95% CI 0.42–0.96) or the southern
United States (OR 0.51, 95% CI 0.36–0.72) than the West. TCQ use was associated independently with higher
reports of musculoskeletal conditions (OR 1.43, 95% CI 1.11–1.83), severe sprains (OR 1.65, 95% CI 1.14–2.40),
and asthma (OR 1.50, 95% CI 1.08–2.10). Half of TCQ users also used yoga for health in the last 12 months. Most
TCQ users reported their practice to be important to maintain health, but only a quarter of users disclosed their
practice to a medical professional.
Conclusions: In the United States, TCQ is practiced for health by a diverse population, and users report benefits
for maintaining health. Further research is needed to establish efficacy and safety for target populations, in-
cluding those with musculoskeletal and pulmonary disease, as well as for preventive health.
China that have migrated to the United States. On the basis of
the National Health Interview Survey (NHIS), Barnes re-
ported that in the United States an estimated 2,500,000 and
500,000 individuals used t’ai chi or qigong, respectively, for
health reasons.1T’ai chi chuan originated from Chinese mar-
tial arts and healing traditions. The literal translation of t’ai chi
chuan from Mandarin is: ‘‘Supreme Ultimate’’ (t’ai chi), a ref-
erence to the philosophical bipolar concept of yin and yang
that also underlies Traditional Chinese Medicine, and ‘‘Fist or
Boxing’’ (chuan). As an ‘‘internal’’ martial art, t’ai chi cultivates
the flow and balance of the practitioner’s qi (vital energy).2
’ai chi (also called t’ai chi chuan or taiji) and qigong (also
calledchikung)aremind–bodypractices originating from
The closely related practice of qigong is also a historical
derivative of Chinese healing practices and manipulates qi
through mind–body exercises. The exact historical origins
of t’ai chi and qigong are controversial and a topic of schol-
arly debate. Though substantial variation within and be-
tween these practices exists, generally speaking, t’ai chi and
qigong are meditative exercises that coordinate gentle move-
ments with mental focus, breathing, and relaxation for
physical, mental, and=or spiritual cultivation.3Many cur-
rent styles of t’ai chi retain their original martial arts applica-
Despite the popularity of t’ai chi and qigong in the United
States, along with a growing body of evidence for clinical ef-
fectiveness,4–6little is known about those who practice t’ai chi
and qigong, and for what reasons. Identifying current trends
1Osher Research Center, Harvard Medical School, Boston, MA.2Division of General Medicine and Primary Care, Beth Israel Deaconess
Medical Center, Boston, MA.
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 15, Number 9, 2009, pp. 969–973
ª Mary Ann Liebert, Inc.
on the use of t’ai chi and qigong may help identify popula-
tions and medical conditions that warrant further research. To
characterize sociodemographic and health factors associated
with t’ai chi and qigong practice in the United States, we con-
ducted a secondary analysis of t’ai chi and qigong users from a
nationally representative survey, the 2002 NHIS.
Data from the 2002 NHIS were analyzed, which obtains
health information from the civilian, noninstitutionalized,
household population in the United States. The survey was
conducted face-to-face in English and=or Spanish utilizing a
multistage stratified design with random selection of house-
holds. For a randomly selected adult within each household,
data were collected on sociodemographics, medical condi-
tions, and health care utilization. The final adult sample had
an overall response rate of 74% (n¼31,044).
In 2002, additional questions were asked regarding the use
of 21 complementary and alternative therapies including t’ai
chi and qigong in an Alternative Medicine Supplement of
NHIS. Respondents were asked if they ever practiced t’ai chi
or qigong for their ‘‘own health or treatment,’’ and if they
practiced ‘‘during the last 12 months.’’ Individuals who
asked if they practiced ‘‘to treat a specific health problem and
condition.’’ They were also asked how important their use
was ‘‘in maintaining…health and well-being.’’ Disclosure
was ascertained by asking respondents if they ‘‘let any con-
ventional medical professionals know of…use.’’
T’ai chi and qigong use for health in the last 12 months was
users was too few to perform a separate statistical analysis
from t’ai chi users. Given the similarity of t’ai chi and qigong
(TCQ),based oncommoncultural derivation and philosophy,
both groups of practitioners were collapsed into a single cat-
egory for analysis. Individuals who practiced both t’ai chi and
qigong were considered as a single TCQ user. Descriptive
statistics were used to characterize TCQ users versus nonu-
sers. To further characterize TCQ users, possible factors were
examined for associations with practice including the fol-
lowing: age categories (18–29, 30–39, 40–49, 50–64, ?65), sex,
race (white, black, other), household income (?$19,999,
$20,000–34,999, $35,000–64,999, ?$65,000), region (Northeast,
South, Midwest, West), education (less than college, any col-
health behaviors were analyzed: current alcohol intake (ab-
stainers, light, moderate, or heavy) and current smoking sta-
self-reported health status (good, very good, or excellent
versus poor or fair) and body mass index (<18.5, 18.5–24.9,
25–29.9, ?30kg=m2) were included. Medical conditions into
multiple categories were collapsed for analysis using a pre-
viously described algorithm:7(1) musculoskeletal (arthritis,
severe sprains in the last year; (3) mental health (depression,
anxiety); (4) asthma; (5) chronic obstructive pulmonary dis-
ease (chronic bronchitis, emphysema); (6) cardiovascular
(myocardial infarction, coronary heart disease, angina, con-
gestive heart failure, other heart condition); (7) hypertension;
and (8) neurologic (seizure, stroke, Parkinson’s, multiple
sclerosis, neuropathy). Severe sprains were categorized sep-
arately from musculoskeletal conditions to capture individ-
uals with acute musculoskeletal injuries. Practice of yoga,
another common mind–body technique, among TCQ users
was also examined. Categories with fewer than 30 respon-
dents were excluded from the analysis. The number of re-
spondents who used TCQ to treat a specific medical condition
was insufficient for analysis.
Sociodemographic factors, health status, health behaviors,
and weight were compared among TCQ and non-TCQ users
with w2tests of independence. Utilizing multivariable logistic
regression analysis, factors independently associated with
TCQ practice were identified selecting covariates of interest
that had a p-value of ?0.20 in bivariable analyses. A model
was developed using a backward elimination strategy re-
taining covariates with a p-value of ?0.05. We performed a
separate analysis of t’ai chi users alone to determine whether
the final model, which combined t’ai chi and qigong users, was
substantially different from a model with t’ai chi users alone.
Descriptive statisitics were used to analyze the importance of
TCQ use for health maintenance and well-being (somewhat
and very important versus little or none), and conventional
provider disclosure. Analyses were performed with SAS-
callable SUDAAN version 8.1 (Research Triangle Institute,
Research Triangle Park, NC) to account for the complex
sampling design. Results are weighted to represent national
estimates. The Harvard Medical School Institutional Review
Board exempted the study from full board review.
In 2002, there were over 2,500,000 t’ai chi users and 500,000
qigong users in the United States.1Combining t’ai chi and=or
qigong users into a single category, there were more than 2.8
million individual TCQ users in the United States. Among
qigong users, 70% also reported practicing t’ai chi. The char-
in Table 1. The age and gender distribution of those who re-
ported practice of TCQ reflected the general population. A
large number of Asians practiced TCQ, though a majority of
users were white and reported attaining a higher education.
TCQ users as compared to non-TCQ users predominately
lived in the West and Northeast. Income and insurance were
not significantly different between groups. Light alcohol
consumption was higher in TCQ users, but smoking rates
were similar to those of non-TCQ users. Though TCQ users
reported more favorable health status, and in comparison to
non-TCQ users, they also reported higher rates of musculo-
skeletal conditions, asthma, and severe sprains. Rates of
mental health and cardiovascular conditions were similar
among TCQ users compared to the rest of the population.
Rates of COPD and neurologic conditions were too small for
analysis. One (1) of every 2 TCQ users also reported yoga
practice within the last 12 months. Only 25% of TCQ practi-
tioners disclosed their use to a medical professional. A ma-
for maintaining their overall health.
The results of the final multivariable regression model are
reported in Table 2 for factors independently associated with
970 BIRDEE ET AL.
TCQ use in the United States. Of note, age and sex categories
were not significant on univariate analysis, and not included
in the model. TCQ use was more likely in Asians relative to
whites and less likely in the South or Midwest compared to
the West. While TCQ users were more likely to have a higher
educational status, income and insurance were not correlated
with use. TCQ users were more likely to be light consumers of
alcohol. A regression model for factors associated with t’ai chi
users alone, rather than combined with qigong, did not sig-
ditions, severe sprains, and asthma were each associated with
practice of TCQ.
In 2002, according to the NHIS survey, there were 2.8
relative to nonusers were more likely to be Asian, educated,
and live in the West or Northeast; however, TCQ use spanned
all ages and genders. Musculoskeletal conditions, severe
sprains, and asthma were associated with TCQ use, but it is
unknown whether these conditions led to TCQ use or were a
result of TCQ use. Despite a large percentage of respondents
reporting the importance of TCQ practice for health mainte-
nance, only a quarter disclosed their practice to their medical
As mind–body practices have grown in popularity in the
United States, there has been a concurrent increase in evi-
dence-based clinical research for TCQ.4–6These findings
suggest the potential need to investigate TCQ practice among
individuals who have musculoskeletal conditions and asth-
ma. Existing research suggests positive benefits of t’ai chi for
balance and postural control,8–11osteoarthritis,12rheumatoid
on the use of t’ai chi or qigong for pulmonary conditions in-
TCQ has also been examined for various other medical
conditions or applications including the following: stress
management,16,17general mental health,18–20depression,21,22
immune system modulation,23–25and cardiovascular appli-
cations such as cardiorespiratory fitness,26,27hypertension,28
cardiac rehabilitation,29and diabetes.30There is also sugges-
tive, but limited, data for qigong in hypertension31and dia-
Yoga, a mind–body exercise from India, may be considered
a parallel practice to TCQ. In a recent analysis, yoga users
were characterized from NHIS,7who differ from TCQ us-
ers with regard to specific sociodemographic factors. TCQ
In contrast, yoga users tended to be younger. This may rep-
resent a broader appeal of TCQ to the elderly and that many
younger, more physically able population. As the elderly
population grows in the United States, TCQ may increase in
prevalence. In addition, TCQ appeared to be gender neutral,
while yoga users were more likely to be women. Historically
in India, yoga was practiced almost exclusively by men, while
in the United States yoga has been feminized within con-
temporary popular culture.33,34T’ai chi is perhaps perceived
as more masculine, given its origin in martial arts. Asians
were also more likely to practice TCQ for health, which
was not observed among yoga users. Other socioeconomic
Table 1. Characteristics of Study Population
by T’ai Chi and Qigong Use (%)
users (n¼429)%aNon-t’ai chi=qigong
Less than 30
65 or greater
Less than College
good, or good
Fair or poor
BMI, body mass index; N=A, not applicable.
aPercents are weighted to reflect national estimates.
bp?0.005 for differences between t’ai-chi=qigong users and non-
cDue to small numbers, BMI scores <18.5 not reported.
T’AI CHI AND QIGONG FOR HEALTH971
patterns such as associations with region, educational level,
and health status were similar to those of yoga users.
Generally, TCQ are considered safe practices, and there
have been few published adverse events. However, there
have been no systematic reviews on the risks of t’ai chi. Re-
views of qigong have reported the potential negative psychi-
atric effects.35,36While data on the safety profile of yoga are
also lacking, there have been more published reports of ad-
verse events,37–40which may simply reflect the higher overall
prevalence ofyoga use. Of TCQ users, the results indicate that
1 of 2 users also practiced yoga. Therefore, the associations
identified between t’ai chi and qigong use may also be partially
explained by concurrent yoga use. For example, TCQ users
were identified as having more severe sprains than non-TCQ
users did. The same association was found with severe
sprains among yoga users compared to non-yoga users. It is
unclear whether the severe sprains seen among the t’ai chi
users are related to yoga use or vice versa. There may be an
underestimation of the potential risks of practice, reflecting
underreporting of adverse events in studies and medical
There are limitations to this study. Data were collected via
questionnaires, and are therefore subject to recall bias. Given
the cross-sectional nature of NHIS, causal relationships can-
not be determined. For example, the increased association of
TCQ use with asthma does not mean that TCQ use causes
as frequency, duration, style, school, or teacher. Variations in
practice may play an important role in potential health ben-
efits. Also, theanalysisis basedon datafrom2002,which may
not reflect current trends. Regardless of these limitations, this
represents the first report and most current information
available on the characteristics of TCQ users based on a na-
TCQ use for health in the United States is being practiced
by a broad group of individuals. As research agendas for the
clinical application of mind–body techniques are developed,
patterns of TCQ use should inform future studies. The prac-
tice of TCQ for musculoskeletal and pulmonary conditions, as
well as for preventive health and health maintenance, should
interventions with multiple components.2Research designs
need to be sensitive to this complexity employing a variety of
methodologies.41The therapeutic role of TCQ will only be
defined by thoughtful and rigorous research evaluating the
feasibility, efficacy, cost, and safety of these practices.
Dr. Birdee is supported by an Institutional National Re-
search Service Award (T32AT00051-06) from National In-
stitutes of Health. Dr. Gloria Yeh is supported by a Career
Investigator Award from the National Center for Com-
plementary and Alternative Medicine, National Institutes of
Health (1K23-AT002624-01). The contents of this article are
solely the responsibility of the authors and do not necessarily
represent the official views of the National Center for Com-
plementary and Alternative Medicine, or the National In-
stitutes of Health.
No competing financial interests exist for the authors of
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Address correspondence to:
Gurjeet S. Birdee, M.D., M.P.H.
Osher Research Center
Harvard Medical School
401 Park Drive Suite 22A-West
Boston, MA 02215
T’AI CHI AND QIGONG FOR HEALTH973
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